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For example order 20mg cialis sublingual, sulfonamides have been found ry macrolide antibiotics (erythromycin buy cialis sublingual mastercard, clarithromycin and to induce a change in microbial diversity by reducing not only microbial azithromycin) are included in this list; they will consequently be mon- biomass cheap cialis sublingual 20mg online, but also the relationship between bacteria and fungi [92] discount cialis sublingual 20mg free shipping. As itored, with it then being possible that they get to be included in the pri- regards the nitrogen cycle, it is known that nitrification and denitrifica- ority substances list for environmental quality standards [55]. Effects of antibiotics on natural microbial communities (environ- fonamides could partially inhibit denitrification and the application to mental side-effects) soil of swine manure containing the antibiotic tylosine has been shown to change the behavior of nitrogen mediated by these microbial Antibiotics are explicitly designed to have an effect on microorgan- communities [79,111]. At high concentrations, antibiotics produce antimicrobial actions the effects of antibiotics on biogeochemical processes. Indirect effects: modifications of bacterial ecology, resistance develop- At high concentrations, antibiotics can act on bacteria with a bacteri- ment and pharmaceutical biodegradation cidal and bacteriostatic effect, although lethal concentrations rarely occur outside of therapeutic applications [60]. The terms bactericidal and bacteriostatic are which are not directly affected by their presence (e. These concentrations can act in three different ways: The detrimental effect of antibiotics on natural microbial communi- ties could be the disappearance or inhibition of some microbial groups – selecting resistance (by enriching for pre-existing resistant bacteria involved in key ecosystem functions by bactericidal and bacteriostatic and by selecting for de novo resistance) [13,69,112]; effects (direct effect). However, antibiotics can act as a selective force – generatinggenetic andphenotypic variability(by increasing the rate on some microbial populations, which can develop resistance, generat- of adaptive evolution, including resistance development); ing genetic and phenotypic variability and influencing various physio- – -as signaling molecules (influencing various physiological activities, logical activities; in some cases bacteria can develop the capability to including virulence, biofilm formation and gene expression) [84]. Inhibition Thetracyclines 50–200 μgkg−1in Soil 50 Incubation with [106] (Chlortetracycline) poultry manure NaClO3 Inhibition Thetracyclines 1mgL−1 Groundwater 5 Nitrate removal and [107] (Chlortetracycline) nitrite production (continued on next page) 34 P. Some conjugative plasmids possess a set of genes (transfer refers to the ability of a microorganism to survive and multiply, despite genes) which are likely to promote their transfer to different cells (hor- the presence of a biocide molecule like an antibiotic [65]. Many plasmids accumulate a form of multiple re- isms have several mechanisms to avoid the lethal actions of antibiotics sistance that thwarts the effect of several antibiotics, rendering any (Figure 1): production of enzymes inactivating them (e. For example, target sites within bacterial cells; active transportation systems like ef- resistance to glycopeptides or beta-lactam strongly modifies the struc- flux pumps in cell walls, which prevent the buildup of antibiotics inside ture of peptidoglycan in Gram-positive bacteria [62], while the antibiot- cells; alternative metabolic pathways. The acquisition of resistance can have un- because they may have already been pre-exposed to such kind of mole- foreseen consequences for bacterial metabolism, and afterwards for cules in nature. Some of the mechanisms can be intrinsic (for example, the evolution of the environmental microbiosphere. However, these as- Gram-negative bacteria are not susceptible to glycopeptides because pects have not yet been fully explored at a community level [70,114, their membrane is naturally impermeable, in a similar way Gram-posi- 115]. Once introduced into a host cell, the plasmid can remain phosphate sources for growth [62]. The plasmids ments serving in resisting high concentrations of antibiotics also have P. For example,bacteria strains or populations able to degrade some antibiotics have been iden- adapting to increased temperature became resistant to rifampicin anti- tified as in the case of some quinolones and sulphonamides [135]. The biodegradation of an antibiotic depends on the presence of mi- At non-lethal concentrations,bacteria can useantibioticsasextracel- crobial populations which are resistant to its detrimental effects [132] lular chemicals to trigger different cellular responses and they can be and have developed the ability to degrade it during previous exposure considered friendly signals that coordinate and regulate microbial com- to the compound [127,129]. Consequently, antibiotics have a dual na- completely remove a toxic compoundfrom the environmentif it is min- ture: as both weapon and signaling molecules; in the latter case, they eralized. Abiotic factors such as temperature, water content, soil texture can have ecological effects [84,121,122]. Oxygen, moisture, the presence/absence of alter- interactions between bacteria and can affect the physiology of some native sources of carbon and nitrogen, and the presence of an acclima- natural microbial populations. For examples, non-lethal levels of antibi- tized bacterial consortium are necessary for antibiotic biodegradation otics can alter the expression of genes involved in a variety of bacterial [132]. Consequently, antibiotics induce re- Specific bacterial groups or strains able to grow on antibiotics as a sponses other than those associated with their antimicrobial activities sole carbon source have recently been isolated from natural environ- and they are signaling molecules with regulatory functions [124,125]. In some cases, they were also able to mineralize It has recently been reported that antibiotic resistance may also be de- them [133,134,137–140]. The majority of the antibiotics biocidal substance and one or more therapeutic antibiotic classes) [126]. Furthermore, each antibiotic-consuming isolate was resistant to 1 integrons (resistance genes for almost all antibiotic families multiple antibiotics at clinically significant concentrations. This phe- including beta-lactams, aminoglycosides, trimethoprim, chlorampheni- nomenon suggests that this unappreciated reservoir of antibiotic-resis- col, fosfomycin, macrolides, lincosamides, rifampicin and quinolones) tance determinants can contribute to increasing levels of multiple are more prevalent in bacteria exposed to detergents and biocides [125, antibiotic resistance in pathogenic bacteria [141]. Plasmids provide limited opportunities for biocides and metals to An Alpha-Proteobacterium (Labrys portucalensis F11) able to use a promote horizontal transfer of antibiotic resistance through co-selection, range of fluoroorganic compounds was found to be able to degrade whereas ample possibilities exist for indirect selection via chromosomal the quinolones ofloxacin, norfloxacin and ciprofloxacin [134]. This bacterium was selected from an ag- effects against other, sensitive bacteria and other microorganisms. For ricultural soil treated for many years with veterinary antibiotics simu- example, the reason for applying antibiotics as growth promoters in lating annual applications of manure from medicated swine. There would be a problem if the same phenom- concentration in the liquid media during the degradation experiment ena occurred in the environment, especially with compounds being was quite high (50 mg L−1), this study is very promising, considering enriched in certain samples, e. It is well known that, if bacterial community diversity is high, the Regarding the possible degradation of antibiotics, natural microbial probability of biodegradation of a compound is also high and this is of communities are key players in several processes controlling the quality critical importance in the testing of antibacterial compounds and the of soil and water ecosystems and regulating the fate of pollution re- evaluation of test results. Microorganisms are involved in that antibiotics from the same or different groups may together have an ecosystem self-purification processes since they can degrade contami- additive effect, which affects their biodegradation [142,143]. Biodegradation is the reason, the impact of antibiotics in the environment is underestimated most important process for eliminating the majority of xenobiotics, in- and the possibility of their biodegradation in the environment is cur- cluding pharmaceuticals [129–132]. Consequently, The main degradation process of an antibiotic depends on its chem- chromosomes of environmental bacteria normally contain antibiotic re- ical structure. Concluding remarks of these genes harbor dozens of acquired resistance elements often con- ferring redundant protection against individual antibiotics [5]. In the The release of antibiotics and resistance genes into natural ecosys- presence of antibiotic pressure they can increase above usually occur- tems is a recent event in evolutionary terms. There is a particular con- ring background levels [62] and, consequently, can be considered pol- cern regarding their impact on non-target bacteria and their related lutants themselves. These pollutants can directly (bactericidal and bac- pathogens in areas with low contamination by antibiotics [63] indicates teriostatic effect with the disappearance or inhibition of some microbial that, once these elements are present in transferable genes, the proba- groups involved in key ecosystem functions) or indirectly (selecting re- bility of keeping them in natural ecosystems can be high. For this reason, it has been suggested that hospital sistance genes, isolation measures should be assessed to avoid, as much discharges, which contain human pathogenic infectious bacteria (resis- as possible, contact between the bacteria linked to the human sphere tant and susceptible) and antibiotics, be treated separately, to prevent and environmental ones. Given the presence Both types of pollution (antibiotics and resistance genes) can affect of resistance genes in environments without a history of antibiotic con- the structure and function of environmental microbial populations. In particular, quantitative data on the abundance of tance genes acquired through horizontal gene transfer to human patho- resistance genes in environments (soil, water) are necessary for their gens, these changes are important for the future of human health. America, Canada Moreover, in addition to controlling of the use of antibiotics, studies and Asia), they are still widely used as growth promoters. Many coun- to improve their degradation in natural environments are needed to tries have also restricted the use of antibiotics in aquaculture, especially combat this type of pollution. In fact, the presence of microbial popula- of those antibiotics used in the treatment of human infections [146]. The biodegradation (and mineralization) of antibiotics have been of antibiotics used in human therapy, their complete elimination is not observed (only for a few molecules), although it requires microbial ad- feasible. It is therefore expected that the amount of antibiotics released aptation and selection processes that occur over relatively long time pe- into the environment from both human and veterinary medicine will riods of exposure in a pristine environment. Some authors have shown terms of exclusionof keystonespecies, alterationof functions, inhibition that the reduction of antibiotics in the environment can also decrease of specific activities, etc. Moreover, the composition of microbial groups the amount of resistance genes and their transfer to humans, but others could be sensitive and not immediately resilient to the presence of anti- that, although the resistance is decreasing, its decline is slow and resis- biotics (which could be considered a disturbance). Moreover, the fact that some resistance tion are often associated with changes in ecosystem process rates. Definitions Definition: Antibiotics are molecules that kill, or stop the growth of, microorganisms, including both bacteria and fungi. Antibiotics that kill bacteria are called "bactericidal" Antibiotics that stop the growth of bacteria are called "bacteriostatic" B. Types of bacteria: Gram stain - A test, resulting in the classification of bacteria, developed in the last century by Hans Christian Gram, a Danish microbiologist - Gram positive bacteria will retain the original blue stain - Gram negative bacteria will lose the blue stain upon intermediate acetone treatment and will stain red 1 2 3 Definitions: Pneumonia: Inflammation of the lung, usually caused by bacteria or viruses. Otis media: Inflammation of the middle ear Endocarditis: Inflammation of the innermost tunic of the heart Septicemia: Systemic disease caused by the spread of microorganisms and their toxins via the circulating blood (also called "blood poisoning") Pathogen: a microorganism that causes disease. The large numbers of bacterial cells, combined with the short generation times facilitate the 11 development of mutants. Most classes of antibiotics, including the b-lactam antibiotics, tetracyclines, aminoglycosides, and macrolides. However, some important classes of antibiotics (including the sulfa antibiotics, the quinolones, and the oxazolidinones) are man-made, originating totally from synthetic chemical operations. After attempt at isolation of compound responsible, judged to be too unstable for use as antibiotic 2. Previous to this, such a structure was proposed but was said to be "impossibly strained" C. Variation at side chain can dramatically affect biological activity against various strains of bacteria D. Penicillin V has more acid stability, and can be administered orally How Does Penicillin Work?

Meadowsweet has been used as an antacid purchase cialis sublingual 20 mg line, anti-inflammatory buy cheap cialis sublingual 20mg line, mild urinary antiseptic discount cialis sublingual online, and astringent purchase cialis sublingual 20 mg with mastercard. It has traditionally been favored for treatment of gastrointestinal tract disturbances ranging from flatulence to hyperacidity. Concurrent use of meadowsweet with warfarin, heparin, 601 602 Part Three / Dietary Supplements aspirin, or any other drug with an anticoagulant effect should be avoided. Until further evidence is available, meadowsweet should not be prescribed for children or used during pregnancy. Mills S, Bone K: Principles and practice of phytotherapy, Edinburgh, 2000, Churchill Livingstone. Sroka Z, Cisowski W, Seredynska M, et al: Phenolic extracts from meadowsweet and hawthorn flowers have antioxidative properties, Z Naturforsch [C] 56:739-44, 2001. It is also traditionally used as a sedative and for treatment of headache, epilepsy, paralysis, hypertension, and debility. Mistletoe lectins have been shown to have cytotoxic effects on cancer cells in vitro. Results of in vitro and in vivo studies suggest that this lectin has immunomodulatory capacity as reflected in upregulation of the produc- tion of proinflammatory cytokines. Mistletoe, like allicin from garlic, induces programmed cell death, thus arresting cellular proliferation. Soy bean, garlic, ginger, and green tea—which in epidemiologic studies have been suggested to reduce the incidence of cancer—may also do so by inducing programmed cell death. A prospective, long-term, epidemiologic, cohort study demonstrated that 603 604 Part Three / Dietary Supplements treatment with Iscador can result in a clinically relevant prolongation of sur- vival time in patients with cancer and that Iscador appears to stimulate self- regulation. Although only a few adverse reactions have been noted, cases of anaphylactic shock have been described. Mistletoe decreases the efficacy of warfarin and interacts with oral contraceptives and estrogen. Primack A: Complementary/alternative therapies in the prevention and treatment of cancer. Thatte U, Bagadey S, Dahanukar S: Modulation of programmed cell death by medicinal plants, Cell Mol Biol (Noisy-le-grand) 46:199-214, 2000. Hutt N, Kopferschmitt-Kubler M, Cabalion J, et al: Anaphylactic reactions after therapeutic injection of mistletoe (Viscum albumL. Pau d’arco, or taheebo, is derived from the inner bark of a tree, Tabebuia impetiginosa. In Brazil, it is used as an analgesic, anti-inflammatory, antineo- plastic, and diuretic. Its antimicrobial, immunostimulant, and cytotoxic properties are under investigation. Both ubiquinol, the reduced form of coenzyme Q, and menaquinone (vitamin K) have significant antioxidant properties. In vitro tests with 607 608 Part Three / Dietary Supplements β-lapachone displayed activity comparable to that of the antipsoriatic drug anthralin against the growth of a human keratinocyte cell line. Lapachol is considered to have antitumor activity and may be used as complementary therapy for certain malignancies. Strict adherence to recommended doses is advocated to pre- vent potential adverse effects, with respect to both bleeding and free radical pathology. Cyclopentene dialdehydes from Tabebuia impetiginosa, Phytochemistry 53:869-72, 2000. Muller K, Sellmer A, Wiegrebe W: Potential antipsoriatic agents: lapacho compounds as potent inhibitors of HaCaT cell growth, J Nat Prod 62:1134-6, 1999. Anesini C, Perez C: Screen of plants used in Argentine folk medicine for antimicrobial activity, J Ethnopharmacol 39:119-28, 1993. Its volatile oils, extracted from leaves and stems harvested just before the plant flowers, are used for medicinal purposes. Peppermint is usually taken after a meal to relieve intestinal colic and dyspepsia. Peppermint is frequently included in topical applications for myalgia and neuralgia. Peppermint oil is used as a spasmolytic, reducing smooth muscle contractions in diverse cir- cumstances. It is usually taken after a meal to reduce indigestion and colonic spasms by dampening the gastrocolic reflex. It increases the pain threshold through activation of the endogenous opiate system and may have a mild sedative effect on the central nervous system. Menthol stimulates the secretion of digestive enzymes and bile and is a mild anesthetic. In a prospective, randomized, double-blind, placebo-controlled, clinical study, three in four patients taking an enteric- coated peppermint oil formulation (Colpermin) three to four times daily, 15 to 30 minutes before meals for 1 month, experienced less severe abdominal pain, less abdominal distension, reduced stool frequency, fewer borborygmi, and less flatulence. Enteric-coated capsules con- taining a fixed combination of 90 mg of peppermint oil and 50 mg of caraway oil have been found to reduce the intensity of pain, pressure, heav- iness, and fullness in patients with dyspepsia. Comparable results were attained with both treatments in the Dyspeptic Discomfort Score regardless of the presence of Helicobacter pylori. A manometric study showed that peppermint oil, 5 drops in 10 mL of water, completely elimi- nated simultaneous esophageal contractions in all patients without lowering esophageal sphincter pressure or altering the pressure or duration of con- tractions in both the upper and lower esophagus. High doses of essential oils may cause headaches, skin rashes, bradycardia, ataxia, pyrosis, and muscle tremors. Peppermint oil should be avoided or used cautiously in patients with salicylate sensitivity or aspirin- induced asthma. Provided that the concentration of pulegone, a constituent of peppermint oil, does not exceed 1%, it appears that peppermint oil is safe when used in cosmetic formulations. Peppermint oil should not be applied to the facial area of infants and young children, since spasm of the glottis has been reported. When tea is prepared by soaking two teaspoons of dried peppermint leaves in boiling water for 5 to 10 minutes, the cup should be covered to trap the volatile oils. Mills S, Bone K: Principles and practice of phytotherapy, Edinburgh, 2000, Churchill Livingstone. May B, Kohler S, Schneider B: Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia, Aliment Pharmacol Ther 14:1671-7, 2000. A multicenter, reference-controlled double-blind equivalence study, Arzneimittelforschung 49:925-32, 1999. Imai H, Osawa K, Yasuda H, et al: Inhibition by the essential oils of peppermint and spearmint of the growth of pathogenic bacteria, Microbios 106(suppl 1):31-9, 2001. Ilmberger J, Heuberger E, Mahrhofer C, et al: The influence of essential oils on human attention. Umezu T, Sakata A, Ito H: Ambulation-promoting effect of peppermint oil and identification of its active constituents, Pharmacol Biochem Behav 69:383-90, 2001. Nair B: Final report on the safety assessment of Mentha piperita (peppermint) oil, Mentha piperita (peppermint) leaf extract, Mentha piperita (peppermint) leaf, and Mentha piperita (peppermint) leaf water, Int J Toxicol 20(suppl 3):61-73, 2001. Phytonutrients are a diverse group of chemicals that provide plants with protection against various predators and diseases. Although they are not a source of energy, minerals, or vitamins, when consumed in moderate amounts by humans, phytochemicals have a health-promoting effect. Phytochemicals may demonstrate antioxidant, antimutagenic, antiestrogenic, anticarcino- genic, and anti-inflammatory effects. Phytosterols found in plant oils are noted for their an anti-inflammatory and immune-modulating effects, whereas phytoestrogens found in soy products are recognized for their hor- monal and antioxidant effects. They impart an astringent flavor to fresh food and can be a source of discoloration and “off flavors. Because phenols readily coprecipitate with protein, they are readily eliminated from food during the manufacturing process. Ferulic acid (oryzanol), derived from rice bran oil, is a strong antioxidant, and caffeic acid has anticarcinogenic activity. Consuming moderate amounts of cinnamates may protect against a range of genotoxic substances. Variations around the middle phenol ring have resulted in flavonoids being categorized into the following seven groups: flavones (e. Good sources of flavones are fruit skin, lemon, and onion; good sources of flavon-3-ols are black grapes, onions, and broccoli; good sources of flavanon(ol)es are cit- rus fruits; good sources of flavan-3-ols are red wine and tea; good sources of anthocyanins are red wine, grapes, and strawberries; good sources of chalones are apples; and good sources of isoflavones are soybeans and chickpeas (see Chapters 65 and 93). Isoflavones, indoles, isothiocyanates, and lignans all modify and dampen the effect of endogenous estrogens and may reduce the risk of cancer.

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This second application of the global burden of disease Publication of the Global Burden of Disease (1990) was a framework permits an analysis of trends observed since the watershed event in the assessment of health and disease cialis sublingual 20 mg cheap. The volume is appropriately cautious in draw- ed a comprehensive portrait of diseases buy discount cialis sublingual 20 mg line, injuries discount cialis sublingual american express, and causes of ing inferences about disease-specific trends because of changes death purchase genuine cialis sublingual. It dealt creatively and carefully with the hundreds of in data sources and, in some instances, improvements in issues that had to be addressed to develop useful, broadly approaches to measurement. These included establishing terms The volume also contains a valuable and admirably frank of trade among disabling conditions, among age groups and chapter on the sensitivity of estimates to various sources of generations, and between the living and the dead. Some estimates are found to that offered tempting shortcuts, the authors decided in favor of have wide bands of uncertainty. Like national income would be much greater without the heroic efforts reflected in accounts, it connected parts to a whole and measured the whole this volume. As a sophisticated measuring My congratulations to the authors and the sponsoring device, it could not be ignored by any serious student of epi- agencies. One might have experimented with its calibrations, but the device itself was irreplaceable. In 2002, a number of organizations—the Fogarty The review generated findings about the comparative cost- International Center of the U. National Institutes of Health, effectiveness of interventions for most diseases important in the World Bank, the World Health Organization, and the Bill & developing countries. This consistency constraint led to downward one dealing with deaths and the disease burden by cause and revision of the estimates of deaths from many diseases. In addition, the because health system activities, including the choice of inter- World Bank invested in generating improved estimates of ventions, depend partly on the magnitude of health problems, deaths and the disease burden by age, cause, and region for and because assessment of the burden of diseases, injuries, and 1990. Results of this initial assessment of the global burden of risk factors includes important methodological and empirical disease appeared both in the World Development Report 1993 dimensions. Organization has also invested in improving the conceptual, During 1999–2004, the authors of this volume and many methodological, and empirical basis of burden of disease collaborators from around the world worked intensively to assessments and the assessment of the disease and injury assemble an updated, comprehensive assessment of the global xvii burden of disease and its causes. New York: Oxford University conditions of the world’s population at the beginning of Press. Quantification of Health Risks: The Global and Regional Burden of New York: Oxford University Press. Prior to joining the World Health Organization health and Head of the School of Population Health at the in 2000, he worked for the Australian Institute of Health and University of Queensland, Australia. Prior to joining the uni- Welfare for 13 years in technical and senior managerial posts. Mathers has published widely on population health Health Organization in Geneva, where he held a series of tech- and mortality analysis; on inequalities in health, health nical and senior managerial posts, including chief epidemiolo- expectancies, and burden of disease; and on health system gist in the Tobacco Control Program (1992–5), manager of costs and performance. He developed the first set of the Program on Substance Abuse (1996–8), director of the Australian health accounts mapping health expenditures by Epidemiology and Burden of Disease Unit (1999–2001), and age, sex, and disease and injury causes (1998) and carried out senior science adviser to the director-general (2002). At the World Health Organization, he played a key role and causes of death, including the impact of the global tobacco in the development of comparable estimates of healthy life epidemic, and on the global descriptive epidemiology of major expectancy for 192 countries, in the reassessment of the global diseases, injuries, and risk factors. He is the coauthor of the burden of disease for the years 2000–2, and in the develop- seminal Global Burden of Disease Study (1996), which has ment of software tools to support burden of disease analysis at greatly influenced debates about priority setting and resource the country level. He has been awarded major research global, regional, and country mortality and burden of disease grants in epidemiology, health services research, and popula- from 2002 to 2030. Mathers graduated with an honors degree and university Queensland; and is a member of Australia’s Medical Services medal in physics from the University of Sydney in 1975 and was Advisory Committee. His principal research interests are the measure- ematics from the University of Western Australia in 1973 and a ment and reporting of population health and its determinants, master of science degree in statistics from Purdue University in burden of disease methods and applications, measurement of the United States. His He has collaborated with leading researchers throughout the principal research interests are analysis of mortality data; bur- world on issues relating to the development and applications of den of disease methods and applications; and quantification of summary measures of population health. He has collaborated extensively with leading researchers Majid Ezzati is an assistant professor of international health at throughout the world on these issues, particularly at Harvard the Harvard School of Public Health. He holds bachelor’s and and Oxford universities, and he holds an adjunct appointment master’s degrees in engineering from McMaster and McGill at Harvard University as professor of population and interna- Universities and a Ph. Ezzati’s research interests center around understanding the causal determinants Colin D. Mathers is a senior scientist in the Evidence and of health and disease, especially as they change in the process of Information for Policy Cluster at the World Health social and economic development and as a result of technolog- Organization in Geneva. World Health Organization’s Epidemiology and Burden of xix His current research focuses on two main areas. Murray is the Richard Saltonstall professor of area is the relationship among energy, air pollution, and health public policy, professor of social medicine, and director of the in developing countries, on which he conducts field research Harvard Initiative for Global Health. This research has led to university, for five years he led the World Health Organization’s the identification and design of technological interventions for Evidence and Information for Policy Cluster, which was dedi- reducing exposure to indoor air pollution from household cated to building the evidence base and fostering a culture of evi- energy use. His second area of research is major health risk fac- dence to inform health decision making. The cluster was respon- tors and their role in the current and future disease burden sible for work on epidemiology and the burden of disease, the globally and in specific countries and regions. His research on World Health Survey,cost-effectiveness analysis,national health risk factors focuses on environmental risks, smoking, and accounts, catastrophic health spending, responsiveness, health nutritional risks. He was the lead scientist for the World Health financing policy, human resources for health systems, coverage Organization’s Comparative Risk Assessment Project, which of health interventions, quality of care and patient safety, stew- was reported in the World Health Report 2002: Reducing Health, ardship of health systems,assessment of health system perform- Promoting Healthy Life. He is currently studying the role of ance,health research policy,and a range of efforts to manage and major risk factors in health inequalities. Jamison is a professor of health economics in the School focused on tuberculosis control and the development with of Medicine at the University of California, San Francisco Alan D. Jamison concurrently serves as an Adjunct Professor in both metric for comparing deaths and disabilities caused by various the Peking University Guanghua School of Management and diseases and the contribution of risk factors to the overall bur- in the University of Queensland School of Population Health. Jamison was on the faculty of the neering effort has been hailed as a major landmark in public University of California, Los Angeles, and also spent a number health and an important foundation for policy formulation of years at the World Bank, where he was a senior economist and priority setting. Murray has contributed to in the research department, division chief for education the development of a range of new methods and empirical policy, and division chief for population, health, and nutri- studies for strengthening the basis for population health meas- tion. In 1992–93 he temporarily rejoined the World Bank to urement and cost-effectiveness analysis. A main thrust of his serve as Director of the World Development Report Office work has been the conceptualization, measurement, and appli- and as lead author for the Bank’s 1993 World Development cation of approaches to understanding the inputs, organiza- Report: Investing in Health. His publications are in the areas of tion, outputs, and outcomes of health systems. Jamison or edited eight books, many book chapters, and more than 90 studied at Stanford (B. National Academies, Gainesville, Florida, United States Perla Santos Ocampo President, National Academy of Science and Thechnology, San Guy de Thé, Co-chair Juan, Philippines Research Director and Professor Emeritus, Institut Pasteur, Paris, France G. Academy of Medical Sciences, Cambridge, Gates Foundation, Seattle, Washington, United States United Kingdom xxi Misael Uribe Witold Zatonski President, National Academy of Medicine of Mexico, Mexico Professor, Health Promotion Foundation, Warsaw, Poland City, Mexico Zhengguo Wang Professor, Chinese Academy of Engineering, Daping, China xxii | Advisory Committee to the Editors Contributors Stephen J. Murray World Bank Harvard University Initiative for Global Health; Harvard School of Public Health Goodarz Danaei Harvard School of Public Health; Harvard University Anthony Rodgers Initiative for Global Health University of Auckland Majid Ezzati Joshua Salomon Harvard School of Public Health; Harvard University Harvard School of Public Health Initiative for Global Health Sonbol A. Jamison Population Reference Bureau; Disease Control Priorities University of California, San Francisco; Disease Control Project Priorities Project Stephen Robert Vander Hoorn Julian Jamison University of Auckland University of California, Berkeley Jelka Zupan Joy E. Lopez University of Queensland; Harvard School of Public Health xxiii Disease Control Priorities Project Partners The Disease Control Priorities Project is a joint enterprise of billion to $22 billion each year in loans to its client countries, the Fogarty International Center of the National Institutes provided $1. The World Bank is working in more than 100 developing and the Population Reference Bureau. For 75 years, the The World Health Organization is the United Nations’ spe- bureau has analyzed complex data and research results to cialized agency for health. Its objective, as set out in its consti- provide objective and timely information in a format easily tution, is the attainment by all peoples of the highest possible understood by advocates, journalists, and decision makers; level of health, with health defined as a state of complete phys- conducted workshops around the world to give key audiences ical, mental, and social well-being and not merely the absence the tools they need to understand and communicate effec- of disease or infirmity. Breman, Mariam Claeson, tutions and individuals spanning a period of more than David B. Richard Suzman of the National Institute on from the contributions of those institutions and the efforts of Aging provided invaluable support and critical reactions. National medical academies or medical divisions of the scientific Institutes of Health. National Bank’s Health, Nutrition, and Population Department, Academy of Sciences, the U. Patrick Kelley and Dianne Stare of the Institute of involvement of Bank staff as coauthors and reviewers.

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