This report presents an analysis of the Early Childhood Development (ECD) subsector, including programs and policies that affect young children in the Republic of Kiribati. This was a collaborative effort between UNICEF and the World Bank Group; it combines the World Bank Group's Systems Approach for Better Education Results SABER-ECD framework, which includes analysis of early learningand child p, health, nutrition, and social rotection policies and interventions in Kiribati, along with regional and international comparisons, as well as the regionally developed UNICEF National Situational Analysis ECD, which takes a greater in-depth look at the following system components, which have been highlighted by the Pacific Region as priority components for quality Early Childhood Care and Education (ECCE) implementation: policy, legislation, and governance; human resources; curriculum, child assessment, and environment; performance monitoring and assessment; and community partnerships. In 2008, the Ministry of Education (MOE) drafted the Kiribati Early Childhood Care and Education (ECCE) Policy, which was formally endorsed by Cabinet in 2010. The ECCE policy, targeting ages three to five, calls ECCE a "national responsibility" with a mission "to culturally nurture young children in a loving and caring environment to enhance through interactive play the fullest potential of their physical, intellectual, social, emotional and spiritual growth in line with trends and development". This country report presents a framework to benchmark Kiribati's ECD system; each of the nine policy levers and five system components are examined in detail, and policy options to strengthen ECD are offered. This report is intended to serve as a first step for decision making within the government of Kiribati to improve the ECD system. Now that some areas in need of policy attention have been identified, the country can move forward in prioritizing policy options to promote healthy and robust development for all children during their early years.
Der vom Bundesamt für Migration und Flüchtlinge erstellte Migrationsbericht 2018 wurde am 8. Januar 2020 durch das Bundesministerium des Innern, für Bau und Heimat vorgestellt. Neben umfassenden Wanderungsdaten zu Deutschland enthält der Bericht einen europäischen Vergleich zum Migrationsgeschehen und zur Asylzuwanderung. Er behandelt das Phänomen der irregulären Migration und informiert über die Struktur und Entwicklung der Bevölkerung mit Migrationshintergrund in Deutschland.
"Im Rahmen der Expertise war die Akademiengruppe 'Altern in Deutschland' insbesondere an drei Fragen interessiert: (1) Wie beeinflussen Arbeitsbedingungen die Gesundheit im Erwachsenenalter? (2) Welchen Einfluss hat Gesundheit auf den Übergang in den Ruhestand? (3) Wie wirkt sich der Übergang in den Ruhestand auf die Gesundheit der - dann ehemals - Erwerbstätigen aus? Die im Jahr 2007 erstellte Expertise fasst den empirischen Forschungsstand zu diesen Fragen zusammen. Grundlage ist die Auswertung der deutschen und internationalen Forschungsliteratur. Die Literaturanalyse zeigt, dass die Arbeitsbedingungen einen starken Einfluss auf die Gesundheit älterer Arbeitskräfte haben. An Bedeutung gewonnen hat insbesondere arbeitsbezogener Stress, der das Risiko psychischer Erkrankungen, stressbedingter körperlicher Krankheiten und gesundheitsschädlicher Verhaltensweisen erhöht. Der Anstieg psychosozialer Belastungen am Arbeitsplatz und die Zunahme von Übergewicht und Bewegungsmangel dämpfen die insgesamt optimistische Erwartung an einen längeren Erhalt der Erwerbsfähigkeit der nachwachsenden Kohorten. Zahlreiche Studien belegen den starken Einfluss der Gesundheit auf das Alter und die Umstände des Wechsels in den Ruhestand. Gesundheitlich beeinträchtigte Personen haben ein erhöhtes Risiko, vorzeitig wegen Arbeitsunfähigkeit, Arbeitslosigkeit oder Frühverrentung aus dem Erwerbsleben auszuscheiden. In vielen Studien war die Gesundheit der bedeutsamste Einzelfaktor. Bei Paaren spielt auch die Gesundheit des Partners oder der Partnerin eine Rolle. Zur Frage der Auswirkung des Übergangs in den Ruhestand auf Gesundheit und Mortalität stützt der empirische Forschungsstand die These, dass dieser Übergang im Allgemeinen kein Risikofaktor für eine Gesundheitsverschlechterung und erhöhte Sterblichkeit ist. Negative gesundheitliche Effekte ergeben sich allerdings, wenn der Ausstieg aus dem Erwerbsleben unfreiwillig und sehr früh (mindestens fünf Jahre vor dem üblichen Renteneintrittsalter) erfolgt. Dies gilt insbesondere für Personen, die am Ende ihres Erwerbslebens länger arbeitslos sind." (Textauszug)
Un quadruple tableau illustre cet article. Ce dernier est complété par un lexique. ; International audience ; [Whatever the territory concerned, the method of foresight is a useful way of thinking about the future. It is not intended to predict the future but to reflect possible future without blinkers. Using it for the European Union, a good knowledge of the initial situation and an open discussion led to distinguish four future scenarios opening a wide field of possibilities. These four scenarios were officially presented to the Reflection Group on the European Union chaired by Felipe Gonzalez, former Prime Minister of Spain.]. ; Quel que soit le territoire considéré, la méthode de la prospective est un moyen fort utile de penser l'avenir. Elle n'a pas pour but de prévoir le futur, mais de réfléchir sans œillères aux futurs possibles. En y recourant pour l'Union européenne, une bonne connaissance de la situation initiale et une réflexion ouverte conduisent à distinguer quatre scénarios prospectifs ouvrant un large champ de possibilités. Ces quatre scénarios ont été officiellement présentés au Groupe de réflexion sur l'Union européenne présidée par Felipe GONZALEZ, ancien Premier ministre de l'Espagne.
Un quadruple tableau illustre cet article. Ce dernier est complété par un lexique. ; International audience ; [Whatever the territory concerned, the method of foresight is a useful way of thinking about the future. It is not intended to predict the future but to reflect possible future without blinkers. Using it for the European Union, a good knowledge of the initial situation and an open discussion led to distinguish four future scenarios opening a wide field of possibilities. These four scenarios were officially presented to the Reflection Group on the European Union chaired by Felipe Gonzalez, former Prime Minister of Spain.]. ; Quel que soit le territoire considéré, la méthode de la prospective est un moyen fort utile de penser l'avenir. Elle n'a pas pour but de prévoir le futur, mais de réfléchir sans œillères aux futurs possibles. En y recourant pour l'Union européenne, une bonne connaissance de la situation initiale et une réflexion ouverte conduisent à distinguer quatre scénarios prospectifs ouvrant un large champ de possibilités. Ces quatre scénarios ont été officiellement présentés au Groupe de réflexion sur l'Union européenne présidée par Felipe GONZALEZ, ancien Premier ministre de l'Espagne.
International audience In 2003, while the United States was preparing for the overthrow of Saddam Hussein in Iraq, the US Secretary of Defense, Donald Rumsfeld, aroused a great deal of controversy, calling what he called an "old Europe". This would include France and Germany, which refuse to associate with American policy, European countries supporting it that the journalists designate by antiphrasing the "new Europe". The geodemographer may wonder whether the Secretary of State did not wish to use the qualification of "old" in the demographic sense, opposing the aged populations of Europe to others who would be young. In other words, would the geography of the population of Europe be dual? ; Un tableau, trois figures et une carte commentée, tous inédits, illustrent cet article. En 2003, alors que les Etats-Unis préparaient le renversement de Saddam Hussein en Irak, le secrétaire d'Etat américain à la Défense, Donald Rumsfeld, suscite une très forte polémique, en dénommant ce qu'il appelle une « vieille Europe ». Celle-ci serait composée notamment de la France et l'Allemagne, qui refusent de s'associer à la politique américaine, aux pays européens la soutenant que les journalistes désignent par antiphrase la « nouvelle Europe ». Le géodémographe peut se demander si le secrétaire d'Etat n'a pas souhaité utiliser la qualification de « vieille » au sens démographique, opposant des populations vieillies de l'Europe à d'autres qui seraient jeunes. Autrement dit, la géographie de la population de l'Europe serait-elle duale ?
Die historische Abteilung der Freien Universität Berlin hat mit Unterstützung der Deutschen Forschungsgemeinschaft eine Datenbank über 7000 Familien in acht hessischen Gemeinden über den Zeitraum von 1700 bis zum 20. Jahrhundert angelegt. Der Autor berichtet über die Ergebnisse und Probleme der Datenerhebung und Bearbeitung. Kernproblem war die Scheidung von rein biologisch bedingten Daten von sozial beeinflußten. Vermittelt werden die Ergebnisse im Bereich der Periodisierung des untersuchten Zeitraums und Daten über Sterblichkeit, Geburten. (BG)
Road traffic crashes (RTCs) represent the 8th leading cause of global mortality. Worldwide, about 3,700 people lose their lives daily and 1.35 million people die annually due to RTCs. Majority of these deaths occur among children and young adults and almost 93% deaths are from low- and middle-income countries (LMIC). Every year, around 50 million people are disabled due to non-fatal injuries during RTCs, posing serious threats to the global public health. 1,2 In 2004, on the recommendations of United Nations (UN) General Assembly, World Health Organization (WHO) established UN Road Safety Collaboration to address the road safety issues across the world. In March 2010, UN General Assembly proclaimed 2011–2020 as the "Decade of Action for road safety" to reduce the RTCs related deaths through safe system approach at national, regional and global levels.3 UN Sustainable Development Goals (SDG) target 3.6 was aimed to halve the number of global deaths and injuries due to RTCs by the year 2020.4 Decade 2011–2020 partially succeeded in making road safety as a global priority by its inclusion in global health and development agenda, developing technical guidance and global partnership along with political and resources mobilization. However, WHO global status report on road safety 2018 showed that with current road traffic deaths rate, SDG target 3.6 will not be met till 2020.2 The projected number of global deaths and injuries related to RTCs is up to 500 million between 2020 and 2030.5 In August 2020, UN General assembly resolution set a new time frame for at least 50% reduction in RTCs related deaths and injuries by 2030 through proclaiming "Decade of Action for Road Safety 2021-2030". Proposed plan of action is focused on various road safety measures including transport system planning, public transport, infrastructure improvements, vehicle safety measures, improvements and implementation of road safety laws, protection of most vulnerable road users, post crash life-saving emergency care and data collection etc.6 Pakistan is the fifth most populous country in the world7 with 268,935 kilometer roads and rapidly growing number of vehicles on road.8 As per Pakistan Bureau of Statistics data for 2018, total registered vehicles in Pakistan were 18,352,500 including 3,638,833 cars and 4-wheeled light vehicles, 19,743,066 motor cycles (2 wheels) and 847,187 motorcycles/motor rickshaws. During 2017-18, 11,121 reported cases of RTCs included 4829 fatal and 6292 non-fatal crashes involving 13,134 vehicles. During these RTCs, 5948 persons lost their lives and 14,489 got injured.8 However, the actual figures may be much higher due to under-reporting and poor data record as previously documented.9 This huge burden of fatal & nonfatal injuries due to road trauma is adversely affecting on the national economy of Pakistan. According to World Bank estimates, Pakistan expenditure on RTCs related deaths and injuries amounted to 4.7% of its gross domestic product, costing about 13.23 billion dollars in 2016.10 In order to address the long term effects of RTCs, Pakistan has taken several steps regarding road safety like establishing National Highways Authority (NHA) in 1991, National Road Safety Database" and "National Road Safety Fund through Road Safety Act 2020.11 Government of Pakistan has already launched the "National Road Safety Strategy 2018-2030" 12, based on the principles of safe system approach. Main features of safe system approach include safe roads and roadsides, safe vehicles, safe speeds, safe road use (behavior), and post-crash response.13 Regarding safe roads and roadsides, NHA is doing excellent job in improving the infrastructural standards of new and existing roads. Main focus is on the engineering aspects like road widths, curves, fencing, barriers and barrier terminals, signage, pavement marking, cat eyes and shoulder sealing etc. However, the safety standards of roads vary significantly from motorways to highways and from urban areas to rural areas. Design standards for the safety of most vulnerable road-users like pedestrians, cyclists and motorcyclists are not meeting the international standards and need special attention.2,10 Majority of the RTCs related fatalities are due to poor structural and safety standards of the vehicles on the roads.10 International vehicle safety standards include frontal and side impact protection, electronic stability control, seat belts & anchorages, child restraints, motorcycle anti-lock braking system, intelligent speed adaptation and pedestrian protection. Like other LMICs, compliance of Pakistan regarding vehicle safety standards is very poor, especially in case of locally manufactured vehicles.2,10,12 Apart from inadequate vehicle safety regulations, poor implementation of the rules and regulations like periodic inspection of old vehicles, imported used vehicles and heavy vehicles by the law enforcing authorities is a critical issue in Pakistan. Safe speed reflects the behaviour of the road users. High speed not only escalates the risk of RTCs but increases the fatality rate and severity of nonfatal injuries as well. Pakistan has a maximum speed limit of 90 km/h for urban road, 110 km/h for rural road & 130 km/h for motorway.2 Pakistan needs to reduce the speed limit to 50km/h for urban arterial roads and 30km/h in city centres to protect the most vulnerable road users. Enforcement of speed limits through fixed speed camera systems, special speed checking squads or traffic police with license penalty points system for drivers will help in achieving the desired safe speed targets. Special public campaigns should be regularly arranged to change the behavior of all road users including drivers, motorcyclists, passengers and pedestrians regarding responsible road use. Special emphasis should be laid to educate people regarding road safety measures like motorcycle helmet wearing, seat-belt use, avoidance of drink-driving, mobile phone use during driving and over speeding. Post-crash response is vital to prevent the death and disability through emergency care provision to the injured persons. Recently, Pakistan has developed the "National Guidelines for Post-Crash Response" in 2019.14 Although, rescue 1122 services are accessible in majority of areas in Pakistan, but optimal pre-hospital emergency care is not widely available to cover to 268,935 kilometer roads across the country. Former certification is not available for pre-hospital care-providers and trauma registry is not up to the mark. Accident and emergency departments of majority of roadside hospitals are not well-equipped with neurosurgical & orthopaedic emergency services including radiology services like CT scan. Federal and provincial governments need to develop a comprehensive plan for establishing emergency medical services to reduce the post-crash morbidity and mortality. Reliable and high quality data collection and local research regarding the burden and magnitude of RTCs is crucial for short and long term planning of road safety. Unfortunately, accident data collection in Pakistan is highly inadequate and not consistent with international standards.2,14,15 Although local research on road safety has been previously conducted in Pakistan,9,15-17 however the extent and gravity of situation demands extensive research on RTCs by involving all stake holders including academic and research institutes to achieve SDG target 3.6 by the year 2030.
Current WHO diagnostic recommendations segregate non-edematous children with severe acute malnutrition (SAM) into one of three anthropometric phenotypes, those with: (1) low mid-upper arm circumference (MUAC) only; (2) low weight-for-height z-score (WHZ) only; or (3) both low MUAC and low WHZ—all of which are eligible for nutritional rehabilitation according to WHO guidelines.But, based on both ease of use and reports purporting higher mortality in SAM identified by MUAC, many agencies and some national governments use only MUAC as the sole diagnostic criterion for admission to therapeutic refeeding programs—disqualifying low WHZ only children from access to treatment. This diagnostic paradigm shift is premature because the links between anthropometric phenotype and functional severity have not yet been clearly delineated. In fact, recent secondary analyses of historic databases have shown that children with SAM that are excluded from treatment within the framework of a MUAC-only program (i.e., low WHZ only) have a similar risk of death as those who are included; moreover, children with both anthropometric deficits (i.e., low MUAC and low WHZ) have a higher risk of death.This dissertation aims to describe and compare the pathophysiology and functional severity associated with the anthropometric phenotypes of children with SAM today. Building on existing comparative work on vulnerability in SAM, it asks: how does the vulnerability profile of children with SAM who are excluded from treatment within the framework of a MUAC-only program (i.e., low WHZ only) compare to the profiles of those children who are included (i.e., low MUAC only and/or both low MUAC and low WHZ)?A multi-centric cohort study was conducted in uncomplicated, non-edematous children with SAM in Bangladesh, Burkina Faso and Liberia. Participants were recruited equally into each of the three anthropometric phenotypes. A wide range of clinical and biochemical indicators of health and nutritional status were collected at admission to, and at key time points throughout, therapeutic refeeding. We assessed emerging biomarkers of pathophysiology and viability in addition to traditional indicators of health status and nutritional deprivation. These included: serum leptin, a robust biochemical predictor of mortality in children with SAM; natural isotopic abundances of carbon and nitrogen (δ13C and δ15N) in hair, promising archives of metabolic status; bio-electric impedance, a portable, non-invasive technique for assessing body composition in the field-setting; and combined biochemical assessment of micronutrient deficiencies (vitamin A and iron) and inflammation (acute phase proteins).Analysis of these indicators demonstrated that all children with SAM (i.e., low WHZ and/or low MUAC) presents with clinical evidence of nutritional deprivation and micronutrient deficiencies, with significant heterogeneities on key criteria. Children with low WHZ only have biochemical and clinical deficits that are more severe than those in children with low MUAC only. These results also indicate that children with both anthropometric deficits have the highest risk of acute and post-discharge death and morbidity. On this basis, low WHZ must be retained as an independent diagnostic criterion, in line with WHO recommendations. Further research is urgently needed to develop innovative diagnostic solutions to identify low WHZ children in the community. ; Les recommandations actuelles de l'OMS séparent les enfants atteints de malnutrition aiguë sévère (MAS) non-œdémateux en trois phénotypes anthropométriques : faible périmètre brachiale (PB) seul ; faible indice poids-taille (IPT) seul ; ou faible PB et ITP. Tous sont éligibles à une réhabilitation nutritionnelle selon les lignes directrices de l'OMS.Cependant, pour des raisons de facilité d'utilisation, et sur la base de données suggérant une surmortalité chez les enfants atteints de MAS diagnostiquée par le seul PB, plusieurs agences et gouvernements considèrent ce dernier critère comme nécessaire et suffisant à l'éligibilité pour une prise en charge de la MAS, excluant de fait les enfants présentant uniquement un faible IPT. Ce changement de paradigme semble prématuré : les liens entre phénotype anthropométrique, retentissement fonctionnelle et risque associés n'ont pas encore été élucidés. En effet, plusieurs ré-analyse de données anciennes montrent que les enfants atteints de MAS inéligibles à une prise en charge sur la base du seul PB (c'est-à-dire les enfants avec uniquement un faible IPT) présentent un risque de décès similaire à ceux éligibles. De plus, ces analyses suggèrent que les enfants présentant simultanément les deux déficits anthropométriques ont un risque de mortalité encore supérieur.Cette thèse vise à décrire et comparer physiopathologie et de la gravité fonctionnelle associée aux phénotypes anthropométriques d'enfants atteints de MAS. En se basant sur l'état actuel des connaissances sur la vulnérabilité chez ces derniers, ces travaux cherchent à répondre à la question suivante : comment les profils de vulnérabilité des enfants atteints de MAS inéligibles à une prise en charge dans le cadre d'un programme basé sur le PB seul (i.e., faible IPT-seul) se comparent-ils aux profils de ceux qui seraient éligibles?Une étude de cohorte multicentrique a été réalisé chez des enfants atteints de MAS sans complications ni œdèmes au Bangladesh, au Burkina Faso, et au Libéria. Les patients ont été inclus de façon équilibré parmi les trois phénotypes anthropométriques. Un large panel de paramètres cliniques et biochimiques indicateurs du statut nutritionnel et de l'état de santé a été recueilli à l'admission à – et à des points clés pendant – la réhabilitation nutritionnelle. Nous avons évalué de nouveaux biomarqueurs de la physiopathologie et de la survie en plus des biomarqueurs conventionnels de l'état de santé et de la dénutrition : la leptine sérique, un paramètre prédictif robuste de mortalité chez les enfants atteints de MAS ; l'abondance isotopique naturelle du carbone et de l'azote (δ13C et δ15N) dans le cheveux, offrant un intéressant historique nutritionnel et métabolique ; la bio-impédancemétrie, une technique mobile et non-invasive pour l'évaluation de la composition corporelle adaptée à une utilisation sur le terrain ; et la mesure de paramètres biochimiques d'inflammation (protéines de la phase aiguë) et de déficience en micronutriments (vitamine A et fer).L'analyse de ces indicateurs ont monté que tous les enfants atteints de MAS, quel que soit leur phénotype anthropométrique, présentent des signes cliniques de dénutrition et des preuves biologiques de déficience en micronutriments—mais avec une hétérogénéité significative sur certains paramètres clés. Les enfants avec un faible IPT seul présentent des anomalies cliniques et biologiques plus sévères que les enfants avec un faible PB seul. Ces résultats montrent également que les enfants avec les deux déficits anthropométriques présentent le risque de morbi-mortalité le plus élevé sur le court terme, et après prise en charge. Ainsi, nos résultats plaident en faveur du maintien de l'IPT comme critère diagnostique indépendant, en accord avec les recommandations de l'OMS. Le développement de méthodes diagnostiques innovantes permettant d'identifier, directement dans la communauté, les enfants présentant un faible IPT doit être une priorité de recherche.
