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Rippin HL, Maximova K, Loyola E, Breda J, Wickramasinghe K, Ferreira-Borges C, Berdzuli N, Hajihosseini M, Novik I, Pisaryk V, Sturua L, Akmatova A, Obreja G, Mustafo SA, Ekinci B, Erguder T, Shukurov S, Hagverdiyev G, Andreasyan D, Bychkov S, Rakovac I. Suboptimal Intake of Fruits and Vegetables in Nine Selected Countries of the World Health Organization European Region. Prev Chronic Dis 2023; 20:E104. [PMID: 37972606 PMCID: PMC10684282 DOI: 10.5888/pcd20.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The objective of this study was to characterize fruit and vegetable consumption in 9 selected countries of the World Health Organization (WHO) European Region. We analyzed data on fruit and vegetable intake and participant sociodemographic characteristics for 30,455 adults in 9 Eastern European and Central Asian countries via standardized STEPS survey methodology. Fruit and vegetable consumption across all countries was suboptimal, with a high percentage of populations not meeting the WHO-recommended intake of at least 5 servings (400 g) per day. Strengthened implementation of evidence-based policies to increase intake of fruit and vegetables is needed to reduce the burden of and disparities in NCDs.
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Affiliation(s)
- Holly L Rippin
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, Division of Country Health Programmes, World Health Organization Regional Office for Europe, Marmovej, Copenhagen, Denmark
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Enrique Loyola
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Joao Breda
- Division of Country Health Policies and Systems, World Health Organization Greece, Athens, Greece
| | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Carina Ferreira-Borges
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Nino Berdzuli
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Irina Novik
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health, Minsk, Belarus
| | - Vital Pisaryk
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health, Minsk, Belarus
| | - Lela Sturua
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Ainura Akmatova
- Department of Public Health, Ministry of Health, Bishkek, Kyrgyzstan
| | - Galina Obreja
- Department of Social Medicine and Management, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Saodat Azimzoda Mustafo
- State Research Institute of Gastroenterology, Ministry of Health and Social Protection of Population, Dushanbe, Republic of Tajikistan
| | - Banu Ekinci
- Department of Chronic Disease and Elderly Health, General Directorate of Public Health of Ministry of Health of Turkey, Ankara, Turkey
| | - Toker Erguder
- World Health Organization Country Office in Turkey, Ankara, Turkey
| | - Shukhrat Shukurov
- Central Project Implementation Bureau of the Health-3 Project, Tashkent, Uzbekistan
| | | | - Diana Andreasyan
- National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Sergei Bychkov
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Ivo Rakovac
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases, Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Williams J, Rakovac I, Loyola E, Sturua L, Maglakelidze N, Gamkrelidze A, Mauer-Stender K, Mikkelsen B, Breda J. A comparison of self-reported to cotinine-detected smoking status among adults in Georgia. Eur J Public Health 2020; 30:1007-1012. [PMID: 32588045 PMCID: PMC7536257 DOI: 10.1093/eurpub/ckaa093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Self-reported measures of tobacco use may have limited validity, particularly among some populations. This study aims to validate self-reported smoking measures among Georgian adults participating in the 2016 STEPS survey using cotinine biomarker measurements, and to explore potential differences according to sociodemographic characteristics. Additionally, this paper examines how the estimated prevalence of smoking in the population varies according to measurement type. METHODS Using the WHO standardized STEPS methodology, adults self-reported their smoking status. In a later stage of the survey, a subset of participants provided a urine sample, which was tested for cotinine. Using each participant's objective cotinine measurement and their self-reported smoking status, we calculated the sensitivity, specificity and positive predictive value of self-reported smoking. Next, we calculated the estimated prevalence of smokers according to the type of measurement. RESULTS Results indicated high sensitivity (83.37%, 95% CI: 76.79-88.37%) among males and relatively low sensitivity (38.60% CI: 29.23-48.90%) among females. According to self-report, the prevalence of smokers was 26.44% (23.61-29.48%), while according to cotinine detection, the prevalence of smokers was 32.27% (29.16-35.55%). Among all subgroups, the self-reported prevalence of smoking was significantly lower than the cotinine-detected prevalence. CONCLUSIONS To the best of our knowledge, this is the first time that the validity of the STEPS self-reported tobacco indicator has been tested. Self-reported measures of smoking status may lead to an under-estimation of smoking prevalence among Georgian adults, especially women. These findings suggest that integration of biochemical measures of smoking into tobacco use studies may be an important investment.
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Affiliation(s)
- Julianne Williams
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Division of Noncommunicable Diseases and Health Through the Lifecourse, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Ivo Rakovac
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Division of Noncommunicable Diseases and Health Through the Lifecourse, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Enrique Loyola
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Division of Noncommunicable Diseases and Health Through the Lifecourse, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Lela Sturua
- Noncommunicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nino Maglakelidze
- Noncommunicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Amiran Gamkrelidze
- Noncommunicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Kristina Mauer-Stender
- Division of Noncommunicable Diseases and Health Through the Lifecourse, WHO Regional Office for Europe, UN City, Copenhagen, Denmark
| | - Bente Mikkelsen
- Division of Noncommunicable Diseases and Health Through the Lifecourse, WHO Regional Office for Europe, UN City, Copenhagen, Denmark
| | - João Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Division of Noncommunicable Diseases and Health Through the Lifecourse, WHO Regional Office for Europe, Moscow, Russian Federation
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Williams J, Rakovac I, Loyola E, Sturua L, Maglakelidze N, Gamkrelidze A, Mauer-Stender K, Mikkelsen B, Breda J. A comparison of self-reported to cotinine-detected smoking status among adults in Georgia. Eur J Public Health 2020; 30:1037. [PMID: 32951029 PMCID: PMC7536248 DOI: 10.1093/eurpub/ckaa160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Balicer RD, Luengo-Oroz M, Cohen-Stavi C, Loyola E, Mantingh F, Romanoff L, Galea G. Using big data for non-communicable disease surveillance. Lancet Diabetes Endocrinol 2018; 6:595-598. [PMID: 29146206 DOI: 10.1016/s2213-8587(17)30372-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ran D Balicer
- Clalit Research Institute, WHO Collaborating Centre for NCD Research Prevention and Control, Chief Physician's Office, Clalit Health Services, Tel Aviv 62098, Israel; Epidemiology Department, Ben Gurion University of the Negev, Be'er Sheva, Israel.
| | | | - Chandra Cohen-Stavi
- Clalit Research Institute, WHO Collaborating Centre for NCD Research Prevention and Control, Chief Physician's Office, Clalit Health Services, Tel Aviv 62098, Israel
| | - Enrique Loyola
- WHO European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Moscow, Russia
| | - Frederiek Mantingh
- Division of Non-Communicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Gauden Galea
- Division of Non-Communicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
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Erkoyun E, Unal B, Mauer-Stender K, Maximova K, Commar A, Loyola E, Galea G. Impact of NCD Control Policies on change in smoking prevalence in the WHO European Region. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Erkoyun
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, Izmir, Turkey
| | - B Unal
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, Izmir, Turkey
| | | | | | | | - E Loyola
- WHO Regional Office for Europe, Moscow, Russia
| | - G Galea
- WHO Regional Office for Europe, Copenhagen, Denmark
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Unal B, Erkoyun E, Breda J, Loyola E, Galea G. Impact of NCD Control Policies on change in body mass index and diabetes in the WHO Europe Region. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Unal B, Erkoyun E, Loyola E, Farrington J, Maximova K, Breda J, Galea G. Impact of NCD policies on change in blood pressure and cholesterol in the WHO European Region. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Unal
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, izmir, Turkey
| | - E Erkoyun
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, izmir, Turkey
| | - E Loyola
- WHO Regional Office for Europe, Moscow, Russia
| | - J Farrington
- WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - J Breda
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - G Galea
- WHO Regional Office for Europe, Copenhagen, Denmark
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Erkoyun E, Unal B, Moller LF, Maximova K, Loyola E, Galea G. NCD control policies and alcohol consumption trends in WHO Europe countries between 2000 and 2014. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Erkoyun
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, Izmir, Turkey
| | - B Unal
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, Izmir, Turkey
| | - LF Moller
- WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - E Loyola
- WHO Regional Office for Europe, Moscow, Russia
| | - G Galea
- WHO Regional Office for Europe, Copenhagen, Denmark
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Unal B, Erkoyun E, Maximova K, Farrington J, Loyola E, Critchley J, Capewell S, Galea G. Impact of NCD policies on ischaemic heart disease and premature NCD mortality change in Europe. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Unal
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, izmir, Turkey
| | - E Erkoyun
- Dokuz Eylül University, Faculty of Medicine, Department of Public Health, izmir, Turkey
| | | | - J Farrington
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - E Loyola
- WHO Regional Office for Europe, Moscow, Russia
| | - J Critchley
- St George's University of London, London, UK
| | - S Capewell
- The University of Liverpool, Liverpool, UK
| | - G Galea
- WHO Regional Office for Europe, Copenhagen, Denmark
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Loyola E, Theodorakis P, Rakovac I, Greenwell F, Stein C. Economic downturn and its consequences in countries’ capacity to monitor population health and health systems impacts: some lessons learnt from Greece. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leitao J, Chandramohan D, Byass P, Jakob R, Bundhamcharoen K, Choprapawon C, de Savigny D, Fottrell E, França E, Frøen F, Gewaifel G, Hodgson A, Hounton S, Kahn K, Krishnan A, Kumar V, Masanja H, Nichols E, Notzon F, Rasooly MH, Sankoh O, Spiegel P, AbouZahr C, Amexo M, Kebede D, Alley WS, Marinho F, Ali M, Loyola E, Chikersal J, Gao J, Annunziata G, Bahl R, Bartolomeus K, Boerma T, Ustun B, Chou D, Muhe L, Mathai M. Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring. Glob Health Action 2013; 6:21518. [PMID: 24041439 PMCID: PMC3774013 DOI: 10.3402/gha.v6i0.21518] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/06/2013] [Accepted: 08/12/2013] [Indexed: 11/21/2022] Open
Abstract
Objective Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. Methods A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. Findings A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. Conclusions The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.
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Affiliation(s)
- Jordana Leitao
- Disease Control and Vector Biology, London School of Hygiene and Tropical Medicine, London, UK
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Rakovac I, Maharjan B, Stein C, Loyola E. Program for validation of aggregated hospital discharge data. Stud Health Technol Inform 2013; 192:1155. [PMID: 23920929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Hospitals are major providers of health services and analysis of hospital activity data is of great interest for both policy makers and public health researchers. The WHO Regional Office for Europe disseminates the hospital discharge data from European countries through the European Hospital Morbidity Database, available on http://data.euro.who.int/hmdb. In order to ensure that reliable high quality data on hospital activities can be published in a timely manner, a program for validation of hospital discharge data has been developed using the R language for statistical computing. This program has been in use since the October 2012 version of the European Hospital Morbidity Database and its use has contributed to improved quality and comparability of data on hospital activities across Europe.
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Affiliation(s)
- Ivo Rakovac
- Division of Information, Evidence, Research and Innovation, World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Schneider MC, Castillo-Salgado C, Bacallao J, Loyola E, Mujica OJ, Vidaurre M, Roca A. Summary of indicators most used for the measurement of the health inequalities. Epidemiol Bull 2005; 26:7-10. [PMID: 16578907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Schneider MC, Castillo-Salgado C, Bacallao J, Loyola E, Mujica OJ, Vidaurre M, Roca A. Methods for measuring health inequalities (Part III). Epidemiol Bull 2005; 26:12-5. [PMID: 16578883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Castillo-Salgado C, Loyola E. Development of the Healthy Condition Index using geographic information systems in health. Epidemiol Bull 2002; 23:7-11. [PMID: 12755084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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Abstract
Measuring health inequalities is indispensable for progress in improving the health situation in the Region of the Americas, where the analysis of average values is no longer sufficient. Analyzing health inequalities is a fundamental tool for action that seeks greater equity in health. There are various measurement methods, with differing levels of complexity, and choosing one rather than another depends on the objective of the study. The purpose of this article is to familiarize health professionals and decision-making institutions with methodological aspects of the measurement and simple analysis of health inequalities, utilizing basic data that are regularly reported by geopolitical unit. The calculation method and the advantages and disadvantages of the following indicators are presented: the rate ratio and the rate difference, the effect index, the population attributable risk, the index of dissimilarity, the slope index of inequality and the relative index of inequality, the Gini coefficient, and the concentration index. The methods presented are applicable to measuring various types of inequalities and at different levels of analysis.
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Loyola E, Castillo-Salgado C, Nájera-Aguilar P, Vidaurre M, Mujica OJ, Martínez-Piedra R. [Geographic information systems as a tool for monitoring health inequalities]. Rev Panam Salud Publica 2002; 12:415-28. [PMID: 12690728 DOI: 10.1590/s1020-49892002001200007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To show how geographic information systems (GISs) can be used as technological tools to support health policy and public health actions. METHODS We assessed the relationship between infant mortality and a number of socio-economic and geographic determinants. In explaining how GISs are applied, we stressed their ability to integrate data, which makes it possible to perform epidemiologic evaluations in a simpler, faster, automated way that simultaneously analyzes multiple variables with different levels of aggregation. In this study, GISs were applied in analyzing infant mortality data with three levels of aggregation in countries of the Americas from 1995 to 2000. RESULTS Infant mortality in the Region of the Americas was estimated at an overall average of 24.4 deaths per 1,000 live births. However, the inequalities that were found indicate that the probability of an infant death is almost 20 times greater in the less developed countries of the Region than in more developed ones. Mapping infant mortality throughout the Region of the Americas allowed us to identify the countries that need to focus more attention on health policy and health programs, but not to determine what specific actions are of the highest priority. An analysis of smaller geopolitical units (states and municipalities) revealed important differences within countries. This shows that, as is true of data for the entire Region of the Americas, using national-level average figures for indicators can obscure the differences that exist within countries. When we examined the relationship between female illiteracy and malnutrition as determinants of infant mortality in Brazil and Ecuador, we identified social and epidemiologic strata where risk factors had different distribution patterns and that thus require health interventions that match their individual social and epidemiologic profiles. CONCLUSIONS With this type of epidemiologic study using GISs at the local level of health services, it is easy to see how a health event and its risk factors behave at a specific period in time. It is also possible to identify patterns in the spatial distribution of risk factors and in these factors' potential impact on health. Using GISs in an appropriate way will make it easier to deliver more effective, equitable public health services.
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Affiliation(s)
- Enrique Loyola
- Programa Especial de Análisis de Salud, Organización Panamericana de la Salud, Washington, D.C., USA
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Bacallao J, Castillo-Salgado C, Schneider MC, Mujica OJ, Loyola E, Vidaurre M. [Indices based on entropy for measuring social inequalities in health]. Rev Panam Salud Publica 2002; 12:429-35. [PMID: 12690729 DOI: 10.1590/s1020-49892002001200008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As described in the scientific literature, indices used to measure social inequalities in health have positive features, but they also have shortcomings, depending on how they are applied. The objective of this article is to put forward and to demonstrate, in both theoretical and practical terms, the advantages of measurements of inequality based on the notion of entropy, which is well known in physics and in information theory. The article defines and presents the main properties of indices based on the notions of entropy and redundancy. The application of the indices is illustrated with two fictitious data sets and also with real data derived from basic health indicators for the Americas, from the Pan American Health Organization. Indices based on the notion of entropy have properties that include: a) not varying with scale changes, b) being symmetrical, c) incorporating a socioeconomic dimension, and d) being easy to interpret thanks to the condition of equivalence between entropy and a system with two categories.
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Affiliation(s)
- Jorge Bacallao
- Instituto Superior de Ciencias Médicas de La Habana, Departamento de Computación y Biometría, La Habana, Cuba.
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Alleyne GAO, Castillo-Salgado C, Schneider MC, Loyola E, Vidaurre M. Overview of social inequalities in health in the region of the Americas, using various methodological approaches. Rev Panam Salud Publica 2002; 12:388-97. [PMID: 12690726 DOI: 10.1590/s1020-49892002001200005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Over the past decade, according to several important indicators, health conditions have improved in the Region of the Americas. However, inequalities persist among the countries of the Region. This article has two primary objectives: 1) to provide some unbiased evidence on health inequalities among countries of the Region of the Americas and 2) to illustrate the application of some of the more frequently used methods for measuring inequalities, including effect measurements, population attributable risk, the slope index of inequality, the relative index of inequality, and the concentration index. Analyses have shown that there are great health disparities in the Region of the Americas. For example, residents of the poorest countries of the Region live nearly 10 years less, on average, than do residents of the richest countries. If the other countries of the Americas had the same incidence of tuberculosis as does the subregion of North America (Bermuda, Canada, and the United States of America), there would be 76% fewer cases of this disease in the Region. In the Americas, nearly 35% of deaths of infants under 1 year old are concentrated in the 20% of live births that occur in the group with the lowest income. As for maternal mortality in the Americas, fewer than 2% of maternal deaths occur in association with the 20% of live births in the group with the highest income. The analyses of health inequalities based on the use of various methods highlight the existence of important disparities among subregions and countries of the Americas that are not readily seen when using only the more-traditional methods for analyzing mortality and morbidity. There is also a need to incorporate the concepts of distribution and socioeconomic dimensions of health when interpreting a given situation. Using this approach will allow decisionmakers to target areas and populations that are in less-favorable conditions. A considerable body of aggregate data at the Regional and country levels from routine information systems is already available--especially on morbidity, mortality, and other health-related factors--that can be used on a regular basis to analyze health inequalities. These kinds of analyses may be regarded as a first step toward the identification of health inequities.
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Affiliation(s)
- George A O Alleyne
- Pan American Health Organization, 525 23rd Street, N.W., Washington, D.C. 20037, USA
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Martinez R, Vidaurre M, Najera P, Loyola E, Castillo-Salgado C, Eisner C. SIGEpi: geographic information system in epidemiology and public health. Epidemiol Bull 2001; 22:4-5. [PMID: 11797235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Najera P, Mártinez R, Vidaurre M, Loyola E, Castillo-Salgado C, Eisner C. Use of SIGEpi for the identification of localities vulnerable to environmental risks in Mexico. Epidemiol Bull 2001; 22:5-10. [PMID: 11797236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Roca A, Crape B, Chase G, Loyola E, Castillo-Salgado C. Intentional use of biological and chemical agents: risks and recommendations. Epidemiol Bull 2001; 22:1-3. [PMID: 11797232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Castillo-Salgado C, Loyola E, Roca A. Inequalities in infant mortality in the American region: basic elements for analysis. Epidemiol Bull 2001; 22:4-7. [PMID: 11583038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Castillo-Salgado C, Mujica O, Loyola E. A subregional assessment of demographic and health trends in the Americas: 1980-1998. Stat Bull Metrop Insur Co 1999; 80:2-12. [PMID: 10327521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Close to 14 percent of the world's population lives in the Americas and the total population of this area is expected to reach 823,225,000 by the year 2000. Periodic assessments of the health situation and trends in conditions throughout subregions of the Americas have been undertaken by the Pan American Health Organization (PAHO) since the mid-1950s. These assessments demonstrate and underscore some major disparities in social, health and economic conditions in the various countries within the region. Analysis of some 38 demographic, socioeconomic, vital statistics and resource availability indicators show encouraging health and social progress between 1980 and 1998. Data concerning the health situation and trends in eight subregions of the Americas show a demographic reshape and an overall improvement in a variety of health indicators over this period. Important changes occurred in the epidemiological profile of the populations, shifting from a mainly communicable disease profile to one in which chronic diseases also affect a major portion of the population. This double health burden is unique in the region of the Americas. Improvements in social as well as health indicators were evidenced throughout the various subregions but at differing levels and at varying rates. Marked changes in total fertility, infant mortality, life expectancy and morbidity rates characterized the period between 1980 and 1998. The discrepancies between countries are highlighted and areas in need of further improvement outlined.
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Abstract
In forensic odontology, accurate detailed and complete recording of ante-mortem information is essential as the basis for odontological identification. Earlier studies on malpractice cases in Sweden indicated that the quality of the recording procedure was not always acceptable. Therefore, the aim of this retrospective study was to investigate the quality of ante-mortem records and its possible implications for identification work. All forensic odontology cases referred to the Department of Forensic Medicine in Göteborg between 1983 and 1992 were studied with regard to the instructions for dental records from the National Board of Health and Welfare. Information on dental characteristics, normal anatomical findings and restorative treatment was complete in 43 (68%) of the cases, incomplete in 17 (27%) and missing in 3 (5%). Registration of previous therapy was missing in about 75 (94%) of the records. It was possible to identify patient radiographs in only 16 of the 40 records where radiographs were available. In spite of this, the inaccuracies in the records did not seem to hamper the identification procedures in this study which could be explained by the character of the cases and the availability of medical and circumstantial information.
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Affiliation(s)
- H Borrman
- Faculty of Odontology, Göteborg University, Sweden
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Rosendo A, Latorre J, Gómez F, Llort R, Loyola E, Olba L, Marinello J, Mestres J, Latorre F, Sala-Planell E. [Intestinal revascularization syndrome: sequential study in dogs]. Angiologia 1984; 36:207-18. [PMID: 6476466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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