Trends in mortality rates are usually presented per tumour site or per country without an overall analysis of the complete data encompassing all three aspects (tumour sites, countries, trends). This paper presents a methodology for such an overall analysis using three-way methods applied to a data set on female mortality rates for 17 tumour sites of 43 countries for the years 1968-1985. Multivariate techniques like biplots and three-mode principal component analysis within an overall three-way analysis-of-variance framework were used. We confirmed the known patterns of comparatively high mortality for women due to cancer of the bladder, intestines, pancreas, rectum, breast, ovary, skin and leukaemia and the relatively low mortality rates for liver cancer in Western and Northern Europe, the USA, Australia and New Zealand. Also, the reverse pattern was observed for Middle and Southern Europe, Hong Kong, Singapore, and in Japan, and in some but not all Latin American countries. The relatively mortality due to cancer was high in the lungs, mouth, larynx and oesophagus in the British Isles, but was much less in other European countries. Mortality due to cancer of the thyroid, uterus, gall bladder and stomach was high in Middle European countries, as was the case in Japan, Chile and Costa Rica. Rates were low for Southern European countries, North America, Australia and New Zealand. Specific deviating patterns in the data were the more rapidly decreasing mortality rates for stomach cancer in Chile and Japan and the more rapidly increasing mortality rates for lung cancer in the USA, Scotland and Denmark. In conclusion, using three-way methods, it was feasible to analyse the cancer mortality data in their entirety. This enabled the simultaneous comparison of trends in relative mortality rates between all countries due to all tumour sites, as well as the identification of specific deviating trends for specific tumour sites in specific countries.
Over the past five years the Tanzanian-Norwegian AIDS Project (MUTAN) has assisted the National AIDS Control Programme in creating and testing innovative HIV/AIDS educational programmes. These programmes, designed to reach a variety of target groups, have been implemented throughout the Arusha and Kilimanjaro regions and include: public meetings, intensive courses, information centres, radio programmes and school-based programmes. A recent survey of 996 participants (15-54 years old) was designed to assess public exposure to HIV/AIDS information. A total of 72% of the participants reported having heard about AIDS on the radio, 74% having read about AIDS in newspapers, and 52% having heard about AIDS from a health worker during the previous month. Furthermore, 26% had listened to MUTAN's weekly radio programme at least once. 31% knew of MUTAN's information centres, and 15% had visited one of these centres. The results indicate that large proportion of the population is receiving in-depth HIV/AIDS information. It is recommended that future work concentrate on how to reach people with no or little formal education, young adults and women.
Immigrants from non-Western countries occupy a fifth of the beds in an acute psychiatric department. There is a prevailing clinical impression that they have higher morbidity than the traditional Norwegian population. MATERIAL: A one-year cohort of patients, n = 415, was retrospectively investigated, 80 of whom had a non-Western background. RESULTS: The proportion of immigrant patients from the department's catchment area was 49 in 10 000, compared to 52 in 10 000 for traditional Norwegian patients, p = 0.72. Significantly more of the immigrants were men, they were younger, they got more compulsory treatment, and more often a diagnosis of psychosis, but they had less substance abuse problems. Suicidality was evenly distributed in both groups. INTERPRETATION: Our clinical impression of a higher frequency of referral of immigrants was not substantiated. However, it is suggested that immigrants have greater difficulties in presenting their psychiatric problems to a general practitioner; hence they probably develop more severe symptoms before referral. The low incidence of referral of female immigrants could indicate a higher level of functioning, or cultural barriers to exhibiting problems.
Comment In: Tidsskr Nor Laegeforen. 2004 May 6;124(9):1278; author reply 127815131720
BACKGROUND: Studies in developed countries have shown that reduced fetal growth is related to raised blood pressure in childhood and adult life. Little is known about this association in developing countries, where fetal growth retardation is common. METHODS: In 1994-1995, we measured blood pressure in 1570 3-6-year-old children living in China, Guatemala, Chile, Nigeria and Sweden. We related their blood pressure to patterns of fetal growth, as measured by body proportions at birth. The children were all born after 37 weeks gestation and weighed more than 2.5 kg at birth. RESULTS: In each country, blood pressure was positively related to the child's current weight. After adjusting for this and gender, systolic pressure was inversely related to size at birth in all countries except Nigeria. In Chile, China and Guatemala, children who were proportionately small at birth had raised systolic pressure. For example, in Chile, systolic pressure adjusted for current weight increased by 4.9 mmHg (95% CI : 2.1, 7.7) for every kilogram decrease in birthweight, by 1 mmHg (95% CI : 0.4, 1.6) for every centimetre decrease in birth length, and by 1.3 mmHg (95% CI : 0.4, 2.2) for every centimetre decrease in head circumference at birth. In Sweden, systolic pressure was higher in children who were disproportionately small, that is thin, at birth. Systolic pressure increased by 0.3 mmHg (95% CI : 0.0, 0.6) for every unit (kg/m3) decrease in ponderal index at birth. These associations were independent of the duration of gestation. CONCLUSIONS: Raised blood pressure among children in three samples from China, Central and South America is related to proportionate reduction in body size at birth, which results from reduced growth throughout gestation. The relation between fetal growth and blood pressure may be different in African populations. Proportionately reduced fetal growth is the prevalent pattern of fetal growth retardation in developing countries, and is associated with chronic undernutrition among women. Improvement in the nutrition and health of girls and young women may be important in preventing cardiovascular disease in developing countries.
Comment In: Int J Epidemiol. 2001 Feb;30(1):57-911171857
To assess the global position of Canadian life expectancy and to determine the areas of greatest negative impact on life expectancy.
Using retrospective data on life expectancy at birth (LE(0) and age-standardized mortality rates, Canada was compared with 13 other countries with the longest LE(0). Linear regression models were used to produce trends and projections of LE(0) until 2010.
Canadian women and men currently rank 8th and 5th, respectively, in LE(0) among the 14 nations. Canada has one of the smallest annual LE(0) improvement rates among the countries studied. Canadian women progressed significantly slower than nine countries and Canadian men progressed slower than five. Women are improving at only half the rate of men due to narrowing gaps in most mortality risks--mostly for cardiovascular diseases, lung cancer and injury. These trends lowered projected LE(0) ranks of Canadians, especially for women, for 2010.
LE(0) of Canadians is slipping relative to most of the other 13 countries, and more so for women than men. This phenomenon is explained by historically higher mortality rates from ischemic heart disease, cancer and respiratory system disease for all Canadians, coupled with recently lower improvement rates in most mortality risks for Canadian women and in cancers and diabetes for Canadian men. Improving the health and wellness of Canadians, particularly women, demands a priority focus on enhanced chronic disease detection and management as well as strategies to reduce obesity and tobacco use by addressing the determinants of these behavioural risk factors.
Today's globalized economy creates opportunities for health professionals but corresponding challenges for countries facing significant shortages of these professionals. The uneven playing field between developed and developing countries hampers the latter in recruiting and retaining trained professionals to oversee and maintain their health systems. Given the salary differentials and variance in working conditions between developed and developing countries, developing countries may lack the pull factors to keep their nurses and doctors from emigrating. However, many developed countries have made significant investments to address this challenge.
Comment On: Nurs Leadersh (Tor Ont). 2009;22(1):24-5019289910
There are an estimated 500,000 cases of cervical cancer every year worldwide, of which 80% occur in developing countries. The World Health Organization has estimated that every year 7 million new cancer cases occur, at least half of which are in low-income countries. In women breast cancer is the most frequent, followed by cervical cancer. Because of late diagnosis and the lack of treatment in the early phase the prospects of treatment are poor. Cervical cancer is the leading malignancy in northeast Brazil, where its annual incidence is 83 cases per 100,000 women. In India 20-70% of female malignant cancers are cervical cancers vs. only 2.6% of female cancers in Sweden. In Kenya cervical cancer dominates in the 40-49 year age group vs. in the 50-59 year age group in high-income countries. The risk factors are early sexual debut, multiple sexual partners, smoking, and papilloma virus infection. Various studies seem to have confirmed that there is an association between cervical cancer and long-term use of oral contraceptives, although some others have questioned this correlation. In Africa and Nigeria in particular patients do not receive adequate treatment. Whereas in Sweden there are 6 oncological regions with at least 1 treatment center and a total of 14 hospitals with high energy radiation therapy, in Africa, with a population of 500 million, there are only 11 countries where such therapy is available. Cervical cancer has a preinvasive stage of 5-10 years and only 10-20% of the cancer in situ develops into invasive cancer. Population-based screening with a 5-10 year interval directed at the high-risk groups would be the most realistic preventive method. In India both visual inspection and cytology was used in a study showing that visual inspection only identified 60% of women as high risk. The screening of the whole population in the 35-64 year age groups every 10 years could reduce the incidence of invasive cervical cancer by about 55%.
While several studies have demonstrated a decline in the overall prevalence of Helicobacter pylori infection in developed countries, there is variability in the burden of infection linked to socioeconomic status and living conditions. Improved socioeconomic status, living conditions and the availability of H. pylori-eradication therapy have been associated with a lower prevalence of infection in First World populations, yet immigrants and indigenous people continue to have a high burden of H. pylori infection and disease. Although the changing prevalence of H. pylori infection in children has been recognized in a few reports, further studies are required to determine the impact of H. pylori infection in this population. Moreover, additional studies are required for those populations at risk.