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Background: Undernutrition in early childhood is associated with a range of negative outcomes across the lifespan. Little is known about the prevalence of exposure to undernutrition among young children with significant cognitive delay., Method: Secondary analysis of data collected on 161 188 three- and four-year-old children in 47 low-income and middle-income countries in Rounds 4-6 of UNICEF's Multiple Indicator Cluster Surveys. Of these, 12.3% (95% confidence interval 11.8-12.8%) showed evidence of significant cognitive delay., Results: In both middle-income and low-income countries, significant cognitive delay was associated with an increased prevalence of exposure to three indicators of undernutrition (underweight, wasting and stunting). Overall, children with significant cognitive delay were more than twice as likely than their peers to be exposed to severe underweight, severe wasting and severe stunting. Among children with significant cognitive delay (and after controlling for country economic classification group), relative household wealth was the strongest and most consistent predictor of exposure to undernutrition., Conclusions: Given that undernutrition in early childhood is associated with a range of negative outcomes in later life, it is possible that undernutrition in early childhood may play an important role in accounting for health inequalities and inequities experienced by people with significant cognitive delay in low-income and middle-income countries., (© 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Background: Liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide. Socioeconomic development, indicated by the Human Development Index (HDI), is closely interconnected with public health. But the manner in which social development and medical advances influenced liver cancer patients in the past decade is still unknown., Aim: To investigate the influence of HDI on clinical outcomes for patients with existing liver cancer from 2008 to 2018., Methods: The HDI values were obtained from the United Nations Development Programme, the age-standardized incidence and mortality rates of liver cancer were obtained from the GLOBOCAN database to calculate the mortality-to-incidence ratio, and the estimated 5-year net survival of patients with liver cancer was provided by the CONCORD-3 program. We then explored the association of mortality-to-incidence ratio and survival with HDI, with a focus on geographic variability across countries as well as temporal heterogeneity over the past decade., Results: From 2008 to 2018, the epidemiology of liver cancer had changed across countries. Liver cancer mortality-to-incidence ratios were negatively correlated and showed good fit with a modified "dose-to-inhibition response" pattern with HDI ( r = -0.548, P < 0.0001 for 2018; r = -0.617, P < 0.0001 for 2008). Cancer survival was positively associated with HDI ( r = 0.408, P < 0.01) and negatively associated with mortality-to-incidence ratio ( r = -0.346, P < 0.05), solidly confirming the interrelation among liver cancer outcome indicators and socioeconomic factors. Notably, in the past decade, the HDI values in most countries have increased alongside a decreasing tendency of liver cancer mortality-to-incidence ratios ( P < 0.0001), and survival outcomes have simultaneously improved ( P < 0.001), with significant disparities across countries., Conclusion: Socioeconomic factors have a significant influence on cancer outcomes. HDI values have increased along with improved cancer outcomes, with significant disparities among countries., Competing Interests: Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.

ABSTRACTThe intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2019;13:5-17).

Humanitarian aid in settings of conflict has always been fraught with challenges. In the absence of political engagement, however, manipulation by state authorities, however, have the potential to pervert aid intervention to inflict harm. South Sudan exemplifies how states may abuse the humanitarian response to retreat from public responsibility, divert funds to further violence and conflict and dictate the distribution of aid. Recent trends toward nationalist policies in the West that favor disengagement and limited military strikes have the very effect of allowing this abuse to transform humanitarian aid into a tool for harm. (Disaster Med Public Health Preparedness. 2018;12:567-568).

Disability as a health outcome deserves more attention than it has so far received. With people living longer and the epidemiological transition from infectious to noncommunicable diseases as the major cause of health burden, we need to focus attention on disability - the non-fatal impact of heath conditions - over and above our concern for causes of mortality.With the first Global Burden of Disease study, WHO provided a metric that enabled the comparison of the impact of diseases, drawing on a model of disability that focused on decrements of health. This model has since been elaborated in the International Classification of Functioning, Disability and Health as being either a feature of the individual or arising out of the interaction between the individual's health condition and contextual factors. The basis of WHO's ongoing work is a set of principles: that disability is a universal human experience; that disability is not determined solely by the underlying health condition or predicated merely on the presence of specific health conditions; and finally, that disability lies on a continuum from no to complete disability. To determine whether interventions at individual or population levels are effective, an approach to disability measurement that allows for an appropriate and fair comparison across health conditions is needed. WHO has designed the Model Disability Survey (MDS) to collect information relevant to understand the lived experience of disability, including the person's capacity to perform tasks actions in daily life, their actual performance, the barriers and facilitators in the environment they experience, and their health conditions. As disability gains prominence within the development agenda in the United Nations Sustainable Development Goals, and the implementation of the United Nations Convention on the Rights of Persons with Disabilities, the MDS will provide the data to monitor the progress of countries on meeting their obligations.The lesson learned from WHO's activities is that disability is a universal human experience, in the sense that everyone can be placed on a continuum of functioning and either currently experiences or is vulnerable to experiencing disability over the course of their lives. This understanding of disability is the key to mainstreaming disability within the public discourse.

There is a scarcity of quantitative research into the effect of FDI on population health in low and middle income countries (LMICs). This paper investigates the relationship using annual panel data from 85 LMICs between 1974 and 2012. When controlling for time trends, country fixed effects, correlation between repeated observations, relevant covariates, and endogeneity via a novel instrumental variable approach, we find FDI to have a beneficial effect on overall health, proxied by life expectancy. When investigating age-specific mortality rates, we find a stronger beneficial effect of FDI on adult mortality, yet no association with either infant or child mortality. Notably, FDI effects on health remain undetected in all models which do not control for endogeneity. Exploring the effect of sector-specific FDI on health in LMICs, we provide preliminary evidence of a weak inverse association between secondary (i.e. manufacturing) sector FDI and overall life expectancy. Our results thus suggest that FDI has provided an overall benefit to population health in LMICs, particularly in adults, yet investments into the secondary sector could be harmful to health., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Immunizations are one of the most important health interventions of the 20th century, yet people in many areas of the world do not receive adequate immunizations. Approximately 3 million people worldwide die every year from vaccine-preventable diseases; about half of these deaths are young children and infants. Global travel is more common; diseases that were once localized now can be found in communities around the world., Problem: Multiple barriers to immunizations have been identified. Healthcare access, cost, and perceptions of safety and trust in healthcare are factors that have depressed global immunization rates., Interventions: Several global organizations have focused on addressing these barriers as part of their efforts to increase immunization rates. The Bill and Melinda Gates Foundation, The World Health Organization, and the United Nations Children's Emergency Fund each have a part of their organization that is concentrated on immunizations., Clinical Implications: Maternal child nurses worldwide can assist in increasing immunization rates. Nurses can participate in outreach programs to ease the burden of patients and families in accessing immunizations. Nurses can work with local and global organizations to make immunizations more affordable. Nurses can improve trust and knowledge about immunizations in their local communities. Nurses are a powerful influence in the struggle to increase immunization rates, which is a vital aspect of global health promotion and disease prevention.

Background: In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target., Methods and Findings: For the period 2010-2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President's Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010-2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for "on ART" and for "viral suppression," respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain., Conclusions: Relatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency.

This study confirms an association between survival probability of becoming a centenarian (SPBC) for those aged 65 to 69 and country-level socioeconomic indicators in Europe: the gender inequality index (GII), male labour force participation (MLP) rates and proportions of seats held by women in national parliaments (PWP). The analysis was based on SPBC data from 34 countries obtained from the United Nations (UN). Country-level socioeconomic indicator data were obtained from the UN and World Bank databases. The associations between socioeconomic indicators and SPBC were assessed using correlation coefficients and multivariate regression models. The findings show significant correlations between the SPBC for women and men aged 65 to 69 and country-level socioeconomic indicators: GII (r=-0.674, p=0.001), MLP (r=0.514, p=0.002) and PWP (r=0.498, p=0.003). The SPBC predictors for women and men were lower GIIs and higher MLP and PWP (R 2=0.508, p=0.001). Country-level socioeconomic indicators appear to have an important effect on the probability of becoming a centenarian in European adults aged 65 to 69. Country-level gender equality policies in European counties may decrease the risk of unhealthy old age and increase longevity in elders through greater national gender equality; disparities in GII and other country-level socioeconomic indicators impact longevity probability. National longevity strategies should target country-level gender inequality.

Introduction: Sixty million people were displaced from their homes due to conflict, persecution, or human rights violations at the end of 2014. This vulnerable population bears a disproportionate burden of disease, much of which is surgically treatable. We sought to estimate the surgical needs for forcibly displaced persons globally to inform humanitarian assistance initiatives., Methods: Data regarding forcibly displaced persons, including refugees, internally displaced persons (IDPs), and asylum seekers were extracted from United Nations databases. Using the minimum proposed surgical rate of 4669 procedures per 100,000 persons annually, global, regional, and country-specific estimates were calculated. The prevalence of pregnancy and obstetric complications were used to estimate obstetric surgical needs., Results: At least 2.78 million surgical procedures (IQR 2.58-3.15 million) were needed for 59.5 million displaced persons. Of these, 1.06 million procedures were required in North Africa and the Middle East, representing an increase of 50 % from current unmet surgical need in the region. Host countries with the highest surgical burden for the displaced included Syria (388,000 procedures), Colombia (282,000 procedures), and Iraq (187,000). Between 4 and 10 % of required procedures were obstetric surgical procedures. Children aged <18 years made up 52 % of the displaced, portending a substantial demand for pediatric surgical care., Conclusion: Approximately three million procedures annually are required to meet the surgical needs of refugees, IDPs, and asylum seekers. Most displaced persons are hosted in countries with inadequate surgical care capacity. These figures should be considered when planning humanitarian assistance and targeted surgical capacity improvements.

This study aimed at investigating differences in mental health problems between attendees of governmental and United Nations Relief and Works Agency for Palestine Refugees health care centers in Jordan. Further, predictors of mental health problems based on women's demographic profile were investigated. A convenience sample of 620 women attending governmental and United Nations Relief and Works Agency for Palestine Refugees health care centers in Jordan was recruited for this purpose. Independent samples t-tests were used to identify differences in mental health, and multiple linear regression was implemented to identify significant predictors of women's mental health problems. Results indicated an absence of significant differences in mental health problems between attendees of the two types of health care centers. Further, among the demographic indicators that were tested, income, spousal violence, and general health were the predictors of at least three different mental health problems in women. This study highlights opportunities for health professionals to decrease women's propensity for mental health problems by addressing these factors when treating women attending primary care centers in different Jordanian towns, villages, and refugee camps.

Background: Ischaemic heart disease (IHD) is the leading cause of death worldwide. The World Health Organisation (WHO) collects mortality data coded using the International Statistical Classification of Diseases (ICD) code., Methods: We analysed IHD deaths world-wide between 1995 and 2009 and used the UN population database to calculate age-specific and directly and indirectly age-standardised IHD mortality rates by country and region., Results: IHD is the single largest cause of death worldwide, causing 7,249,000 deaths in 2008, 12.7% of total global mortality. There is more than 20-fold variation in IHD mortality rates between countries. Highest IHD mortality rates are in Eastern Europe and Central Asian countries; lowest rates in high income countries. For the working-age population, IHD mortality rates are markedly higher in low-and-middle income countries than in high income countries. Over the last 25 years, age-standardised IHD mortality has fallen by more than half in high income countries, but the trend is flat or increasing in some low-and-middle income countries. Low-and-middle income countries now account for more than 80% of global IHD deaths., Conclusions: The global burden of IHD deaths has shifted to low-and-middle income countries as lifestyles approach those of high income countries. In high income countries, population ageing maintains IHD as the leading cause of death. Nevertheless, the progressive decline in age-standardised IHD mortality in high income countries shows that increasing IHD mortality is not inevitable. The 20-fold mortality difference between countries, and the temporal trends, may hold vital clues for handling IHD epidemic which is migratory, and still burgeoning., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The economic impact of remittances on migrant-sending countries has been a subject of debate in the scholarly literature on migration. We consider the topic using a household-level approach. We use a new survey, "Georgia on the Move," to examine migrant-level, household-level, and contextual variables associated with the probability that a household in the Republic of Georgia receives remittances. We then apply propensity score matching to estimate how remittances affect particular types of household expenditures, savings, labor supply, health, and other measures of well-being. Separate analysis of the subsample of households with a migrant currently abroad distinguishes the effects of remittances from the effects of migration as such. In Georgia, remittances improve household economic well-being without, for the most part, producing the negative consequences often suggested in the literature. We find evidence for an important aspect that has not been widely discussed in prior studies: remittances foster the formation of social capital by increasing the amount of money that households give as gifts to other households.

The United Nations Children's Fund (UNICEF) plays a leading role in the collection, compilation, analysis and dissemination of data to inform sound policies, legislation and programmes for promoting children's rights and well-being, and for global monitoring of progress towards the Millennium Development Goals. UNICEF maintains a set of global databases representing nearly 200 countries and covering the areas of child mortality, child health, maternal health, nutrition, immunization, water and sanitation, HIV/AIDS, education and child protection. These databases consist of internationally comparable and statistically sound data, and are updated annually through a process that draws on a wealth of data provided by UNICEF's wide network of >150 field offices. The databases are composed primarily of estimates from household surveys, with data from censuses, administrative records, vital registration systems and statistical models contributing to some key indicators as well. The data are assessed for quality based on a set of objective criteria to ensure that only the most reliable nationally representative information is included. For most indicators, data are available at the global, regional and national levels, plus sub-national disaggregation by sex, urban/rural residence and household wealth. The global databases are featured in UNICEF's flagship publications, inter-agency reports, including the Secretary General's Millennium Development Goals Report and Countdown to 2015, sector-specific reports and statistical country profiles. They are also publicly available on www.childinfo.org, together with trend data and equity analyses.

Projections of countries' future populations, broken down by age and sex, are widely used for planning and research. They are mostly done deterministically, but there is a widespread need for probabilistic projections. We propose a bayesian method for probabilistic population projections for all countries. The total fertility rate and female and male life expectancies at birth are projected probabilistically using bayesian hierarchical models estimated via Markov chain Monte Carlo using United Nations population data for all countries. These are then converted to age-specific rates and combined with a cohort component projection model. This yields probabilistic projections of any population quantity of interest. The method is illustrated for five countries of different demographic stages, continents and sizes. The method is validated by an out of sample experiment in which data from 1950-1990 are used for estimation, and applied to predict 1990-2010. The method appears reasonably accurate and well calibrated for this period. The results suggest that the current United Nations high and low variants greatly underestimate uncertainty about the number of oldest old from about 2050 and that they underestimate uncertainty for high fertility countries and overstate uncertainty for countries that have completed the demographic transition and whose fertility has started to recover towards replacement level, mostly in Europe. The results also indicate that the potential support ratio (persons aged 20-64 per person aged 65+) will almost certainly decline dramatically in most countries over the coming decades.

Objectives: The 1999 World Bank report claimed that growth in gross domestic product (GDP) between 1960 and 1990 only accounted for 15% of concomitant growth in life expectancy in developing countries. These findings were used repeatedly by the World Health Organization (WHO) to support a policy shift away from promoting social and economic development, towards vertical technology-driven programmes. This paper updates the 1999 World Bank report using the World Bank's 2005 dataset, providing a new assessment of the relative contribution of economic growth., Study Design: Time-series analysis., Methods: Cross-sectional time-series regression analysis using a random effect model of associations between GDP, education and technical progress and improved health outcomes. The proportion of improvement in health indicators between 1970 and 2000 associated with changes in GDP, education and technical progress was estimated., Results: In 1970, a 1% difference in GDP between countries was associated with 6% difference in female (LEBF) and 5% male (LEBM) life expectancy at birth. By 2000, these values had increased to 14% and 12%, explaining most of the observed health gain. Excluding Europe and Central Asia, the proportion of the increase in LEBF and LEBM attributable to increased GDP was 31% and 33% in the present analysis, vs. 17% and 14%, respectively, estimated by the World Bank. In the poorest countries, higher GDPs were required in 2000 than in 1970 to achieve the same health outcomes., Conclusions: In the poorest countries, socio-economic change is likely to be a more important source of health improvement than technical progress. Technical progress, operating by increasing the size of the effect of a unit of GDP on health, is likely to benefit richer countries more than poorer countries, thereby increasing global health inequalities., (Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Millennium Development Goal 4 calls for a reduction in the under-five mortality rate (U5MR) by two-thirds between 1990 and 2015. In 2011, estimates were published by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) and the Institute for Health Metrics and Evaluation (IHME). The difference in the U5MR estimates produced by the two research groups was more than 10% and corresponded to more than ten deaths per 1,000 live births for 10% of all countries in 1990 and 20% of all countries in 2010, which can lead to conflicting conclusions with respect to countries' progress. To understand what caused the differences in estimates, we summarised differences in underlying data and modelling approaches used by the two groups, and analysed their effects., Methods and Findings: UN IGME and IHME estimation approaches differ with respect to the construction of databases and the pre-processing of data, trend fitting procedures, inclusion and exclusion of data series, and additional adjustment procedures. Large differences in U5MR estimates between the UN IGME and the IHME exist in countries with conflicts or civil unrest, countries with high HIV prevalence, and countries where the underlying data used to derive the estimates were different, especially if the exclusion of data series differed between the two research groups. A decomposition of the differences showed that differences in estimates due to using different data (inclusion of data series and pre-processing of data) are on average larger than the differences due to using different trend fitting methods., Conclusions: Substantial country-specific differences between UN IGME and IHME estimates for U5MR and the number of under-five deaths exist because of various differences in data and modelling assumptions used. Often differences are illustrative of the lack of reliable data and likely to decrease as more data become available. Improved transparency on methods and data used will help to improve understanding about the drivers of the differences. Please see later in the article for the Editors' Summary.

Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the under-five mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and (5)q(0)). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990-2000 to 2.5% for the period 2000-2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths.

We describe a Bayesian projection model to produce country-specific projections of the total fertility rate (TFR) for all countries. The model decomposes the evolution of TFR into three phases: pre-transition high fertility, the fertility transition, and post-transition low fertility. The model for the fertility decline builds on the United Nations Population Division's current deterministic projection methodology, which assumes that fertility will eventually fall below replacement level. It models the decline in TFR as the sum of two logistic functions that depend on the current TFR level, and a random term. A Bayesian hierarchical model is used to project future TFR based on both the country's TFR history and the pattern of all countries. It is estimated from United Nations estimates of past TFR in all countries using a Markov chain Monte Carlo algorithm. The post-transition low fertility phase is modeled using an autoregressive model, in which long-term TFR projections converge toward and oscillate around replacement level. The method is evaluated using out-of-sample projections for the period since 1980 and the period since 1995, and is found to be well calibrated.

Background: Pneumonia is the leading cause of child deaths globally. The aims of this study were to: a) estimate the number and global distribution of pneumonia deaths for children 1-59 months for 2008 for countries with low (<85%) or no coverage of death certification using single-cause regression models and b) compare these country estimates with recently published ones based on multi-cause regression models., Methods and Findings: For 35 low child-mortality countries with <85% coverage of death certification, a regression model based on vital registration data of low child-mortality and >85% coverage of death certification countries was used. For 87 high child-mortality countries pneumonia death estimates were obtained by applying a regression model developed from published and unpublished verbal autopsy data from high child-mortality settings. The total number of 1-59 months pneumonia deaths for the year 2008 for these 122 countries was estimated to be 1.18 M (95% CI 0.77 M-1.80 M), which represented 23.27% (95% CI 17.15%-32.75%) of all 1-59 month child deaths. The country level estimation correlation coefficient between these two methods was 0.40., Interpretation: Although the overall number of post-neonatal pneumonia deaths was similar irrespective to the method of estimation used, the country estimate correlation coefficient was low, and therefore country-specific estimates should be interpreted with caution. Pneumonia remains the leading cause of child deaths and is greatest in regions of poverty and high child-mortality. Despite the concerns about gender inequity linked with childhood mortality we could not estimate sex-specific pneumonia mortality rates due to the inadequate data. Life-saving interventions effective in preventing and treating pneumonia mortality exist but few children in high pneumonia disease burden regions are able to access them. To achieve the United Nations Millennium Development Goal 4 target to reduce child deaths by two-thirds in year 2015 will require the scale-up of access to these effective pneumonia interventions.

This article explores the accountability of international financial institutions (IFIs), such as the World Bank, for human rights violations related to the massive leakage of funds from sub-Saharan Africa's health sector. The article begins by summarizing the quantitative results of Public Expenditure Tracking Surveys performed in six African countries, all showing disturbingly high levels of leakage in the health sector. It then addresses the inadequacy of good governance and anticorruption programs in remedying this problem. After explaining how the World Bank's Inspection Panel may serve as an accountability mechanism for addressing the leakage of funds, discussing violations of specific Bank policies and procedures that would support a claim related to leakage and examining the relevance of human rights concerns to such as claim, the article explores some of the Panel's limitations and the positive steps taken to address these concerns.

Estimates of global and regional HIV incidence and prevalence are helpful for gauging the state of the epidemic. However, they do not contain as much information as the HIV transmission rate for judging the potential speed of HIV spread. The HIV transmission rate can be defined as follows: for every 100 persons living with HIV, the number of HIV infections transmitted to seronegative partners in one year. Here, we estimate the transmission rate for the global epidemic for the years 2001 and 2007, and for 10 major international regions for the year 2007. The transmission rate is calculated as incidence divided by prevalence, and the quotient then multiplied by 100. Previously published and publicly available, the Joint United Nations Programme on HIV/AIDS estimates of HIV incidence and prevalence at the global and regional levels were utilized. Between 2001 and 2007, the global HIV transmission rate dropped from 10.2 to 8.2, a decrease of 19.6% in six years time. The regional estimates for 2007 ranged from 3.7 in Western and Central Europe, to 10.5 in the Middle East and Northern Africa, to 17.6 in Oceania. The global transmission rate for 2007 of 8.2 indicates that 91.8% or more of persons living with HIV are not transmitting to other persons in a given year. The 19.6% decrease in HIV transmission rate between 2001 and 2007 appears to indicate some success in global HIV prevention efforts. The range of regional estimates helps to identify areas with the potential for rapidly growing epidemics, even if the raw numbers of new infections and prevalence are low. I believe the transmission rate to be a useful statistic and recommend its further adoption.

There is mixed evidence of a relation for suicide rates in the general population with urbanisation. A cross-national study of 76 countries was undertaken examining the a priori hypothesis that the relation of the general population suicide rates with urbanisation, using data from the World Health Organization and United Nations, would be curvilinear and follow an inverted U-shaped curve, with a quadratic pattern. The predicted curvilinear relation was not found. This may have been due to major methodological limitations in cross-national studies, so this hypothesised curvilinear relationship may be better examined in longitudinal studies over time in individual countries undergoing urbanisation.

Background: Elderly suicides rates are associated with socio-economic status and life expectancy. Although suicide rates in younger people are associated with both higher and lower levels of educational attainment, little is known about this association in the elderly., Method: The relationship between Human Development Index (HDI)--a composite index measuring average achievements on three basic dimensions of human development (life expectancy, educational attainment and socio-economic status)--and elderly suicide rates was examined in a cross-national study utilizing secondary data from the World Health Organization and the United Nations., Results: There was a significant curvilinear (inverted U-shaped curve) relationship between elderly suicide rates in males and the HDI, fitting the quadratic equation y = a + bx - cx2. A similar curvilinear relationship was observed in females, but the significance level only approached 0.05., Conclusions: A model with four sequential stages was proposed to explain the findings: (i) low elderly suicide rate--low human development society; (ii) high elderly suicide rate--low human development society; (iii) high elderly suicide rate--high human development society; and (iv) low elderly suicide rate--high human development society.

Analyses of individual and aggregated data have yielded an association between suicide and unemployment, particularly for men in younger age groups. Examination of the relationship of elderly suicide rates with measures of unemployment in a cross-national study of 27 countries did not produce any statistically significant association between these two variables. Also, the magnitude of the actual correlations was small. One reason for low magnitude of correlations may be better welfare systems in the studied countries which mainly reported medium and high income.

A negative correlation between societal suicide rates and social integration has been reported, but rarely specifically examined for suicide rates of the elderly although suicide rates of elderly persons are among the highest. The associations of suicide rates of elderly persons and fertility rates for 81 countries were examined using data from the World Health Organisation and United Nations. Fertility rates were considered a proxy measure for social integration. Multiple regression analysis indicated that suicide rates for males and females in the age bands 65-74 years and 75+ years were independently (negative) correlated with fertility rates. Fertility rates, as a measure of social integration, may interact with, modify and mediate the effect of cultural factors on suicide rates of elderly persons.

This study evaluates the mental health of Japan Self-Defense Force (JSDF) members of the peacekeeping contingent in the Golan Heights before and since the Second Gulf War between 1998 and 2003. Before the war, the General Health Questionnaire 30 (GHQ30) scores during and after duty tended to be lower than those before duty; all scores were lower than those of adult Japanese men in general. After the war, GHQ30 scores did not significantly change between before, during, and after duty. Manifest Anxiety Scale (MAS) scores were not significantly different between groups. Stressors identified included problems with foreign language and familial matters at home. Post war stressors included work content and relationships with collaborating foreign army units. These findings suggest that the mental health of contingent members remained stable, with some variation in mental health conditions influenced by the situation in the Middle East. This study suggests that the stable mental condition of JSDF personnel during their deployment in the absence of combat, and that this could be enhanced by education about mental health issues and by providing counseling support to their families., ((c) 2008 APA, all rights reserved)

A comprehensive approach to highly pathogenic avian influenza (HPAI) is crucial for identifying all the factors that contribute to its emergence, spread and persistence. Epidemiological understanding makes it possible to predict the evolution of the virus and to prevent and control the socioeconomic, environmental, institutional and policy consequences. At FAO, risk assessment and intelligence with regard to HPAI are based on lessons learnt from assisting countries to design strategies and on implementation of technical assistance programmes, which reveal important elements, such as the roles of ducks, live-bird markets and trade. Wild birds were found to contribute, by transporting the H5N1 virus over long distances. The contributions of different poultry farming systems and market chains in the epidemiology of HPAI are well recognized; however, the respective roles of smallholder systems and commercial farms are unclear. FAO considers that smallholders will continue to be an important factor and should be taken into account in control and prevention programmes. Changes in poultry farming are essentially driven by the private sector and market forces and could have negative consequences on the livelihoods of smallholders and on ecologically balanced production systems and agricultural biodiversity. Biosecurity can, however, be improved at the level of farms and markets. Institutional factors, such as the capacity of animal health systems to deliver control programmes, are also important, requiring strengthening and innovation in risk analysis and management.

Summary: Maternal mortality reduction has been a focus of major international initiatives for the past two decades. Widespread provision of emergency obstetric care (EmOC) has been shown to be an important strategy for addressing many of the complications that might otherwise lead to maternal death. However, unsafe abortion is one of the major causes of pregnancy-related deaths, and will be only partially addressed by EmOC. This manuscript presents a comprehensive approach to measuring whether abortion-related needs are met., Proposed Methods: We propose a set of indicators for monitoring the implementation of safe abortion care (SAC) interventions. We build on the model developed for monitoring the availability and use of Emergency Obstetric (EmOC) services. We describe the critical elements ("signal functions") of SAC - including treatment of abortion complications, legal, induced abortion and postabortion contraception - and define the indicators necessary to assess the availability, utilization and quality of abortion-related services., Sample Evidence: Data from 5 countries suggest there are sufficient service delivery points to provide decentralized abortion care, but that the full range of necessary abortion care services may not be provided at all these sites. Studies from several countries also show that many women receiving services for the treatment of abortion complications accept contraceptive methods when offered prior to discharge. This is an important strategy for reducing unwanted pregnancy, repeat unsafe abortion and risk for abortion-related mortality. Both findings suggest there are considerable opportunities within the present facilities to improve the delivery of abortion care services., Conclusion: This article recommends that the proposed model undergo field-testing on its own or in conjunction with the EmOC indicators, and encourages increased support for this important but often neglected aspect of pregnancy-related health.

Follow-up data from 187 male Norwegian veteran officers from unarmed UN military observer missions were compared with follow-up data from 211 male veteran officers from Norwegian contingents of the UNIFIL peacekeeping mission in South Lebanon on stress exposure, posttraumatic stress symptoms, level of alcohol consumption, and problems with social adaptation after redeployment from the mission. Observer mission veterans reported exposure to significantly higher levels of war zone stressors than veterans from peacekeeping units did. Observer veterans also reported significantly more posttraumatic stress symptoms at follow-up, higher alcohol consumption levels during service and at follow-up, and more problems with social adaptation to their lives at home in the years after their UN military service. All of these difficulties were most prominent in observers having served in missions with high-intensity stress exposure. Multivariate analyses demonstrated stress exposure during the mission and problems with social adaptation after homecoming to predict posttraumatic stress symptoms at follow-up.

This article presents trends and differentials in exclusive breastfeeding patterns that occurred in developing settings during the 1990s and considers these trends in relation to the breastfeeding-support activities in that decade. Between 1990 and 2000, the data suggest that exclusive breast-feeding levels in the developing world increased 15% overall among infants younger than 4 months (from 46% to 53%) and among infants older than 6 months (from 34% to 39%). The increase in urban areas is of special note. Urban areas are presumed to be most susceptible to the ambient health system and social and commercial pressures against breastfeeding; the support activities of the 1990s (eg, the Baby-friendly Hospital Initiative and the International Code of Marketing of Breastmilk Substitutes) were developed to address these pressures. Given this, implementation of the Global Strategy for Infant and Young Child Feeding, which supports these proven interventions, should be effective in further increasing optimal breast-feeding practices.

Objective: To produce projections of the number of dementia cases in Australia from 2000 to 2050. These projections examine the effects of an ageing population on number of dementia cases and also the potential impact of preventive strategies that delay age of dementia onset., Method: Data from several meta-analyses of dementia prevalence and incidence were combined with age-specific population projections to arrive at estimates of future numbers of cases. A statistical model of dementia incidence was developed and used to estimate the effects of delaying onset by up to 5 years., Results: Without prevention, prevalence of dementia is estimated to increase from 172 000 in 2000 to 588 000 in 2050. Over the same period, the incidence of dementia is estimated to increase from 43 000 to 143 000 new cases a year. Delaying onset by 5 years would decrease prevalence in 2050 by 44%. Even a 6-month delay would reduce prevalence by 6%., Conclusions: Ageing of the population will lead to a rapid increase in number of dementia cases and an increasing burden for the working-age population. However, even modest prevention efforts could lessen the impact.

Objective: To investigate the extent of tobacco expenditures in Bangladesh and to compare those costs with potential investment in food and other essential items., Design: Review of available statistics and calculations based thereon., Results: Expenditure on tobacco, particularly cigarettes, represents a major burden for impoverished Bangladeshis. The poorest (household income of less than $24/month) are twice as likely to smoke as the wealthiest (household income of more than $118/month). Average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure. An estimated 10.5 million people currently malnourished could have an adequate diet if money on tobacco were spent on food instead. The lives of 350 children could be saved each day., Conclusion: Tobacco expenditures exacerbate the effects of poverty and cause significant deterioration in living standards among the poor. This aspect of tobacco use has been largely neglected by those working in poverty and tobacco control. Strong tobacco control measures could have immediate impact on the health of the poor by decreasing tobacco expenditures and thus significantly increasing the resources of the poor. Addressing the issue of tobacco and poverty together could make tobacco control a higher priority for poor countries.

Context: The rising number of deaths among United Nations (UN) peacekeeping forces after the Cold War has made some troop-contributing countries hesitant to participate in peacekeeping operations. While the number and scale of missions have increased, no data have demonstrated a parallel increase in risks to peacekeepers., Objective: To determine the association of characteristics of UN peacekeeping operations with risks and mortality rates among UN peacekeeping forces in both the Cold War and post-Cold War periods., Design, Setting, and Participants: Descriptive analysis of 1559 personnel deaths during 49 UN peacekeeping missions from 1948-1998 based on the casualty database maintained by Department of Peacekeeping Operations, UN Headquarters., Main Outcome Measures: Number and percentage of deaths by circumstance, total crude death rate, and crude death rate and relative risk of death by circumstance (hostile acts, unintentional violence, and illness or other causes) and time period (Cold War vs post-Cold War), geographic region, and nature of peacekeeping response; and regression analysis of mission variables (strength, duration, and humanitarian mandate) associated with total number of deaths., Results: More deaths have occurred among UN peacekeeping forces in the past decade alone than in the previous 40 years of UN peacekeeping (807 vs 752), but crude death rates did not differ significantly by time period (Cold War vs post-Cold War, 21.8 vs 21. 2 deaths per 10,000 person-years; P =.58), level of peacekeeping response, or for geographic regions other than East Europe and Central America, where rates were lower (P<.001 for both regions). Unintentional violence accounted for 41.2% of deaths, followed by hostile acts (36.1%), and illness or other causes (22.7%). Deaths from hostile acts increased after the Cold War (relative risk [RR] 1. 51; 95% confidence interval [CI], 1.22-1.88), while rates for deaths caused by unintentional violence decreased (RR, 0.79; 95% CI, 0.67-0. 94) but remain high, particularly in the Middle East and Asia (RR, 1. 39; 95% CI, 1.15-1.69). Regression analysis showed a significant association between number of deaths and the strength (P<.001) and duration (P<.001) of a peacekeeping mission., Conclusion: The increase in number of deaths among UN peacekeeping personnel since 1990 can be attributed to the increased number and scale of missions after the Cold War rather than increased RR of death. Post-Cold War peacekeeping personnel have a higher risk of dying from hostile acts in missions where more force is required. In missions providing or facilitating humanitarian assistance, both the RR of deaths from all causes and deaths from hostile acts are increased. JAMA. 2000;284:598-603

In this article, the author examines the overlap between feminism and animal causes, particularly through the lives of two women, the sculptor, Alice Morgan Wright (1881-1975), and her friend, Edith Goode (1882-1970). Feminism and animal causes had connections in the late nineteenth century, particularly in campaigns to abolish vivisection. Wright and Goode held to these politics throughout their lives, and were "precursors of a generation yet to come" who would argue the connections - as many ecofeminists do today. Both women were involved in suffrage campaigns, and continued to be involved in women's organisations such as the National Woman's Party. They were, however, opposed to all injustice, including human mistreatment of animals. Feminism was, to Wright and Goode, part of a wider set of problems; animal cruelty reflected a greater barbarism leading to mistreatment of humans. Accordingly, they actively campaigned for legislation to protect animals and the environment, and lobbied the fledgling United Nations to include such measures. That challenge to the United Nations represented a unique attempt to bring animals into citizenship' a move being made again today, through initiatives such as the Great Ape Project.

This article has the objective of approaching the political and scientific context that led Brazil to the position of Unesco paradigm for racial matters. I set out from the hypothesis that soon after the Holocaust, the positive image of race relations in Brazil was in greater evidence, becoming sort of anti-Nazi Germany. At this time, a number of unforeseen efforts took place in the sense of striving for an association between the search for understanding the German totalitarian phenomenon, the radical critique of the scientific standing of the concept of race, the evidencing of socio-economic demands of underdeveloped countries, and the choice of Brazil as a socio-anthropological laboratory. This combination of aims only became viable from the onset of a transnational political-academic alliance universalistic in nature.

Given the paucity of international comparative data, this paper analyzes United Nations data on young people (ages 10-19 years) with disabilities for the purpose of (a) highlighting available information on these populations by age and gender; (b) analyzing interrelationships among and between disability prevalence rates for young people and socioeconomic, health, and geographic variables; and (c) recommending future research. Utilizing the United Nations International Disability Statistics Database (DISTAT), 19 countries with reported data on 10- to 14-year-old young people and 23 countries with data on 15- to 19-year-old young people with disabilities were analyzed. Independent variables included geographic location, age, gender, gross national product (GNP), female illiteracy, access to health care, infant mortality, life expectancy, and fertility rate. There was wide variance in disability rates for young people among the countries studied. Consistently, adolescent males had higher rates than females. A positive correlation was found between disability rates and GNP. Consistently higher rates were noted for rural areas. There appears to be a lack of consistency in definitions of disabilities among countries studied, which influences prevalence rates. Methodologies for data collection may also vary. The higher rates for males may reflect gender bias in the provision of medical interventions in many developing countries.

Demographic data published by the United Nations in 1987 are analysed in terms of the Gompertz function. Projections for maximum life spans are obtained, with the data broadly divisible into three clusters. These are attributable not only to the influence of high infant mortality, but suggest also constitutional and/or environmental variations among members of the clusters. The difference between life span and life expectancy is estimated analytically. A comparison with an earlier analysis supports the view that there are important differences between the life expectancies of the sexes.