Neighbourhood sociodemographic factors and COVID-19 vaccine uptake in the Netherlands: an ecological analysis.

BACKGROUND: While overall COVID-19 vaccine uptake is high in the Netherlands, it lags behind in certain subpopulations. AIM: We aimed to explore the characteristics of groups with lower COVID-19 vaccine uptake at neighbourhood level to inform the strategy to improve uptake and guide research into barriers for vaccination. METHODS: We performed an ecological study using national vaccination register and socio-demographic data at neighbourhood level. Using univariate and multivariable generalized additive models we examined the (potentially non-linear) effect of each determinant on uptake. We focused on those aged 50 years and older, since they are at highest risk of severe disease. RESULTS: In those over 50 years of age, a higher proportion of individuals with a non-Western migration background and higher voting proportions for right-wing Christian and conservative political parties were at neighbourhood level univariately associated with lower COVID-19 vaccine uptake. In contrast, higher socioeconomic status and higher voting proportions for right-wing liberal, progressive liberal and Christian middle political parties were associated with higher uptake. Multivariable results differed from univariate results in that a higher voting proportion for progressive left-wing political parties was also associated with higher uptake. In addition, with regard to migration background only a Turkish background remained significant. CONCLUSION: We identified determinants associated with COVID-19 vaccine uptake at neighbourhood level and observed heterogeneity in uptake between different subpopulations. Since the goal of vaccination is not only to reduce suffering and death by improving the average uptake, but also to reduce health inequity, it is important to focus on subpopulations with lower uptake.

The pervasive association between political ideology and COVID-19 vaccine uptake in Brazil: an ecologic study.

BACKGROUND: Despite the unequivocal benefits of vaccination, vaccine coverage has been falling in several countries in the past few years. Studies suggest that vaccine hesitancy is an increasingly significant phenomenon affecting adherence to vaccines. More recently, during the COVID-19 pandemic, political views have emerged as an additional influencing factor for vaccine hesitancy. METHODS: In this ecologic study, we used information from publicly available databases to investigate the association between political ideology, depicted by the percentage of votes for the right-wing candidate Jair Bolsonaro in the presidential elections of 2018 and 2022, and COVID-19 vaccination in Brazilian municipalities. The primary endpoint was the COVID-19 vaccination index, calculated as the number of COVID-19 vaccine doses administered up to September 2022 divided by the number of inhabitants in each municipality. The analysis was conducted using Pearson correlation coefficients and linear regression models adjusted for HDI, the percentage of male voters, the percentage of voters who were older than 50 years old, and the percentage of voters with a middle school education or less. In addition, we explored whether the effect of the percentage of Bolsonaro voters on the COVID-19 vaccination index was modified in different quartiles of HDI using an interaction term. RESULTS: Five thousand five hundred sixty-three Brazilian municipalities were included in the analysis. For both the 2018 and 2022 elections, the percentage of votes for Jair Bolsonaro was significantly and inversely associated with COVID-19 vaccine uptake after adjustment for the sociodemographic characteristics of the voters (change in mean vaccination index in 2018 for each 1% increase in Bolsonaro voters -0.11, 95% confidence interval [CI] -0.13 to -0.08, p < 0.001; change in mean vaccination index in 2022 for each 1% increase in Bolsonaro voters -0.09, 95% CI -0.11 to -0.07, p < 0.001). We also found a statistically significant interaction between the primary predictor of interest and HDI scores, with a more significantly detrimental effect of the right-wing political stance in municipalities in the lower HDI quartiles (interaction p < 0.001 for the first HDI quartile; p = 0.001 for the second HDI quartile). CONCLUSION: Our findings suggest that political ideologies have influenced COVID-19 vaccine hesitancy in Brazilian municipalities, affecting communities inequitably. The politicization of vaccines is a new challenge for vaccine programs. Strategies to face these challenges should include joint efforts from governments and civil society for a common public health goal.

Political factors, entrepreneurship and female employment vulnerability in sub-Saharan Africa.

This study examines the relationship between political factors, entrepreneurship, and female employment vulnerability in sub-Saharan Africa. Using data from the World Development Indicators (WDI) and World Governance Indicators (WGI) of the World Bank for the period 2001 - 2022, the study employs the Generalised Method of Moments to control for endogeneity. The results show that there exists an elastic relationship between voice and accountability and female vulnerability to employment in these sub-regions. It implies that a percentage increase in voice and accountability will result in a 11.9%, 3.07%, 1.08% decrease in female vulnerability to employment in Central, East, West and Southern Africa, respectively. These findings suggest that improving political institutions and reducing corruption could help to promote female entrepreneurship and reduce vulnerability in Sub-Saharan Africa.

Cette étude examine la relation entre les facteurs politiques, l'entrepreneuriat et la vulnérabilité de l'emploi des femmes en Afrique subsaharienne. Utilisant les données des Indicateurs de développement dans le monde (WDI) et des Indicateurs de gouvernance mondiale (WGI) de la Banque mondiale pour la période 2001-2022, l'étude utilise la méthode généralisée des moments pour contrôler l'endogénéité. Les résultats montrent qu'il existe une relation élastique entre la voix et la responsabilité et la vulnérabilité des femmes à l'emploi dans ces sous-régions. Cela implique qu'une augmentation en pourcentage de la voix et de la responsabilité entraînera une diminution de 11,9 %, 3,07 % et 1,08 % de la vulnérabilité des femmes à l'emploi en Afrique centrale, orientale, occidentale et australe, respectivement. Ces résultats suggèrent que l'amélioration des institutions politiques et la réduction de la corruption pourraient contribuer à promouvoir l'entrepreneuriat féminin et à réduire la vulnérabilité en Afrique subsaharienne.

[ROWING AGAINST THE CURRENT]. / REMANDO A CONTRACORRIENTE.

At Lalonde we know that the determinants that most influence the health of the population are lifestyle, genetics and the environment. Health represents only 10% and is the determinant that consumes the most resources. It has been shown that a salutogenic approach focused on the social determinants of health and the support of public policies to improve the environment are more efficient in the long term than medicine focused on hospitals, technology and super-specialization. Primary Care (PC) that has an approach centered on the person and families with a community vision, is the ideal level to provide health care, and to influence lifestyles. However it is not invested in PC. In this article we review the socioeconomic and political factors that globally influence the lack of interest in the development of PC.

Introducing modern technology to promote transparency in health services.

PURPOSE: Quantitative indicators show that Bangladeshi maternal and child healthcare is progressing satisfactorily. However, healthcare quality is still inadequate. It is hypothesised that modern technology enhances healthcare quality. Therefore, the purpose of this paper is to investigate how modern technology such as electronic record keeping and the internet can contribute to enhancing Bangladeshi healthcare quality. This study also explores how socio-economic and political factors affect the healthcare quality. DESIGN/METHODOLOGY/APPROACH: This paper is based on a qualitative case study involving 68 in-depth interviews with healthcare professionals, elected representatives, local informants and five focus group discussions with healthcare service users to understand technology's effect on health service quality. The study has been conducted in one rural and one urban service organisations to understand how various factors contribute differently to healthcare quality. FINDINGS: The findings show that modern technology, such as the internet and electronic devices for record keeping, contribute significantly to enhancing health service transparency, which in turn leads to quality health and family planning services. The findings also show that information and communication technology (ICT) is an effective mechanism for reducing corruption and promoting transparency. However, resource constraints impact adversely on the introduction of technology, which leads to less transparent healthcare. Progress in education and general socio-economic conditions makes it suitable to enhance ICT usage, which could lead to healthcare transparency, but political and bureaucratic factors pose a major challenge to ensure transparency. PRACTICAL IMPLICATIONS: This paper can be a useful guide for promoting governance and healthcare quality in developing countries including Bangladesh. It analyses the ICT challenges that healthcare staff face when promoting transparent healthcare. ORIGINALITY/VALUE: This paper provides a deeper understanding of transparency and healthcare quality in an ICT context using empirical data, which has not been explored in Bangladesh. This critical thinking is useful for policy makers and healthcare practitioners for promoting health service quality.

Factors affecting major depression in Iran: a mixed-method study.

Depression is a major cause of disability and, if left untreated, can increase the risk of suicide. Evidence on the determinants of depression is incomplete, making it challenging to interpret results across studies. This study aims to identify the social, economic, environmental, political, and technological factors influencing the great recession in Iran. The study was conducted in two parts. The first step involved a literature review to identify the factors, using PubMed, Scopus, and Web of Science for the search. The reference lists of all identified articles were reviewed to find relevant studies, and the extracted information was summarized and reported descriptively. The second steps involved compiling and consulting 14 experts from different fields, using a framework analysis method. Twenty-four articles were used as primary sources of information, and a total of 28 factors were found to exist. After removing duplicates and related factors, 19 of these were subsequently declared as factors, resulting in a total of 36 determinants being identified. Most of these factors belong to the social category. The health policies implemented have a significant impact on disease risk factors and ultimately their occurrence. Political decisions and policy-making processes play a crucial role in all areas, particularly in addressing disease risk factors. Severe depression can disrupt all aspects of the healthcare system, underscoring the importance of access to care. Policies concerning physical education, transportation, nutrition, employment, green spaces, recreational facilities, and tobacco are vital in this context. The influence of health policies on disease risk factors and disease occurrence is profound. Severe depression can have far-reaching effects on the healthcare system, emphasizing the critical need for access to care. The formulation of policies to combat depression must be thoroughly evaluated in terms of economic, political, social, technological, and environmental factors. The findings suggest that addressing social inequalities and emphasizing the role of political action, as highlighted by the social determinants of health, should be top priorities in addressing depression. Efforts to prevent depression should incorporate ecological approaches that consider the impact of the socioeconomic environment on depressive symptoms.

Determinants of COVID-19 Vaccine Uptake in The Netherlands: A Nationwide Registry-Based Study.

By September 2022, the uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies have indicated a lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination program and generate hypotheses for research on drivers of, and barriers to, vaccination. A retrospective database study was performed including the entire Dutch population ≥ 18. Vaccination data (5 January 2021-18 November 2021) were at individual levels linked to sociodemographic data. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. The most important determinant was age; uptake increased until the age of 80 (67% in 18-35 years, 92% in 67-79 years, and 88% in those > 80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower among individuals in the lowest income group (69%), those receiving social benefits (56%), and individuals with two parents born abroad (59%). Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. How to best address this inequity in future vaccination campaigns requires further research.

Comparing the magnitude of oral health inequality over time in Canada and the United States.

OBJECTIVES: To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. METHODS: Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. RESULTS: Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. CONCLUSIONS: There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

A COVID-19 Lesson: Better Health Emergency Preparedness Standards Are Needed.

This article reports on an assessment of the value of 4 widely recognized standards of health sector emergency preparedness as predictors of effective preparedness for, and response to, the COVID-19 pandemic in the United States. The standards are sponsored by the National Health Security Preparedness Index (NHSPI), the Trust for America's Health (TFAH), the Emergency Management Accreditation Program (EMAP), and the Public Health Accreditation Board (PHAB). The measure of effectiveness was states' cumulative COVID-19 deaths per 100,000 population, from January 21, 2020, through January 20, 2022. Linear regression analysis found no statistically significant associations when controlling for 3 intervening variables. Cross-tabulation of states' preparedness status with their COVID-19 death rates found that high NHSPI and TFAH preparedness scores were generally, but not uniformly, associated with lower death rates. EMAP and PHAB accreditation had negligible association with low or high death rates. Lack of accreditation was associated with lower death rates. Higher prior state public health spending related to COVID-19 preparedness and higher state household income, an indicator of state economic strength, were associated with lower death rates. States with Democratic control of the legislative and executive branches of government generally had substantially lower death rates than states with Republican control. A science-based, practice-oriented research initiative is recommended to improve the predictive power of health sector preparedness standards and to enhance protection for US residents from large-scale future health threats.

Remando a contracorriente / Rowing against the current

At Lalonde we know that the determinants that most influence the health of the population are lifestyle, genetics and the environment. Health represents only 10% and is the determinant that consumes the most resources. It has been shown that a salutogenic approach focused on the social determinants of health and the support of public policies to improve the environment are more efficient in the long term than medicine focused on hospitals, technology and super-specialization. Primary Care (PC) that has an approach centered on the person and families with a community vision, is the ideal level to provide health care, and to influence lifestyles. However it is not invested in PC. In this article we review the socioeconomic and political factors that globally influence the lack of interest in the development of PC.(AU)

Desde Lalonde sabemos que los determinantes que más influyen en la Salud de la población son el estilo de vida, la genética y el entorno. La sanidad representa solo el 10% y es el determinante que más recursos consume. Está demostrado que un enfoque salutogénico centrado en los determinantes sociales de la salud y el apoyo de políticas públicas para mejorar el entorno, son más eficientes a largo plazo que la medicina centrada en los hospitales, la tecnología y la superespecialización. La Atención Primaria (AP) que tiene un enfoque centrado en la persona y las familias con una visión comunitaria, es el nivel idóneo para proveer atención sanitaria, y para influir en los estilos de vida. Sin embargo no se invierte en AP. En este artículo revisamos los condicionantes socioeconómicos y políticos que influyen de manera global en la falta de interés en el desarrollo de la AP.(AU)

Influences on GP coping and resilience: a qualitative study in primary care.

BACKGROUND: 'Neoliberal' work policies, austerity, NHS restructuring, and increased GP consultation rates provide the backdrop against increasing reports of GP burnout and an impending shortage of GPs. AIM: To explore GPs' experiences of workplace challenges and stresses, and their coping strategies, particularly focusing on understanding the impact of recent NHS workplace change. DESIGN AND SETTING: Study design was qualitative, with data collected from two focus groups and seven one-to-one telephone interviews. METHOD: Focus groups and one-to-one telephone interviews explored the experiences of GPs currently practising in England, recruited through convenience sampling. Data were collected using a semi-structured interview approach and analysed using thematic analysis. RESULTS: There were 22 GP participants recruited: focus groups (n = 15) and interviews (n = 7). Interviewees understood GPs to be under intense and historically unprecedented pressures, which were tied to the contexts in which they work, with important moral implications for 'good' doctoring. Many reported that being a full-time GP was too stressful: work-related stress led to mood changes, sleep disruption, increases in anxiety, and tensions with loved ones. Some had subsequently sought ways to downsize their clinical workload. Workplace change resulted in little time for the things that helped GP resilience: a good work-life balance and better contact with colleagues. Although some GPs were coping better than others, GPs acknowledged that there was only so much an individual GP could do to manage their stress, given the external work issues they faced. CONCLUSION: GPs experience their emotional lives and stresses as being meaningfully shaped by NHS factors. To support GPs to provide effective care, resilience building should move beyond the individual to include systemic work issues.

Coalizão partidária, aporte financeiro e desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras / Party coalitions, budget outlay, and performance of medical and dental care in two health regions of Brazil / Coalición partidaria, aporte financiero y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas

Coalizações de governo distintas encontram limites para produzir mudanças na orientação de políticas. O objetivo foi descrever a orientação política dos partidos de coalização, o aporte financeiro, a estrutura e o desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras distintas socioeconomicamente e na oferta de serviços. Utilizaram-se indicadores a partir de dados oficiais relativos ao período de 2007 a 2014 e caraterísticas da coalização partidária definidas pelas preferências eleitorais municipais e de intensidade da competição eleitoral em cada estado da respectiva região. Maior aporte financeiro per capita e maior porcentagem de população potencialmente coberta pela atenção básica e pelas equipes de saúde bucal da Estratégia Saúde da Família estavam relacionados com o município-polo da região de coalização partidária mais à esquerda, ao passo que o município-polo da região de coalização partidária mais à direita mostrou aumento expressivo na porcentagem de população potencialmente coberta por médicos. Em ambos os municípios-polo, a efetividade melhorou. Os achados confirmaram a noção de que as coalizações mais à esquerda aportam mais recursos em políticas sociais, mas encontram limites para superar desigualdades estruturais e converter suas preferências programáticas em políticas efetivas.

Various government coalitions encounter limits when attempting to implement policy changes. The study aimed to describe the policy orientation of party coalitions, budget outlay, and the structure and performance of medical and dental care in two health regions of Brazil with different socioeconomic conditions and supplies of services. The indicators used were based on official data from 2007 and 2014 and characteristics of the party coalition defined by municipal electoral preferences and the intensity of electoral competition in each state of the respective major geographic region. Higher per capita budget outlay and higher percentage of the population potentially covered by primary care and by the oral health teams under the Family Health Strategy were related to the regional hub municipality with a more left-leaning party coalition, while the regional hub municipality with the more right-leaning party coalition showed an important increase in the percentage of the population potentially covered by physicians. The effectiveness improved in both hub municipalities. The findings confirmed the notion that more left-leaning coalitions tend to earmark more budget resources for social policies but encounter limits for overcoming structural inequalities and for converting their platform preferences into actual policies.

Coaliciones de gobierno distintas encuentran límites para producir cambios en la orientación de políticas. El objetivo fue describir la orientación política de los partidos de coalición, el aporte financiero, la estructura y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas, distintas socioeconómicamente y en la oferta de servicios. Se utilizaron indicadores a partir de datos oficiales relacionados con el período de 2007 a 2014 y características de la coalición partidaria, definidas por las preferencias electorales municipales y de intensidad en la competición electoral en cada estado de la respectiva región. Mayor aporte financiero per cápita y mayor porcentaje de población potencialmente cubierta por la atención básica y por los equipos de salud bucal de la Estrategia Salud de la Familia estaban relacionados con el municipio polo de la región de la coalición partidaria más a la izquierda, mientras que el municipio polo de la región de coalición partidaria más a la derecha mostró un aumento expresivo en el porcentaje de población potencialmente cubierta por médicos. En ambos municipios polo, la efectividad mejoró. Los resultados confirmaron la noción de que las coaliciones más a la izquierda aportan más recursos en políticas sociales, pero encuentran límites para superar desigualdades estructurales y convertir sus preferencias programáticas en políticas efectivas.

French abortion drug RU 486: U.S. research battles heat up.

PIP: With increasing evidence that the controversial French-made abortifacient RU-486 may serve as a treatment to some diseases, Congress and researchers have stopped up the pressure on the Food and Drug Administration to make the drug more available for clinical trials. The FDA has banned the import of RU-486 for personal use, and has placed strict restrictions on importations for clinical studies, having approved only 10 Investigational New Drug applications as of December 1990. Legislators and researchers say that RU-486's maker, Roussel-UCLAF, has also kept tight control of the drug because its parent company, Hoechst, fears reprisals from anti-abortion groups. Nonetheless, preliminary clinical results have shown the drug to have positive results in the treatment of unresectable meningioma, breast cancer. Cushing's syndrome, and endometriosis. A clinical trial conducted at the University of Southern California showed that a daily dose of RU-486 led to minor tumor regressions in 6 of 24 patients with the normally untreatable unresectable meningioma. These results have not gone unnoticed by Congress; the House Small Business Subcommittee on Regulation held a meeting to discuss the issue. The Subcommittee heard from researchers who say that their studies have been affected by the FDA's actions. An FDA representative explained the tight control over the drug by saying the possibility exists that a black market for the drug might arise. Nonetheless, he said that the FDA is not trying to prevent legitimate research. But Subcommittee Chairman Ron Wyden, who favors abortion rights, criticized the FDA's ban as politically motivated.^ieng

Feminist group plans "economic pressure campaign" for access to RU 486.

PIP: A grant for $10 million has boosted the efforts of the Feminist majority Foundation, a Boston activist group committed to bringing RU-486 into the US. The group is planning to research the corporate structure of Hoechst, A.G., the owner of Roussel-Uclaf, and that of its US subsidiary Hoechst Celanese Corporation of Somerville, NJ. Ultimate strategies may include a boycott of Hoechst products in the US, formation of a consortium of small pharmaceutical companies, or of a feminist pharmaceutical firm to research and develop RU-486 or other antiprogestins for the US. The Hoechst Company denies any connection to Roussel-Uclaf. Meanwhile, US researchers have organized in some states to encourage research on the drug, and a bill has been introduced to force the US Food and Drug Administration to lift its ban on importation. An opposition bill to ban importation of RU-486 for any purpose including research has also been introduced by right-to-life forces. New research is underway to test the antineoplastic effects of RU-486 on breast cancer in Canada, and on meningioma in California.^ieng

The future of medical dosimetry.

The world of health care delivery is becoming increasingly complex. The purpose of this manuscript is to analyze current metrics and analytically predict future practices and principles of medical dosimetry. The results indicate five potential areas precipitating change factors: a) evolutionary and revolutionary thinking processes, b) social factors, c) economic factors, d) political factors, and e) technological factors. Outcomes indicate that significant changes will occur in the job structure and content of being a practicing medical dosimetrist. Discussion indicates potential variables that can occur within each process and change factor and how the predicted outcomes can deviate from normative values. Finally, based on predicted outcomes, future opportunities for medical dosimetrists are given.

Catalizando cambios sociales y bioculturales sobre el cáncer. Diseño de acciones transdisciplinarias contra la pandemia / Catalyzing biocultural and social changes about cancer. Design of transdisciplinary actions against the pandemic

RESUMEN Objetivo Diseñar y analizar una experiencia de formación y organización transdisciplinaria sobre el cáncer, en la que expertos de múltiples disciplinas y actores con diferentes horizontes convergen en un diagnóstico y un panorama de intervención en múltiples escalas. Método Se diseñó e implementó un diplomado de 140 horas con más de 60 ponentes y 50 actores relevantes en torno al cáncer. Se llevó a cabo un taller transversal de 20 horas, usando como mediación las metodologías del diseño para la transición, que proponen estrategias para la construcción de diagnósticos e intervenciones en problemáticas complejas y conflictivas. Resultados Se logró construir un mapa de actores, preocupaciones, conflictos, causas-raíces, escenarios ideales y modelos potenciales de intervención con base en un trabajo colegiado. Se generaron recursos visuales que funcionan como mapas y estructuras donde se ubican los factores bioculturales que facilitan o impiden la efectiva implementación de estrategias de intervención. Las infografías y tablas funcionaron como mediaciones transdisciplinarias en tanto que posibilitaron que el espacio político (múltiples actores) fuera también un espacio pedagógico (múltiples epistemologías) situado en un contexto económico y ecológico concreto (interdependencia material de actores y ambientes). Conclusión Con la metodología del diseño para la transición se logró catalizar un trabajo transdisciplinario entre expertos y actores sociales en torno al cáncer. A través de las mediaciones visuales como mapas, infografías y tablas, se logró sintetizar y usar un diagnóstico compartido y avanzar así en intervenciones más incluyentes que reconozcan la complejidad biocultural de esta pandemia.(AU)

ABSTRACT Objective Design and analyze a transdisciplinary training and organization experience on cancer, where experts from multiple disciplines and actors with different horizons converge on a diagnosis and intervention horizon on multiple scales. Method A 140-hour diploma course with more than 60 speakers and 50 relevant actors around cancer was designed and implemented. A 20-hour transversal workshop was developed, using the Design for Transition methods as mediation of collaborative strategies for the construction of diagnoses and interventions in complex and conflict situations. Results It was possible to build a series of maps with a common view of stakeholders, concerns, conflicts, root causes, ideal scenarios and potential models of intervention, based on diverse participant's input. The visual resources generated were able to function as guides and structures that made possible the identification of biocultural factors that facilitate or impede implementation of strategies and interventions. Infographic material functioned as transdisciplinary mediations that enabled a diverse political (multiple-actors) and pedagogical (multiple-epistemologies) space to act upon an economic and ecological context (material interdependence of actors and environments). Conclusion The Design for Transition methodology catalized transdisciplinary work by enabling cancer experts and social actors interactions. Through visual mediations such as maps, infographics and tables, it was possible to synthesize and use a shared diagnosis and thus advance towards more inclusive interventions that recognize the biocultural complexity of this pandemic.(AU)

Declining prevalence of HIV-1 infection in young Thai men.

OBJECTIVE: To evaluate trends in HIV-1 seroprevalence in Thailand. DESIGN: HIV-1 serosurvey of successive cohorts of young Thai men entering service with the Royal Thai Army (RTA) between November 1989 and November 1994. METHODS: In November 1989, the RTA Medical Department began routine HIV-1-antibody screening of men who were selected by lottery for conscription. Between November 1989 and November 1994, 311,108 young men were screened at induction. Demographic data were collected between November 1991 and May 1993 and again in November 1994. RESULTS: The seroprevalence of HIV-1 among conscripts nationwide increased rapidly from 0.5% in 1989 to 3.5% in 1992 and reached 3.7% in 1993. In 1994, the overall prevalence decreased to 3.0%. The decrease was greatest in the upper North (from 12.4% in 1992 to 7.9% in 1994), where the prevalence has been the highest. However, decreases were observed in men from all regions of residence in the country, from both rural and urban areas, and at all educational levels. CONCLUSIONS: The decline in prevalence suggests declining incidence and that HIV control programs in Thailand are having an impact on the HIV epidemic.

PIP: Since 1989, the Royal Thai Army has screened new conscripts for human immunodeficiency virus (HIV)-1 infection. An analysis of HIV test results for the 311,108 young men entering the Army between November 1989 and November 1994 indicates that the Thailand Government's acquired immunodeficiency syndrome (AIDS) prevention program has had a positive impact on high-risk behaviors. The HIV seroprevalence increased from 0.5% in 1989 to 3.5% in 1992 and 3.7% in 1993, but then fell to 3.0% in 1994. The prevalence in the North--the region with the highest rate--peaked at 7.5% in 1992, then declined to 5.1% in 1994. This pattern of decline was observed in all regions of residence and at all educational levels. The only exception was a slight increase (from 4.1% in 1992 to 5.0% in 1994) in seroprevalence among the 4.2% of conscripts aged 22-29 years. Condom use, less frequent visits to commercial sex workers, and decreasing rates of sexually transmitted diseases are assumed to be the factors contributing to the decline in HIV infection.

HIV and AIDS in Indonesia.

PIP: Indonesia is the fourth most populous nation in the world, with a population of 184 million in 1993. By the end of December 1993, the Ministry of Health had reported 193 confirmed HIV infections. There have been 34 deaths from AIDS and HIV infections have been reported from 11 of the 27 provinces in the country. Where nationality is known, native Indonesians comprise 51% of HIV infections and non-Indonesians the remaining 49%. Sexual transmission accounts for 96% of cases where the route of transmission is known; route is unknown in 54 cases. Male:female sex ratio is 23:1 for reported AIDS cases and 4:1 for HIV infections for which sex is known. There have been no pediatric cases reported and 96% of those infected for whom age is known are 15-49 years. The present reporting system definitely underestimates the actual number of HIV infections. The window of prevention in the linear growth phase of the epidemic closed in 1992, when Indonesia began to experience exponential epidemic growth. Although the epidemiologic situation is worsening rapidly, a chance remains that HIV can be kept from becoming a major development problem. The government is now addressing the epidemic as a developmental issue, calling for action across sectors and in partnership with nongovernmental organizations and the private sector much earlier than elsewhere. The successful family planning program instituted in response to the population crisis will serve as a model for HIV prevention strategies and programs in Indonesia.^ieng

AIDS in Malaysia.

PIP: The first people to be infected with HIV in Malaysia were mainly homosexual men with foreign connections. IV drug users, however, rapidly became the population group with the highest prevalence of HIV. Accurate, timely data are needed in order to responsibly describe the pattern of HIV infection and AIDS in any given setting. In Malaysia, however, there has been little systematic surveillance in population groups other than blood donors. This surveillance indicates the existence of a rapidly increasing rate of seropositivity among blood donors. Otherwise, many people are loathe to undergo voluntary HIV testing to determine their serostatus. Moreover, some people with STDs avoid contact with the health system and the potential for HIV testing. The extent to which AIDS cases are underreported or reported late is unknown. On the other hand, an estimated 10% of notified AIDS cases have been wrongly classified as such. The lack of hard data on HIV/AIDS in Malaysia makes it difficult to project the future course of the epidemic in the country. Since Malaysia shares a land border with Thailand and there is much sea-borne traffic between the two countries, it is highly possible that Malaysia will experience a significant epidemic of HIV infection similar to its neighbors. A National AIDS Committee was established April 1985 to develop responses to the HIV epidemic, while the National AIDS Program Manager of the Ministry of Health is responsible for controlling STDs. A national plan of action for the prevention and control of AIDS, drawn up in 1985 and revised in 1988, includes planning for the continued surveillance of HIV infection and AIDS through existing notification systems, and for screening and sentinel programs for IV drug users, prostitutes, and STD patients. Recent nongovernmental organization responses complement government efforts to prevent HIV and AIDS in Malaysia.^ieng