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A state-of-the-art review of what is currently known about the epidemiology of cardiovascular diseases in elderly people and the possibilities for prevention. Noting that little attention has been given to the problem of cardiovascular diseases in this age group, the report aims to highlight opportunities for prevention while also underscoring the medical social and economic implications of increased longevity and the corresponding increase in the prevalence of cardiovascular disease. Both population-based approaches to prevention and strategies for reaching high-risk individuals are considered. Areas where knowledge is weak and research is urgently needed are also indicated. The report has six main sections. The first on demographic trends summarizes key characteristics of the elderly population in various parts of the world discusses the current and projected size of the elderly population and describes changes in life expectancy over the past four years. A profile of cardiovascular diseases in the elderly is provided in the second section, which includes information on the global burden of cardiovascular diseases trends in mortality rates and possible explanations, the most important cardiovascular diseases affecting the elderly, and eight principal risk factors. The third and most extensive section reviews health policy options for the prevention of cardiovascular diseases in elderly people and discusses their relative cost-effectiveness. Emphasis is placed on lifestyle approaches and on the medical management of risk factors. The remaining sections discuss opportunities for rehabilitation and establish guidelines for the development of health policies aimed at the prevention of cardiovascular disease in the elderly.

A state-of-the-art review of what is currently known about the epidemiology of cardiovascular diseases in elderly people and the possibilities for prevention. Noting that little attention has been given to the problem of cardiovascular diseases in this age group, the report aims to highlight opportunities for prevention while also underscoring the medical social and economic implications of increased longevity and the corresponding increase in the prevalence of cardiovascular disease. Both population-based approaches to prevention and strategies for reaching high-risk individuals are considered. Areas where knowledge is weak and research is urgently needed are also indicated. The report has six main sections. The first on demographic trends summarizes key characteristics of the elderly population in various parts of the world discusses the current and projected size of the elderly population and describes changes in life expectancy over the past four years. A profile of cardiovascular diseases in the elderly is provided in the second section, which includes information on the global burden of cardiovascular diseases trends in mortality rates and possible explanations, the most important cardiovascular diseases affecting the elderly, and eight principal risk factors. The third and most extensive section reviews health policy options for the prevention of cardiovascular diseases in elderly people and discusses their relative cost-effectiveness. Emphasis is placed on lifestyle approaches and on the medical management of risk factors. The remaining sections discuss opportunities for rehabilitation and establish guidelines for the development of health policies aimed at the prevention of cardiovascular disease in the elderly.

Annotation. Despite considerable progress in malaria control over the last 10 years, malaria is still a serious problem, particularly in sub-Saharan Africa where about 90 per cent of clinical cases occur. Malaria, either alone or in combination with other diseases, is estimated to kill between 1.1 and 2.7 million people worldwide each year. This report analyses the effect of health sector reforms on malaria control programmes.

This report provides an expert practical guide to the formulation and implementation of national dietary guidelines based on recommended foods and food groups rather than nutrients. Addressed to policy-makers and the nutritionists who advise them the report aims to facilitate the use of food-based dietary guidelines as a sensible new way to help consumers make healthy food choices. Throughout the report recommendations - whether concerning the importance of food variety or the percent of dietary protein that should be of animal origin - draw on the latest biochemical and physiological knowledge about human nutritional requirements in health and disease. Health problems related to both dietary insufficiency and excess are considered in this comprehensive report. The book opens with an explanation of the many reasons why dietary recommendations based on foods are more effective as an instrument of public health nutrition than are guidelines based on nutrients. Readers are also reminded of the need to formulate dietary guidelines in response to specific diet-related health problems important in a country, and to ensure that recommendations are based on sound scientific evidence. Against this background, the first main section establishes the scientific rationale for the development of food-based dietary guidelines, drawing on current knowledge in four main areas: nutrition science; food science and technology; educational, behavioural, and social sciences; and agricultural and environmental sciences. The section also compares different methods for assessing the nutritional quality of diets and explains each of the steps to follow when reorienting dietary recommendations from nutrients to foods. Methods of monitoring food and nutrient intake are presented and compared in the next section, which includes advice on how data from a range of sources can be used when setting dietary goals and formulating recommendations. Section three provides detailed, step-by-step guidance on how to develop food-based dietary guidelines and ensure that populations understand them and follow their advice. The remaining sections explain how to transform guidelines into message and slogans and monitor their effectiveness in improving dietary practices. In a key achievement, the second part of the report provides an expert state-of-the-art review of scientific knowledge, from animal, clinical, and epidemiological studies, about the relationship between diet, nutrition and health. Throughout this review, a special effort is made to identify areas where scientific data support firm dietary recommendations based on individual foods, food groups, and food combinations. Information ranges from advice on the use of nutrient densities in the development and evaluation of dietary guidelines, through data on the role of vitamins as chemopreventive agents, to a discussion of non-nutrient components found in fruit that may explain their capacity to prevent cardiovascular diseases and gastrointestinal cancers. The report concludes with examples of the ways in which foods and food groups have been incorporated into dietary guidelines in selected countries.

Explores ways to improve the performance of health centres as a key component of efforts to strengthen district health systems based on primary health care and thus meet local needs for preventive as well as curative services. The role of health centres in overall strategies for health development is emphasized. Noting that health centres continue to perform poorly in most parts of the world, the report makes a special effort to identify factors responsible for the discrepancy between the great potential of health centres and the reality of their performance. Throughout the report, experiences from around the world are used to illustrate both the challenges faced and innovative ways of meeting them. The report has two parts. The first considers the role and functions of health centres and looks at the factors that influence their effectiveness. Issues discussed include political and legal frameworks, policies for management, the provision and training of staff, factors influencing the range and quality of services, and mechanisms for financing these services. Problems identified range from inadequate financial and logistic support, to the provision of services that are either of poor quality or inappropriate to local needs, from the paucity of data for planning and management, to poor and irregular salaries that undermine the commitment of staff. Against this background, the second section considers the radical changes needed to convert health centres from providing largely curative services to offering a comprehensive and dynamic primary health care programme. Four lines of activity are identified: defining the health centre's catchment area and developing a community profile, adopting a systematic approach to planning and implementation, generating the information needed to support health centre operations, and defining an active research and development agenda. The report then explains how each of these objectives can be achieved using a range of practical tools for generating information and using this information to improve planning, management, and services. The report concludes with an annex indicating the range of competencies and skills needed by staff in a properly functioning health centre.