OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e. g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score II). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events...

Os eventos adversos a medicamentos são comuns e provavelmente irão ocorrer em qualquer sistema, entretanto, é essencial identificar suas causas e tentar minimizar os riscos visando à segurança do paciente. O objetivo desse estudo foi analisar os eventos adversos a medicamentos em um hospital público do estado do Amazonas, com base nos relatos da equipe de enfermagem e propor estratégias à instituição para otimizar o sistema de medicamentos para a segurança do paciente. Um estudo do tipo descritivo, adotando-se a Técnica do Incidente Crítico como norteadora dos procedimentos metodológicos foi realizado com 15 enfermeiros, 09 auxiliares e 44 técnicos de enfermagem de um hospital de ensino de Manaus-AM. A análise dos dados constou da identificação e agrupamento das situações, comportamentos e consequências. A maioria dos profissionais entrevistados era do sexo feminino (89,7%), predominando a classe de idade de 31 a 35 anos (30,9%). Os resultados foram agrupados e categorizados em 47 situações, correspondentes a nove tipos de erros de medicação. Dos tipos de erros identificados pela equipe de enfermagem, os erros de diluição (23,4%), dose (14,9%), medicamentos não autorizados (14,9%), erro de via de administração (10...

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e.g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score Il). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events...

Computerized provider order entry(CPOE) and other clinical information systems can help reduce medical errors, promote practice standardization, and improve the quality of patient care. However, implementing these systems can result in unintended adverse consequences. Our multidisciplinary team used qualitative methods to gather and analyze data describing unintended adverse consequences related to CPOE adoption and use. Overdependence on technology emerged as one of nine major types we identified. Careful analysis of these data revealed three themes: 1) system downtime can create chaos when there are insufficient backup systems in place, 2) users have false expectations regarding data accuracy and processing, and 3) some clinicians cannot work efficiently without computerized systems. We provide recommendations for mitigating these important issues.

Background: Social norms around what is culturally accepted in terms of alcohol consumption and drunken comportment appear important regarding the acceptance of alcohol-related adverse consequences; however, investigations often neglect to consider differences in terms of attribution. This study aims at assessing cross-cultural differences in the reporting of alcohol-related adverse consequences. It also considers differences across consequences that might explain which type of consequences (mainly acute or mainly chronic) are most affected by an attribution process. Methods: Conditional regression models were estimated based on data from eight European countries participating in the Gender, Alcohol and Culture—An International Study (GENACIS) project. Cases were matched to controls based on usual drinking patterns in order to control for average volume of alcohol and frequency of ‘risky single occasion drinking’ (RSOD). Results: Differences among the patterns of associations between countries and consequences were evident. The distinction between Nordic and other European countries was persistent. A higher variability of associations was observed for some consequences, namely the mainly acute instances. Finally, the Isle of Man and Switzerland showed specific trends with associations across consequences. Conclusion: Reporting of alcohol-related adverse consequences seemed strongly affected by cultural norms. The latter may be exemplified by viewing drinking as ‘time-out’ behaviour. Respondents in countries with a stereotypical history of being ‘dry’ or with a stereotyped ‘binge’ drinking culture were more likely to attribute consequences to their alcohol consumption than people in ‘wet’ countries. This was particularly true for consequences that related to episodic ‘time-out’ heavy drinking.

In this study, the use-dependent, nicotinic receptor antagonist bis (2, 2, 6, 6-tetramethyl-4-piperidinyl) sebacate (BTMPS) was evaluated for its ability to attenuate the adverse consequences associated with morphine in rats in all three phases of an abstinence model of drug seeking: self-administration, acute withdrawal, and delayed test of drug seeking. Rats were allowed to self-administer morphine (FR1 schedule) with an active response lever, on a 24hr basis inside operant chambers, for 14 days. Each rat was subsequently evaluated for stereotypical behaviors associated with spontaneous morphine withdrawal. Rats were then placed in standard housing cages for a six week period of protracted abstinence from morphine. After this period, each rat was placed back into its respective operant chamber for a 14 day assessment of unrewarded drug seeking responses. BTMPS was administered to the animals in all three clinically relevant phases in three separate sets of experiments. BTMPS treatment during the self-administration phase resulted in up to a 34% reduction of lever responses to morphine when compared to vehicle treated control animals, as well as a 32% reduction in the dose of morphine self-administered. When given during self-administration and acute withdrawal...

Over the past three decades, economists and others have devoted considerable effort to assessing the impact of alcoholic-beverage taxes and prices on alcohol consumption and its related adverse consequences. Federal and State excise taxes have increased only rarely and, when adjusted for inflation, have declined significantly over the years, as have overall prices for alcoholic beverages. Yet studies examining the effects of increases of monetary prices (e.g., through raising taxes) on alcohol consumption and a wide range of related behavioral and health problems have demonstrated that price increases for alcoholic beverages lead to reduced alcohol consumption, both in the general population and in certain high-risk populations, such as heavier drinkers or adolescents and young adults. These effects seem to be more pronounced in the long run than in the short run. Likewise, price increases can help reduce the risk for adverse consequences of alcohol consumption and abuse, including drinking and driving, alcohol-involved crimes, liver cirrhosis and other alcohol-related mortality, risky sexual behavior and its consequences, and poor school performance among youth. All of these findings indicate that increases in alcoholic-beverage taxes could be a highly effective option for reducing alcohol abuse and its consequences.

In contrast with a growing literature on the drivers of aggregate volatility in developing countries, its consequences in terms of individual incomes have received less attention. This paper looks at the impact of cyclical output fluctuations and extreme output events (crises) on unemployment, poverty, and inequality. The authors find robust evidence that aggregate volatility has a regressive, asymmetric, and non linear impact, as reflected in the strong influence of extreme output drops. The findings show that, in addition to the mitigating role of personal wealth, public expenditure and labor protection exert a similar benign effect. These findings are in line with the income substitutions view of social safety nets, and cast a new light on the value of social programs and labor market regulation in crisis prone developing countries.

The surge in global commodity prices of the past few years has presented a tremendous development challenge for South Asian countries. The large loss of income from the terms of trade shock has worsened macroeconomic balances, fueled rapid inflation, and hurt growth. Although commodity prices have come down recently, the benefits are being clouded by the emergence of a severe global financial crisis. The adverse consequences of the food price hike for the poor are large; the global financial crisis could further worsen the situation due to falling economic opportunities and government revenues. South Asian countries need to accelerate reforms to avoid facing a serious downturn in economic activity, investment, exports, and income. Governments in South Asia have responded by stabilizing domestic food prices through a number of short-term measures, tightened monetary policy to reduce inflation, and increased spending on a range of safety net programs for the poor. Some of the policies employed, such as export bans...

Solvency is an intertemporal concept, relating to the present value of revenues and expenditures, and encompassing both assets and liabilities. But the standard practice among policy makers, financial market participants and international financial institutions is to assess the strength of the fiscal accounts solely on the basis of the cash deficit. Short-term cash flows matter, but a preponderant focus on them can encourage governments to invest too little, especially during episodes of fiscal tightening. This has potentially adverse consequences for growth and, paradoxically, even for fiscal solvency itself. The paper offers an overview of the links between fiscal targets, public investment, and public sector solvency. After reviewing the international experience with public investment under fiscal adjustment, the paper lays out an analytical framework to illustrate the consequences of using the public deficit as a guide to solvency. The paper then discusses some alternatives to conventional cash deficit rules and their implications for investment and fiscal solvency.

The surge in global commodity prices of the past few years has presented a tremendous development challenge to South Asian countries. On a net basis South Asia is estimated to have suffered an income loss equivalent to some 9.6 percent of Gross Domestic Product (GDP) between January 2003 and April 2008. Although much of the income loss resulted from the hike in petroleum prices, the surge in food prices between January 2007 and April 2008, especially of staple food ? wheat and rice ? has created tremendous adverse social impact in South Asia. All countries have witnessed unprecedented surge in food prices, although India was able to limit this increase owing to good harvests and timely interventions using stock management and public food distribution. Net food importing countries like Afghanistan, Sri Lanka and Bangladesh have suffered the most from the food price crisis. The emerging global financial crisis is adding fuel to the fire, with expected future adverse consequences for macroeconomic balances and growth.

Financial systems can contribute to economic development by providing people with useful tools for risk management, but when they fail to manage the risks they retain, they can create severe financial crises with devastating social and economic effects. The financial crisis that hit the world economy in 2008-2009 has transformed the lives of many individuals and families, even in advanced countries, where millions of people fell, or are at risk of falling, into poverty and exclusion. For most regions and income groups in developing countries, progress to meet the Millennium Development Goals by 2015 has slowed and income distribution has worsened for a number of countries. Countries hardest hit by the crisis lost more than a decade of economic time. As the efforts to strengthen the financial systems and improve the resilience of the global financial system continue around the world, the challenge for policy makers is to incorporate the lessons from the failures to take into consideration the complex linkages between financial...

The authors examine patterns of media ownership in 97 countries around the world. They find that almost universally the largest media firms are controlled by the government or by private families. Government ownership is more pervasive in broadcasting than in the printed media. Government ownership is generally associated with less press freedom, fewer political and economic rights, inferior governance, and, most conspicuously, inferior social outcomes in education and health. The adverse effects of government ownership on political and economic freedom are stronger for newspapers than for television. The adverse effects of government ownership of the media do not appear to be restricted solely to instances of government monopoly. The authors present a range of evidence on the adverse consequences of state ownership of the media. State ownership of the media is often argued to be justified on behalf of the social needs of the disadvantaged. But if their findings are correct, increasing private ownership of the media--through privatization or by encouraging the entry of privately owned media--can advance a variety of political and economic goals...

Background: Antenatal magnesium sulphate, widely used in obstetrics to improve maternal and infant outcomes, may be associated with adverse effects for the mother sufficient for treatment cessation. This systematic review aimed to quantify maternal adverse effects attributed to treatment, assess how adverse effects vary according to different regimens, and explore women’s experiences with this treatment. Methods: Bibliographic databases were searched from their inceptions to July 2012 for studies of any design that reported on maternal adverse effects associated with antenatal magnesium sulphate given to improve maternal or infant outcomes. Primary outcomes were life-threatening adverse effects of treatment (death, cardiac arrest, respiratory arrest). For randomised controlled trials, data were meta-analysed, and risk ratios (RR) pooled using fixed-effects or random-effects models. For non-randomised studies, data were tabulated by design, and presented as RR, odds ratios or percentages, and summarised narratively. Results: A total of 143 publications were included (21 randomised trials, 15 non-randomised comparative studies, 32 case series and 75 reports of individual cases), of mixed methodological quality. Compared with placebo or no treatment...

This study examines empirical information for major Sub-Saharan African countries and provides an analysis of whether recent trade and economic policy changes by some Sub-Saharan African (SSA) countries enhanced their international competitiveness and improved their export performance. Specifically, it addresses the following points: (i) have recent exports from the Sub-Saharan African countries recently grown at a relatively faster pace and now come close to matching the average growth in world trade? (ii) Studies show Sub-Saharan African countries have been increasingly marginalized in world trade, as reflected in secular declines in their shares of this exchange and in shares of their major traditional exports (Ng and Yeats 1997). Does the available evidence indicate these trends have been reversed? (iii) Aggregate analyses of the composition of African countries' exports typically reveals a structure often held to be detrimental to industrialization and growth. African exports are typically concentrated in a relatively few primary commodities whose unstable prices (and export revenues) are thought to make development planning difficult. Does the available evidence indicate that shifts are occurring in the structure of exports toward products (like labor-intensive manufactures) that could play a more positive role in improving the prospects for industrialization and growth? (iv) Are positive micro-level changes occurring which are not reflected in aggregate trade statistics? Specifically...

The United Nations estimates that global food demand will double by 2050, with much of that growth in developing countries. The world will have 2.3 billion more people, and given the deep transformation of growth trajectories in low-income countries, they will be increasingly affluent, with demands for more, different, and better food. While countries in Latin America and the Caribbean (LAC) are quite heterogeneous in their production potential, overall they are well equipped to contribute to meeting this challenge. LAC has always maintained a strong comparative advantage in agricultural production, as indicated not only by its position as a net food exporter but also by its high comparative advantage. LAC is also well endowed in renewable water resources, with about a third of the 42,000 cubic kilometers worldwide. Per capita, LAC has the highest endowment of renewable water among developing regions, though some sub regions in LAC face higher than average scarcity. This report's in-depth look at Argentina and Brazil identifies looming logistics and policy issues that threaten to derail these locomotives of agricultural growth and some policy choices that have contributed to their success and that might be worth emulating. While LAC countries have substantially reduced the anti-export and anti-agricultural biases in their trade regimes...

Referring to the original context of Dutch Disease, the term refers to the fears of de-industrialization that gripped the Netherlands as a result of the appreciation of the Dutch currency that followed the discovery of natural gas deposits. Expansion of petroleum exports in the 1960s not only crowded out other exports, it actually reduced other exports disproportionately and fueled the fears of dire consequences for Dutch manufacturing. In the case of Equatorial Guinea, the secondary sector represents about 2 percent of the gross domestic product, manufacturing represents less than 1 percent, and oil represents more than 95 percent. The negative impact of the Dutch Disease in this context would be limited given the structure of the economy and on the contrary may even be a good thing because it fuels the structural transformational process of the economy, which is needed in Equatorial Guinea. This paper argues that the ongoing Dutch Disease is a natural and necessary reallocation of resources in the economy of Equatorial Guinea. The magnitude of negative macroeconomic consequences of the Dutch Disease depends on the country's economic structure and stage of development. In a country where the manufacturing sector barely exists or where the non-oil primary sector is structurally deficient...

While there is a great deal of anecdotal evidence on the economic effects of adverse health shocks, there is relatively little hard empirical evidence. The author builds on recent empirical work to explore in the context of postreform Vietnam two related issues: (1) how far household income and medical care spending responds to health shocks, and (2) how far household consumption is protected against health shocks. The results suggest that adverse health shocks - captured by negative changes in body mass index (BMI) - are associated with reductions in earned income. This appears to be only partly - if at all - due to a reverse feedback from income changes to BMI changes. By contrast, there is a hint - the relevant coefficient is not significant - that adverse BMI shocks may result in increases in unearned income. This may reflect additional gifts, remittances, and so on, from family and friends following the health shock. Medical spending is found to increase following an adverse health shock, but not among those with health insurance. The impact for the uninsured is large, equal in absolute size to the income loss associated with a BMI shock. The lack of impact for the insured points to complete insurance against the medical care costs associated with health shocks...

Problématique : Depuis bientôt deux décennies, la République Démocratique du Congo (RDC) est le territoire d’un conflit armé qui, selon l’International Rescue Commite, aurait occasionné plus de 3 millions de décès et autant de déplacés internes. Plusieurs rapports font également cas des nombreux actes de violence sexuelle (les viols, les mutilations, l’esclavage, l’exploitation sexuelle, etc.) commis envers les filles, les femmes et dans une moindre ampleur les hommes. S’il existe un consensus sur le côté barbare des actes de violence sexuelle liés aux conflits armés, rares sont les études qui ont évalué leurs conséquences sur la santé reproductive des survivantes surtout en termes d’issues telles que les fistules, les douleurs pelviennes chroniques (DPC), le désir de rapports sexuels, le désir d’enfant et le désir d’interruption de la grossesse issue de tels actes. Par ailleurs, même si la santé mentale des populations en zones de conflit représente un sujet d’intérêt, l’impact spécifique de la violence sexuelle liée au conflit sur la santé mentale des survivantes a été peu étudié. De plus, ces travaux s’intéressent aux effets de la violence sexuelle liée au conflit sur la santé mentale et sur la santé reproductive séparément et ce...

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e.g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score Il). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events...