O que a Pesquisa Nacional de Saúde tem a dizer sobre a influência do gasto com cigarro no rendimento domiciliar? / What does the Brazilian National Health Survey have to say about the influence of cigarette spending on household income? / ¿Qué dice la Encuesta Nacional de Salud brasileña sobre la influencia del gasto en cigarrillos en los ingresos del hogar?

Em um Brasil no qual os indicadores de empobrecimento da população seguem aumentando, preocupa o fato de que indivíduos gastem dinheiro para comprar cigarro em vez de usarem esse recurso em ações que fortaleçam aspectos do bem-estar de suas jornadas de vida e de suas famílias. Estimou-se, a partir da Pesquisa Nacional de Saúde de 2019, a influência que o gasto com cigarro industrializado teve no orçamento familiar nos domicílios com pelo menos um fumante, estratificada por características sociodemográficas. Os fumantes brasileiros destinaram cerca de 8% do rendimento médio mensal domiciliar per capita para a compra de cigarros industrializados. O percentual do gasto médio mensal chegou a quase 10% desse rendimento, entre os fumantes de 15 a 24 anos, e foi ainda maior para aqueles com Ensino Fundamental incompleto (aproximadamente 11%). Nas regiões Norte e Nordeste do país, esse gasto ultrapassou os 9%. O estado com o maior comprometimento da renda domiciliar foi o Acre (13,6%), seguido por Alagoas (11,9%), Ceará, Pará e Tocantins (todos com aproximadamente 11%). Nossos achados reforçam, portanto, a importância de fortalecer a implementação de medidas efetivas de redução da proporção de fumantes, tal como a política tributária. Dessa forma, o dinheiro que atualmente é destinado pelos indivíduos à compra de cigarros poderá ser revertido no atendimento de suas necessidades básicas, contribuindo para a promoção da saúde e melhoria da qualidade de vida.

In a country whose indicators of population impoverishment continue to increase, it is concerning that individuals spend money to buy cigarettes instead of using this resource in actions that strengthen aspects of the well-being of their lives and that of their families. Based on the Brazilian National Health Survey conducted in 2019, the influence of spending on manufactured cigarettes on the family budget in households with at least one smoker was estimated, stratified by sociodemographic characteristics. Brazilian smokers allocated around 8% of their average per capita monthly household income to the purchase of manufactured cigarettes. The percentage of average monthly expenditure on cigarettes reached almost 10% of this income among smokers aged 15 to 24 and was even higher for those with incomplete elementary education (approximately 11%). In the North and Northeast regions of the country, this expenditure exceeded 9%. The state with the most significant impact on household income was Acre (13.6%), followed by Alagoas (11.9%), Ceará, Pará, and Tocantins (all with approximately 11%). Our findings, therefore, reinforce the importance of strengthening the implementation of effective measures, such as tax policy, to reduce the proportion of smokers. Thus, the money that individuals currently allocate to purchase cigarettes can be used to meet their basic needs, contributing to the promotion of health and improving the quality of life.

En un Brasil donde los indicadores de empobrecimiento de la población siguen aumentando, es preocupante el hecho de que las personas gasten dinero para comprar cigarrillo en lugar de usarlo en acciones para fortalecer los aspectos del bienestar de sus vidas y la de sus familias. A partir de la Encuesta Nacional de Salud brasileña realizada en 2019, se estimó la influencia del gasto en cigarrillo industrializado en el presupuesto familiar de los hogares donde vivía al menos un fumador, estratificado por características sociodemográficas. Los fumadores brasileños destinaron alrededor del 8% del ingreso per cápita mensual promedio del hogar para la compra de cigarrillos industrializados. El porcentaje del gasto mensual promedio en cigarrillos alcanzó casi el 10% de este ingreso entre los fumadores de 15 a 24 años y fue aún mayor para los que tenían educación primaria incompleta (aproximadamente el 11%). En el Norte y Nordeste del país, ese gasto superó el 9%. El estado con un mayor compromiso con los ingresos del hogar fue Acre (el 13,6%), seguido por Alagoas (el 11,9%), Ceará, Pará y Tocantins (todos con aproximadamente el 11%). Por lo tanto, nuestros resultados resaltan la importancia de fortalecer la implementación de medidas efectivas para reducir la proporción de fumadores, tal como la política tributaria. Así, el dinero que actualmente las personas destinan a la compra de cigarrillos podría utilizarse en la atención de sus necesidades básicas, contribuyendo a promover la salud y la mejora de la calidad de vida.

An econometric study of the number of undernourished people in Colombia from 2000 to 2021

The importance of food (in)security has been one of the United Nations Sustainable Development's main goals. Over 828 million people worldwide cannot acquire enough food to meet the minimum daily dietary energy requirements (undernourished). Therefore, the present study examines the factors that affect the number of undernourished people in Colombia by assessing macroeconomic data for the period 2000-2021 including gross domestic product (GDP) per capita, unemployment, and inflation rates. A quantitative, empirical, correlation design was used to examine and describe the relationship among the variables. The findings showed that the proposed variables presented the correct signs, were statistically significant, and were in line with the economic theory Thus, the study concluded that although income shocks brought on by inflation and unemployment undoubtedly impact household food (in)security, other factors must also be considered for policy and practice to effectively reduce food insecurity for households.

La importancia de la (in)seguridad alimentaria ha sido uno de los principales objetivos del Desarrollo Sostenible de las Naciones Unidas y más de 820 millones de personas en el mundo no pueden adquirir suficientes alimentos para satisfacer los requerimientos mínimos diarios de energía dietética (subalimentadas). Por lo tanto, el presente estudio examina los factores que afectan el número de personas subalimentadas en Colombia mediante la evaluación de datos macroeconómicos para el período 2000-2021, incluido el producto interno bruto (PIB) per cápita, el desempleo y las tasas de inflación. Se utilizó un diseño cuantitativo, empírico y correlacional, para examinar y describir la relación entre las variables. Los hallazgos mostraron que las variables propuestas presentaron los signos correctos, fueron estadísticamente significativas y de acuerdo con el propuesto por la teoría económica. Por lo tanto, el estudio concluyó que, si bien los impactos en los ingresos causados por la inflación y el desempleo indudablemente afectan la inseguridad alimentaria de los hogares, también es importante considerar otros factores en los esfuerzos de políticas y prácticas para mitigar la inseguridad alimentaria de los hogares.

A importância da (in)segurança alimentar tem sido um dos principais objetivos do Desenvolvimento Sustentável das Nações Unidas e mais de 820 milhões de pessoas no mundo não podem adquirir alimentos suficientes para atender às necessidades energéticas diárias mínimas (subalimentadas). Por tanto o presente estudo examina os fatores que afetam o número de pessoas subalimentadas na Colômbia, avaliando dados macroeconômicos para o período 2000-2021, incluindo produto interno bruto (PIB) per capita, desemprego e taxas de inflação. Um desenho quantitativo, empírico e de correlação foi usado para examinar e descrever a relação entre as variáveis. Os achados mostraram que as variáveis propostas apresentaram os sinais corretos, foram estatisticamente significativas e em consonância com a teoria econômica. Assim, o estudo concluiu que, embora os choques de renda causados pela inflação e pelo desemprego indubitavelmente afetem a insegurança alimentar das famílias, outros fatores também são importantes a serem considerados nos esforços de políticas e práticas para mitigar a insegurança alimentar das famílias.

Consultas médicas per cápita en el sistema de salud del Perú, 2019. Hacia una nueva descripción del sistema de salud peruano

Introducción. El objetivo del estudio es contribuir a una nueva mirada del sistema de salud peruano a partir de la producción de bienes públicos en salud. Métodos. Se calculó el promedio de prestaciones de salud per cápita producidas por el sistema de salud peruano en niveles nacional, regional y provincial, a partir de fuentes de datos abiertos de la Superintendencia Nacional de Salud (SUSALUD), el Seguro Integral de Salud (SIS) y el Seguro Social de Salud (EsSalud) para el año 2019. Se desarrolló un análisis exploratorio de asociación entre las consultas médicas per cápita y variables socio-económicas. Resultados. Se encontró un promedio nacional de consultas médicas per cápita de 1,8, encontrándose una gran variabilidad de valores a nivel regional (2,9 a 0,8). A nivel provincias se encontró un primer cuartil superior, 50 provincias con valores entre 5,52 y 1,75 que concentran el 55% de la población peruana y el 71,3% de todas las prestaciones médicas. Un segundo cuartil agrupa 47 provincias con valores entre 1,73 - 1,33 y dos cuartiles inferiores que agrupan a 95 provincias con valores entre 1,32 y 0,08. El análisis exploratorio mostro asociación entre las consultas médicas per cápita a nivel regional y las variables analizadas, destacando la tasa de médicos por 1000 habitantes (R2: 064, valor p= 0,000) y el producto bruto interno regional per cápita (R2: 0,59, valor p=0,000). Conclusiones. La distribución por cuartiles en la producción de consultas médicas per cápita permiten identificar territorios con mejor atención, con mayor definición que los atributos de estructura del sistema (número de establecimientos, médicos por 1000 habitantes).

Introduction. The objective of the study is to contribute with a new perspective about the peruvian health system, based on the production of public goods in health. Methods. For this purpose, we calculated the per capita average of health encounters produced by the peruvian health system at the national, regional and provincial levels. Information was collected on the number of medical encounters, registered at the open data sources of the National Health Superintendence (SUSALUD), the Public Health Insurance (SIS), and the Health Social Insurance (EsSalud) for year 2019. Results. The national average of medical encounters per capita was 1.8, with a great variability of values at the regional level (2.9 to 0.8). In the case of the provinces, a first upper quartile was found, which group 50 provinces with values between 5.52 and 1.75 and concentrate 55% of the Peruvian population and 71.3% of all medical encounters produced by the health system. A second quartile groups 47 provinces, with values between 1.73 - 1.33; and two lower quartiles that group 95 provinces with values between 1.32 and 0.08. We showed an association between per capita medical encounters at the regional level and the socio-economic variables analyzed, in particular the Density of Physicians per 1000 population (R2: 0.64, p-value= 0.000) and the regional gross domestic product per capita (R2: 0.59, p-value=0.000). Conclusion. Medical encounters per capita is a useful indicator, that allows us to identify better served territories, with higher definition than other structure indicators (doctors per 1000 people; number of facilities).

Incidence and lethality by COVID-19 in the population of the Federal District: an ecological study / Incidência e letalidade por COVID-19 na população do Distrito Federal: um estudo ecológico / Incidencia y letalidad por COVID-19 en la población del Distrito Federal: un estudio ecológico

Background and objectives: understanding the social situation of COVID-19 in poor and less developed countries is still doubtful. Thus, this study aimed to estimate the incidence and lethality by COVID-19, according to the per capita income of the administrative regions of the Federal District (FD). Methods: this is a descriptive ecological study, based on secondary data. Thirty-one administrative regions of the FD were included, and the population consisted of 382,488 individuals. The variables considered were sex, incidence, mortality, lethality, age group, population estimate and education. Results: despite the greater contamination by women, in terms of total mortality, more men died, representing 57.3% of the total deaths in the period. Regarding the influence of the level of education and income on the incidence, it appears that the highest rates of confirmed cases occurred in groups with higher levels of education and income. Despite this higher incidence, it is the group that exhibits the lowest lethality and the third lowest mortality per 100,000 inhabitants. Conclusion: the highest incidence rates were observed in regions with higher per capita income. On the other hand, lethality occurred more incisively in regions with lower purchasing power. In view of this, it is necessary to apply long-term preventive measures in unequal regions.(AU)

Justificativa e objetivos: o entendimento da situação social da COVID-19 em países pobres e menos desenvolvidos ainda é dubitável. Desse modo, o objetivo deste estudo é estimar a incidência e letalidade por COVID-19, de acordo com a renda per capita das regiões administrativas do Distrito Federal (DF). Métodos: trata-se de um estudo ecológico descritivo, baseado em dados secundários. Foram incluídas 31 regiões administrativas do DF, e a população foi composta por 382.488 indivíduos. Consideraram-se como variáveis sexo, incidência, mortalidade, letalidade, faixa etária, estimativa populacional e escolaridade. Resultados: apesar da contaminação maior por parte das mulheres, em termos de mortalidade total, mais homens foram a óbito, representando 57,3% do total de mortos no período. A respeito da influência do grau de escolaridade e da renda na incidência, verifica-se que os maiores índices de casos confirmados aconteceram em grupos com maior nível de escolaridade e de renda. Apesar dessa maior incidência, é o grupo que exibe a menor letalidade e a terceira menor mortalidade por 100.000 habitantes. Conclusão: as mais altas taxas de incidência foram observadas nas regiões com maior renda per capita. Por outro lado, a letalidade ocorreu, de forma mais incisiva, nas regiões de menor poder aquisitivo. Diante disso, é necessário aplicar medidas preventivas de longo prazo em regiões desiguais.(AU)

Justificación y objetivos: la comprensión de la situación social del COVID-19 en los países pobres y menos desarrollados aún es dudosa. Así, el objetivo de este estudio es estimar la incidencia y letalidad por COVID-19, según el ingreso per cápita de las regiones administrativas del Distrito Federal (DF). Métodos: se trata de un estudio ecológico descriptivo, basado en datos secundarios. Se incluyeron 31 regiones administrativas del DF, la población estuvo conformada por 382,488 individuos. Se consideraron como variables el sexo, la incidencia, la mortalidad, la letalidad, el grupo de edad, la población estimada y la escolaridad. Resultados: a pesar de la mayor contaminación por mujeres, en términos de mortalidad total, fallecieron más hombres, representando el 57,3% del total de defunciones en el período. En cuanto a la influencia del nivel de educación e ingresos en la incidencia, parece que las tasas más altas de casos confirmados ocurrieron en grupos con mayores niveles de educación e ingresos. A pesar de esta mayor incidencia, es el grupo que presenta la menor letalidad y la tercera mortalidad más baja por 100.000 habitantes. Conclusión: las tasas de incidencia más altas se observaron en las regiones con mayor ingreso per cápita. Por otro lado, la letalidad se produjo de forma más incisiva en las regiones de menor poder adquisitivo. Ante esto, es necesario aplicar medidas preventivas a largo plazo en regiones desiguales.(AU)

Determinants Of Maternal Mortality: An Empirical Study of Indian States Based on The Random Effect Model Analysis

Background: Healthcare for mothers and children is a significant indicator of a country's well-being. In-dia is one of the nations that were experiencing a rather slow improvement in maternal and child health. Aims: The objective of this study is to analyse the changes in health infrastructure, government health expenditure, antenatal care, postnatal care, institutional delivery, Maternal Mortality Ratio (MMR) and the determinants of MMR in India. Methodology: The study is based on secondary data. It employs an Average Increasing Rate (AIR) and Average Reduction Rate (ARR), as well as a panel data random effect model. Results: Empirical results say MMR has a statistically significant inverse relationship with female litera-cy, Per capita Net State Domestic Product (PNSDP), and institutional delivery. The study concludes that after the introduction of NRHM and its constituent elements like JSY and JSSK, government expenditure on health, health infrastructure, the percentage of antenatal care, post-natal care, and institutional deliv-ery increased in most of the Indian states, thus helping to increase the pace of the reduction of MMR. However, state performance varies greatly. Conclusions: Policy alone will not provide the desired results; it is also critical to focus on education, particularly female literacy, and economic empowerment.

GNI PER CAPITA AND HAPPY PLANET INDEX - A COMPARATIVE ANALYSIS ACROSS DIFFERENT COUNTRY GROUPS

In order to assess the well-being of a country and to make comparative analysis across countries, Gross National Income (GNI) per capita is the most commonly and frequently used indicator of well-being. Apart from that, this paper discusses another well-being marker: Happy Planet Index (HPI) which is relatively new in its kind with a view of incorporating higher degree of subjectivity. For the purpose of establishing correspondence (if any) between these well-being indicators, a large number of countries are considered and grouped accordingly

Cost of National Vector Borne Disease Control Programme in North India

Background & objectives: Despite significant resources being spent on National Vector Borne Disease Control Programme (NVBDCP), there are meagre published data on health system cost upon its implementation. Hence, the present study estimated the annual and unit cost of different services delivered under NVBDCP in North India. Methodology: Economic cost of implementing NVBDCP was estimated based on data collected from three North Indian States, i.e. Punjab, Haryana and Himachal Pradesh. Multistage stratified random sampling was used for selecting health facilities across each level [i.e. subcentres (SCs), Primary Health Centres (PHCs), community health centres (CHCs) and district malaria office (DMO)] from the selected States. Data on annual consumption of both capital and recurrent resources were assessed from each of the selected facilities following bottom-up costing approach. Capital items (equipment, vehicles and furniture) were annualized over average life span using a discount rate of 3 per cent. The mean annual cost of implementation of NVBDCP was estimated for each level along with unit cost. Results: The mean annual cost of implementing NVBDCP at the level of SC, PHC and CHC and DMO was ? 230,420 (199,523-264,901), 686,962 (482,637-886,313), 1.2 million (0.9-1.5 million) and 9.1 million (4.6-13.5 million), respectively. Per capita cost for the provision of complete package of services under NVBDCP was ? 45 (37-54), 48 (29-73), 10 (6-14) and 47 (31-62) at the level of SC, PHC, CHC and DMO level, respectively. The per capita cost was higher in Himachal Pradesh (HP) at SC [? 69 (52-85)] and CHC [? 20.8 (20.7-20.8)] level and in Punjab at PHC level [? 89 (49-132)] as compared to other States. Interpretation & conclusions: The evidence on cost of NVBDCP can be used to undertake future economic evaluations which could serve as a basis for allocating resources efficiently, policy development as well as future planning for scale up of services.

Relación entre la anemia infantil y el desempeño intelectual en la juventud

Objetivo: Determinar la relación que entre la anemia padecida por una generación cuando eran niños y su rendimiento en la prueba PISA a los 15 años de edad. Material y métodos: Se relacionó el puntaje que los jóvenes de cada país obtuvieron en la prueba PISA 2018 con la prevalencia de anemia infantil en 2005, el Ingreso Nacional Bruto per cápita y los Años Esperados de Escolaridad del Índice de Desarrollo Humano del año 2018. Resultados: El puntaje obtenido en la prueba PISA se relaciona con la anemia cuando niños, el Ingreso Nacional Bruto per cápita y los Años Esperados de Escolaridad (Esfuerzo Educativo) con coeficientes de determinación (r2) de 0.5168, 0.1951 y 0.3536, respectivamente. Conclusión: El puntaje obtenido en la prueba PISA se asocia con más fuerza con la prevalencia de anemia que padeció esa generación cuando eran niños que con cualquier otro factor económico o social actuales.

Prevalência de mamoplastia redutora feminina no Brasil de 2015 a 2019 / Prevalence of female reduction mammoplasty in Brazil from 2015 to 2019

RESUMO Introdução: A mamoplastia redutora feminina visa restaurar o volume fisiológico das mamas em casos de hipertrofia mamária, de modo a manter a simetria e com um número mínimo de complicações. Embora tal procedimento seja usual, a literatura carece de dados epidemiológicos e descritivos acerca da cirurgia de redução de mama. Desse modo, esse estudo tem como objetivo descrever a prevalência da mamoplastia redutora no Brasil dos anos de 2015 a 2019; comparar a prevalência de mamoplastia redutora entre as regiões do Brasil de 2015-2018 com a do ano de 2019; e avaliar a relação entre a renda familiar regional e a prevalência da mamoplastia redutora feminina no país de 2015-2019. Métodos: Estudo ecológico de base populacional cujos dados foram coletados por meio do Departamento de Informática do Sistema Único de Saúde e censos demográficos do Instituto Brasileiro de Geografia e Estatística. Foram coletados dados de 2015 a 2019. Resultados: A prevalência de mamoplastia redutora no Brasil no ano de 2019 foi de 0.08%, enquanto que nos anos de 2015 a 2018, essa prevalência foi de 0.07%. Não houve diferença estatisticamente significante quando comparadas as prevalências regionais dos anos de 2015 a 2018 com a prevalência de 2019. As prevalências de mamoplastia redutora nas regiões do Brasil de 2015-2019 apresentaram correlação positiva moderada com renda domiciliar média per capita. Conclusão: A prevalência de mamoplastia redutora feminina no Brasil apresenta uma tendência de estabilidade temporal ao longo dos anos de 2015-2019 e-m âmbito nacional e regional. Sugere-se uma correlação positiva entre a renda familiar per capita regional e a prevalência desse procedimento.

ABSTRACT Introduction: Female reducing mammoplasty aims to restore the physiological volume of the breasts in cases of breast hypertrophy, to maintain symmetry and with a minimum number of complications. Although such a procedure is usual, the literature lacks epidemiological and descriptive data on breast reduction surgery. Thus, this study aims to describe the prevalence of reducing mammoplasty in Brazil from 2015 to 2019; to compare the prevalence of reducing mammoplasty among the regions of Brazil from 2015-2018 with that of 2019, and to evaluate the relationship between regional family income and the prevalence of female reduction mammoplasty in the country of 2015-2019. Methods: Population-based ecological study whose data were collected through Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics demographic censuses. Data were collected from 2015 to 2019. Results: The prevalence of reducing mammoplasty in Brazil in 2019 was 0.08%, while from 2015 to 2018, this prevalence was 0.07%. There was no statistically significant difference compared to the regional prevalence from 2015 to 2018 with the prevalence of 2019. The prevalence of reducing mammoplasty in the regions of Brazil from 2015-2019 showed a moderate positive correlation with average household income per capita. Conclusion: The prevalence of female reduction mammoplasty in Brazil shows a trend of temporal stability over the years 2015-2019 at national and regional levels. A positive correlation between regional per capita family income and the prevalence of this procedure is suggested.

A prospective study to determine social demographic pattern in severe acute malnutrition in 6 months to 5 years aged children

Background: Burden of malnutrition is much higher in South Asia as compared to that in Africa and rest of the World. South Asia contributes to about 60% of the cases. Education of women has been seen to be the most effective in improving child's health. Present study is done to evaluate social demographic pattern in cases of severe acute malnutrition.Methods: Present study is prospective observational comparative study conducted at Department of Pediatrics included 175 cases after taking a informed written consent from the parent. Out of which 22 were lost to follow up and remaining 153 cases were analysed and further evaluated in the studyResults: Cases who were from 6 month to 24 months of age were 73.2% (n=112) and rest of them were above 24 months of age. Girls were 53.6 % and 46.4% were boys. Percentage of illiterate mother was 41.2%, till primary were 28.8% and Only 10.4% of mothers were graduate. Nearly 50% of the households had per capita income less than or equal to 1000.Conclusions: SAM was more common in children < 24 months of age, boys and girls were almost equally affected. Maternal literacy and low per capita income was an important factor associated with SAM patients.

Crises econômicas, mortalidade de crianças e o papel protetor do gasto público em saúde / Economic crises, child mortality and the protective role of public health expenditure

Resumo O objetivo do estudo foi analisar como as crises econômicas afetam a saúde infantil a nível global e entre subgrupos de países com diferentes níveis de renda. Foram utilizados dados do Banco Mundial e da OMS para 127 países entre os anos de 1995 e 2014. Foi utilizado um modelo de efeitos fixos, avaliando o efeito da mudança em indicadores macroeconômicos (PIB per capita, taxa de desemprego e de inflação, e taxa de desconforto) na taxa de mortalidade neonatal, infantil, e de menores de cinco anos. Adicionalmente, avaliou-se a modificação do efeito da associação de acordo com a renda dos países e também a influência do gasto público em saúde nessa relação. As evidências mostraram que piores indicadores econômicos (menor PIB per capita e maiores inflação, taxa de desemprego e taxa de desconforto) estão associados com maiores taxas de mortalidade infantil. Nas subamostras por estrato de renda, observa-se a mesma relação, porém com efeitos de maior magnitude entre os países de renda baixa e média. Verificou-se ainda que um maior percentual nos gastos públicos em saúde ameniza os efeitos dos indicadores econômicos nas taxas de mortalidade infantil. Desta forma, é necessário aumentar a atenção aos efeitos nocivos das crises macroeconômicas para garantir melhorias na saúde infantil.

Abstract The aim of the study was to analyze how economic crises affect child health globally and between subgroups of countries with different levels of income. Data from the World Bank and the World Health Organization were used for 127 countries between 1995 and 2014. A fixed effects model was used, evaluating the effect of the change on macroeconomic indicators (GDP per capita, unemployment and inflation rates and misery index) in neonatal, infant and under-five mortality rates. Moreover, we evaluated whether there was a change in the association effect according to the income of the countries and also analyzed the role of public health expenditure in this association. Evidence has shown that worse economic indicators (lower GDP per capita, higher inflation, unemployment rates and misery index) are associated with higher child mortality rates. In the subsamples by income strata, the same association is observed, but with effects of greater magnitude for low- and middle-income countries. We also verified that a higher percentage in public health expenditures alleviates the effects of economic indicators on child mortality rates. Thus, more attention needs to be paid to the harmful effects of the macroeconomic crises to ensure improvements in child health.

Mapping a Climate Change Vulnerability Index: An Assessment in Agricultural, Geological and Demographic Sectors across the Districts of Karnataka (India)

Climate change is a continuous phenomenon and over hundreds of years, the atmosphere has changed considerably around the world. Karnataka has the second largest drought prone area in the country next only to Rajasthan. Assessment of vulnerability index could play a major role in designing appropriate mitigation and adaptation policies to overcome the impacts of climate change. The vulnerability assessment is an exhaustive procedure determined by a large number of indicators. This study attempted to capture a picture of composite vulnerability index of different districts of Karnataka by considering agronomic, climatic and demographic indicators. The secondary data on climatic, agronomic and demographic factors were collected from various sources for the year 2017-18. The findings of the study as shown that the average vulnerability index for 30 districts is 0.577 and 16 districts placed above the average composite vulnerability index level. Bidar (0.655) is the most vulnerable district followed by Kolar (0.658) and Yadgir (0.638) districts. Shivamogga (0.440), Davanagere (0.486) and Udupi (0.486) districts exhibit the least vulnerability to changing climate. The results suggest that agricultural and climatic indicators are the major factors which influence vulnerability. So special attention should be given to agricultural and climatic sectors to minimize the impacts of climatic change in the most vulnerable districts.

Density of in-vitro fertilization centers and its correlation with socioeconomic factors in Maharashtra state, India

Background: The infertility due to various reasons is increasing and correspondingly the number in vitro fertilization (IVF) centers is also increasing. Some procedures in these centers can deliver desired sex of the unborn child. The gender discrimination in India has already resulted unfavorable child sex ratio for girls. Maharashtra is one of the badly affected states. It is feared that the child sex ratio may further decline due to IVF centers. The study was carried out to measure correlation between number of IVF centers with various indicators of sex ratio infertility, and some socio-economic factors.Methods: The study was conducted in 2014 using secondary data. District wise internet search by using words ‘In-Vitro Fertilization center’ and ‘infertility treatment center’ was carried out. Whenever IVF center/procedure was noticed on the internet, the center with its address was included in that district list.Results: There was positive correlation between IVF centers and urbanization, per capita income, female literacy and negative correlation with population sex ratio and no correlation with sex ratio at birth or child sex ratio. The best correlation was observed with urbanization, which explains the observed correlation with other variables.Conclusions: The number of IVF centers is not related with magnitude of infertility and not affecting sex ratio whereas IVF density seems to be an outcome of extent of urbanization.

Características e procedência da lenha usada na cocção no Brasil / Characteristics and procedures of firewood used in cooction in Brazil

A lenha vem sendo substituída ao longo dos anos por novas formas de energia, como o gás liquefeito de petróleo (GLP) e a eletricidade. Porém, esse combustível ainda representa uma fração significativa da matriz energética brasileira, muito embora as pesquisas referentes ao seu uso ainda sejam limitadas e regionais. O objetivo deste estudo foi realizar um levantamento da produção, consumo e características da lenha usada com a finalidade de cocção. De acordo com os resultados, em 2016, 26,5% da lenha produzida no Brasil foram empregados com fins residenciais, ou seja, em torno de 2x107 toneladas. A lenha é proveniente tanto da silvicultura, sendo o Paraná o maior produtor, quanto do extrativismo, sendo a Bahia a maior produtora. O estado que apresenta maior dependência desse combustível para a cocção é o Pará, enquanto o Rio de Janeiro, praticamente, não a usa para esse fim. O consumo per capita varia muito de uma região a outra do país. Com base nos dados de 2016, foi estimado um consumo de 1,7 kg/pessoa/dia. No entanto, estudos in loco mostraram variação de 0,7 a 8,5 kg/pessoa/dia. O levantamento aponta que uma parte considerável da lenha é proveniente de matas nativas que têm reflexos no desmatamento de uma dada região. A pouca disponibilidade de dados e a variação entre eles impede uma avaliação mais precisa do uso deste combustível no país e suas implicações para a saúde das florestas. A implantação de políticas públicas deveria ser prioridade do governo, pois o uso da lenha de forma inadequada afeta o manejo da vegetação nativa, além de ser uma questão socioambiental, econômica e de saúde pública.

Firewood has been replaced over the years by new forms of energy, such as liquefied petroleum gas (LPG) and electricity. However, this fuel still accounts for a significant fraction of the Brazilian energy matrix. Research regarding its use remains limited and regional in the country. The objective of this study was survey the production, consumption and characteristics of firewood used for cooking. According to the results, in 2016 26.5% of the firewood produced in Brazil was used for residential purposes, around 2×107 metric tons. Firewood comes from both silviculture, Paraná being the largest producer, and extractivism, Bahia being the largest producer. Pará presented the greatest dependence of this fuel, while Rio de Janeiro practically does not use it for this purpose. Per capita consumption varies from one region to another. Based on data from 2016, it was estimated that consumption was 1.7 kg/person/day. In situ studies showed consumption ranges from 0.7 to 8.5 kg/person/day. The study shows an obvious reliance on native forests to obtain firewood, resulting in deforestation in some areas. The low availability of data and the variation among them prevents a better assessment of the use of this fuel in Brazil and the implications for forest health. The im-plementation of public policies should be a priority of the government, as the improper use of firewood negatively affects the management of native vegetation, as well as being a socio-environmental, economic and public health burden.

Gasto público y salud en el mundo, 1990-2012 / A Public expenditure and world's health, 1990-2012

Introducción: La evidencia empírica dispar relacionada con el efecto del gasto público en materia sanitaria puede deberse a las importantes variaciones metodológicas de los estudios y a las diferencias significativas en la forma en que el gasto público influye dependiendo del nivel de desarrollo de los países. Objetivo: Determinar la relación entre el gasto público total del Gobierno general y la mortalidad infantil y la esperanza de vida. Métodos: Investigación realizada en una muestra de 78 países segmentada por niveles de renta, desde 1990 hasta 2012. Se constituyeron cinco submuestras de países divididos por su nivel de renta mediante un procedimiento de agrupación no jerárquico de k-medias. Se verificó la procedencia de la segmentación mediante el test de Chow. Para cada una de las submuestras construidas, se estimó el modelo correspondiente por mínimos cuadrados generales lineales y un test de cointegración. Resultados: En las submuestras superiores en nivel de renta, la salud se relacionó significativa y consistentemente con el gasto público. Sin embargo, en los países de renta inferior-baja, el coeficiente del gasto presentó un signo contrario al esperado. Conclusiones: Se demuestra un impacto positivo y de largo plazo entre el gasto público y la situación sanitaria. Sin embargo, para los países de menor renta, este parece haber superado su punto óptimo, lo que indicaría su ineficiencia en términos sanitarios. Se conjetura que lo anterior se debe a la baja capacidad institucional de estos países, lo que impide que un mayor gasto obtenga mejores resultados sanitarios(AU)

Introduction: The disparate empirical evidence related with the effect of public expenditure on health may be due to the significant methodological variations of the studies, as well as the significant differences in the way in which public expenditure influences depending on the level of development of the countries. Objective: To determine the relation among the total public expenditure of the General Government, and infant mortality and life expectancy. Methods: Research project carried out with a sample of 78 countries segmented by income levels from 1990 to 2012. By means of a non - hierarchical grouping of k - media, five sub-samples of countries were formed and divided by their income level. The origin of the segmentation was verified by means of the Chow test. Linear GLS and a cointegration test were applied on each subsample. Results: In the upper subsamples at the income level, health was significantly and consistently related to public expenditure. However, in the lower-low income countries, the expenditure coefficient showed a sign opposite to that expected. Conclusions: There is evidence of a positive and long-term impact among public expenditure and the health situation. However, for lower income countries, this seems to have surpassed its optimum point, which would indicate its inefficiency in sanitary terms. It is conjectured that this is due to the low institutional capacity of these countries, which hampers that greater expenditure obtains better sanitary results(AU)

Desenvolvimento de correlação para estimativa da taxa de geração per capita de resíduos sólidos urbanos no estado de São Paulo: influências da população, renda per capita e consumo de energia elétrica / Development of a correlation to estimate per capita municipal solid waste generation rates in São Paulo state, Brazil: population, per capita income and electricity consumption influences

RESUMO A previsão da geração dos resíduos sólidos urbanos (RSU) é fundamental para escolha e dimensionamento das operações e dos processos envolvidos na cadeia de gerenciamento em âmbito municipal. O desafio da sustentabilidade financeira desse gerenciamento passa pela criação de indicadores que permitam a cobrança individualizada e proporcional da geração per capita de cada munícipe. Buscou-se, então, desenvolver equações para estimar a taxa de geração per capita (TGP) de RSU nos municípios do estado de São Paulo. Adotou-se a premissa de que as variáveis população (P), renda per capita diária (RPC) e consumo per capita diário de energia elétrica (Ce) nos municípios eram intervenientes na TGP. A série de dados envolveu 238 municípios que rotineiramente pesaram seus resíduos no ano-base de 2013. Diversas funções foram testadas com o intuito de ajustar as TGPs observadas às calculadas pelo método dos mínimos quadrados. A qualidade dos ajustes foi avaliada por meio da comparação dos valores previstos e observados com a reta bissetriz do primeiro quadrante, dos coeficientes de correlação de Pearson (r) e de determinação (R2), das raízes quadradas dos erros médios ao quadrado (RMSEs) e dos erros percentuais médios (Ep). A equação que melhor representou o conjunto de dados forneceu r de 0,49, R2 de 0,24, RMSE de 0,217 kg.hab-1.d-1 e Ep de -14,1%. Apesar de R2 relativamente baixo, foi demonstrado, pelo teste de t de Student, que a equação proposta foi capaz de representar valores médios e resultar em mesma variância com probabilidade acima de 99%, fato que permitiu considerar a equação adequada para prever as TGPs nos municípios paulistas.

ABSTRACT Forecasting municipal solid waste (MSW) generation is fundamental in choosing and scaling the operations and processes involved in municipal management. The challenge for the financial sustainability of this management is to create indicators that enable municipal solid waste fees to be charged in proportion to the amount of MSW generated by each resident. To this end, we sought to develop equations to estimate the per capita waste generation rate (TGP) in the municipalities of the state of São Paulo, Brazil. It was assumed that the variables of population (P), daily per capita income (RPC) and daily per capita consumption of electric energy (Ce) in the municipalities were determining factors of the TGP. The dataset involved 238 municipalities that routinely weighed their solid wastes in the baseline year of 2013. Several functions were tested in order to adjust the observed TGP to those calculated by the least squares method. The quality of the adjustments was evaluated by comparing the expected and observed values with the bisector of the first quadrant, as well as by the Pearson (r) and determination (R2) coefficients, root-mean-square error (RMSE), and mean percentage error (Ep) values. The equation that best represented the dataset had an r of 0.49, R2 of 0.24, RMSE of 0.217 kg.person-1.d-1 and Ep of -14.1%. Despite the relatively low R2, it was demonstrated by Student's t-test that the proposed equation was able to represent mean values and result in the same variance with probability higher than 99%. This fact allows to consider the equation adequate for predicting the TGP in the municipalities of the state of São Paulo.

ROCCIPI Analysis of Tianchang County's New Rural Cooperative Global Per Capita Budget Reform in the County's Healthcare Alliance / 中国医院管理

Based on the literature research and ROCCIPI framework,the paper analyzes Tianchang County's New Rural Cooperative global per capita budget reform under the context of the county's healthcare alliance from the perspectives of the policy content,opportunity of development,motivation,process and capacity and the cognition of stakeholders in relevant.In addition,the dissection of the factors and conditions,as well as the latent problems and the corresponding recommendations of the reform,is put forward.

Individual dosage monitoring results in medical radiation staffs in Guangzhou City,2008-2014 / 中国职业医学

OBJECTIVE: To investigate the individual external dose level of medical radiation staffs in Guangzhou City.METHODS: The medical radiation staffs of Guangzhou City who conducted individual dose monitoring at Guangdong Province Hospital Center for Occupational Diseases Prevention and Treatment from 2008 to 2014 were selected as study subjects by convenient sampling method.Their individual dosage monitoring data were analyzed.RESULTS: A total of 17 754 person-times were monitored in 7 years.The annual collective effective dose was 10 621.1 person·mSv and the median per capita annual effective dose was 0.21 mSv/a.The per capita annual effective dose in 2008-2012 showed an increasing trend each year( P < 0.05),peaked in 2012,and then decreased in 2013 and 2014( P < 0.05).The per capita annual effective dose of radiology staffs in level Ⅱ medical institutions was higher than that of level Ⅲ medical institutions,level Ⅰ medical institutions and those below level Ⅰ( P < 0.01).The per capita annual effective dose of radiation staffs in level Ⅲ medical institutions was higher than level Ⅰ medical institutions and those below level Ⅰ( P <0.01).The effective monitoring rates of radiation staffs monitored for 4 cycles every year increased with time from 2008 to 2014( P < 0.01).The effective monitoring rate increased with the hospital level( P < 0.01).The per capita annual effective dose of the staffs in radiological diagnosis department was lower than that of clinical nuclear medicine,radiotherapy and interventional radiology( P < 0.01).CONCLUSION: The radiation dose of medical radiation staffs in Guangzhou City was within the national standard limit.Protection should be focused on the the staffs in secondary hospitals,clinical nuclear medicine,radiotherapy and interventional radiology.

The socioeconomic variables influence in the alpha-tocopherol concentration of the maternal serum / Influência das variáveis socioeconômicas na concentração de alfa-tocoferol do soro materno

Abstract Objectives: To evaluate the influence of the socioeconomic factors on the alpha-tocopherol concentration in maternal serum. Methods: a retrospective, observational, cross-sectional study with the participation of 103 adult parturient volunteers attended at Hospital Universitário Ana Bezerra (Ana Bezerra University Hospital) in Santa Cruz - Rio Grande do Norte. 5.0 mL of blood was collected from each participant in fasting before the delivery to extract alpha-tocopherol of the serum. Socioeconomic and demographic information were obtained by a previously structured questionnaire. Alpha-tocopherol serum was determined by a High-Performance Chromatography Liquid (Cromatografia Líquida de Alta Eficiência (CLAE). Results: The average concentration of alpha-tocopherol in the serum was 1281.4 (594.8) µg/dL, and 6% of the women presented vitamin E deficiency (DVE). Most pregnant women aged between 18 and 24 years (59%), marital status was married or consensual marriage (77%), elementary schooling complete (34%), low family income (74%) and living in the urban area (73%). No significant differences were found in the alpha-tocopherol concentration according to socioeconomic characteristics and none of the studied factors were associated to the presence of DVE ( p >0.05). Conclusions: The maternal social characteristics were not determinants for the alpha-tocopherol serum and DVE. Further investigations should be carried out during lactation to assess which factors may be involved in the presence of this deficiency.

Resumo Objetivos: avaliar a influência de fatores socioeconômicos sobre a concentração de alfa-tocoferol no soro materno. Métodos: estudo transversal observacional retrospectivo, com participação de 103 parturientes voluntárias adultas atendidas no Hospital Universitário Ana Bezerra em Santa Cruz - Rio Grande do Norte. Foram coletados 5,0 mL de sangue em jejum antes do parto para extração de alfa-tocoferol no soro. As informações socioeconômicas e demográficas foram obtidas por um questionário previamente estruturado. A determinação do alfa-tocoferol sérico foi por Cromatografia Líquida de Alta Eficiência (CLAE). Resultados: a concentração média de alfa-tocoferol no soro foi de 1281,4 (594,8) µg/dL, e 6% das mulheres apresentaram deficiência de vitamina E (DVE). A maioria das parturientes tinha idade entre 18 e 24 anos (59%), estado civil casada ou união estável (77%), com ensino fundamental completo (34%), baixa renda (74%) e moradia localizada na zona urbana (73%). Não foram encontradas diferenças significativas na concentração de alfa-tocoferol segundo característica socioeconômica, e nenhum dos fatores estudados foi associado a presença da DVE (p>0,05). Conclusões: as características sociais maternas não foram determinantes para o alfa-tocoferol sérico e DVE. Maiores investigações devem ser realizadas durante a lactação para avaliar quais fatores podem estar envolvidos na presença dessa deficiência.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh / 예방의학회지

OBJECTIVES: As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. METHODS: A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. RESULTS: The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. CONCLUSIONS: The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.