Demographic trends and social equity: challenges for the health sector

Includes bibliography

Demographic trends and social equity: challenges facing the health sector

Includes bibliography

Migration, labor and business in the worlding cities of the Arabian Peninsula

This short essay, built on a foundation of more than a decade of fieldwork in the hydrocarbon-rich societies of the Arabian peninsula, distills a set of overarching threads woven through much of that time and work. Those threads include a discussion of the social heterogeneity of the Gulf State citizenries, the central role of development and urban development in these emergent economies, the multifaceted impact of migrants and migration upon these host societies, and the role of foreign 'imagineers' in the portrayal of Gulf societies, Gulf values, and Gulf social norms.

Traffic safety trends and forecasts.

Mode of access: Internet.

Traffic safety trends and forecasts.

Mode of access: Internet.

Demographic trends and drug abuse, 1980-1995 /

Mode of access: Internet.

Demographic change and recent worktrip travel trends /

"February 1985."

Demographic trends in suicide in the UK and Ireland 1980 - 2010.

Background Ireland has the 17th highest suicide rate in the EU and the 4th highest among 15 to 24-year-old males (WHO 2012). Suicide is the leading cause of death in this age group; death by hanging accounted for 69 % of suicides in 2010. Methods This study examines youth suicide rates from 1980 to 2010 in Ireland and compares them to the rates in Northern Ireland, Scotland, England and Wales. Irish data were obtained from the Central Statistics Office and their annual reports on Vital Statistics. Northern Irish data were obtained from the Northern Ireland Statistics and Research Agency website; Scottish data were from the General Register Office for Scotland and English/Welsh data from the Office for National Statistics website. Results There has been a threefold increase in young male suicide in Ireland over the past three decades (8.9 - 29.7 per 100,000). In contrast, there has been approximately a threefold reduction in deaths by road traffic accidents in young men in the same period (42.7 - 16.2 per 100,000). Suicide rates in young men are similar in Scotland and Northern Ireland for the same period but are 50 % lower in England and Wales. Despite the rates of hanging as a method of suicide increasing in all jurisdictions, the overall rate in England and Wales has continued to decline. Conclusion The suicide rate in Ireland remains very high and strategies to address this are urgently required. Our study indicates that national suicide prevention strategies can be effective.

Lower extremity amputation in people with diabetes: Trends and determinants

Introduction: The prevalence of diabetes is rising rapidly. Assessing quality of diabetes care is difficult. Lower Extremity Amputation (LEA) is recognised as a marker of the quality of diabetes care. The focus of this thesis was first to describe the trends in LEA rates in people with and without diabetes in the Republic of Ireland (RoI) in recent years and then, to explore the determinants of LEA in people with diabetes. While clinical and socio-demographic determinants have been well-established, the role of service-related factors has been less well-explored. Methods: Using hospital discharge data, trends in LEA rates in people with and without diabetes were described and compared to other countries. Background work included concordance studies exploring the reliability of hospital discharge data for recording LEA and diabetes and estimation of diabetes prevalence rates in the RoI from a nationally representative study (SLAN 2007). To explore determinants, a systematic review and meta-analysis assessed the effect of contact with a podiatrist on the outcome of LEA in people with diabetes. Finally, a case-control study using hospital discharge data explored determinants of LEA in people with diabetes with a particular focus on the timing of access to secondary healthcare services as a risk factor. Results: There are high levels of agreement between hospital discharge data and medical records for LEA and diabetes. Thus, hospital discharge data was deemed sufficiently reliable for use in this PhD thesis. A decrease in major diabetes-related LEA rates in people with diabetes was observed in the RoI from 2005-2012. In 2012, the relative risk of a person with diabetes undergoing a major LEA was 6.2 times (95% CI 4.8-8.1) that of a person without diabetes. Based on the systematic review and meta-analysis, contact with a podiatrist did not significantly affect the relative risk (RR) of LEA in people with diabetes. Results from the case-control study identified being single, documented CKD and documented hypertension as significant risk factors for LEA in people with diabetes whilst documented retinopathy was protective. Within the seven year time window included in the study, no association was detected between LEA in patients with diabetes and timing of patient access to secondary healthcare for diabetes management. Discussion: Many countries have reported reduced major LEA rates in people with diabetes coinciding with improved organisation of healthcare systems. Reassuringly, these first national estimates in people with diabetes in the RoI from 2005 to 2012 demonstrated reducing trends in major LEA rates. This may be attributable to changes in diabetes care and also, secular trends in smoking, dyslipidaemia and hypertension. Consistent with international practice, LEA trends data in Ireland can be used to monitor quality of care. Quantifying this improvement precisely, though, is problematic without robust denominator data on the prevalence of diabetes. However, a reduction in major diabetes-related LEA rates suggests improved quality of diabetes care. Much controversy exists around the reliability of hospital discharge data in the RoI. This thesis includes the first multi-site study to explore this issue and found hospital discharge data reliable for the reporting of the procedure of LEA and diagnosis of diabetes. This project did not detect protective effects of access to services including podiatry and secondary healthcare for LEA in people with diabetes. A major limitation of the systematic review and meta-analysis was the design and quality of the included studies. The data available in the area of effect of contact with a podiatrist on LEA risk are too sparse to say anything definitive about the efficacy of podiatry on LEA. Limitations of the case-control study include lack of a diabetes register in Ireland, restricted information from secondary healthcare and lack of data available from primary healthcare. Due to these issues, duration of disease could not be accounted for in the study which limits the conclusions that can be drawn from the results. The model of diabetes care in the RoI is currently undergoing a re-configuration with plans to introduce integrated care. In the future, trends in LEA rates should be continuously monitored to evaluate the effectiveness of changes to the healthcare system. Efforts are already underway to improve the availability of routine data from primary healthcare with the recent development of the iPCRN (Irish Primary Care Research Network). Linkage of primary and secondary healthcare records with a unique patient identifier should be the goal for the future.

Trends and Determinants of Work-Retirement Transitions under Changing Institutional Conditions: Germany, England and Japan compared

Many governments world-wide are promoting longer working life due to the social and economic repercussions of demographic change. However, not all workers are equally able to extend their employment careers. Thus, while national policies raise the overall level of labour market participation, they might create new social and labour market inequalities. This paper explores how institutional differences in the United Kingdom, Germany and Japan affect individual retirement decisions on the aggregate level, and variations in individuals’ degree of choice within and across countries. We investigate which groups of workers are disproportionately at risk of being ‘pushed’ out of employment, and how such inequalities have changed over time. We use comparable national longitudinal survey datasets focusing on the older population in England, Germany and Japan. Results point to cross-national differences in retirement transitions. Retirement transitions in Germany have occurred at an earlier age than in England and Japan. In Japan, the incidence of involuntary retirement is the lowest, reflecting an institutional context prescribing that employers provide employment until pension age, while Germany and England display substantial proportions of involuntary exits triggered by organisational-level redundancies, persistent early retirement plans or individual ill-health.

A global blended tropopause based on ERA data, Part II: trends and tropical broadening

A new tropopause definition involving a flow-dependent blending of the traditional thermal tropopause with one based on potential vorticity has been developed and applied to the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalyses (ERA), ERA-40 and ERA-Interim. Global and regional trends in tropopause characteristics for annual and solsticial seasonal means are presented here, with emphasis on significant results for the newer ERA-Interim data for 1989-2007. The global-mean tropopause is rising at a rate of 47 m decade−1 , with pressure falling at 1.0 hPa decade−1 , and temperature falling at 0.18 K decade−1 . The Antarctic tropopause shows decreasing heights,warming,and increasing westerly winds. The Arctic tropopause also shows a warming, but with decreasing westerly winds. In the tropics the trends are small, but at the latitudes of the sub-tropical jets they are almost double the global values. It is found that these changes are mainly concentrated in the eastern hemisphere. Previous and new metrics for the rate of broadening of the tropics, based on both height and wind, give trends in the range 0.9◦ decade−1 to 2.2◦ decade−1 . For ERA-40 the global height and pressure trends for the period 1979-2001 are similar: 39 m decade−1 and -0.8 hPa decade−1. These values are smaller than those found from the thermal tropopause definition with this data set, as was used in most previous studies.

Determining trends and environmental drivers from long-term marine mammal and seabird data : examples from Southern Australia

Climate change is acknowledged as an emerging threat for top-order marine predators, yet obtaining evidence of impacts is often difficult. In south-eastern Australia, a marine global warming hotspot, evidence suggests that climate change will profoundly affect pinnipeds and seabirds. Long-term data series are available to assess some species' responses to climate. Researchers have measured a variety of chronological and population variables, such as laying dates, chick or pup production, colony-specific abundance and breeding success. Here, we consider the challenges in accurately assessing trends in marine predator data, using long-term data series that were originally collected for other purposes, and how these may be driven by environmental change and variability. In the past, many studies of temporal changes and environmental drivers used linear analyses and we demonstrate the (theoretical) relationship between the magnitude of a trend, its variability, and the duration of a data series required to detect a linear trend. However, species may respond to environmental change in a nonlinear manner and, based on analysis of time-series from south-eastern Australia, it appears that the assumptions of a linear model are often violated, particularly for measures of population size. The commonly measured demographic variables exhibit different degrees of variation, which influences the ability to detect climate signals. Due to their generally lower year-to-year variability, we illustrate that monitoring of variables such as mass and breeding chronology should allow detection of temporal trends earlier in a monitoring programme than observations of breeding success and population size. Thus, establishing temporal changes with respect to climate change from a monitoring programme over a relatively short time period requires careful a priori choice of biological variables. © 2014 Springer-Verlag Berlin Heidelberg.

Obesity Trends and Body Mass Index Changes After Starting Antiretroviral Treatment: The Swiss HIV Cohort Study

BACKGROUND The factors that contribute to increasing obesity rates in human immunodeficiency virus (HIV)-positive persons and to body mass index (BMI) increase that typically occurs after starting antiretroviral therapy (ART) are incompletely characterized. METHODS We describe BMI trends in the entire Swiss HIV Cohort Study (SHCS) population and investigate the effects of demographics, HIV-related factors, and ART on BMI change in participants with data available before and 4 years after first starting ART. RESULTS In the SHCS, overweight/obesity prevalence increased from 13% in 1990 (n = 1641) to 38% in 2012 (n = 8150). In the participants starting ART (n = 1601), mean BMI increase was 0.92 kg/m(2) per year (95% confidence interval, .83-1.0) during year 0-1 and 0.31 kg/m(2) per year (0.29-0.34) during years 1-4. In multivariable analyses, annualized BMI change during year 0-1 was associated with older age (0.15 [0.06-0.24] kg/m(2)) and CD4 nadir <199 cells/µL compared to nadir >350 (P < .001). Annualized BMI change during years 1-4 was associated with CD4 nadir <100 cells/µL compared to nadir >350 (P = .001) and black compared to white ethnicity (0.28 [0.16-0.37] kg/m(2)). Individual ART combinations differed little in their contribution to BMI change. CONCLUSIONS Increasing obesity rates in the SHCS over time occurred at the same time as aging of the SHCS population, demographic changes, earlier ART start, and increasingly widespread ART coverage. Body mass index increase after ART start was typically biphasic, the BMI increase in year 0-1 being as large as the increase in years 1-4 combined. The effect of ART regimen on BMI change was limited.