Health tourism trends in the United Kingdom: Are they net exporters of health services?

The study investigates the inbound and outbound health tourism in the United Kingdom (UK) to determine if the UK can be considered as a net exporter of health services. Although there is an increasing number of studies analysing the phenomenon of health tourism, little empirical data are available. This paper contributes to reducing this gap by providing reliable data on health tourism flows for the British case. Using microdata drawn from the International Passenger Survey (IPS) for the period 2000-2014, we estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. In addition, we analyse the main destinations of UK residents (outbound health tourists), and country of origin of overseas residents (inbound health tourists). The results show the upward trend of inbound and outbound patients (163 and 364% during the period 2000-2014, respectively), the strong seasonality in outbound patients (lower during the summer), and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, India and Hungry are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, United Arab Emirates and Greece are the main countries providing inbound health patients. Public policy considerations are given.

Emerging trends in the sea state of the Beaufort and Chukchi seas

The sea state of the Beaufort and Chukchi seas is controlled by the wind forcing and the amount of ice-free water available to generate surface waves. Clear trends in the annual duration of the open water season and in the extent of the seasonal sea ice minimum suggest that the sea state should be increasing, independent of changes in the wind forcing. Wave model hindcasts from four selected years spanning recent conditions are consistent with this expectation. In particular, larger waves are more common in years with less summer sea ice and/or a longer open water season, and peak wave periods are generally longer. The increase in wave energy may affect both the coastal zones and the remaining summer ice pack, as well as delay the autumn ice-edge advance. However, trends in the amount of wave energy impinging on the ice-edge are inconclusive, and the associated processes, especially in the autumn period of new ice formation, have yet to be well-described by in situ observations. There is an implicit trend and evidence for increasing wave energy along the coast of northern Alaska, and this coastal signal is corroborated by satellite altimeter estimates of wave energy.

Time-trends in infant mortality rates in the southern Europe

Infant Mortality Rate (IMR) has been considered an important health indicator in monitoring quality of health care. Objectives: To examine trends in IMR in Southern Europe (SE) over the last two decades. Methods: Number of live births and infant deaths reported for SE (Portugal, Italy, Greece and Spain) between 1990 and 2013 were abstracted from World Health Organization Database. Annual IMR per 1,000 live births was computed for each country and for SE as a whole. Joinpoint regression models were used to estimate average annual percent change (AAPC) in IMR and respective 95% Conidence Interval (95% CI) and to identify points in time when signiicant changes in trend occurred (joinpoints). Results: Between 1990 and 2013, IMR signiicantly decreased from 9.2 to 3.4 in SE and the highest decrease was observed from 1992 to 1998 (AAPC = -6.1%; 95%CI: -6.5%; -5.8%). Signiicant decline in IMR was observed in all countries but the pattern was different across countries. IMR varied across countries between 11.5 and 8.3 and between 3.1 and 3.8 in 2013; highest IMR were observed in Portugal for 1990 and in Greece for 2013. Most notable decreases in IMR were observed from 1990 to 1995 in Portugal (AAPC = -8.4% 95%CI: -8.8; -8.1), from 1993 to 1997 in Italy (AAPC = -6.6% 95%CI: -7.8; -5.5) from 1998 to 2006 in Greece (AAPC = -6.8% 95%CI: -7.0; -6.5), and from 1993 to 1996 in Spain (AAPC = -7.3% 95%CI: -9.0; -5.6). Decreases in IMR were signiicant during all time period in Italy and Greece but in Portugal and Spain IMR became unchangeable after 2010-2011. Conclusions: Decrease in IMR in countries of SE suggests steadily improvement in the quality of health care. However differences in the pattern of decrease across countries during the last years deserve particular attention.

Global trends in relative and absolute income inequality

Este documento muestra una visión general de las tendencias históricas de la desigualdad mundial de ingreso en términos absolutos y relativos -- Dependiendo del concepto usado, las tendencias de desigualdad difieren considerablemente -- La desigualdad entre países aumentó fuertemente durante el periodo 1820-2000 y ha comenzado a disminuir a principios del siglo veintiuno, independiente si es medido en términos relativos o absolutos -- La desigualdad dentro de los países, por el contrario, ha crecido especialmente fuerte en las últimas décadas: su tasa de crecimiento aceleró a partir de 1950 en términos absolutos y a partir de 1975 en términos relativos -- En términos absolutos la desigualdad global también se incrementó sustancialmente en el periodo post-1950, mientras en términos relativos la desigualdad global ha disminuido ligeramente en el mismo periodo

Trends in vertical movement of hexazinone herbicide considering typic eutrorthox soil of Espraiado´s stream cultivated with sugar-cane crop - local and default data scenarios.

2009

Application of the UK Foresight Obesity Model in Ireland: The Health and Economic Consequences of Projected Obesity Trends in Ireland

Given the scale of the current obesity epidemic and associated health consequences there has been increasing concern about the economic burden placed on society in terms of direct healthcare costs and indirect societal costs. In the Republic of Ireland these costs were estimated at €1.13 billion for 2009. The total direct healthcare costs for six major obesity related conditions (coronary heart disease & stroke, cancer, hypertension, type 2 diabetes and knee osteoarthritis) in the same year were estimated at €2.55 billion. The aim of this research is to project disease burden and direct healthcare costs for these conditions in Ireland to 2030 using the established model developed by the Health Forum (UK) for the Foresight: Tackling Obesities project.

Trends in Water Quality within the Broward County Portion of the Biscayne Aquifer

Continuous and reliable monitoring of contaminants in drinking water, which adversely affect human health, is the main goal of the Broward County Well Field Protection Program. In this study the individual monitoring station locations were used in a yearly and quarterly spatiotemporal Ordinary Kriging interpolation to create a raster network of contaminant detections. In the final analysis, the raster spatiotemporal nitrate concentration trends were overlaid with a pollution vulnerability index to determine if the concentrations are influenced by a set of independent variables. The pollution vulnerability factors are depth to water, recharge, aquifer media, soil, impact to vadose zone, and conductivity. The creation of the nitrate raster dataset had an average RMS Standardized error close to 1 at 0.98. The greatest frequency of detections and the highest concentrations are found in the months of April, May, June, July, August, and September. An average of 76.4% of the nitrate intersected with cells of the pollution vulnerability index over 100.

Long-term Trends in Magnitude and Frequency of Extreme Rainfall Events in Florida

This study computed trends in extreme precipitation events of Florida for 1950-2010. Hourly aggregated rainfall data from 24 stations of the National Climatic Data Centre were analyzed to derive time-series of extreme rainfalls for 12 durations, ranging from 1 hour to 7 day. Non-parametric Mann-Kendall test and Theil-Sen Approach were applied to detect the significance of trends in annual maximum rainfalls, number of above threshold events and average magnitude of above threshold events for four common analysis periods. Trend Free Pre-Whitening (TFPW) approach was applied to remove the serial correlations and bootstrap resampling approach was used to detect the field significance of trends. The results for annual maximum rainfall revealed dominant increasing trends at the statistical significance level of 0.10, especially for hourly events in longer period and daily events in recent period. The number of above threshold events exhibited strong decreasing trends for hourly durations in all time periods.

New trends in food science: the use of nutraceuticals as an antiinflammatory therapeutic tool in exercise

Prolonged high-intensity training seems to result in increased systemic inflammation, which might explain muscle injury, delayed onset muscle soreness, and overtraining syndrome in athletes. Furthermore, an impaired immune function caused by strenuous exercise leads to the development of upper respiratory tract infections in athletes. Nutraceuticals might help counteract these performance-lowering effects. The use of nanotechnology is an interesting alternative to supply athletes with nutraceuticals, as many of these substances are insoluble in water and are poorly absorbed in the digestive tract. The present chapter starts with a brief review of the effects of exercise on immunity, followed by an analysis on how nutraceuticals such as omega-3 fatty acids, glutamine, BCAAs, or phytochemicals can counteract negative effects of strenuous exercise in athletes. Finally, how nanostructured delivery systems can constitute a new trend in enhancing bioavailability and optimizing the action of nutraceuticals will be discussed, using the example of food beverages.

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

Background: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings: We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

Background: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence - defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs - in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings: We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4-7·0) in 1980 to 9·0% (7·2-11·1) in 2014 in men, and from 5·0% (2·9-7·9) to 7·9% (6·4-9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3– 19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8– 144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

Trends in NE Atlantic landings (southern Portugal): identifying the relative importance of fisheries and environmental variables

Time series of commercial landings from the Algarve (southern Portugal) from 1982 to 1999 were analyzed using min/max autocorrelation factor analysis (MAFA) and dynamic factor analysis (DFA). These techniques were used to identify trends and explore the relationships between the response variables (annual landings of 12 species) and explanatory variables [sea surface temperature, rainfall, an upwelling index, Guadiana river (south-east Portugal) flow, the North Atlantic oscillation, the number of licensed fishing vessels and the number of commercial fishermen]. Landings were more highly correlated with non-lagged environmental variables and in particular with Guadiana river flow. Both techniques gave coherent results, with the most important trend being a steady decline over time. A DFA model with two explanatory variables (Guadiana river flow and number of fishermen) and three common trends (smoothing functions over time) gave good fits to 10 of the 12 species. Results of other models indicated that river flow is the more important explanatory variable in this model. Changes in the mean flow and discharge regime of the Guadiana river resulting from the construction of the Alqueva dam, completed in 2002, are therefore likely to have a significant and deleterious impact on Algarve fisheries landings.

Black carbon trends in southwestern Iberia in the context of the financial and economic crisis. The role of bioenergy.

Since black carbon concentrations are useful to reveal changes in anthropogenic activities, measurements taken from 2007 to 2015 in a Portuguese city are used to assess to which extent the ambient air was impacted by the economic crisis. The average black carbon concentrations are representative of an urban area of small size (1.3 ± 1.3 μg m−3). The highest concentrations are observed in the heating season, being biomass combustion one of the causes for the high values. The daily cycle of black carbon concentrations presents both morning and evening peaks, mainly due to road traffic and, in the heating season, to domestic heating as well. The yearly averaged black carbon mass concentrations decreased 33 % from 2007 to 2015, possibly due to a combination of the economic recession and environmental legislation. The reduction in road traffic led to a decrease in the daily morning peak from 2007 to 2015. This reduction was not followed by a decrease in the evening peak, explained by an increase in biomass burning. Biomass is the cheapest heating fuel in Portugal, and its consumption increased in the aftermath of the economic crisis. The use of bioenergy is an alternative to fossil fuels and presents many advantages. However, energy policies should discourage inefficient biomass burning and promote better ways of exploiting the available energy resources and emission air pollution mitigation strategies.

Opioid overdose mortality in Australia, 1964-1997: birth-cohort trends

Objective: To examine trends in rates of opioid overdose deaths from 1964 to 1997 in different birth cohorts. Design: Age-period-cohort analysis of national data from the Australian Bureau of Statistics. Main outcome measures: Annual population rates of death attributed to opioid dependence or accidental opioid poisoning in people aged 15-44 years, by sex and birth cohort tin five-year intervals, 1940-1944 to 1975-1979). Results: The rate of opioid overdose deaths increased 55-fold between 1964 and 1997, from 1.3 to 71.5 per million population aged 15-44 years. The rate of opioid overdose deaths also increased substantially over the eight birth cohorts, with an incidence rate ratio of 20.70 (95% confidence interval, 13.60-31.46) in the 1975-1979 cohort compared with the 1940-1944 cohort. The age at which the cumulative rate of opioid overdose deaths reached 300 per million fell in successive cohorts (for men, from 28 years among those born 1955-1959 to 22 years among those born 1965-1974; for women, from 33 years among those born 1955-1959 to 27 years among those born 1965-1969). Conclusions: Heroin use in Australia largely began in the early 1970s and rates of heroin use have markedly increased in birth cohorts born since 1950.