Articles: health.
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Diarrheal diseases are major causes of morbidity, with attack rates ranging from two to 12 or more illnesses per person per year in developed and developing countries. In addition, diarrheal illnesses account for an estimated 12,600 deaths each day in children in Asia, Africa, and Latin America. The causes of diarrhea include a wide array of viruses, bacteria, and parasites, many of which have been recognized only in the last decade or two. ⋯ The rational management of infectious diarrhea requires the highly selective use of laboratory tests for these varied etiologic agents, depending on the clinical and epidemiologic setting. The purpose of this review is to provide an overview of the magnitude, special settings, and etiologies of diarrhea endemic to developed and developing countries. This information permits a practical approach to the diagnosis and management of common diarrheal illnesses in different settings.
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The World Health Organization estimates that almost half a million women in developing countries die in pregnancy and childbirth every year. Unsafe induced abortion is responsible for perhaps one-quarter of these deaths. ⋯ United States international policy on funding abortion-related activities in maternal health and family planning programs is especially restrictive. A new policy approach is clearly needed if unacceptably high rates of maternal morbidity and mortality in many countries are to be reduced.
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Epidemiologic reviews · Jan 1990
ReviewThe epidemiology of acute respiratory infections in children and adults: a global perspective.
While a number of advances have been made in our understanding of the epidemiology of acute respiratory infections in the past two decades, a number of serious questions still require urgent answers. The associations of factors such as chronic disease in adults, direct smoking, passive smoking, crowding, and breast feeding to acute respiratory infections are now well documented. Appropriate changes in public health policy need not be predicated on results from still further studies. ⋯ Greater standardization of data collection methods in developed and developing countries also needs to be more seriously addressed. Given that some advances have been made in this area, the time may be right for development of acute symptom questionnaires, akin to the American Thoracic Society chronic respiratory questionnaire, for use in both developed and developing countries. Standardization of diaries, although somewhat more difficult, would also be extremely useful in many instances.
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Comparative Study
Do nutrition programs make a difference? The case of Brazil.
Four Brazilian food and nutrition programs operating during some part of 1974-86 are evaluated for their effectiveness in curing or preventing infant and child malnutrition, including low birth weight when pregnant women were beneficiaries. Two programs distributed free food to identified clients: traditional commercial foods in one case and specially formulated supplements in the other. The other two programs subsidized four or more basic foodstuffs: one experiment quantitatively restricted a subsidy to identified families, and the other was unrestricted and open to all families patronizing certain shops. ⋯ Donation programs including medical and educational components proved more effective than pure subsidies, showing that while poverty may be the chief cause of malnutrition, the problem should be seen as poor health rather than simply low food consumption. Evaluation also shows that programs were inefficient in transferring benefits, and that clients were deterred from participating by the costs of obtaining the food and its poor quality and small volume. Longer participation improved results, but more frequent participation in a given interval did not necessarily do so.