An assessment of the economic impact of climate change on the health sector In Jamaica

Climate change is a naturally occurring phenomenon in which the earth‘s climate goes through cycles of warming and cooling; these changes usually take place incrementally over millennia. Over the past century, there has been an anomalous increase in global temperature, giving rise to accelerated climate change. It is widely accepted that greenhouse gas emissions from human activities such as industries have contributed significantly to the increase in global temperatures. The existence and survival of all living organisms is predicated on the ability of the environment in which they live not only to provide conditions for their basic needs but also conditions suitable for growth and reproduction. Unabated climate change threatens the existence of biophysical and ecological systems on a planetary scale. The present study aims to examine the economic impact of climate change on health in Jamaica over the period 2011-2050. To this end, three disease conditions with known climate sensitivity and importance to Jamaican public health were modelled. These were: dengue fever, leptospirosis and gastroenteritis in children under age 5. Historical prevalence data on these diseases were obtained from the Ministry of Health Jamaica, the Caribbean Epidemiology Centre, the Climate Studies Group Mona, University of the West Indies Mona campus, and the Meteorological Service of Jamaica. Data obtained spanned a twelve-year period of 1995-2007. Monthly data were obtained for dengue and gastroenteritis, while for leptospirosis, the annual number of cases for 1995-2005 was utilized. The two SRES emission scenarios chosen were A2 and B2 using the European Centre Hamburg Model (ECHAM) global climate model to predict climate variables for these scenarios. A business as usual (BAU) scenario was developed using historical disease data for the period 2000-2009 (dengue fever and gastroenteritis) and 1995-2005 (leptospirosis) as the reference decades for the respective diseases. The BAU scenario examined the occurrence of the diseases in the absence of climate change. It assumed that the disease trend would remain unchanged over the projected period and the number of cases of disease for each decade would be the same as the reference decade. The model used in the present study utilized predictive empirical statistical modelling to extrapolate the climate/disease relationship in time, to estimate the number of climate change-related cases under future climate change scenarios. The study used a Poisson regression model that considered seasonality and lag effects to determine the best-fit model in relation to the diseases under consideration. Zhang and others (2008), in their review of climate change and the transmission of vector-borne diseases, found that: ―Besides climatic variables, few of them have included other factors that can affect the transmission of vector-borne disease….‖ (Zhang 2008) Water, sanitation and health expenditure are key determinants of health. In the draft of the second communication to IPCC, Jamaica noted the vulnerability of public health to climate change, including sanitation and access to water (MSJ/UNDP, 2009). Sanitation, which in its broadest context includes the removal of waste (excreta, solid, or other hazardous waste), is a predictor of vector-borne diseases (e.g. dengue fever), diarrhoeal diseases (such as gastroenteritis) and zoonoses (such as leptospirosis). In conceptualizing the model, an attempt was made to include non-climate predictors of these climate-sensitive diseases. The importance of sanitation and water access to the control of dengue, gastroenteritis and leptospirosis were included in the Poisson regression model. The Poisson regression model obtained was then used to predict the number of disease cases into the future (2011-2050) for each emission scenario. After projecting the number of cases, the cost associated with each scenario was calculated using four cost components. 1. Treatment cost morbidity estimate. The treatment cost for the number of cases was calculated using reference values found in the literature for each condition. The figures were derived from studies of the cost of treatment and represent ambulatory and non-fatal hospitalized care for dengue fever and gastroenteritis. Due to the paucity of published literature on the health care cost associated with leptospirosis, only the cost of diagnosis and antibiotic therapy were included in the calculation. 2. Mortality estimates. Mortality estimates are recorded as case fatality rates. Where local data were available, these were utilized. Where these were unavailable, appropriate reference values from the literature were used. 3. Productivity loss. Productivity loss was calculated using a human capital approach, by multiplying the expected number of productive days lost by the caregiver and/or the infected person, by GDP per capita per day (US$ 14) at 2008 GDP using 2008 US$ exchange rates. 4. No-option cost. The no-option cost refers to adaptation strategies for the control of dengue fever which are ongoing and already a part of the core functions of the Vector Control Division of the Ministry of Health, Jamaica. An estimated US$ 2.1 million is utilized each year in conducting activities to prevent the post-hurricane spread of vector borne diseases and diarrhoea. The cost includes public education, fogging, laboratory support, larvicidal activities and surveillance. This no-option cost was converted to per capita estimates, using population estimates for Jamaica up to 2050 obtained from the Statistical Institute of Jamaica (STATIN, 2006) and the assumption of one expected major hurricane per decade. During the decade 2000-2009, Jamaica had an average inflation of 10.4% (CIA Fact book, last updated May 2011). This average decadal inflation rate was applied to the no-option cost, which was inflated by 10% for each successive decade to adjust for changes in inflation over time.

Jamaica: Report of the macro socio-economic effects of the events in western Kingston area 22 May- 7 June 2010

.--I. Background.--II. The affected population.--III. Sectoral analysis of damage and loss.--IV. The macro socio economic effect of the event.--V. Conclusions and recommendations

Systemic analysis of the health sector through the input-output matrix, 2000-2005

This article provides a systemic analysis of the health sector in Brazil, based on a study of its productive structure and its interactions with the other sectors of the economy. The article draws on unpublished data on the National Health Accounts provided by the Brazilian Geographical and Statistical Institute (ibge); and it proposes a methodology for harmonizing the System of National Accounts (input-output matrix) with the Health Satellite Accounts for 2000 and 2005. This sheds light on the relations that exist between the health sector and the other sectors the economy, through input-output indicators.

Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study

Mortality among HIV-infected persons is decreasing, and causes of death are changing. Classification of deaths is hampered because of low autopsy rates, frequent deaths outside of hospitals, and shortcomings of International Statistical Classification of Diseases and Related Health Problems (ICD-10) coding.

Causes of death and determinants of outcome in critically ill patients

INTRODUCTION: Whereas most studies focus on laboratory and clinical research, little is known about the causes of death and risk factors for death in critically ill patients. METHODS: Three thousand seven hundred patients admitted to an adult intensive care unit (ICU) were prospectively evaluated. Study endpoints were to evaluate causes of death and risk factors for death in the ICU, in the hospital after discharge from ICU, and within one year after ICU admission. Causes of death in the ICU were defined according to standard ICU practice, whereas deaths in the hospital and at one year were defined and grouped according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) score. Stepwise logistic regression analyses were separately calculated to identify independent risk factors for death during the given time periods. RESULTS: Acute, refractory multiple organ dysfunction syndrome was the most frequent cause of death in the ICU (47%), and central nervous system failure (relative risk [RR] 16.07, 95% confidence interval [CI] 8.3 to 31.4, p < 0.001) and cardiovascular failure (RR 11.83, 95% CI 5.2 to 27.1, p < 0.001) were the two most important risk factors for death in the ICU. Malignant tumour disease and exacerbation of chronic cardiovascular disease were the most frequent causes of death in the hospital (31.3% and 19.4%, respectively) and at one year (33.2% and 16.1%, respectively). CONCLUSION: In this primarily surgical critically ill patient population, acute or chronic multiple organ dysfunction syndrome prevailed over single-organ failure or unexpected cardiac arrest as a cause of death in the ICU. Malignant tumour disease and chronic cardiovascular disease were the most important causes of death after ICU discharge.

Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study

Background: Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. Objective: This paper provides an overview of evidence-based interventions for adjustment disorders. Methods: We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. Results: Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. Conclusions: E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders.

Na 1 Nachlass Max Horkheimer, 50 - Korrespondenzen u.a. an die Firma A. L. Stamm & Co (p. I 23, 190-421)

9 Briefe und Beilage zwischen Alfred Sohn-Rethel und Max Horkheimer, 1936-1940 sowie Briefwechsel mit Joan M. Levi; 6 Briefe zwischen Joan M. Levi und Max Horkheimer, 1940; 1 Brief von Max Horkheimer an Assistac Westcent, 25.06.1937; 1 Brief von John MacMurray an Walter Adams, 19.05.1937; 1 Brief von Walter Adams an Theodor W. Adorno, 01.06.1937; 2 Briefe zwischen Charles Somlo & Co und Max Horkheimer, 06.06.1939, 12.09.139; 1 Brief von Martin Sommerfeld an Max Horkheimer, 29.05.1934; 3 Briefe von Josef Sondek an Max Horkheimer, 1937, 1942; 3 Briefe zwischen Elsa Sontheimer, Max Sontheimer und Max Horkheimer, Februar 1940, 07.03.1940; 1 Drucksache von der The Southard School an Max Horkheimer; 1 Brief von der Soziologischen Verlagsanstalt an Gertrud Janosi, 20.07.1931; 9 Briefe zwsichen Maurice J. Speiser und Max Horkheimer, 1936-1948; 2 Briefe zwischen de Spengler und Max Horkheimer, 30.11.1936, 27.01.1937; 5 Briefe zwischen Sterling D. Spero und Max Horkheimer, 1936-1937; 1 Lebenslauf von Herbert Spielberg; 1 Brief und 2 Beilagen von René A. Spitz an Max Horkheimer, 23.06.1938; 2 Briefe von Elsa Spriesterbach an Max Horkheimer, Juli 1949; 1 Brief von Ida M. Stadie an Max Horkheimer, 21.05.1937; 20 Rechnungen von A. L. Stamm & Co an Max Horkheimer, 1938-1939; 1 Brief von Rose Horkheimer an A. L. Stamm und Co, 28.09.1938; 1 Betriebsanleitung und 1 Auslieferugnsschein für Max Horkheimer vom Standard Air Conditioning, 03.03.1936; 1 Brief von Max Horkheimer an Standard Air Conditioning, 28.03.1936; 5 Briefe zwischen Taylor Starck und Max Horkheimer, 1943; 8 Briefe zwischen Hans Staudinger und Max Horkheimer, 1937, 1943; 1 Briefauszug und Beilage von Paul Stefan, 1940 sowie Briefwechsel mit Samuel R. Wachtell; 1 Brief von Samuel R. Wachtell an Gertrude Blitz, 23.10.1940; 3 Briefe zwischen Leo Löwenthal und Samuel R. Wachtell, September 1940, 23.10.1940; 1 Brief von Loe Löwenthal an Hermann Kesten, 01.10.1940; 7 Briefe und Beilage zwischen George Stefansky und Max Horkheimer, 1939-1940; 2 Briefe zwischen dem Refugee Section of the American Friends Service Committee und Max Horkheimer, 16.05.1940, 28.05.1940; 3 Briefe zwischen dem Institute of International Education und Max Horkheimer, 09.04.1940, April 1940; 1 Brief von Max Horkheimer an Friess, 01.03.1940; 1 Brief vom Institute of Sociology Malvern und Max Horkheimer, 31.01.1940; 3 Briefe zwischen Stein und Max Horkheimer, 30.11.1934, 1936, 1937; 7 Briefe von Estell A. Stein an Max Horkheimer, 1929, 1937; 1 Brief von Franz Stein an Max Horkheimer; 1 Brief von Friedrich Pollock an Gertrude R. Stein, 22.03.1939; 1 Brief von Leo Stein an Max Horkheimer, 25.07.1944; 1 Brief von Max Horkheimer an Emilia Steinacher, 20.07.1937; 4 Briefe zwischen Friedrich Steinfeld und Max Horkheimer, 1941, 1945; 1 Brief und Beilage von Eugene G. Steinhof an Max Horkheimer; 3 Briefe zwischen Ernst Steinitz und Max Horkheimer, 25.04.1938, April 1938; 2 Briefe zwischen Theodor Steltzer und Eric E. Warburg, 07.03.1948; 4 Brief zwischen Hermine Sterler und Max Horkheimer, 11.09.1939, 1939, 1941; 4 Briefe zwischen Alfred K. Stern und Max Horkheimer, 1938, 1940 sowie 1 Brief und 1 Beilage von Max Gottschalk; 1 Brief von Max Gottschalk an Max Horkheimer; 2 Briefe und 1 Beilage zwischen Erich Stern und Max Horkheimer, 26.02.1937, 17.03.1937; 2 Briefe und Beilage von Eugene I. Stern an Max Horkheimer, 1938; 2 Briefe zwischen Joseph M. Weidberg und Max Horkheimer, 15.07.1938, 29.07.1938; 1 Brief von Max Horkheimer an das Cooperative Bureau for Teachers, 03.02.1938; 12 Briefe zwischen Günther Stern und Max Horkheimer, 1936, 1938 sowie Briefwechsel mit John Guggenheim Memorial Foundation; 3 Briefe und 1 Beilage zwischen der John Simon Guggenheim Memorial Foundation und Max Horkheimer, 1937; 1 Brief vom Social Research Quarterly an Max Horkheimer, 03.01.1937; 3 Briefe zwischen Hugo Stern und Max Horkheimer, 06.12.1937, Dezember 1937;