Predictors of smokeless tobacco use among the adult population of north-east India during 2009-2017: A decomposition analysis

Background & objectives: Contrary to overall declining trend in smokeless tobacco (SLT) use in India, an increase is observed in north-east (NE) India. This study examined the predictors of daily SLT use by gender and assessed the demographic and socio-economic characteristics that contribute to gender differences in SLT use in NE India. Methods: Data collected from 15,259 and 13,574 adults in the two rounds of Global Tobacco Adult Survey 1 and 2 for NE India during 2009-2010 and 2016-2017 were analyzed. Relative change, multivariable binary logistic regression and Blinder-Oaxaca decomposition analysis were used for analysis. Results: The findings suggest that among women in NE India, the daily SLT use significantly increased by 58 per cent between 2009-2010 to 2016-2017. Women residing in Nagaland, Manipur, Mizoram and Tripura were 3.5 and 2.5 times, respectively more likely to be daily SLT users compared to those in Assam. While age, education and wealth were the significant predictors of SLT use in both women and men, increased odds of SLT use were observed with women’s type of occupation and the State of residence. The majority of the gender differences in daily SLT use was explained by differences in work status (44%), age (26%), education (14%) and wealth status (9%) between men and women. Interpretation & conclusions: Increasing prevalence of SLT use amongst women in the NE States necessitates integration of gender-specific messages on harmful effects of SLT in the ongoing tobacco control programmes and development of culturally appropriate community-based interventions for cessation of SLT use.

Factores predictivos de cesación tabáquica en adultos de Argentina: Análisis secundario de la encuesta mundial de tabaco / Who quit smoking and who wants to quit?: Secondary analysis from Global Adult Tobacco Survey in Argentina

INTRODUCCIÓN: La reducción del daño a la salud causado por el tabaco depende de la cesación. Se han descripto características sociodemográficas y personales relacionadas con el cese, pero no se cuenta con análisis en esta población. El objetivo fue evaluar los predictores de ser ex fumador o estar en una etapa favorable para dejar de fumar en la población urbana de Argentina. MÉTODOS: Análisis secundario de la Encuesta Mundial de Tabaquismo en Adultos (EMTA-GATS) empleando regresión logística multivariable. RESULTADOS: Se incluyó a 6299 sujetos (edad media: 43,3 años; hombres: 46,39%; fumadores: 23,16%). Ser ex fumador se asoció a edad (OR 1,11; IC95%: 1,02-1,20 cada 5 años), hogares en los que no se fuma (OR 2,92; IC95%: 1,78-4,78), apoyo al aumento de impuestos al tabaco (OR 2,32; IC95%: 1,52-3,56), no fumar a diario (OR 2,06; IC95%: 1,25-3,39) y ser mujer (OR 1,53; IC95%: 1,06-2,19), independientemente del nivel educativo y de ingresos. Entre los fumadores, la edad (OR 1,10; IC95%: 1,01-1,26 cada 5 años) y estar sensibilizado por advertencias sanitarias (OR 4,64; IC95%: 2,28-9,41) se asociaron a querer dejar, independientemente del género y nivel educativo. El consejo médico se asoció con la decisión de dejar de fumar (OR 6,25; IC95%: 2,91- 13,42), independientemente del nivel educativo y de ingresos. DISCUSIÓN: Implementar campañas de hogares libres de humo, advertencias sanitarias y el asesoramiento médico son estrategias útiles para contribuir a la cesación.

Displace of Smoking Into the Home and Second-hand Smoke Exposure at Home Among Malaysian Adults -findings From Two National Population-based Studies in Malaysia

@#Introduction: Expansion of smoke-free areas in public domains is suspected to displace smoking into the home. However, the scarcity of such information in Malaysia warrants an investigation to determine SHS exposure at home among adults in Malaysia. Methods: This study studied 4,250 and 21,445 adults who participated in the 2011 Global Adult Tobacco Survey-Malaysia (GATS-M) and, the National Health and Morbidity Survey (NHMS) 2015, respectively. Multivariable logistic regression modelling was used to compare the odds of SHS exposure at home among adults in 2011 (GATS-M) to odds of SHS exposure at home among adults in 2015 (NHMS 2015). Results: Approximately one third of respondents were exposed to SHS at home in 2011 (38.4%) and 2015 (37.9%). MLR analysis revealed the odds of SHS exposure at home was not significantly different from 2011 [AOR 1.14, 95 % CI (0.99-1.31). 2015 exposure to SHS as reference]. This study also indicates no significant displacement of smoking into the home by socio-demographic and smoking status between 2011 and 2015. Conclusion: The findings suggest that smoking has not been displaced into the home in the past four years although the number of smoke-free public areas have increased. More public smoke free areas should be established.

Implementation of MPOWER Approach for Tobacco Control in Malaysia: Findings from the Global Adult Tobacco Survey (GATs)

@# Tobacco induced illness remains a major contribution to premature death and global burden of diseases. The introduction of MPOWER policies by World Health Organization held the value to monitor the implementation of the anti-smoking measures in all signatory countries. This paper aimed to investigate the application of the six MPOWER indicators among Malaysia population. Methods: We utilized the data of Global Adult Tobacco Survey-Malaysia (GATS-M) which recruited 5112 nationally representative samples of Malaysians of 15 years old and above. Descriptive statistical analysis was used to illustrate the social demographic characteristic of the respondents while cross tabulation was employed to describe all elements of the MPOWER indicators. Results: About one quarter (23.1%) of Malaysian adults were current tobacco users. The SHS exposure at home (38.4%) and restaurant (42.1%) were high. Approximately eight in ten (80.2%) of the smokers intended to quit, while for those attempted to quit in past one year, 9.0% utilized pharmacotherapy and 4.4% attended counseling. The awareness about tobacco related diseases was generally excellent. The overall tax make up of the cigarettes’ retail price ranging from 41.7% up to 80%. Conclusion: Tobacco consumption remains prevalent and plateau among Malaysian adults over the last two decades with substantial proportion of the population exposed to SHS. The inadequacy in the current anti-smoking policies needs urgent improvement in order to reduce the smoking norms among Malaysians population besides to achieve the ultimate goal of tobacco control end game by year 2045.

Epidemiology investigation of nonalcoholic fatty liver disease in Yichang professional crowd and its correlation with the metabolic syndrome / 重庆医学

Objective To study the prevalence rate of nonalcoholic fatty liver disease (NAFLD)and its correlation with the metabolic syndrome among professional crowd in Yichang city ,and analyze the characteristic of prevalence of NAFLD .Methods Physical check‐up and liver ultrasonography were done and fasting blood GLU ,TG ,HDL‐C ,UA ,CRP were measured for sampling survey professional people in Yichang city .We sampled 6 450 people in 15 company ,including 3 284 men ,3 166 women(20 to 70 years old) ,the results were analyzed .Results The NAFLD prevalence rate of Yichang professional crowd was 21 .71% ,28 .68% in male and 14 .47% in female respectively(P<0 .01) .The prevalence rate in male was higher than that of female before 60 years old . NAFLD prevalence rate in women showed a trend of increasing along with the age growth ,the incidence rate come up to 31 .31%when women were over 60 years old .The highest prevalence rate of MS related components in NAFLD group were obesity (69 .98% )、high blood TG level(61 .10% ) .Conclusion Male before 60 years old and female over 60 years old of Yichang profes‐sional crowd belong to NAFLD high‐risk groups ,the group should be focused on as regular monitoring ,prevention and interven‐tion .NAFLD prevalence rate significantly increased in people with MS .The most important factors of suffering from NAFLD are o‐besity ,high blood TG level .

Encuesta mundial de tabaquismo en adultos 2012: resultados de la primera implementación en Argentina / Global Adult Tobacco Survey, 2012: Results of the First Implementation in Argentina

INTRODUCCIÓN: La Encuesta Mundial de Tabaquismo en Adultos (EMTA) es el estándar para monitorear de forma sistemática el consumo y los principales indicadores de control del tabaco. OBJETIVO: Monitorear la epidemia de tabaquismo en adultos en Argentina con una herramienta estandarizada propuesta por la Organización Mundial de la Salud. MÉTODOS: Se utilizó la metodología estandarizada a nivel mundial para relevar la información sobre uso de tabaco (para fumar y sin humo), cesación del consumo, exposición al humo de tabaco ajeno (HTA), economía, medios de comunicación y conocimientos, actitudes y percepciones acerca del uso. Se utilizó un diseño muestral multietápico, estratificado por conglomerados, para generar datos representativos a nivel nacional y regional. RESULTADOS: Se evidenció una prevalencia de tabaquismo del 22,3%, mayor en varones (29,6%) que en mujeres (15,7%). El 73,6% de los fumadores había planeado o estaba pensando en dejar de fumar, y el 48,6% había hecho un intento el último año. El 31,6% de los adultos que trabajaban en ambientes cerrados había estado expuesto allí a HTA; el 33% sufrió esa exposición en su hogar. El 75,8% obtuvo información sobre los peligros de fumar en medios de comunicación, mientras que el 41,9% advirtió publicidades de cigarrillos en los sitios de venta. CONCLUSIONES: La encuesta permitió conocer con mayor profundidad las características de la epidemia de tabaquismo en Argentina y realizar una comparación a nivel mundial.

INTRODUCTION: The Global Adult Tobacco Survey (GATS) is the world standard to sy stematically monitor tobacco consumption and the main indicators for tobacco control. OBJECTIVE: To monitor tobacco epidemic in adults in Argentina with a standardized tool suggested by the World Health Organization. METHODS: A globally standardized methodology was used to gather information on tobacco use (smoking and smokeless), cessation, second-hand smoke (SHS), economics, media, and knowledge, attitudes and perceptions towards tobacco use. A multi-stage stratified cluster sample design was used to produce representative data both at national and regional level. RESULTS: Tobacco smoking prevalence was 22.3%, with a high errate in men (29.6%) than in women (15.7%). A total of 73.6% of the smokers had planned or was planning to quit, and 48.6% had made a quit attempt in the previous year. Among adults working in enclosed places 31.6% were exposed to SHS, and 33% were exposed at home. Besides, 75.8% obtained anti-cigarette smoking information on mass media, while 41.9% noticed advertising at cigarette stores. CONCLUSIONS: The survey allowed a better understanding of tobacco epidemic in Argentina and also a comparison with other countries in the worl.

Distribuição da força de trabalho: eqüidade e negociação / Workforce distribution: equity and negotiation

A enorme desproporção na densidade de recursos humanos - existente entre os países da África e o resto do mundo - coloca a questão da eqüidade na distribuição da força de trabalho como destaque estratégico para a resolução dos problemas de saúde. Daí a relevância do tema recursos humanos na agenda política global e nas prioridades para o setor saúde. A política de captação e recrutamento por parte dos países desenvolvidos, associada à ausência de políticas claras, nos países em desenvolvimento, contribui para o aumento da migração. Algumas agências internacionais, sob a liderança da Organização Mundial da Saúde (OMS), têm-se destacado na definição ou desenvolvimento de políticas de recursos humanos em saúde (RHS). No entanto, a existência de um paradoxo entre a interdependência e a soberania dos países requer um posicionamento ético estratégico, no sentido de fortalecer as nações em suas transações comerciais. Assim, um dos desafios para a saúde global está em aproveitar o potencial de articulação oferecido pelo General Agreement on Trade in Services (GATS), para as negociações internacionais de RHS.

The significant existing disproportion in the density of human resources makes the equity of human resources distribution a strategic issue for possible solutions of health problems. This can explain the importance of the human resources issue in the global health agenda and its priority for the health sector. The policy of recruitment of health workers by developed countries as well as a lack of clear policies to prevent brain drain by developing countries are contributing migration factors. Under the leadership of WHO, some international agencies have been developing and subsidizing human health resources policies. However the existing paradox between the interdependency and sovereignty of countries requires an ethical and strategic standpoint in order to strengthen nations in their commercial dealings. Therefore one of the challenges to global health is in grabbing the opportunities offered by GATS for international human health resource negotiations.

Libre comercio y autonomía universitaria, un dilema actual: el caso colombiano / Livre-comercio e autonomia universitária, um dilema atual: o caso colombiano / Free trade and university autonomy, a present day dilemma: the Colombian case

En el presente ensayo se analizan las consecuencias que para la educación superior puede implicar la globalización y, en particular, el libre comercio. Para caracterizar con mayor especificidad el fenómeno, luego de indagar por la naturaleza de la universidad – institución emblemática de la educación superior– a través de un recorrido por la historia de ésta y del planteamiento de sus misiones y funciones sustantivas, se examinan los términos en que el Acuerdo General de Comercialización de Servicios –GATS– incluye la educación dentro de su ordenamiento, planteando las posibles consecuencias que tal inclusión puede tener para la educación superior. Luego se exponen los potenciales escenarios de la educación superior colombiana relacionados con la posición política que podría asumir el país con respecto a las directrices del GATS en los tratados que sobre el tema de Educación Superior pudiese llegar a suscribir.

No presente ensaio analiso as possíveis conseqüências produzidas pela globalização, particularmente o livre - comercio, no ensino superior. Para caracterizar com maior especificidade o fenômeno, logo após indagar pela natureza da universidade — instituição emblemática de ensino superior —, através de um recorrido pela história desta e da exposição da sua missão e funções substantivas, são examinados os termos pelos quais o Acordo Geral de Comercialização de Serviços (GATS) inclui o ensino dentro do seu ordenamento, expondo as possíveis conseqüências que tal inclusão pode ter para o ensino superior. Logo exponho os potenciais cenários do ensino superior colombiano, relacionados com a posição política que poderia assumir o país em relação às diretrizes do GATS nos tratados que sobre o tema de Ensino Superior pudesse chegar a subscrever.

This paper analyzes the consequences of globalization, and particularly of free trade, on higher education. Starting with a consideration of the nature and mission of the university, through a brief survey of its history, the paper examines the terms in which the General Agreement on Trade and Services–GATS–treats education, and reflects on the consequences of this treatment for higher education. Finally, it proposes the possible scenarios for Colombian higher education in terms of the position which the country might take regarding the orientations of GATS in terms of the treaties on higher education that might eventually be subscribed.

Health Care System for the Persons with Disabilities in Developed Countries and Opening of the Health Care Market

In Korea, the need of medical care is high in persons with disabilities. But the health care system, especially the continuum of long-term rehabilitation care for the persons with disabilities is not well established. Under the General Agreement on Trade in Services (GATS), the pressure to open up the health care market has been increased in Korea. This article examines the health care system of developed countries (USA, UK and Japan) with review of the health policies, laws, income security and pensions, payment systems, medical rehabilitation facilities, and home health services for the persons with disabilities. And this article also discusses the process of the health care market opening in Korea, the debating issues, the implications for the domestic medical market, and the matter of concern in rehabilitation medicine field. In the viewpoint of the rehabilitation medicine, the transitional services and home health services for the persons with disabilities should be prepared, and the public health should be expanded as the social network of the persons with disabilities, before the health care market is fully opened up.

WTO DDA and Negotiations on Healthcare Servics

The multilateral trading system embodied in the World Trade Organization has contributed significantly to economic growth, development and employment throughout the past fifty years. We are determined, particularly in the light of the global economic slowdown, to maintain the process of reform and liberalization of trade policies, thus ensuring that the system plays its full part in promoting recovery, growth, and development. The negotiations on trade in services shall be conducted with a view to promoting the economic growth of all trading partners and the development of developing and least-developed countries. The General Agreement on Trade in Services (GATS) is among the World Trade Organization's most important agreements. The accord, which came into force in January 1995, is the first and only set of multilateral rules covering international trade in services. Ig has been negotiated by the Governments themselves, and it sets the framework within which firms and individuals can operate. The GATS has two part: the framework agreement containing the general rules and disciplines ; and the notional "schedules" which list individual countries' specific commitments on access to their domestic markets by foreign suppliers. Each WTO Member lists in its national schedule those services for which it wishes to guarantee access to foreign suppliers. All commitments apply on a non-discriminatory basis to all other Members. There is complete freedom to choose which services to commit. In addition to the services committed, the schedules limit the degree to which foreign services providers can operate in the market. For example, a country making a commitment to allow foreign banks to operate in its territory may limit the number of banking licenses to be granted (a market access limitation). It might also fix a limit on the number of branches a foreign bank may open (a national treatment limitation). The GATS covers all internationally-traded services with two exception : services provided to the public in the exercise of governmental authority, and , in the air transport sector, traffic rights and all services directly related to the exercise of traffic rights and all services directly related to the exercise of traffic rights. The GATS also defines four ways in which a service can be traded, known as "modes of supply" Services supplied from one country to another (e.g international telephone calls), officially known as "cross-border supply"; Consumers from one country making use of a service in another country(e.g tourism), officially known as "consumption abroad"; A company from ton country setting up subsidiaries or branches to provide services in another country (e.g a bank from one country setting up operations in another country), officially known as "commercial presence" ; and Individuals travelling from their own country to supply services in another (e.g an actress or construction worker), officially known as "movement of natural persons". Trade liberalization, and even economic growth, are not the ends in themselves. The ultimate aim of Government is to promote human welfare in the broadest sense, and trade policy is only one of many instruments Governments use in pursuing this goal. But trade policy is nevertheless very important, both in promoting growth and in preventing conflict. The building of the multilateral trading system over teh past 50 years has been one of the most remarkable achievements of international cooperation in history. The system is certainly imperfect, which is one of the reasons why periodic negotiations are necessary, but the world would be a far poorer and more dangerous place without it. In January 2000, WTO Member Governments started a new round of negotiations to promote the progressive liberalization of trade in services. The GATS agreement specifically states that the negotiations "shall take place with a view to promoting the interests of all participants on a mutually advantageous basis" and "with due respect for national policy objectives and the level of development of individual Members". The pace and extent of these negotiations are set by the WTO's 140 Member Goverments themselves according to their different national policy priorities. Recently, however, the negotiations and the GATS itself have become the subject of ill-informed and hostile criticism. Scare stories are invented and unquestioningly repeated, however implausible. It is claimed for example that the right to maintain public services and the power to enforce health and safty standards are under threat, though both are explicitly safeguarded under the GATS. How have serious people come to believe what is, on the face of it, out of the question? Why should any Government, let alone 140 Governments, agrees to allow themselves to be forced, or force each toher, to surrender of compromise powers which are important to them, and to all of us? Decision-making in open societies presupposes informed public discussion. It must be based on fact rather than fiction. The purpose of this booklet is to contribute to this discussion and to a greater public understanding of the GATS by correcting statements made in some recent publication which we believe are misleading the public and undermining support for international economic cooperation. It must not be assumed that becuase we have disputed some allegations we accept that others are well-founded: these are merely examples.

WTO DDA and lssues on Healthcare Services

The GATS is the first and only set of multilateral rules and commitment covering Government measures which affect trade in services. It has two parts-the framework agreement containing the rules, and the national schedules of commitments through which each Member specifies the degree of access and is prepared for foreign service suppliers. The GATS covers all services with two exceptions, i.e., services provided in the exercise of governmental authority and , in the air transport sector, air traffic rights and all services directly related to the exercise of traffic rights. Notwithstanding this very broad scope, the agreement and the negotiations taking place under it are one of the least controversial areas of the current work in the WTO. This is because of its remarkable flexibility, which allows Governments, to a very great extent, to determine the level of obligations they will assume. There are four main elements of flexibility: Member Governments choose those service sectors or subsectors on which they will make commitments guaranteeing the right of foreign suppliers to provide the service. Each Member must have a schedule of commitments, but there is no minimum requirement as to its coverage and some cover only a small part of one sector; For those services that are committed, Governments may set limitations specifying the level of market access and the degree of national treatment they are prepared to guarantee; Governments were able to limit commitments to one or more of the four re cognized "modes of supply" through which services are traded. They may also withdraw and renegotiate commitments ; In order to provide more favorable treatment to certain trading partners, Governments may take exemption, in principle limited to a 10 years’ duration, from the MFN principle, which is otherwise applicable to all services, whether scheduled or not. The agreement contains a number of general obligations applicable to all services, the most important of which is the MFN rule. But apart from these, each Member defines its own obligations through the commitments undertaken in its schedule. Because it is a basic principle of the agreement that developing countries are expected to liberalize fewer sectors and types of transactions, in line with their development situation, the commitments of developing countries are in general less extensive than those of more industrialized countries. It was this flexibility in the scheduling of commitments which put an end to the north-south controversy over services which marked the early years of th e Uruguay Round. So far, South Korea has been asked by 14 economies, including the U.S., EU, and China, to open its services market wider. According to the initial requests submitted to the World Trade Organization (WTO), these countries urged Seoul to grant greater access to the domestic medical treatment, legal services, education, finance, and distribution markets. The ministry of Foreign Affairs and Trade (MOFAT) plans to hold a related ministerial meeting today and roll out countermeasures by next March for follow-up negotiations with the nations concerned. In the initial requests, Korean newspapers reported that the U.S has demanded Seoul guarantee full access to the medical service markets and provide the same business conditions for American companies as local ones. This was, however, denied by the Korean government, while it accepted that fact that the China also called for the removal of barriers in the herbal medicine market as well as in the education. The WTO member economies have submitted initial requests for follow-up negotiations by sector to the new round of WTO talks in November last year. Thereafter, South Korea is required to come up with a response by next March to resolve the issues by the end of 2004. An agreement with the 14 countries should take effect from January 2005.