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[The demographic activities of the Council of Europe] Les activites demographiques du Conseil de l'Europe
Forum Statisticum. 1983 Mar; (19):63-86.The demographic activities of the Council of Europe are described. Consideration is given to the work of the Committee of Directors for Demographic Questions, the organization of conferences and seminars, and the work of the Parliamentary Assembly. Appendixes contain a list of demographic publications issued by the Council of Europe and a summary of the conclusions of the 1982 European Demographic Conference. (ANNOTATION)
London, England, IPPF, April 1983. 9 p. (IPPF Fact Sheet)Discusses the International Planned Parenthood Federation's (IPPF) position on the use of injectable contraceptives. The 2 currently available injectable contraceptives are depot medroxyprogesterone acetate (DMPA), which is marketed under the name Depo-Provera, and norethisterone acetate (NET-EN), sold as Noristerat or Norigest. Injectable contraceptives are highly effective, convenient, and have a long-acting effect which is an advantage. DMPA has been approved for contraceptive use in more than 80 developing and developed countries, and NEP-EN, a recent introduction, in 40 countries. After the contraceptive has been approved for domestic use, it is supplied by IPPF to those countries which request it. Injectables are also provided for contraceptive use by the World Health Organization (WHO) and the United Nations Fund for Population Activities (UNFPA). The current positions of the WHO and the IPPF are covered, as well as the positions of Britain, Sweden, and the United States. Criticisms of the injectable contraceptives and IPPF's position regarding these are also discussed. After taking the criticisms into account, IPPF concludes that there is not sufficient reason to change its current position on injectable contraceptives. It will continue to keep all methods under close and continuous review.
Infant and young child nutrition, including the nutritional value and safety of products specifically intended for infant and young child feeding and the status of compliance with and implementation of the International Code of Marketing of Breast-milk Substitutes: report by the Director-General.
Geneva, Switzerland, WHO, March 1983. 39 p.This report to the Health Assembly is presented in 3 parts: Part I--a summary of the present global nutritional situation with particular reference to infants and young children--is based on an initial reading of the results of national surveillance and monitoring activities in over 50 countries. Part II has been prepared in accordance with resolution WHA34.23 which requested the Director-General to report to the Assembly on steps taken to assess the changes that occur with time and under various climatic conditions in the quality, nutritional value and safety of products specifically intended for infant and young child feeding. Part III, in accordance with resolution WHA34.22, summarizes information provided by Member States on action being taken to give effect to the International Code of Marketing of Breast-milk Substitutes. It should be read in conjunction with section VI of the Director-General's progress report which informed the 35th World Health Assembly of action taken by WHO and its Member States in the field of infant and young child feeding. In light of the information on the implementation of the Code contained in these 2 reports, and in the absence of any suggestions from Member States for change, the Director-General considers that it would be premature, at this time, to propose any revision of the text of the Code, either its form or content. The Health Assembly's attention will be drawn, in future biennial progress reports on infant and young child feeding, to any development which may have a bearing on the International Code, in accordance with its Article 11.7 and resolution WHA33.32.
[Unpublished] 1983 Mar 1. 27 p. (IESA/P/ICP.1984/EG.II/30)The UN Fund for Population Activities (UNFPA), in extending assistance for population concerns, has pursued a multifaceted program of work in order to respond to the wide ranging needs of the developing countries it serves. This paper examines its assistance in the area of population distribution and migration, taking into account how both internal and international migration affect and are affected by trends in socioeconomic development. Some of the issues that surface under the rubric "population distribution, migration, and development" are summarized. UNFPA's assistance to activities in population distribution, migration, and development fall into 4 categories: data collection, research and analysis, policy formulation and planning, and awareness creation. UNFPA has supported data collection in order to improve knowledge of migratory movements. It has funded research on interrelationships between population distribution and socioeconomic factors. Much of this research has focused on the interplay between population movement and labor force opportunities. The strengthening of institutions and the training of personnel involved in work on population distribution, migration, and development have made up an important part of UNFPA's work in this area. Generally, UNFPA does not support action programs in this area. Within the context of a comprehensive redistribution program, UNFPA may provide assistance for those service programs within its mandate--family planning service, population information campaigns, and educational support for the execution of such schemes. Thus far UNFPA's assistance in the field of population distribution, migration, and development has totaled about US$15 million. Much of the research supported by UNFPA has attempted to clarify the interactions between the migration flows and economic opportunities and has sought to identify viable policy options that countries may pursue in order to bring about more satisfactory patterns of population distribution. The bulk of UNFPA assistance in Africa for population redistribution and migration has been for research activities in this field. Most countries of the Asian and Pacific region are predominantly concerned about rural urban migration and are committed to formulating policies aimed at correcting or at least reducing the dislocations attendant on unbalanced distribution of population. The concern with employment related migration is evident in several of the projects dealing wtih internal migration tha UNFPA supports in the Asia and Pacific region. Several of the projects that UNFPA has financed in the Latin American and Caribbean region involve providing information to rural populations about economic and social conditions in urban areas. UNFPA has sponsored a Conference on International Migration in the Arab world and is financing a study on migration trends in Southern Europe. In general, the interregional and global activities supported by UNFPA have focused on methodological issues, the creation of awareness, and the dissemination of information.
In: Connor E, Mullan F, ed. Community oriented primary care: new directions for health services delivery. Washington, D.C., National Academy Press, 1983. 250-7.Education of doctors for community oriented primary care (COPC) in the Netherlands is described. A basic doctor has 6 years of training and is prepared for further specialty training in general practice (currently only 1 year), clinical specialty (4-6 years), and social medicine (4 years). After high school, a weighted lottery is performed. Out of 6000 interested graduates, 1950 are placed in medical faculties. Only straight A students have a double chance. In 1970, the Dutch government started a new medical faculty that was community oriented and emphasized primary health care. For this, the educational system of this facility had to be different. A problem-oriented system was adopted. In 1974, an integrated innovative curriculum was started. The basic philosophy emphasizes a preference for orienting medical education to primary care. By the 5th and 6th year, students must acquire: 1) practical experience in solving primary care problems; and 2) the ability to recognize unusual problems and develop appropriate referral. During the 1st 4 years the problem-solving process is encountered; the problems must be increasingly complex; and the teaching program progresses from the general to the specific. The teaching program should begin with health problems and proceed to consider normal and abnormal functioning. The original arrangement for hospital internships is not yet feasible. It seems that hospital organization is too rigid to combine with a less department-linked program. Evaluation is mandatory. A theoretical final M.D. exam was designed. The World Health Organization (WHO) held a meeting at which key figures from 18 selected schools were brought together. From this meeting, it was agreed that a network would be developed linking schools. The network members met again and formulated objectives.
Population trends and issues, statement made at the Meeting of the Netherlands Association of Demographers, The Hague, Netherlands, 14 September, 1983.
New York, N.Y., UNFPA, . 7 p. (Speech Series No. 97)If world population is to stabilize by the end of the next century, it will be necessary to strengthen and sustain the downward trend in fertility already begun in most developing countries. Whatever reductions have been achieved in the rate of population growth are the result of fertility declines accompanied by moderate reduction in mortality. Added to the challenge of high birth, mortality and growth rates in some parts of the developing world, a number of issues of equal importance have emerged since the United Nations World Population Conference held in Bucharest in 1974. There are, for example, issues relating to aging, international and local migration, including urbanization, and the interrelationships between population, resources, the environment and development. Most of these problems have national as well as international dimensions. The Government of the Netherlands has taken important steps to alleviate some of these problems. For example, it considers that social and economic policy should constantly take in requirements resulting from changes in the age structure of the population. The Government has been a major donor to the United Nations Fund for Population Activities (UNFPA) since its inception and has contributed nearly US$105 million in 14 years.
The Bulgarian experience, statement made at the Special Convocation, Sofia State University, Sofia, Bugaria, 7 October, 1983.
New York, N.Y., UNFPA, . 5 p.Although world fertility has entered a perceptible period of decline heralding a deceleration in the rate of population growth, even with the current rate, which is about 1.7%/year, the world is still adding close to 78 million people to its population each year. This figure is estimated to rise to 89 million by the year 2000. A major concern confronting most developing countries at present is the integration of population factors into the development process. In this context, Bulgaria's progress in the twin fields of population and development provides an outstanding example of what can be achieved. Demographic development in the country since 1950 has been impressive. Although the bulk of transition in fertility and growth rate of population had occurred by 1950, the consistent improvement in health services has achieved at an early date what was sought by the World Population Plan of Action in its 2 quantified targets: lower infant mortality rates and longer life expectancy. A major reason for this success is the official policy in regard to the full integration of women into the development process. Internally, Bulgaria pursues a pronatalist policy. Within the context of Bulgaria's national goals of development objectives and human resource potential, this policy is understandable. Bulgaria's population program includes activities to reduce infant and child mortality, improve maternal health, augment reproductive health and increase marital fertility. The United Nations Fund for Population Activities, because of its respect for the sovereign rights of countries to determine their own population policies, has provided assistance for the implementation of this national program.
Universitas. 1983 Dec; 25(4):253-63.Unescos reports on the gap existing in mass media between the developed and the developing countries shows that in 1978 the 3rd world countries accounted for 70% of the world population, but only 22% of the published book titles, 9% of newsprint consumption, 18% of the radio receivers, and 12% of the television receivers. The contrast is more noticeable with the extremely marked urban rural gap in Central and South America, Africa, and Asia. Although illiteracy is "overleaped" by radio and television, in vast regions of the world participation in the "information-based society" does not go beyond a transistor radio of limited range. The progress in technological development might result in widening further the development gap between North and South in the field of information and communicaton. Research and development are possible almost only in the industrial countries and a few "threshold countries" such as India or Brazil. Satellites, cable networks, or networks of television transmitters confront most developing countries with unsolvable financing problems and human resources needs. While technology can make communications easier in many respects, nearly all developing countries areunable to establish the link to the information-based society with their own resources. Some theorists in North and South either negatethe need for such a link or question it. The international debate in recent years shows that the developing countries recognize both the apparent dangers and the great opportunities of the modern information and communication media: "drop out of the system" has changed to better participation, both in its products and in its control. The essence of the "media declaration" passed by the Unesco general conference in 1978 is a double commitment on the part of the member countries to the goal of a "free flow and a wider and better balanced dissemination of information" and to cooperation in the expedited building up of the inadequate structures in the developing countries. How this commitment is to be realized remains the most important issue for the future. In nearly all developing countries much needs to be done before a functioning media system which reaches all citizens and can be used by everyone is achieved. The Federal Republic of Germany, as a donor country and through government channels, political foundations, and nongovernment organizations, has given 1 billion deutsch marks for media aid to developing countries. The main emphasis is on the supply of equipment and material and on training and consultative assistance. For several years cooperation in the building of new agencies has been a priority, and it is hoped that this will continue so that the media declaration of 1978 can be kept.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.
Evaluation of WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). 1. Task Force on Infertility.
In: Assessment of the WHO Special Programme of Research, Development and Research Training in Human Reproduction [HRP]. II. Task Force reports. Country reports, [compiled by] Sweden. Swedish Agency for Research Cooperation with Developing Countries [SAREC]. Stockholm, Sweden, SAREC, 1983 Apr.  p..To date, Sweden has provided the WHO Special Program of Research, Development, and Research Training in Human Reproduction (HRP) with 265 million Swiss Cr. A 2-part, in-depth assessment of selected aspects of HRP was thus undertaken to ensure that the program is indeed achieving its objectives and meeting the specific needs of developing countries rather than more global interests in technological advancement. The assessment was limited by the inability of the Swedish investigators to gain access to confidential, unpublished HRP documents. However, a review of infertility-related materials indicated that activities in this area are predominantly focused on developed countries. The situation in Third World countries, where both primary and secondary infertility are widespread, is not receiving the necessary attention. The topic of infertility itself is greatly overshadowed in developing countries by an emphasis on the control of fertility. A review of HRP activities in a specific Third World setting--Zambia--provided further evidence of a failure to ensure that the HRP is addressing the prevailing health research priorities in these countries. Although social realities, such a poverty and family size preferences, comprise major obstacles to family planning acceptance in Zambia, the HRP has concentrated its efforts on research into new contraceptive technologies--in keeping with its global agenda, rather than Zambia's. Any activities that have been initiated by HRP in Zambia have been located in isolation of the existing health service delivery system, making them an academic exercise at best. In general, HRP's work in Zambia appears to have actually weakened Zambian-based research capacity. This review suggests that Sweden's contribution to Zambia would have been better utilized had it been channeled directly on a bilateral basis rather than through the HRP.