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This paper describes major points of a study on the future of dementia in the period 1990-2010. By means of a literature review and consultation of experts in a Delphi-study exploratory scenarios and a target-setting scenario were constructed. The paper delineates the exploratory reference-scenario, which includes the most probable processes and developments according to the majority of the experts. Furthermore necessary measures and strategies are described to increase the quality of care to demented elderly in the next twenty years.

The objective of this study was to produce a malaria distribution map that would constitute a useful tool for development and health planners in West Africa. The recently created continental database of malaria survey results (MARA/ARMA 1998) provides the opportunity for producing empirical models and maps of malaria distribution at a regional and eventually at a continental level. This paper reports on the mapping of malaria distribution for sub-Saharan West Africa based on these data. The strategy was to undertake a spatial statistical analysis of malaria parasite prevalence in relation to those potential bio-physical environmental factors involved in the distribution of malaria transmission intensity which are readily available at any map location. The resulting model was then used to predict parasite prevalence for the whole of West Africa. We also produced estimates of the proportion of population of each country in the region exposed to various categories of risk to show the impact that malaria is having on individual countries. The data represent a very large sample of children in West Africa. It constitutes a first attempt to produce a malaria risk map of the West African region, based entirely on malariometric data. We anticipate that it will provide useful additional guidance to control programme managers, and that it can be refined once sufficient additional data become available.

Results are presented of a 'demonstration project' in care for the elderly in the region South-East Groningen. Three issues were at stake in this project: extension of home-care, interventions in the referral processes to nursing homes and homes for the aged and coordinated allocation and planning of services for the elderly. Effects of the intervention were assessed with a quasi-experimental control-group design. In this paper, the issue of substitution is addressed from two different angles. First, changes in utilization of services in the experimental period (1988-1990) were evaluated. Second, changes in disability of elderly clients were evaluated. In both analyses, controls for national developments took place. The analyses show that substitution occurred, both in terms of utilization of care (more home-care, less institutional care) and in terms of the levels of need of clients (increases in mean level of disability in the populations of home-care and homes for the aged).