885 resultados para Geography|Sociology, Public and Social Welfare|Transportation|Urban and Regional Planning


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Background Estimates of the disease burden due to multiple risk factors can show the potential gain from combined preventive measures. But few such investigations have been attempted, and none on a global scale. Our aim was to estimate the potential health benefits from removal of multiple major risk factors. Methods We assessed the burden of disease and injury attributable to the joint effects of 20 selected leading risk factors in 14 epidemiological subregions of the world. We estimated population attributable fractions, defined as the proportional reduction in disease or mortality that would occur if exposure to a risk factor were reduced to an alternative level, from data for risk factor prevalence and hazard size. For every disease, we estimated joint population attributable fractions, for multiple risk factors, by age and sex, from the direct contributions of individual risk factors. To obtain the direct hazards, we reviewed publications and re-analysed cohort data to account for that part of hazard that is mediated through other risks. Results Globally, an estimated 47% of premature deaths and 39% of total disease burden in 2000 resulted from the joint effects of the risk factors considered. These risks caused a substantial proportion of important diseases, including diarrhoea (92%-94%), lower respiratory infections (55-62%), lung cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart disease (83-89%), and stroke (70-76%). Removal of these risks would have increased global healthy life expectancy by 9.3 years (17%) ranging from 4.4 years (6%) in the developed countries of the western Pacific to 16.1 years (43%) in parts of sub-Saharan Africa. Interpretation Removal of major risk factors would not only increase healthy life expectancy in every region, but also reduce some of the differences between regions, The potential for disease prevention and health gain from tackling major known risks simultaneously would be substantial.

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This paper develops an Internet geographical information system (GIS) and spatial model application that provides socio-economic information and exploratory spatial data analysis for local government authorities (LGAs) in Queensland, Australia. The application aims to improve the means by which large quantities of data may be analysed, manipulated and displayed in order to highlight trends and patterns as well as provide performance benchmarking that is readily understandable and easily accessible for decision-makers. Measures of attribute similarity and spatial proximity are combined in a clustering model with a spatial autocorrelation index for exploratory spatial data analysis to support the identification of spatial patterns of change. Analysis of socio-economic changes in Queensland is presented. The results demonstrate the usefulness and potential appeal of the Internet GIS applications as a tool to inform the process of regional analysis, planning and policy.

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In order to be relevant and useful in a fragmented developing country context, community and regional planning needs to shift away from the use of rigid tools to more flexible, adaptive approaches. An international review of planning curricula indicated a widespread consensus with respect to key competencies required of planners. This understanding was used in the development of new teaching programs at three Sri Lankan universities. Complementing the technical core knowledge areas, strong emphases on problem structuring, critical and strategic thinking, and the understanding of the political and institutional contexts appear to be crucial to making the agenda of planning for sustainable development more than a fashionable cliche. In order for these core areas to have relevance in a developing country context, however, planning curricula need to achieve a balance between local priorities and a global perspective.

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The practice of participatory planning in discrete Indigenous settlements has been established since the early 1990s. In addition to technical and economic goals, participatory planning also seeks community development outcomes, including community control, ownership and autonomy. This paper presents an evaluation of one such planning project, conducted at Mapoon in 1995. The Plan successfully improved physical infrastructure and housing, but had mixed success in terms of community development. Despite various efforts to follow participatory processes, the Plan was essentially a passing event, community control progressively diminished after its completion, and outcomes fell short of notions of ownership and autonomy. This suggests some misunderstandings between the practice of participatory planning and the workings of governance.

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Background Our aim was to calculate the global burden of disease and risk factors for 2001, to examine regional trends from 1990 to 2001, and to provide a starting point for the analysis of the Disease Control Priorities Project (DCPP). Methods We calculated mortality, incidence, prevalence, and disability adjusted life years (DALYs) for 136 diseases and injuries, for seven income/geographic country groups. To assess trends, we re-estimated all-cause mortality for 1990 with the same methods as for 2001. We estimated mortality and disease burden attributable to 19 risk factors. Findings About 56 million people died in 2001. Of these, 10.6 million were children, 99% of whom lived in low-and-middle-income countries. More than half of child deaths in 2001 were attributable to acute respiratory infections, measles, diarrhoea, malaria, and HIV/AIDS. The ten leading diseases for global disease burden were perinatal conditions, lower respiratory infections, ischaemic heart disease, cerebrovascular disease, HIV/AIDS, diarrhoeal diseases, unipolar major depression, malaria, chronic obstructive pulmonary disease, and tuberculosis. There was a 20% reduction in global disease burden per head due to communicable, maternal, perinatal, and nutritional conditions between 1990 and 2001. Almost half the disease burden in low-and-middle-income countries is now from non-communicable diseases (disease burden per head in Sub-Saharan Africa and the low-and-middle-income countries of Europe and Central Asia increased between 1990 and 2001). Undernutrition remains the leading risk factor for health loss. An estimated 45% of global mortality and 36% of global disease burden are attributable to the joint hazardous effects of the 19 risk factors studied. Uncertainty in all-cause mortality estimates ranged from around 1% in high-income countries to 15-20% in Sub-Saharan Africa. Uncertainty was larger for mortality from specific diseases, and for incidence and prevalence of non-fatal outcomes. Interpretation Despite uncertainties about mortality and burden of disease estimates, our findings suggest that substantial gains in health have been achieved in most populations, countered by the HIV/AIDS epidemic in Sub-Saharan Africa and setbacks in adult mortality in countries of the former Soviet Union. our results on major disease, injury, and risk factor causes of loss of health, together with information on the cost-effectiveness of interventions, can assist in accelerating progress towards better health and reducing the persistent differentials in health between poor and rich countries.