The Biological Standard of Living in the two Germanies.

Physical stature is used as a proxy for the biological standard of living in the two Germanies before and after unification in an analysis of a cross-sectional sample (1998) of adult heights, as well as among military recruits of the 1990s. West Germans tended to be taller than East Germans throughout the period under consideration. Contrary to official proclamations of a classless society, there were substantial social differences in physical stature in East-Germany. Social differences in height were greater in the East among females, and less among males than in the West. The difficulties experienced by the East-German population after 1961 is evident in the increase in social inequality of physical stature thereafter, as well as in the increasing gap relative to the height of the West-German population. After unification, however, there is a tendency for East-German males, but not of females, to catch up with their West-German counterparts

Shopping Streets versus Shopping Malls - Determinants of Agglomeration Format Attractiveness from the Customers' Point of View

The decline of shopping streets and the rise of shopping malls have been major trends in European retailing for decades. So far, research has failed to investigate this shift of agglomeration format (AF) patronage from a marketing perspective, including the consumers’ point of view. This paper presents a theoretical comparison of generic similarities and conceptual differences between shopping streets and shopping malls. Based on this comparison the AF-specific characteristics perceived by consumers are compared and discussed with respect to their impact on agglomeration attractiveness. This leads to the development of a conceptual framework which is empirically tested using a web-based survey of almost 1,000 consumers representing a typical urban central European retail market. The relative importance of nine distinctive AF characteristics on attractiveness was analysed using structural equation modelling. The findings proved to be quite similar for both shopping streets and shopping malls; the retail tenant mix and atmosphere had the highest relative importance

Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007

<p>Abstract</p> <p>Background</p> <p>Antenatal care aims to prevent maternal and perinatal mortality and morbidity. In Indonesia, at least four antenatal visits are recommended during pregnancy. However, this service has been underutilized. This study aimed to examine factors associated with underutilization of antenatal care services in Indonesia.</p> <p>Methods</p> <p>We used data from Indonesia Demographic and Health Survey (IDHS) 2002/2003 and 2007. Information of 26,591 singleton live-born infants of the mothers' most recent birth within five years preceding each survey was examined. Twenty-three potential risk factors were identified and categorized into four main groups, external environment, predisposing, enabling, and need factors. Logistic regression models were used to examine the association between all potential risk factors and underutilization of antenatal services. The Population Attributable Risk (PAR) was calculated for selected significant factors associated with the outcome.</p> <p>Results</p> <p>Factors strongly associated with underutilization of antenatal care services were infants from rural areas and from outer Java-Bali region, infants from low household wealth index and with low maternal education level, and high birth rank infants with short birth interval of less than two years. Other associated factors identified included mothers reporting distance to health facilities as a major problem, mothers less exposed to mass media, and mothers reporting no obstetric complications during pregnancy. The PAR showed that 55% of the total risks for underutilization of antenatal care services were attributable to the combined low household wealth index and low maternal education level.</p> <p>Conclusions</p> <p>Strategies to increase the accessibility and availability of health care services are important particularly for communities in rural areas. Financial support that enables mothers from poor households to use health services will be beneficial. Health promotion programs targeting mothers with low education are vital to increase their awareness about the importance of antenatal services.</p

Mortality in Central Java: results from the indonesian mortality registration system strengthening project

Background. Mortality statistics from death registration systems are essential for health policy and development. Indonesia has recently mandated compulsory death registration across the entire country in December 2006. This article describes the methods and results from activities to ascertain causes of registered deaths in two pilot registration areas in Central Java during 2006-2007. The methods involved several steps, starting with adaptation of international standards for reporting causes of registered deaths for implementation in two sites, Surakarta (urban) and Pekalongan (rural). Causes for hospital deaths were certified by attending physicians. Verbal autopsies were used for home deaths. Underlying causes were coded using ICD-10. Completeness of registration was assessed in a sample of villages and urban wards by triangulating data from the health sector, the civil registration system, and an independent household survey. Finally, summary mortality indicators and cause of death rankings were developed for each site. Findings. A total of 10,038 deaths were registered in the two sites during 2006-2007; yielding annual crude death rates of 5.9 to 6.8 per 1000. Data completeness was higher in rural areas (72.5%) as compared to urban areas (52%). Adjusted life expectancies at birth were higher for both males and females in the urban population as compared to the rural population. Stroke, ischaemic heart disease and chronic respiratory disease are prominent causes in both populations. Other important causes are diabetes and cancer in urban areas; and tuberculosis and diarrhoeal diseases in rural areas. Conclusions. Non-communicable diseases cause a significant proportion of premature mortality in Central Java. Implementing cause of death reporting in conjunction with death registration appears feasible in Indonesia. Better collaboration between health and registration sectors is required to improve data quality. These are the first local mortality measures for health policy and monitoring in Indonesia. Strong demand for data from different stakeholders can stimulate further strengthening of mortality registration systems

Characterizing bird-keeping user-groups on Java reveals distinct behaviours, profiles and potential for change

Over 70 million cage‐birds are kept across 12 million households on the island of Java, Indonesia, fuelling serious concerns for the health of regional wild bird populations. Understanding the behaviours, preferences and demographic profiles of bird‐keepers will guide attempts to reduce demand for wild birds and hence the impact of trade on wild populations and their host ecosystems. We profile three songbird‐keeping user‐groups based on interviews of nearly one thousand people across Java: hobbyists, who own birds primarily as pets; contestants, who own birds to enter in singing contests; and breeders, who own birds to breed and train for resale or as a pastime. User‐groups diverged in their bird‐keeping habits and preferences. Hobbyists tended to own small numbers of inexpensive and typically native birds, while contestants and breeders owned larger numbers of often valuable birds. Hobbyists were far less likely to consider origin when buying a bird, owned a larger proportion of both potentially wild‐caught and globally threatened birds, but showed no preference for any taxon. By contrast, owning relatively large numbers of lovebirds Agapornis spp. and Zebra Doves Geopelia striata were key characteristics of contestants, while breeders owned the largest number of birds and species, in particular White‐rumped Shamas Kittacincla malabarica. Within a 2‐year period, user‐group membership was fluid, with much transitioning between non‐bird ownership and hobbyists, recruitment of non‐bird owners to contestants and movement both in and out of the breeder group. Our study provides behavioural change efforts with demographic and geographic profiles to target bird‐keepers, who tended to be more affluent and urban and to live in the eastern provinces. Among bird‐keepers, hobbyists tended to be middle‐aged and lived in the western provinces, contestants were younger urban bird‐keepers employed in business and breeders were commoner in the eastern provinces, reflecting the cultural importance of bird‐keeping among the Javanese. Efforts to increase the sustainability of bird‐keeping in Java should focus on emphasizing the importance of captive‐bred birds, in particular to hobbyists, the largest user‐group, whose bird‐keeping behaviour poses the biggest threat to wild bird populations, whilst also incentivizing legitimate breeding enterprises among contestants and breeders

The effect of five years versus two years of specialised assertive intervention for first episode psychosis - OPUS II: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The Danish OPUS I trial randomized 547 patients with first-episode psychosis to a two-year early-specialised assertive treatment programme (OPUS) versus standard treatment. The two years OPUS treatment had significant positive effects on psychotic and negative symptoms, secondary substance abuse, treatment adherence, lower dosage of antipsychotic medication, and a higher treatment satisfaction. However, three years after end of the OPUS treatment, the positive clinical effects were not sustained, except that OPUS-treated patients were significantly less likely to be institutionalised compared with standard-treated patients. The major objective of the OPUS II trial is to evaluate the effects of five years of OPUS treatment versus two years of OPUS treatment.</p> <p>Methods</p> <p>The OPUS II trial is designed as a randomized, open label, parallel group trial with blinded outcome assessment. Based on our sample size estimation, 400 patients treated in OPUS for two years will be randomized to further three years of OPUS treatment versus standard treatment. The specialized assertive OPUS treatment consists of three core elements: assertive community treatment, psycho-educational family treatment, and social skills training.</p> <p>Discussion</p> <p>It has been hypothesized that there is a critical period from onset up to five years, which represents a window of opportunity where a long-term course can be influenced. Extending the specialized assertive OPUS treatment up to five years may allow the beneficial effects to continue beyond the high-risk period, through consolidation of improved social and functional outcome.</p> <p>Trial registration</p> <p>Clinical Trial.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00914238">NCT00914238</a></p

Housing deficits as a frame for housing policy: demographic change, economic crisis and household formation in Indonesia

The idea of housing deficit is a common, seemingly objective frame for housing policies that promote increased supply. This paper critically examines the concept through a case study of Indonesia, where different sources report a deficit of between 3 and 14 million dwelling units estimated without a transparent methodology. The wide range of estimates demonstrates the multiple interpretations of the term's meaning. In the paper, changes in household formation trends in urban Indonesia from 1990 to 2007 are used to estimate a quantitative housing deficit. I find the decreasing rate of household formation that is being interpreted as a housing deficit. However, this interpretation is complicated by the country's demographic transition and the high urbanization rate. Further, the abrupt change in household formation occurred around the year 2000, suggesting that the economic and political upheavals following the Asian financial crisis played an important role. Comparison of household formation rates across socioeconomic groups and urban areas shows housing markets also matter, illustrating the complexity of the issue. © 2013 Copyright Taylor and Francis Group, LLC

Why don't some women attend antenatal and postnatal care services?: a qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia

<p>Abstract</p> <p>Background</p> <p>Antenatal, delivery and postnatal care services are amongst the recommended interventions aimed at preventing maternal and newborn deaths worldwide. West Java is one of the provinces of Java Island in Indonesia with a high proportion of home deliveries, a low attendance of four antenatal services and a low postnatal care uptake. This paper aims to explore community members' perspectives on antenatal and postnatal care services, including reasons for using or not using these services, the services received during antenatal and postnatal care, and cultural practices during antenatal and postnatal periods in Garut, Sukabumi and Ciamis districts of West Java province.</p> <p>Methods</p> <p>A qualitative study was conducted from March to July 2009 in six villages in three districts of West Java province. Twenty focus group discussions (FGDs) and 165 in-depth interviews were carried out involving a total of 295 respondents. The guidelines for FGDs and in-depth interviews included the topics of community experiences with antenatal and postnatal care services, reasons for not attending the services, and cultural practices during antenatal and postnatal periods.</p> <p>Results</p> <p>Our study found that the main reason women attended antenatal and postnatal care services was to ensure the safe health of both mother and infant. Financial difficulty emerged as the major issue among women who did not fulfil the minimum requirements of four antenatal care services or two postnatal care services within the first month after delivery. This was related to the cost of health services, transportation costs, or both. In remote areas, the limited availability of health services was also a problem, especially if the village midwife frequently travelled out of the village. The distances from health facilities, in addition to poor road conditions were major concerns, particularly for those living in remote areas. Lack of community awareness about the importance of these services was also found, as some community members perceived health services to be necessary only if obstetric complications occurred. The services of traditional birth attendants for antenatal, delivery, and postnatal care were widely used, and their roles in maternal and child care were considered vital by some community members.</p> <p>Conclusions</p> <p>It is important that public health strategies take into account the availability, affordability and accessibility of health services. Poverty alleviation strategies will help financially deprived communities to use antenatal and postnatal health services. This study also demonstrated the importance of health promotion programs for increasing community awareness about the necessity of antenatal and postnatal services.</p