Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union.

BACKGROUND: Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality. METHODS: Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality. RESULTS: The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change. CONCLUSIONS: These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.

Testing for multiple bubbles in the copper price: Periodically collapsing behavior.

This study investigates whether multiple bubbles exist in the copper price on the basis of the Generalized Supremum Augmented Dickey-Fuller (GSADF) approach (Phillips et al., 2013). This technique delivers date-stamping strategies for the emergence as well as collapse of explosive bubble episodes and is best suited for practical application to time series. The results reveal that four explosive bubbles are detected over the period of 1980-2019 when copper price deviates from fundamental value. Besides, this finding is in accordance with the asset pricing model (Gürkaynak, 2008), which generally considers both fundamental and bubble components in the presence of asset prices. Based on the empirical results, the multiple emergence and collapse of multiple price bubbles are attributed to speculation, depreciation of the U.S. dollar, an imbalance between supply and demand, and financial crises. Policymakers should actively recognize bubble episodes and monitor their evolution, which could be conducive to achieving the effective stabilization of the international copper price. To reduce excess price fluctuations and explosive copper bubbles, authorities should impose restrictions on excessive speculative behaviors under extreme market conditions.

Economic and non-economic determinants of Iranian pharmaceutical companies' financial performance: an empirical study.

BACKGROUND: The pharmaceutical industry in Iran is influenced by various parameters such as internal factors caused by the financial information of each economic unit and external factors including major economic and non-economic variables. METHODS: This study is aiming to examine the effect of such variables on the stock return of 34 pharmaceutical companies in the Tehran Securities Exchange market using quarterly data from 1995 to 2016. In this research, an autoregressive model was utilized to examine the way that variables affect the stock market index. In such patterns, there is no need for explicit short-term structural relationships and structural knowledge is extracted from causal relationships. Finally, to analyze the results, impulse-response functions, forecast error variance, and historical decomposition were collected. RESULTS: Results of this research show that positive shock to the variables, namely the currency rate, collection period of quests, and healthcare costs lead to a decrease in the return of pharmaceutical companies. On the other hand, a positive shock to the variables such as GDP, and money volume, leads to an increase in the stock return of pharmaceutical companies. CONCLUSION: Different factors contribute to the stock return of pharmaceutical companies. Among the variables examined in this study, market currency rate, money volume, pharmaceutical sector inflation, bank interest rate, GDP in the healthcare sector, healthcare costs, and collection period of quests have the most effect on describing changes within the stock return of pharmaceutical companies.

Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013.

STUDY DESIGN: Retrospective database analysis. OBJECTIVE: The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. METHODS: The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. RESULTS: From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R2 value between the number of surgeries and the S&P 500 Index was statistically significant (P ≤ .05). CONCLUSIONS: The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

Impact of the Economic Downturn on Elective Cervical Spine Surgery in the United States: A National Trend Analysis, 2003-2013.

OBJECTIVE: To analyze overall trends of elective cervical spine surgery in the United States from 2003 to 2013 with the goal of determining whether the economic downturn had an impact. METHODS: Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification were used to identify elective cervical spine surgery procedures in the Nationwide Inpatient Sample from 2003 to 2013. National Health Expenditure, gross domestic product, and S&P 500 Index were used as measures of economic performance. The economic downturn was defined as 2008-2009. Confidence intervals were determined using subgroup analysis techniques. Linear regressions were completed to determine the association between surgery trends and economic conditions. RESULTS: From 2003 to 2013, posterior cervical fusions saw a 102.7% increase. During the same time frame, there was a 7.4% and 14.7% decrease in the number of anterior cervical diskectomy and fusions (ACDFs) and posterior decompressions, respectively. The trend of elective cervical spine surgeries per 100,000 persons in the U.S. population may have been affected by the economic downturn from 2008 to 2009 (-0.03% growth). The percentage of procedures paid for by private insurance decreased from 2003 to 2013 for all ACDFs, posterior cervical fusions, and posterior decompressions. The linear regression coefficients (ß) and R2 values between the number of surgeries and each of the macroeconomic factors analyzed were not statistically significant. CONCLUSIONS: The overall elective cervical spine surgery trend was not likely impacted by the economic downturn. Posterior cervical fusions grew significantly from 2003 to 2013, whereas ACDFs and posterior decompressions decreased.

Macro influencers of electronic health records adoption.

While adoption rates for electronic health records (EHRs) have improved, the reasons for significant geographical differences in EHR adoption within the USA have remained unclear. To understand the reasons for these variations across states, we have compiled from secondary sources a profile of different states within the USA, based on macroeconomic and macro health-environment factors. Regression analyses were performed using these indicator factors on EHR adoption. The results showed that internet usage and literacy are significantly associated with certain measures of EHR adoption. Income level was not significantly associated with EHR adoption. Per capita patient days (a proxy for healthcare need intensity within a state) is negatively correlated with EHR adoption rate. Health insurance coverage is positively correlated with EHR adoption rate. Older physicians (>60 years) tend to adopt EHR systems less than their younger counterparts. These findings have policy implications on formulating regionally focused incentive programs.

Companies reduce prices for HIV drugs in developing countries.

PIP: This article reports the decision of pharmaceutical companies to reduce the prices of anti-HIV drugs in developing countries. It is stated that some of the companies have pledged to sell the pharmaceuticals at prices just above the manufacturing costs, at a discount of up to 90%. This strategy is part of an unprecedented effort to combat AIDS in sub-Saharan Africa. Participating companies include Glaxo Wellcome, Boehringer Ingelheim, Bristol-Myers Squibb, Hoffman-La Roche and Merck & Co. Experts say that lowering the price of medicines is not the sole solution to the problem, but new efforts also must be introduced to improve prevention, medical infrastructure, international funding, and political involvement. On the other hand, President Bill Clinton issued an executive order regarding the actions of the US Trade Representative's office against nations who seek access to cheap drugs. The ruling provides that the office can no longer threaten trade sanctions against developing nations that use the intellectual property rules of the World Trade Organization to gain access to cheaper drugs.^ieng

Availability of condoms in urban and rural areas of KwaZulu-Natal, South Africa.

BACKGROUND: Promoting condom use to prevent HIV transmission is futile if condoms are not readily available. GOAL: This study assessed condom availability in clinics, shops, and other outlets in urban and rural South Africa. STUDY DESIGN: Snowball sampling was used to select 70 private-sector and public-sector outlets. One male and one female black fieldworker were posed as clients seeking condoms to assess condom availability and provider attitudes. RESULTS: Condoms were available in nine (100%) public clinics, in five of nine (55%) private doctor's rooms, and in only 5 of 52 (10%) nonhealth outlets. Access was limited in the public sector by clinic opening times, inadequate clinic signs and markings, and by some providers' attitudes. CONCLUSION: A major opportunity to make condoms available in nonhealth outlets in rural areas and urban townships is being missed in South Africa. Above all, the high level of condom awareness is not being matched by easy availability.

Cautious welcome for antiretroviral cost reduction in South Africa.

PIP: South Africa has cautiously welcomed the pledge of five pharmaceutical firms (GlaxoWellcome, Boehringer Ingelheim, Bristol-Myers Squibb, Roche, and Merck) to cut the prices of their HIV/AIDS drugs by up to 90% for African countries and other developing nations. Africa's AIDS activists are concerned that the deal will be conditional on governments undertaking not to promote the use of generic substances. In this regard South Africa¿s health minister, Mantho Tshabalala-Msimang, welcomed the decision by US President Bill Clinton to drop the threat of trade sanctions against countries planning to produce cheap generic drugs. In another development, South African Airways admitted that it had acted ¿unjustifiably¿ by excluding a job seeker who was HIV-positive. The airline agreed to pay the man R100,000 and his legal costs.^ieng

A multivariate method for estimating mortality rates among children under 5 years from health and social indicators in Iraq.

BACKGROUND: Many reports on Iraq suggest that a rise in rates of death and disease have occurred since the Gulf War of January/February 1991 and the economic sanctions that followed it. METHODS: Four preliminary models, based on unadjusted projections, were developed. A logistic regression model was then developed on the basis of six social variables in Iraq and comparable information from countries in the State of the World's Children report. Missing data were estimated for this model by a multiple imputation procedure. The final model depends on three socio-medical indicators: adult literacy, nutritional stunting of children under 5 years, and access to piped water. RESULTS: The model successfully predicted both the mortality rate in 1990, under stable conditions, and in 1991, following the Gulf War. For 1996, after 5 years of sanctions and prior to receipt of humanitarian food via the oil for food programme, this model shows mortality among children under 5 to have reached an estimated 87 per 1000, a rate last experienced more than 30 years ago. CONCLUSIONS: Accurate and timely estimates of mortality levels in developing countries are costly and require considerable methodological expertise. A rapid estimation technique like the one developed here may be a useful tool for quick and efficient estimation of mortality rates among under 5 year olds in countries where good mortality data are not routinely available. This is especially true for countries with complex humanitarian emergencies where information on mortality changes can guide interventions and the social stability to use standard demographic methods does not exist.

Is low income a constraint to contraceptive use among the Pakistani poor?

This paper examines whether low income is a barrier to contraceptive use in Pakistan, a country in which economic conditions are deteriorating at a time when the private sector is becoming a more important supplier of contraception. Multivariate regression analysis performed using the Pakistan Contraceptive Demand Survey suggests that low income is a deterrent to modern contraceptive use in Pakistan. This is particularly the case for contraceptive methods supplied through the private sector. It is concluded that, if the aim of family planning programmes is to reach low-income people, the prices of contraceptives supplied through the private sector should be kept as low as possible.

Work from waste.

PIP: In Tanzania, rural residents are seeking better opportunities in the capital city of Dar-es-Salaam. This migration has generated problems, such as unplanned housing, low water supplies, and unemployment. In view of the competition in food processing, Mwanaidi Msosa and other members of the Kisutu Women Development Trust (KIWODET) sought financial returns in trash collecting. This paper reports how women workers are cleaning up their city, and breaking new ground in small-scale private sector employment. In 1998, 20 home-based workers from the KIWODET started ridding the city, as well as neighboring areas, of trash in exchange for money. When the Dar-es-Salaam City Commission privatized urban trash collection and street cleaning, KIWODET tendered with other contractors and organizations to operate in their neighborhood. Such an approach not only made the city cleaner, but has also created an estimate of 1000 new jobs. In addition, recycling was introduced as an attractive side-business.^ieng

"At my age I should be sitting under that tree": the impact of AIDS on Tanzanian lakeshore communities.

In 1992, the author led a participatory rural appraisal (PRA) exercise for a community fisheries project in Kagera region, on the western side of Lake Victoria, Tanzania. The PRA team visited four settlements: the prime harbor settlement on Kerebe Island; N'toro beach, in Bukoba district, near the Ugandan border; Chamkwikwi landing site in Muleba district; and Buzirayombo bay settlement in Biharamulo district in the south. This article draws on that research, to give an outsider's analysis of the ways in which AIDS was changing livelihoods in poor fishing and farming communities. On the lakeshore and islands, adults were falling ill and dying. This loss of men and women in their prime was causing major economic and social stresses for the single parents, grandparents, and orphans whom the authors met. They showed resilience and adaptability in the face of this threat to their already precarious livelihoods. The article ends by suggesting ways in which development policy makers and practitioners should support livelihoods in the era of AIDS.

Reform's enfeebling effect.

PIP: This paper comments on the implications of economic reforms for the reduction of economic inequalities and the assurance of greater social justice in India. Data from the 1997 National Sample Survey, which indicate the poverty reduction process, were used to analyze India's economic and social conditions. The author presents the causes of the increase in population living below the poverty line and observes that even the 5% annual economic growth will not ensure reduction in poverty. The author then suggests measures to help decrease the proportion of those living below the poverty line. He stresses the importance of health, education, infrastructural development, housing, transportation and sanitation. He also emphasizes the role of nongovernmental organizations in offsetting the negative impacts of the economic reforms on the poor.^ieng

Working in the informal economy.

PIP: Informal ways of working are widespread and central to the economy and markets. This paper explores what informal economy is and how it could be more valuable for men and women. The informal economy is a mix of the following activities: 1) subsistence work which includes agriculture, marginal economic projects, and unpaid work in the home; 2) informal work which includes unregistered businesses, and illegal or criminal activities; 3) casual production, a sub-contracted or ¿off-the-books¿ work which deprives workers of the benefits tied to recognized employment; and 4) community work and barter. It is shown that more women, when compared to men, work and live on the border between the household and the market economy. Usually men do more technical or mechanized production while women tend to do activities within traditional women's roles. Men and women often have different understanding of what work is. Men consistently underestimate the women's contribution to the household income. To improve this critical issue of gender differences, rules, norms, and laws that cause problems must be identified, and then work can begin with both men and women to change laws and policies, as well as ideas and beliefs about women's contribution to the economy.^ieng

Today, more than ever, we as human beings can do something about the problems around us. From the Advisory Council.

PIP: This paper focuses on the appeal of Maurice Tempelsman, chairman of the Harvard AIDS Institution, to the US government to strive for the allocation on AIDS treatment and vaccine research. The growing economy in regions like Africa and Asia are being jeopardized by the alarming rise in the incidence of AIDS. Budgets on health care services averages $100 per year and the basic medical intervention for AIDS patients is an estimate of $300 in sub-Saharan Africa and $1000 in Thailand. Government funds during these cases could use up public facilities and resources. The government offsets this loss by raising taxes or curtailing medical and social services, which could eventually weaken the thriving condition of the country. A proposed allocation of $2 billion by the US government earned from African affiliates may be invested in vaccine research to change the course of the epidemic. Research contributions by the US could greatly benefit not only those in Africa but also in Asia where the epidemic has yet to release its fury.^ieng

AIDS care: why and how should industry respond?

PIP: This article reports the AIDS care response of industries to the rising AIDS epidemic in South Africa. It has been reported that during 1993-99 the rate of hospital bed occupancy doubled to over 8/1000 and that 50% of ill-health retirements in 1998 were due to AIDS. Important issues to be considered by industries are the medical separation due to ill health, poor health care services. The focus of HIV/AIDS care should be on the patient, family, care giver, community, and health services, and must be based on the principles of decentralization and integration of sustainable and cost-effective HIV/AIDS services. The development of a care package must be based on six dimensions; namely, appropriateness, acceptability, accessibility, effectiveness, efficiency, and equity. On the other hand, identification of indicators in relation to the components of the care package must include support groups and networks of people living with HIV; the provision of home-based care; responsiveness of the health system; the existence and application of clinical guidelines; and the effectiveness of referrals. Any organization with a commitment in providing care should establish a Care Task Team to develop a care strategy. It should focus on who can have access to the care, what the care consists of, and who will cover the cost. In addition, a review of the existing HIV/AIDS services must be done to identify shortfalls and highlight priority gaps.^ieng

The direct costs of HIV / AIDS in a South African sugar mill.

PIP: This article assesses the impact of HIV on a retrospective cohort of HIV-infected sugar mill employees and the cost incurred by their employers in the province of KwaZulu-Natal, South Africa. In a single occupational health clinic that provides the primary care needs of a sugar mill workforce with approximately 400 employees (96% males), records of 23 workers who took ill-health retirement due to HIV during 1991-98 were inspected. Direct cost estimation associated with HIV infections were obtained from the occupational health clinic, hospital and insurance sources. In the preliminary study, the cost of HIV treatment increased in the last 2 years of the employee's tenure. Using the human resource data and employee job description, the cost of lost productivity was approximately R100 for each day lost, while the total cost per worker annually for the period of the analysis is R9543.73. These costs could be divided equally into replacement worker costs, productivity losses and absenteeism. Similar findings were also obtained in separate studies conducted in Zimbabwe and Kenya. This article confirms the significant amount of lost economic activity due HIV infection and the increasing burden on the economic industry as the epidemic matures.^ieng

American businesses unite to fight HIV spread in Africa.

PIP: This article focuses on the formation of a Corporate Task Force on AIDS in Africa and will attempt to examine the role of American corporations in preventing the spread of HIV infection. The HIV/AIDS epidemic in Africa threatens to destroy any significant economic gain and would continually affect any American corporation doing business in Africa. The task force would examine and propose various courses of actions for American corporations. Although the corporate sector cannot solve the problem alone, they are expected to sponsor some of the innovative and progressive work on AIDS in Africa. Likewise, American private sectors take on the leadership role in the fight against AIDS. The first role of the task force will be to propose a unified business approach to assist US companies to have a positive impact in this issue at home and abroad.^ieng

The impact of structural adjustment and the changing nature of women's work in the People's Republic of China.

PIP: This paper examines the impact of structural adjustment and the changing nature of women's work in the People's Republic of China (PRC). It is noted that more than two-thirds of the developing countries have adopted structural adjustment policy packages as an answer to the economic crisis they are facing. Such an adjustment is a conscious change in the fundamental nature of economic relationships within a society. In relation to women, the structural changes have resulted to the collapse of many small and home-based industries, thus changing the role of women in economy. It is noted that although the policy shifts have created a wide range of job opportunities for women in other countries, in PRC gender inequalities exist in the economic area wherein women experience low employment and lack of work benefits. In addition, the fact that the rate of women's employment in China is higher than other developing and some developed countries worsens the situation as it indicates that more women suffer under the discriminatory employment system.^ieng