Income distribution and poverty through crisis and adjustment

Includes bibliography

Income poverty and unsatisfied basic needs

Incluye Bibliografía

An assessment of fiscal and regulatory barriers to deployment of energy efficiency and renewable energy technologies in Guyana

Includes bibliography.

Reduction of infant mortality in Latin America and the Caribbean: uneven progress requiring a variety of responses

Infant mortality has unquestionably declined throughout Latin America over the last decade, even under conditions of low and unstable economic growth and a meagre overall reduction of poverty in the region. The declines in infant mortality vary from one country to another. The persistence of high infant mortality rates is related to low income, teenage pregnancy and lack of access to basic services, as well as to the lack of appropriate health care infrastructure. At the same time, both the rural population as a whole, and the indigenous and Afro-descendent population in particular, has fallen markedly behind, with overall infant mortality rates much higher than among the rest of the population. Moreover, the cause and incidence of death in this age group have been changing according with the changes in neonatal and post-neonatal deaths. Our editorial line-up has created space for opinions from adolescents and youth, as well as from policy experts on the problem, its causes, and approaches to dealing with infant mortality. We also offer succinct information on a broad range of programmes—utilizing various interventions—in different countries of the region regarding maternal and infant care, in an attempt to bring about a reduction in mortality.

Tax policy in Latin America: Assessment and guidelines for a second generation of reforms

Includes bibliography

The employment situation in Latin America and the Caribbean: Labour productivity and distribution issues

Although the economies of Latin America and the Caribbean grew more slowly in 2011 than in 2010, there were some improvements on the employment front. Workers benefited from the region’s satisfactory economic performance in an increasingly complex international setting. The unemployment rate fell from 7.3% in 2010 to 6.7% in 2011 thanks to a halfpercentage- point gain in the urban employment rate. Both rates are at levels that have not been seen for a long time. The proportion of formal jobs with social benefits rose as well, and underemployment declined. The average wage and the minimum wage both increased in real terms, albeit only moderately. Economic performance and the employment situation varied widely among the subregions. The unemployment rate dropped by 0.6 percentage points in South America but 0.4 percentage points in the countries of the northern part of Latin America. In the countries of the Caribbean, the employment rate was up by 0.2 percentage points. The data show that substantial labour market gaps and serious labour-market insertion issues remain. This is especially the case for women and young people, for whom unemployment rates and other labour indicators are still unfavourable. The second part of this report looks at whether the fruits of economic growth and rising productivity have been distributed equitably between workers and companies. Between 2002 and 2008 (the most recent expansionary economic cycle), wages as a percentage of GDP fell in 13 of the 21 countries of the region for which data are available and rose in just 8. This points to redistribution that is unfavourable to workers, which is worrying in a region which already has the most unequal distribution of income in the world. Underlying this trend is the fact that, worldwide, wages have grown less than productivity. Beyond the ethical dimension of this issue, it jeopardizes the social and economic sustainability of growth. For example, one of the root causes of the recent financial crisis was that households in the United States responded to declining wage income by borrowing more to pay for consumption and housing. This turned out to be unsustainable in the long run. Over time, it undermines the labour market’s contribution to the efficient allocation of resources and its distributive function, too, with negative consequences for democratic governance. Among the triggers of this distributive worsening most often cited in the global debate are market deregulation and its impact on financial globalization, technological change that favours capital over labour, and the weakening of labour institutions. What is needed here is a public policy effort to help keep wage increases from lagging behind increases in productivity. Some countries of the region, especially in South America, saw promising developments during the second half of the 2000s in the form of a positive trend reversal in wages as a percentage of GDP. One example is Brazil, where a minimum wage policy tailored to the dynamics of the domestic market is considered to be one of the factors behind an upturn in the wage share of GDP. The region needs to grow more and better. Productivity must grow at a steady pace, to serve as the basis for sustained improvements in the well-being of the populace and to narrow the gap between the economies of Latin America and the Caribbean and the more advanced economies. And inequality must be decreased; this could be achieved by closing the productivity gap between upgraded companies and the many firms whose productivity is low. As set out in this report, the region made some progress between 2002 and 2010, with labour productivity rising at the rate of 1.5% a year. But this progress falls short of that seen in other regions such as Sub-Saharan Africa (2.1%) and, above all, East Asia (8.3%, not counting Japan and the Republic of Korea). Moreover, in many of the countries of the region these gains have not been distributed equitably. Therein lies a dual challenge that must be addressed: continue to increase productivity while enhancing the mechanisms for distributing gains in a way that will encourage investment and boost worker and household income. The Economic Commission for Latin America and the Caribbean (ECLAC) and the International Labour Organization (ILO) estimate that the pace of economic growth in the region will be slightly slower in 2012 than in 2011, in a global economic scenario marked by the cooling of several of the main economic engines and a high degree of uncertainty concerning, above all, prospects for the euro zone. The region is expected to continue to hold up well to this worsening scenario, thanks to policies that leveraged more favourable conditions in the past. This will be felt in the labour markets, as well, so expectations are that unemployment will edge down by as much as two tenths of a decimal point.

ß-2 microglobulina e citocinas séricas como indicadores de falha terapêutica aos anti-retrovirais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Women's subjective and objective health over time : the role of psychosocial conditions and physiological stress responses

Today, health problems are likely to have a complex and multifactorial etiology, whereby psychosocial factors interact with behaviour and bodily responses. Women generally report more health problems than men. The present thesis concerns the development of women’s health from a subjective and objective perspective, as related to psychosocial living conditions and physiological stress responses. Both cross-sectional and longitudinal studies were carried out on a representative sample of women. Data analysis was based on a holistic person-oriented approach as well as a variable approach. In Study I, the women’s self-reported symptoms and diseases as well as self-rated general health status were compared to physician-rated health problems and ratings of the general health of the women, based on medical examinations. The findings showed that physicians rated twice as many women as having poor health compared to the ratings of the women themselves. Moreover, the symptom ”a sense of powerlessness” had the highest predictive power for self-rated general health. Study II investigated individual and structural stability in symptom profiles between adolescence and middle-age as related to pubertal timing. There was individual stability in symptom reporting for nearly thirty years, although the effect of pubertal timing on symptom reporting did not extend into middle-age. Study III explored the longitudinal and current influence of socioeconomic and psychosocial factors on women’s self-reported health. Contemporary factors such as job strain, low income, financial worries, and double exposure in terms of high job strain and heavy domestic responsibilities increased the risk for poor self-reported health in middle-aged women. In Study IV, the association between self-reported symptoms and physiological stress responses was investigated. Results revealed that higher levels of medically unexplained symptoms were related to higher levels of cortisol, cholesterol, and heart rate. The empirical findings are discussed in relation to existing models of stress and health, such as the demand-control model, the allostatic load model, the biopsychosocial model, and the multiple role hypothesis. It was concluded that women’s health problems could be reduced if their overall life circumstances were improved. The practical implications of this might include a redesign of the labour market giving women more influence and control over their lives, both at and away from work.

Analyzing convergence of Agricultural and Rural Areas in the Enlarged EU: The case of Hungary

The fall of the Berlin Wall opened the way for a reform path – the transition process – which accompanied ten former Socialist countries in Central and South Eastern Europe to knock at the EU doors. By the way, at the time of the EU membership several economic and structural weaknesses remained. A tendency towards convergence between the new Member States (NMS) and the EU average income level emerged, together with a spread of inequality at the sub-regional level, mainly driven by the backwardness of the agricultural and rural areas. Several progresses were made in evaluating the policies for rural areas, but a shared definition of rurality is still missing. Numerous indicators were calculated for assessing the effectiveness of the Common Agricultural Policy and Rural Development Policy. Previous analysis on the Central and Eastern European countries found that the characteristics of the most backward areas were insufficiently addressed by the policies enacted; the low data availability and accountability at a sub-regional level, and the deficiencies in institutional planning and implementation represented an obstacle for targeting policies and payments. The next pages aim at providing a basis for understanding the connections between the peculiarities of the transition process, the current development performance of NMS and the EU role, with particular attention to the agricultural and rural areas. Applying a mixed methodological approach (multivariate statistics, non-parametric methods, spatial econometrics), this study contributes to the identification of rural areas and to the analysis of the changes occurred during the EU membership in Hungary, assessing the effect of CAP introduction and its contribution to the convergence of the Hungarian agricultural and rural. The author believes that more targeted – and therefore efficient – policies for agricultural and rural areas require a deeper knowledge of their structural and dynamic characteristics.

Assessing Food Security in Selected Mediterranean Countries

Food Security has become an important issue in the international debate, particularly during the latest economic crisis. It relevant issue also for the Mediterranean Countries (MCs), particularly those of the southern shore, as they are is facing complex economic and social changes. On the one hand there is the necessity to satisfy the increasing and changing food demand of the growing population; on the other hand it is important to promote economic growth and adjust the agricultural production to food demand in a sustainable perspective. The assessment of food security conditions is a challenging task due to the multi-dimensional nature and complexity of the matter. Many papers in the scientific literature focus on the nutritional aspects of food security, while its economic issues have been addressed less frequently and only in recent times. Thus, the main objective of the research is to assess food (in)security conditions in the MCs. The study intends to identify and implement appropriate theoretical concepts and methodological tools to be used in the assessment of food security, with a particular emphasis on its economic dimension within MCs. The study follows a composite methodological approach, based on the identification and selection of a number of relevant variables, a refined set of indicators is identified by means of a two-step Principal Component Analysis applied to 90 countries and the PCA findings have been studied with particular attention to the MCs food security situation. The results of the study show that MCs have an higher economic development compared to low-income countries, however the economic and social disparities of this area show vulnerability to food (in)security, due to: dependency on food imports, lack of infrastructure and agriculture investment, climate condition and political stability and inefficiency. In conclusion, the main policy implications of food (in)security conditions in MCs are discussed.

Sustainable development in Darjeeling Hills, India : ecological and socio-economic aspects for small-scale farmers with supportive observations from Kanagawa, Japan

Organic farming means a holistic application of agricultural land-use, hence, this study aimed to assess ecological and socio-economic aspects that show benefits of the strategy and achievements of organic farming in comparison to conventional farming in Darjeeling District, State of West Bengal, India and Kanagawa Prefecture/Kanto in Central Japan. The objective of this study has been empirically analysed on aspects of crop diversity, yield, income and sales prices in the two study regions, where 50 households each, i.e. in total 100 households were interviewed at farm-level. Therefore, the small sample size does not necessarily reflect the broad-scale of the use and benefit of organic farming in both regions. The problems faced in mountainous regions in terms of agriculture and livelihoods for small-scale farmers, which are most affected and dependant on their immediate environment, such as low yields, income and illegal felling leading to soil erosion and landslides, are analyzed. Furthermore, factors such as climate, soils, vegetation and relief equally play an important role for these farmers, in terms of land-use. To supplement and improve the income of farmers, local NGOs have introduced organic farming and high value organic cash crops such as ginger, tea, orange and cardamom and small income generating means (floriculture, apiary etc.). For non-certified and certified organic products the volume is given for India, while for Japan only certified organic production figures are given, as there are several definitions for organic in Japan. Hence, prior to the implementation of organic laws and standards, even reduced chemical input was sold as non-certified organic. Furthermore, the distribution and certification system of both countries are explained in detail, including interviews with distribution companies and cooperatives. Supportive observations from Kanagawa Prefecture and the Kanto region are helpful and practical suggestions for organic farmers in Darjeeling District. Most of these are simple and applicable soil management measures, natural insect repelling applications and describe the direct marketing system practiced in Japan. The former two include compost, intercropping, Effective Microorganisms (EM), clover, rice husk charcoal and wood vinegar. More supportive observations have been made at organic and biodynamic tea estates in Darjeeling District, which use citronella, neem, marigold, leguminous and soil binding plants for soil management and natural insect control. Due to the close ties between farmers and consumers in Japan, certification is often neither necessary nor wanted by the producers. They have built a confidence relationship with their customers; thus, such measures are simply not required. Another option is group certification, instead of the expensive individual certification. The former aims at lower costs for farmers who have formed a cooperative or a farmers' group. Consumer awareness for organic goods is another crucial aspect to help improve the situation of organic farmers. Awareness is slightly more advanced in Kanto than in Darjeeling District, as it is improved due to the close (sales) ties between farmers and consumers in Kanto. Interviews conducted with several such cooperatives and companies underline the positive system of TEIKEI. The introduction of organic farming in the study regions has shown positive effects for those involved, even though it still in its beginning stages in Darjeeling District. This study was only partly able to assess the benefits of organic agriculture at its present level for Darjeeling District, while more positively for the organic farmers of Kanto. The organic farming practice needs further improvement, encouragement and monitoring for the Darjeeling District farmers by locals, consumers, NGOs and politicians. The supportive observations from Kanagawa Prefecture and the Kanto region are a small step in this direction, showing how, simple soil improvements and thus, yield and income increases, as well as direct sales options can enhance the livelihood of organic farmers without destroying their environment and natural resources.

Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures

The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain, decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the exiting roots, the need for only minimum external fixation, the possibility for early mobilisation and clearly decreased nursing problems. There are some reasons why those goals can be reached better by anterior surgery. Usually the bony compression of the cord and roots comes from the front therefore anterior decompression is usually the procedure of choice. Also, the anterior stabilisation with a plate is usually simpler than a posterior instrumentation. It needs to be stressed that closed reduction by traction can align the fractured spine and indirectly decompress the neural structures in about 70%. The necessary weight is 2.5 kg per level of injury. In the upper cervical spine, the odontoid fracture type 2 is an indication for anterior surgery by direct screw fixation. Joint C1/C2 dislocations or fractures or certain odontoid fractures can be treated with a fusion of the C1/C2 joint by anterior transarticular screw fixation. In the lower and middle cervical spine, anterior plating combined with iliac crest or fibular strut graft is the procedure of choice, however, a solid graft can also be replaced by filled solid or expandable vertebral cages. The complication of this surgery is low, when properly executed and anterior surgery may only be contra-indicated in case of a significant lesion or locked joints.

Tuberculosis in HIV-Negative and HIV-Infected Patients in a Low-Incidence Country: Clinical Characteristics and Treatment Outcomes

Background In Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS). Methods and Findings All patients diagnosed with culture-confirmed TB in the SHCS and a random sample of culture-confirmed cases reported to the national TB registry 2000–2008 were included. Outcomes were assessed in HIV-infected patients and considered successful in case of cure or treatment completion. Ninety-three SHCS patients and 288 patients selected randomly from 4221 registered patients were analyzed. The registry sample included 10 (3.5%) coinfected patients not enrolled in the SHCS: the estimated number of HIV-infected patients not enrolled in the SHCS but reported to the registry 2000–2008 was 146 (95% CI 122–173). Coinfected patients were more likely to be from sub-Saharan Africa (51.5% versus 15.8%, P<0.0001) and to present disseminated disease (23.9% vs. 3.4%, P<0.0001) than HIV-negative patients. Coinfected patients not enrolled in the SHCS were asylum seekers or migrant workers, with lower CD4 cell counts at TB diagnosis (median CD4 count 79 cells/µL compared to 149 cells/µL among SHCS patients, P = 0.07). There were 6 patients (60.0%) with successful outcomes compared to 82 (88.2%) patients in the SHCS (P = 0.023). Conclusions The clinical presentation of coinfected patients differed from HIV-negative TB patients. The number of HIV-infected patients diagnosed with TB outside the SHCS is similar to the number diagnosed within the cohort but outcomes are poorer in patients not followed up in the national cohort. Special efforts are required to address the needs of this vulnerable population.

Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration

AIMS: To compare the gender distribution of HIV-infected adults receiving highly active antiretroviral treatment (HAART) in resource-constrained settings with estimates of the gender distribution of HIV infection; to describe the clinical characteristics of women and men receiving HAART. METHODS: The Antiretroviral Therapy in Lower-Income Countries, ART-LINC Collaboration is a network of clinics providing HAART in Africa, Latin America, and Asia. We compared UNAIDS data on the gender distribution of HIV infection with the proportions of women and men receiving HAART in the ART-LINC Collaboration. RESULTS: Twenty-nine centers in 13 countries participated. Among 33,164 individuals, 19,989 (60.3%) were women. Proportions of women receiving HAART in ART-LINC centers were similar to, or higher than, UNAIDS estimates of the proportions of HIV-infected women in all but two centers. There were fewer women receiving HAART than expected from UNAIDS data in one center in Uganda and one center in India. Taking into account heterogeneity across cohorts, women were younger than men, less likely to have advanced HIV infection, and more likely to be anemic at HAART initiation. CONCLUSIONS: Women in resource-constrained settings are not necessarily disadvantaged in their access to HAART. More attention needs to be paid to ensuring that HIV-infected men are seeking care and starting HAART.

Physical long-term health problems and mental comorbidity: evidence from Vietnam

OBJECTIVE: The mental health of children living in low-income countries remains a neglected research area despite the high burden of disease. This study is one of the first that examines the effects of long-term physical health problems on child mental health disorders in a low-income country and investigates whether this association is modified by the socio-economic status of the child's family. METHODS: Community-based cross-sectional survey of 975 eight-year-old children from 20 sites in Vietnam. Long-term physical health problems were measured by a caregiver report and included conditions such as anaemia, congenital malformation, physical disability and skin problems. Child mental disorders were assessed using the strengths and difficulties questionnaire (SDQ). Generalised estimating equations models were fitted to explore the association between long-term physical health problems and child mental disorders. RESULTS: Vietnamese children who suffer from long-term physical health problems have odds 2:1 times greater than children without long-term physical health problems of having a mental disorder (95% CI 1.2 to 3.6, p = 0.006). No significant interaction with socio-economic status was found. CONCLUSIONS: This study showed a high burden of mental disorders among physically ill children, re-enforcing the idea that there is "no health without mental health". While this association needs to be explored longitudinally, children with long-term health problems may be a visible group for targeted mental-health interventions.