Prognostic value of non-specific ST-T changes and left ventricular hypertrohpy electrocardiographic criteria in hypertensive patients: 16-year follow-up results from the MINACOR cohort

Background: Non-specific electrocardiographic ST-T wave changes and voltage criteria for left ventricular hypertrophy (LVH) have been associated with cardiovascular morbidity and mortality. The aim of the cohort study was to evaluate the prognostic value of non-specific ST-T changes and LVH electrocardiographic criteria on cardiovascular events and mortality in hypertensive patients. Methods: A cohort study of 352 non-diabetic hypertensive patients, without associated cardiovascular disease, randomly selected from 1,780 hypertensive patients atte nded in a primary care center. An electrocardiogram was performed at the baseline visit (classified according to the Minnesota Code). Cardiovascular events and death from any cause during the follow-up period were evaluate d. A multivariate analysis adjusted for gender, age and cardiovascular risk factors was performed. Results: Data of 273 patients were analyzed: 58.2% women, age 44.1 (7.9) years, 27.8% smokers, blood pressure at baseline 142.7 (15.3)/89.3 (9.6) mmHg. During the 197. 5 (59.24) month follow-up, 62 patients (22.7%) had a cardiovascular event. On multivariate analysis, age, systolic blood pressure, incidence of diabetes, smoking and electrocardiographic LVH criteria (HR 2.66 [CI 95% 1.39 - 5.10]), were significantly a ssociated with cardiovascular events, but the presence of non-specific ST-T abnormali ties (HR 0.97 [CI 95% 0.49 -1. 90]) was not significantly associated with cardiovascular morbidity and mortality. Conclusions: Hypertensive patients with LVH electrocardiographic criteria have significantly higher cardiovascular mortality and morbidity, but non-specific electrocardiographic ST-T changes are not associated with cardiovascular morbidity and mortality. Keywords: Electrocardiogram, Cardiovascular events, Hypertension, Left ventricular hypertrophy, Major and minor electrocardiographic abnormalities, Repolarization electrocardiographic abnormalitie

EL IMPACTO ECOLÓGICO Y EL BIENESTAR NACIONAL (EL CASO DE BRASIL: 1965-1998)

El crecimiento del producto interno bruto (PIB) como indicador de adelanto social ha sido criticado como engañoso pues pasa por alto las consecuencias ambientales y sociales de una economía creciente. En este trabajo desarrollo un indicador alternativo que no sólo toma en cuenta estos dos aspectos, sino además cómo los problemas ambientales están distribuidos dentro de la población. Aplico mi metodología a datos sobre Brasil de 1965 a 1998 y encuentro que, a pesar de un crecimiento anual más alla de 3% en el PIB, el bienestar nacional aumenta mucho más lentamente o, incluso, disminuye. Los resultados refuerzan las dudas sobre el PIB y demuestran la importancia de la distribución ecológica en relación con el bienestar nacional de un país

Sustainability or natural capital disinvestment? A retrospective on Brazilian economic growth, 1965-1993

This paper evaluates the consequences of the Brazilian ‘economic miracle’ of the 1960s and 70s on the country’s natural environmental, with particular attention to two questions. First, to what extent did natural resource depletion - particularly Amazonian deforestation - after the economic miracle impact adversely on the opportunity for continued well-being improvements in Brazil? Second, was the government policy of targeting incentives toward investment in the Brazilian states in the North and Center-West economically sustainable in the long run? To address the first question, I use a ‘green accounting’ framework that corrects GDP growth for the value of depleted mineral, timber, and soil stocks, and apply it to Brazilian data from 1965 to 1993. For the second question, I base sustainability on whether gross capital formation exceeds the total value of resource depletion, and compare results under two alternative indicators for the same period. The results are generally inauspicious, especially in years subsequent to 1980, and cast considerable doubt on the efficacy of earlier government policies.Este trabalho avalia as conseqüências do ‘milagre econômico’ dos anos sessenta e setenta sobre o meio ambiente, com particular atenção a duas questões. Primeiro, em que medida o esgotamento dos recursos naturais depois do milagre - especialmente o desflorestamento no interior do País - afetou adversamente a possibilidade de melhoria continuada no bem-estar social brasileiro? Segundo, teria sido sustentável, no longo prazo, a política de dirigir os incentivos econômicos para investimentos nas regiões Norte e Centro-Oeste? Para responder à primeira pergunta, utilizo um método de ‘contabilidade verde’, que corrige o crescimento de PIB pelo valor dos recursos naturais exauridos - minerais, madeira, e solo, neste caso - e o aplico a dados das contas nacionais de1965 a1993. Quanto à segunda pergunta, baseio a noção de sustentabilidade na possibilidade de a formação bruta de capital fixo exceder o valor total dos recursos exauridos, e comparo os resultados para o mesmo período com dois indicadores alternativos. Os resultados finais são geralmente desfavoráveis, especialmente após 1980, e lançam considerável dúvida sobre a eficácia da política dos anos anteriores

Environmental Damage and the Mismeasure of Poverty and Inequality: Applications to Indonesia and the Philippines

Environmental and natural resource accounting has heretofore mostly been conducted in a national income accounting context. Yet income inequality and poverty statistics are often exceedingly optimistic absent an adequate accounting of environmental losses. Following Khan’s study on Bangladesh (1997), this paper adjusts for inequality and poverty measures to account for estimated environmental damage, in this case for Indonesia and the Philippines. Unlike Khan, the paper uses actual data on environmental losses published by the World Resources Institute, and tests for different assumptions regarding the within-population distribution of the environmental damage. Results show that both Gini coefficients and poverty rates increase in each country after the adjustments. The study provides further evidence that growth in gross domestic product (GDP) is not always an adequate poverty reduction measure and, more importantly, calls into question the so-called “environment–equity trade-off”, implying that pro-environment policies have the potential to produce “win-win” outcomes in less developed countries such as Indonesia and the Philippines

Welfare, inequality, and resource depletion: A reassessment of Brazilian economic growth, 1965–1993

The use of GDP growth as an indicator of national progress has many critics. Ahluwalia and Chenery noted that GDP growth places greater weight on the income growth of richer income groups, and proposed distribution-neutral and pro-poor alternatives. More recently, studies by the World Resources Institute and others have questioned the sustainability of GDP growth and have introduced natural resource modifications to national income accounting. To date, no studies have undertaken both types of revisions concurrently, creating a revised sustainable development measure based on GDP but corrected for both distributional bias and resource depletion. This dissertation adjusts GDP growth for both concerns, developing an indicator that reflects both the social and the environmental changes that often accompany rapid GDP growth. This sustainable development framework is applied to the case of Brazil, a country that has, in addition to experiencing rapid economic growth in recent decades, suffered massive deforestation and worsened income inequality. First, the Brazilian income accounts are adjusted for the marketable value loss associated with depletion in the mineral, commercial wood, and soil accounts. Next, the estimated value of non-marketable—e.g., indirect, option, and existence—benefits lost as a consequence of Amazonian deforestation are deducted from the revised accounts. Finally, annual growth in the adjusted indicator is compared to growth under the distribution-neutral and pro-poor weighting schemes, following Ahluwalia and Chenery. The three weighting schemes—denoted GDP, equal, and poverty weights—are also applied to the allocation of social cost associated with resource depletion, generating nine possible outcomes. The results of this dissertation cast doubt on the proposition that rapid economic growth in Brazil has resulted in comparable welfare gains. Moreover, the evidence presented illustrates the often unsustainable nature of rapid GDP growth phases. The chief policy implication is that Brazil should discontinue—or at least severely curtail—the regressive and resource-intensive economic policies it has followed in recent decades, in the interest of welfare improvement not only for the poorer groups in society, but for future generations of Brazilians as well

EL IMPACTO ECOLÓGICO Y EL BIENESTAR NACIONAL (EL CASO DE BRASIL: 1965-1998)

El crecimiento del producto interno bruto (PIB) como indicador de adelanto social ha sido criticado como engañoso pues pasa por alto las consecuencias ambientales y sociales de una economía creciente. En este trabajo desarrollo un indicador alternativo que no sólo toma en cuenta estos dos aspectos, sino además cómo los problemas ambientales están distribuidos dentro de la población. Aplico mi metodología a datos sobre Brasil de 1965 a 1998 y encuentro que, a pesar de un crecimiento anual más alla de 3% en el PIB, el bienestar nacional aumenta mucho más lentamente o, incluso, disminuye. Los resultados refuerzan las dudas sobre el PIB y demuestran la importancia de la distribución ecológica en relación con el bienestar nacional de un país