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Switzerland (Geneva) 77

WORLD HEALTH STATISTICS QUARTERLY

1992 - VOLUME 45, NUMERO 4
EPIDEMIOLOGY AND PUBLIC HEALTH ASPECTS OF DIABETES

93.77.01 - English - M.J. WYSOCKI, M. CHANSKA, National Institute of Hygiene, Warsaw (Poland), M. BAK and A.S. CZYZYK, Department of Gastroenterology and Metabolic Disorders, Medical Academy, Warsaw (Poland)

Incidence of Insulin-dependent Diabetes Mellitus in Children and Young Adults in Warsaw, Poland, 1983-1988 (p. 315-320)

93.77.02 - English - WHO Ad Hoc Diabetes Reporting Group (Switzerland)

Diabetes and Impaired Glucose Tolerance in Women Aged 20-39 Years (p. 321-327)

93.77.03 - English - Zeljko METELKO, Gojka ROGLIC, and Zdenko SKRABALO, Institute for Diabetes, Endocrinology and Metabolic Diseases, "Vuk Vrhovac", Zagreb (Croatia)

Diabetes in Time of Armed Conflict: The Croatian Experience (p. 328-333)

93.77.04 - English - Morsi ARAB, Department of Medecine, University of Alexandria, Alexandria (Egypt)

Diabetes Mellitus in Egypt (p. 334-337)

93.77.05 - English - Margaret PHILLIPS, London School of Hygiene and Tropical Medicine, London (U.K.), and Jorge SALMERON, Instituto Mexicano del Seguro Social, Mexico City (Mexico)

Diabetes in Mexico - A Serious and Growing Problem (p. 338-346)

According to a recent national health survey and due to an underestimation by at least 50%, there may be as many as 1.7 million persons with diabetes in Mexico, with a prevalnce of approximately 6% in the age range 30-64 years. The average age at death for Mexicans with diabetes is 57 years, compared to 69 years for the population as a whole. Diabetes is the fifth most important cause of death in the Mexican population, and the third cause in people over 45 years of age, in whom it accounts for 10% of all deaths. There is evidence for important increases in diabetes-related mortality over time. (MEXICO, CAUSES OF DEATH, DIABETES)

93.77.06 - English - Braxton D. MITCHELL and Michael P. STERN, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas (U.S.A.)

Recent Developments in the Epidemiology of Diabetes in the Americas (p. 347-349)

93.77.07 - English - John H. FULLER, Department of Epidemiology and Public Health, University College London, London (U.K.)

Recent Developments in Diabetes Epidemiology in Europe (p. 350-354)

93.77.08 - English - Ala'din A.S. ALWAN, Noncommunicable Diseases, WHO Regional Office for the Eastern Mediterranean, Alexandria (Egypt), and Hilary KING, Diabetes and Other Noncommunicable Diseases Unit, WHO, Geneva (Switzerland)

Diabetes in the Eastern Mediterranean Region (p. 355-359)

93.77.09 - English - Gary K. DOWSE and Paul ZIMMET, International Diabetes Institute, Melbourne (Australia)

A Model Protocol for a Diabetes and Other Noncommunicable Disease Field Survey (p. 360-372)

1993 - VOLUME 46, NUMBER 1
VIOLENCE AND HEALTH

93.77.10 - French - Robert BOURBEAU, Université de Montréal, C.P. 6128, Suc. "A", Montréal, QC H3C 3J7 (Canada)

Comparative Analysis of Violent Deaths in the Developed Countries and some Developing Countries, 1985-1989 (Analyse comparative de la mortalité violente dans les pays développés et dans quelques pays en développement durant la période 1985-1989) (p. 4-33)

A comparative analysis of crude death rates and specifically of deaths from violence was conducted for a large number of developed and developing countries which provide data to the World Health Organization's data bank. For these countries, the analysis shows, first of all, that violent deaths rank third among the major causes of death, after diseases of the circulatory system and malignant tumours, in most developed countries and in some developing countries with reliable data. The comparative analysis also reveals substantial variations in the level and structure of death rates, both among the developed and the developing countries. Thus the crude death rate varies by a factor of 2 in both sexes, both in the developed and the developing countries. For violent deaths, the ranges are even wide: the highest death rate is 3 to 4 times greater than the lowest, except for women in developing countries where it is only twice as high. The method reveals in which countries the situation regarding violent deaths is relatively tolerable and in which countries the situation is decidedly bad. Although it is difficult to draw up a clear classification whereby countries can be grouped according to their profile of deaths by cause, it can be seen that a number of countries have a fairly characteristic profile of mortality by cause; these are mainly the developed countries (Western Europe and other regions) and some developing countries (Hong Kong and Israel) with low crude death rates. In these countries certain causes of violent death predominate as a result of the level of development achieved: motor vehicle accidents, falls and suicides. Moreover, in the other developed countries (in Eastern Europe) and in the developing countries (except Hong Kong and Israel) there is a more "traditional" profile of mortality by cause; this profile is characteristic of the less-developed countries where there are generally fewer deaths from suicide and from motor-vehicle accidents and where unintentional factors predominate over intentional factors. This analysis also brings out the very distinctive situation of the countries of Latin America with regard to violent deaths, particularly the large number of deaths from homicide in a number of countries. This is unquestionably a high-risk region for which further studies need to be undertaken, and where preventive measures need to be applied in order to curb the rising tide of violence and its harmful consequences for these societies. Lastly, the analysis of excess male mortality from violence shows not only the extent of the difference between the sexes, but also highlights certain countries where excess male mortality form violence is highest: Finland, France, Mexico, Puerto Rico and Chile. (MORTALITY, VIOLENT DEATHS, COMPARATIVE ANALYSIS)

93.77.11 - English - Olivier JEANNERET, Faculté de Médecine, Université de Genève, Genève (Switzerland), and E.A. SAND, Faculté de Médecine, Université Libre de Bruxelles, Bruxelles (Belgium)

Intentional Violence among Adolescents and Young Adults: An Epidemiological perspective (p. 34-51)

Intentional violence consists mainly of non-accidental interpersonal violence and suicidal behaviour; the results are other violence and/or violence whose intention is undetermined. In almost all the countries considered in this study, intentional violence is taking on worrying proportions in adolescence (10-19-year-olds) and is on the increase among young adults (15-24-year-olds). The scale of the problem is relatively well known thanks to national mortality rates. The relative proportions of murders and suicides vary considerably from one country to another, though they remain fairly constant over time, whether the diachronic progression of mortality due to intentional violence increases, remains stable or fails in the country concerned; this is true for both sexes and for both the age groups considered (15-19 and 20-24). Nevertheless, in view of the much higher incidence of intentionally violent behaviour that does not result in death, more resources should be allocated to epidemiological studies in that area, especially in terms of quantitative and qualitative methods, where possible in association with interdisciplinary projects. Only with a better knowledge of the risk factors and if possible identification of the predictive factors (in the probabilistic sense of the term) could we devise, conduct and evaluate preventive measures that are better targeted than those used so far, whether the factors are sociocultural, socioeconomic or psychosocial. This is the justification, especially the ethical justification, of further epidemiological studies of an analytical or even interventional nature, going beyond the descriptive studies that have been made by most researchers to date. (VIOLENCE, VIOLENT DEATHS, SOCIAL BEHAVIOUR, EPIDEMIOLOGY)

93.77.12 - English - R.F.W. DIEKSTRA, Department of Psychology, University of Leiden (Netherlands), and W. GULBINAT, Division of Mental Health, WHO, Geneva (Switzerland)

The Epidemiology of Suicidal Behaviour: A Review of Three Continents (p. 52-68)

Suicidal behaviour includes suicidal ideation, parasuicide or attempted suicide, and completed suicide. Assessment and recording of suicidal ideation and parasuicide is most difficult, and the first internationally comparable data on parasuicide are expected from an ongoing WHO-coordinated study in 15 European centres. On the other hand, about 50% of WHO's 186 Member States report suicide as part of their mortality statistics. Although there is no uniformity in definitions of suicidal acts nor in recording procedures, certain patterns of suicidal behaviour emerge across countries. The incidence of parasuicide is 10 to 20 times higher than that of completed suicide; the male/female ratios for suicide and attempted suicide are reciprocal: 3 times more women then men commit parasuicide, while in most countries about 3 times more men than women commit suicide. From a public health point of view, suicide in adolescents and young adults is particularly important: suicide in adolescence and young adulthood ranks among the 5 leading causes of death in many countries. There have been clear and dramatic increases in suicide rates in most WHO Member States which report mortality statistics to the Organization, especially among young men. Suicide in old age, particularly among men, is about 2 to 3 times more frequent than in younger age groups. Although it is not surprising that mortality increases with age, death by suicide is considered in most cultures and by most people as particularly deplorable and unnecessary. The epidemiological analysis of suicidal behaviour globally does not identify clear-cut risk factors amenable to preventive programmes. It does, however, pinpoint countries with "unusual" suicide patterns which, it is hoped, will initiate country-specific research into causes of such behaviour. Particularly promising, from the perspective of suicide prevention, seems to be research into the methods of suicide, and the impact of publicity of suicidal acts, as it has been shown repeatedly that restricting access to the prevailing method of suicide in a country will decrease suicide rates, while wide publicity about suicidal acts will increase them. (SUICIDE, EPIDEMIOLOGY, COMPARATIVE ANALYSIS)

93.77.13 - English - Mark A. BELSEY, Maternal and Child Health and Family Health, WHO, Geneva (Switzerland)

Child Abuse: Measuring a Global Problem (p. 69-77)

Child abuse and neglect include four distinct conditions: physical abuse, neglect, emotional abuse and sexual abuse. We are proposing an additional approach for monitoring presumed child abuse and neglect-related mortality. Applying this approach to regions or groups of countries for which there are sufficient data, the expected under-5 rate of presumed child abuse and neglect would be between 13 and 20 per 100 000 live births. These estimates are higher than those made either from community-based registers or forensic reporting systems. Differences in these estimates will need to be resolved through further research. Injury and injury-related mortality can be classified as intentional, unintentional or resulting from varying degrees of neglect. Death from physical abuse represents a willful act or series of actions. Death from neglect may arise from willful behaviour but may also arise from ignorance and irresponsible behaviour. Mortality data provide virtually no measure of sexual abuse. In contrast to physical abuse, sexual abuse is defined on the basis of facts reported by the child victim or an adult which are not generally confirmed by physical examination. Estimates of either the prevalence or incidence of sexual abuse are derived from surveys of adult populations, child abuse registers or populations referred for evaluation and treatment following the disclosure of sexual abuse. Data are presented on the levels of presumed child abuse and neglect mortality for 64 countries and territories for which recent data are available. For several countries, time trends are presented in the cumulative 5-year rate of presumed child abuse and neglect of mortality. The methodological issues in assessing the levels of child abuse and neglect are discussed. (CHILD ABUSE, INFANT MORTALITY, VIOLENT DEATHS)

93.77.14 - English - Lori HEISE, Centre for Women's Global Leadership, The State University of New Jersey, New Brunswick, NJ (U.S.A.)

Violence Against Women: The Hidden Health Burden (p. 78-85)

Violence against women is a major health problem around the world. It often goes unnoticed and undocumented partly due to its taboo nature. A number of recent studies have explored the extent and patterns as well as the health consequence of violence in different cultures. The studies cited indicate that violence against women is widespread and an important cause of morbidity and mortality among women. Injuries due to violence have only recently been recognized as an important public health problem. More research is needed to improve our understanding of gender violence, and to design better interventions. (VIOLENCE, WOMEN'S STATUS, FEMALE MORTALITY)

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