Role of smoking in global and regional cardiovascular mortality

Background - Smoking is a major cause of cardiovascular disease mortality. There is little information on how it contributes to global and regional cause-specific mortality from cardiovascular diseases for which background risk varies because of other risks. Method and Results - We used data from the American Cancer Society's Cancer Prevention Study II (CPS II) and the World Health Organization Global Burden of Disease mortality database to estimate smoking-attributable deaths from ischemic heart disease, cerebrovascular disease, and a cluster of other cardiovascular diseases for 14 epidemiological subregions of the world by age and sex. We used lung cancer mortality as an indirect marker for accumulated smoking hazard. CPS-II hazards were adjusted for important covariates. In the year 2000, an estimated 1.62 (95% CI, 1.27 to 2.04) million cardiovascular deaths in the world, 11% of total global cardiovascular deaths, were due to smoking. Of these, 1.17 million deaths were among men and 450 000 among women. There were 670 000 (95% CI, 440 000 to 920 000) smoking-attributable cardiovascular deaths in the developing world and 960 000 (95% CI, 770 000 to 1 200 000) in industrialized regions. Ischemic heart disease accounted for 54% of smoking-attributable cardiovascular mortality, followed by cerebrovascular disease (25%). There was variability across regions in the role of smoking as a cause of various cardiovascular diseases. Conclusions - More than 1 in every 10 cardiovascular deaths in the world in the year 2000 were attributable to smoking, demonstrating that it is an important preventable cause of cardiovascular mortality.

The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: Developing the evidence base for national, regional and global public health action

Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years) which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates for 2000, but substantial uncertainty around the disease burden caused by major conditions, including, HIV, remains. The rapid implementation of cost-effective data collection systems in developing countries is a key priority if global public policy to promote health is to be more effectively informed.

Quality-of-life in children and adolescents with cystic fibrosis managed in both regional outreach and cystic fibrosis center settings in Queensland

To assess the health-related quality-of-life (HRQOL) of children/adolescents with cystic fibrosis (CF) and compare HRQOL in children managed by cystic fibrosis outreach service (CFOS) with those treated in a cystic fibrosis center (CFC). To compare HRQOL of children with CF in Queensland with previously published HRQOL data from the United States and examine the relationship between HRQOL scores and pulmonary function. Study design: Participants were children/adolescents with CF and their parents managed by the Royal Children’s Hospital Queensland at a CFC or CFOS. Two HRQOL surveys were used: PedsQL™ and Cystic Fibrosis Questionnaire (CFQ). Results: There were 91 CFC and 71 CFOS participants with similar demographics. PedsQL™ total summary score was statistically higher in CFOS, P = .05. There was no significant difference in CFQ scores between groups. Queensland parents reported lower HRQOL for their children compared with US parents (P

Regional patterns of agricultural land use and deforestation in Colombia

An expanding human population and associated demands for goods and services continues to exert an increasing pressure on ecological systems. Although the rate of expansion of agricultural lands has slowed since 1960, rapid deforestation still occurs in many tropical countries, including Colombia. However, the location and extent of deforestation and associated ecological impacts within tropical countries is often not well known. The primary aim of this study was to obtain an understanding of the spatial patterns of forest conversion for agricultural land uses in Colombia. We modeled native forest conversion in Colombia at regional and national-levels using logistic regression and classification trees. We investigated the impact of ignoring the regional variability of model parameters, and identified biophysical and socioeconomic factors that best explain the current spatial pattern and inter-regional variation in forest cover. We validated our predictions for the Amazon region using MODIS satellite imagery. The regional-level classification tree that accounted for regional heterogeneity had the greatest discrimination ability. Factors related to accessibility (distance to roads and towns) were related to the presence of forest cover, although this relationship varied regionally. In order to identify areas with a high risk of deforestation, we used predictions from the best model, refined by areas with rural population growth rates of > 2%. We ranked forest ecosystem types in terms of levels of threat of conversion. Our results provide useful inputs to planning for biodiversity conservation in Colombia, by identifying areas and ecosystem types that are vulnerable to deforestation. Several of the predicted deforestation hotspots coincide with areas that are outstanding in terms of biodiversity value.

Transient temperature rise in a mouse due to low-frequency regional hyperthermia

A refined nonlinear heat transfer model of a mouse has been developed to simulate the transient temperature rise in a neoplastic tumour and neighbouring tissue during regional hyperthermia using a 150 kHz inductive coil. In this study, we incorporate various bio-energetic enhancements to the heat transfer equation and numerical validations based on experimental findings for the mouse, in terms of nonlinear metabolic heat production, homeothermy, blood perfusion parameters, thermoregulation, psychological and physiological effects. The discretized bio-heat transfer equation has been validated with the commercial software FEMLAB on a canonical multi-sphere object before applying the scheme to the inhomogeneous mouse voxel phantom. The time-dependent numerical results of regional hyperthermia of mouse thigh have been compared with the available experimental temperature results with only a few small disparities. During the first 20 min of local unfocused heating, the temperature in the tumour and the surrounding tissue increased by around 7.5 degrees C. The objective of this preliminary study was to develop a validated electrothermal numerical scheme for inductive hyperthermia of a small mammal with the intention of expanding the model into a complete numerical solution involving ferromagnetic nanoparticles for targeted heating of tumours at low frequencies. In addition, the numerical scheme herein could assist in optimizing and tailoring of focused electromagnetic fields for hyperthermia.

Effects of care pathways on stroke care practices at regional hospitals

Background: Our previous work identified deficiencies in stroke care practices at regional hospitals in comparison to standards suggested by published stroke care guidelines. These deficiencies might be improved by the implementation of clinical pathways. The aim of this study was to assess changes in acute stroke care practices following the implementation of stroke care pathways at four regional Queensland hospitals. Methods: The medical records of two cohorts of 120 patients with a discharge diagnosis of stroke or transient ischaemic attack were retrospectively audited before and after implementation of stroke care pathways to identify differences in the use of acute interventions, investigations and secondary prevention strategies. Results: Following pathway implementation there were clinically important, but not statistically significant, increases in the rates of swallow assessment, allied health assessment (significant for occupational therapy, P = 0.04) and use of deep vein thrombosis prevention strategies (also significant, P = 0.006). Fewer patients were discharged on no anti-thrombotic therapy (statistically significant in the subgroup of patients with atrial fibrillation, P = 0.02). Only 37% of the patients audited were actually enrolled on the pathway. Among this subgroup there were significant increases in the rates of swallow assessment (first 24 h, P = 0.01; any time during admission, P = 0.0001), allied health assessments (all P < 0.05), estimation of blood glucose level (P = 0.0015) and the use of deep vein thrombosis prevention strategies (P = 0.0003). Conclusion: Stroke care pathways appear to improve the process of care. Whether this influences outcomes such as mortality, functional and neurological recovery, the incidence of complications, length of stay or the cost of care was beyond the scope of this study and will require further examination.

Cattle, crops and clearing: Regional drivers of landscape change in the Brigalow Belt, Queensland, Australia, 1840-2004

Landscape change occurs through the interaction of a multitude of natural and human driving forces at a range of organisational levels, with humans playing an increasingly dominant role in many regions of the world. Building on the current knowledge of the underlying drivers of landscape change, a conceptual framework of regional landscape change was developed which integrated population, economic and cultural values, policy and science/technology. Using the Southern Brigalow Belt biogeographic region of Queensland as a case study, the role of natural and human drivers in landscape change was investigated in four phases of settlement since 1840. The Brigalow Belt has experienced comparable rates of vegetation clearance over the past 50 years to areas of tropical deforestation. Economic factors were important during all phases of development, but the five regional drivers often acted in synergy. Environmental constraints played a significant role in slowing rates of change. Temporal trends of deforestation followed a sigmoidal curve, with initial slow change accelerating though the middle phases then slowing in recent times. Future landscape management needs to take account of the influence of all the components of the conceptual framework, at a range of organisational levels, if more ecologically sustainable outcomes are to be achieved. (c) 2006 Elsevier B.V. All rights reserved.

Assessing the Conservation Status and Threats to Priority Plants: a threat assessment approach and case study in South-East Queensland, Australia

bstract: During the Regional Forest Agreement (RFA) process in south-east Queensland, the conservation status of, and threats to, priority vascular plant taxa in the region was assessed. Characteristics of biology, demography and distribution were used to assess the species' intrinsic risk of extinction. In contrast, the threats to the taxa (their extrinsic risk of extinction) were assessed using a decision-support protocol for setting conservation targets for taxa lacking population viability analyses and habitat modelling data. Disturbance processes known or suspected to be adversely affecting the taxa were evaluated for their intensity, extent and time-scale. Expert opinion was used to provide much of the data and to assess the recommended protection areas. Five categories of intrinsic risk of extinction were recognised for the 105 priority taxa: critically endangered (43 taxa); endangered (29); vulnerable (21); rare (10); and presumed extinct (2). Only 6 of the 103 extant taxa were found to be adequately reserved and the majority were considered inadequately protected to survive the current regimes of threatening processes affecting them. Data were insufficient to calculate a protection target for one extant taxon. Over half of the taxa require all populations to be conserved as well as active management to alleviate threatening processes. The most common threats to particular taxa were competition from weeds or native species, inappropriate fire regimes, agricultural clearing, forestry, grazing by native or feral species, drought, urban development, illegal collection of plants, and altered hydrology. Apart from drought and competition from native species, these disturbances are largely influenced or initiated by human actions. Therefore, as well as increased protection of most of the taxa, active management interventions are necessary to reduce the effects of threatening processes and to enable the persistence of the taxa.

The network structure of a regional tourism organization: Application of he social network theory in one region of Queensland

Regional tourism organizations (RTOs) plays a central role in planning, coordinating and marketing tourism in many areas, including Queensland, Australia. RTOs rely on interaction with a network of other organizations for their efficient functioning. This paper describes an exploratory case study that develops a method for use of social network analysis techniques to analyse the inter-organizational network in one RTO region in Queensland. Results indicate that differences exist in the structure of inter-organizational links between commercial tourism organizations and planning organizations, between tourism organizations and other sectoral clusters, and between organizations at local, regional and state levels. The results highlight areas or improvement in the role and responsibilities of RTOs in Queensland.

A comparison of telepaediatric activity at two regional hospitals in Queensland

We conducted a 15-month feasibility study of telepaediatrics. A novel service was offered to two hospitals in Queensland (Mackay and Hervey Bay). We used data from all other hospitals throughout the state as the control group. Although both intervention hospitals were provided with the same service, the telepaediatric activity generated and the effect on admissions and outpatient activity were markedly different. There was a significant decrease in the number of patient admissions to Brisbane from the Mackay region. In addition, there was an increase in the number of Mackay patients treated locally (as outpatients). In contrast, little change was observed in Hervey Bay. We assessed whether the observed differences between the two hospitals were due to various factors which influenced the use of the telepaediatric service. These factors included the method of screening patients before transfer to the tertiary centre and the physical distance between each facility and the tertiary centre. We believe that the screening method used for patient referrals was the most important determinant of the use of the telepaediatric service.

ALIANÇA ESTRATÉGICA INTERSETORIAL: UM ESTUDO DE CASO DO FÓRUM PERMAMENTE DE DESENVOLVIMENTO REGIONAL DE PARANAVAÍ-PR

As alianças estratégicas intersetoriais, o desenvolvimento regional e descentralização do Estado são foco de estudo nessa dissertação. A descentralização do Estado através da participação da sociedade em decisões regionalizadas tem mudado a forma de gestão e formado identidades únicas a cada grupo regional. O objetivo principal do estudo foi o de conhecer as alianças estratégicas formadas entre os setores da economia de Paranavaí/PR e região noroeste do Paraná, formada por 28 municípios, com a participação de representantes de cada cidade e setor participam das reuniões e decisões tomadas pelo Fórum de Desenvolvimento. Pretende-se, ainda, identificar os motivadores da formação do Fórum de Desenvolvimento e relatar sua importância nas empresas, sociedade e Estado. Através de um roteiro de entrevista semiestruturada foi possível identificar a efetividade das alianças estratégicas e os problemas que devem ser corrigidos. Por meio de uma análise documental é possível comprovar as ações e resultados atingidos pelo Fórum de Desenvolvimento. Trata-se de uma pesquisa qualitativa exploratória e descritiva O trabalho busca contribuir para a gestão do desenvolvimento regional e o crescimento dos setores na localidade, além de ampliação do diálogo sobre o tema.

A Cultura Caiçara do Litoral Norte Paulista mostrada na revista Beach&Co Estereótipos do caiçara das cidades de Caraguatatuba, São Sebastião, Ubatuba e Ilhabela em um veículo regional impresso

Estudo dos estereótipos que a revista regional Beach&Co fez do caiçara - povo nativo que mantém uma cultura relacionada ao mar e a mata nas cidades de Caraguatatuba, São Sebastião, Ubatuba e Ilhabela, no Litoral Norte Paulista. Aplicou-se uma metodologia de caráter híbrido que mesclou os Estudos Culturais com base nas obras de Douglas Kellner, Stuart Hall e Raymond Williams com a Análise de Discurso nas obras de Dominique Maingueneau, Eni Orlandi, Patrick Charaudeau e Audre Alberguine. Também foram resgatados os estudos da Cultura Caiçara feitos por Carlos Diegues, Gioconda Mussolini, Emilio Willems, e por fim redefiniu-se o gênero jornalístico Reportagem e contextualizou-se o Jornalismo Regional de Revista. Posteriormente, analisou-se a primeira década da revista Beach&Co, totalizando 120 edições publicadas de janeiro de 2002 a junho de 2012, no qual foram mostradas as diversas abordagens que a publicação fez do caiçara, bem como a evolução da própria revista nos aspectos editoriais, comercial e de design gráfico. Em seguida, selecionou-se 23 reportagens nas editorias de turismo, gastronomia, esportes e outras relacionadas à Cultura Caiçara, que tiveram seus discursos semânticos e os elementos valorativos de linguagens analisados. Nas conclusões, constatou-se que a cobertura jornalística da Beach&Co privilegia as áreas do turismo e do desenvolvimento do Litoral Norte e Baixada Santista; que a revista passou por readaptações e esquematismos dominantes na produção jornalística e encontrou mercado nas especificidades do Litoral Paulista; a Beach&Co se consolidou como uma revista regional profissional, de qualidade e criativa, distante do amadorismo, do bairrismo e da mimetização simplista; apesar de muitas vezes ter usado o caiçara para adjetivar os aspectos turísticos e gastronômicos do Litoral Norte, a revista trabalhou a produção simbólica do caiçara de forma ampla e retratou vários aspectos da Cultura Caiçara, reforçando o poder desta revista regional, como retroalimentando os sotaques do Litoral Paulista nas demais regiões do país onde a publicação também é lida.

O ADOLESCENTE E A TELEVISÃO REGIONAL: estudo da audiência do programa Em Movimento

Trata-se de um estudo de audiência do programa de televisão Em Movimento. Este é um programa regional produzido e exibido pela TV Gazeta, afiliada da Rede Globo, que tem como público-alvo os adolescentes. O objetivo consiste em compreender o conjunto de motivações que leva o adolescente capixaba a assistir ao programa. Também foi interesse deste estudo investigar quais os usos que os adolescentes fazem do conteúdo apresentado no programa e quais as gratificações que o mesmo traz aos adolescentes. Essa investigação teve como referencial teórico os conceitos sobre comunicação regional e a perspectiva dos usos e gratificações. A técnica utilizada para a coleta de dados foi a discussão em grupo, que consistiu na formação de grupos de adolescentes na faixa etária entre 15 e 18 anos para discussão do tema. Conclui-se que os adolescentes têm como principais motivações para assistir ao Em Movimento a vontade de aprender sobre si e sobre o ambiente em que vivem, confirmar conceitos já pré-estabelecidos por eles mesmos e ainda se sentirem próximos à realidade retratada no programa.