Articles: mortality.
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To illustrate the magnitude of the impact of AIDS on projections of mortality, to explain the reasons for the differences in projections by major international organizations and to provide a simple approach to estimating the impact of AIDS on life expectancy. ⋯ It is clear that AIDS has already increased mortality significantly in many countries and will continue to do so in the coming decades. Uncertainty about current and future levels of HIV prevalence among adults leads to differences in the projections of future AIDS-related mortality. As data and projection methodologies improve, the differences in projections may be reduced for sub-Saharan Africa, but the growing epidemic in some of the largest countries of Asia may increase uncertainty about future global impacts.
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Most public-health assessments of climate-control policies have focused on long-term impacts of global change. Our interdisciplinary working group assesses likely short-term impacts on public health. ⋯ The mortality estimates are indicative of the magnitude of the likely health benefits of the climate-policy scenario examined and are not precise predictions of avoidable deaths. While characterized by considerable uncertainty, the short-term public-health impacts of reduced PM exposures associated with greenhouse-gas reductions are likely to be substantial even under the most conservative set of assumptions.
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Close to half of all infant deaths world-wide now occur in the first week of life, almost all in developing countries, and the perinatal mortality rate (PNMR) is used as an indicator of the quality of health service delivery. Clinical audit aims to improve quality of care through the systematic assessment of practice against a defined standard, with a view to recommending and implementing measures to address specific deficiencies in care. Perinatal outcome audit evaluates crude or cause-specific PNMRs, reviewing secular trends over several years or comparing rates between similar institutions. ⋯ The forum for comparing observed practice with the standard may be external, utilising an 'expert committee', or internal, in which care providers audit their own activities. Local internal audit is more likely to result in improvements in care if it is conducted in a structured and culturally sensitive way, and if all levels of staff are involved in reviewing activities and in formulating recommendations. However, further research is needed to identify the factors which determine the effectiveness and sustainability of perinatal audit in different developing country settings.
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We argue that over the past 300 years human physiology has been undergoing profound environmentally induced changes made possible by numerous advances in technology. These changes, which we call technophysio evolution, increased body size by over 50%, and greatly improved the robustness and capacity of vital organ systems. Because technophysio evolution is still ongoing, it is relevant to forecasts of longevity and morbidity and, therefore, to forecasts of the size of the elderly population and pension and health care costs.