Home About us Contact
|
Home About us Contact | ||
|
|
||
Health Measures (health + measure)
Kinds of Health Measures Selected AbstractsThe development and validation of the Indigenous Risk Impact Screen (IRIS): a 13-item screening instrument for alcohol and drug and mental health riskDRUG AND ALCOHOL REVIEW, Issue 2 2007CARLA M. SCHLESINGER Abstract The study aimed to assess the psychometric properties of the Indigenous Risk Impact Screen (IRIS) as a screening instrument for determining (i) the presence of alcohol and drug and mental health risk in Indigenous adult Australians and (ii) the cut-off scores that discriminate most effectively between the presence and absence of risk. A cross-sectional survey was used in clinical and non-clinical Indigenous and non-Indigenous services across Queensland Australia. A total of 175 Aboriginal and Torres Strait Islander people from urban, rural, regional and remote locations in Queensland took part in the study. Measures included the Indigenous Risk Impact Screen (IRIS), the Severity of Dependence Scale (SDS), the Alcohol Use Disorders Identification Test (AUDIT) and the Leeds Dependence Questionnaire (LDQ). Additional Mental Health measures included the Depression Anxiety and Stress Scale (DASS-21) and the Self-Report Questionnaire (SRQ). Principle axis factoring analysis of the IRIS revealed two factors corresponding with (i) alcohol and drug and (ii) mental health. The IRIS alcohol and drug and mental health subscales demonstrated good convergent validity with other well-established screening instruments and both subscales showed high internal consistency. A receiver operating characteristics (ROC) curve analysis was used to generate cut-offs for the two subscales and t-tests validated the utility of these cut-offs for determining risky levels of drinking. The study validated statistically the utility of the IRIS as a screen for alcohol and drug and mental health risk. The instrument is therefore recommended as a brief screening instrument for Aboriginal and Torres Strait Islander people. [source] Carcinogenicity of acetaldehyde in alcoholic beverages: risk assessment outside ethanol metabolismADDICTION, Issue 4 2009Dirk W. Lachenmeier ABSTRACT Aims In addition to being produced in ethanol metabolism, acetaldehyde occurs naturally in alcoholic beverages. Limited epidemiological evidence points to acetaldehyde as an independent risk factor for cancer during alcohol consumption, in addition to the effects of ethanol. This study aims to estimate human exposure to acetaldehyde from alcoholic beverages and provide a quantitative risk assessment. Methods The human dietary intake of acetaldehyde via alcoholic beverages was estimated based on World Health Organization (WHO) consumption data and literature on the acetaldehyde contents of different beverage groups (beer, wine, spirits and unrecorded alcohol). The risk assessment was conducted using the European Food Safety Authority's margin of exposure (MOE) approach with benchmark doses obtained from dose,response modelling of animal experiments. Life-time cancer risk was calculated using the T25 dose descriptor. Results The average exposure to acetaldehyde from alcoholic beverages was estimated at 0.112 mg/kg body weight/day. The MOE was calculated to be 498, and the life-time cancer risk at 7.6 in 10 000. Higher risk may exist for people exposed to high acetaldehyde contaminations, as we have found in certain unrecorded alcohol beverages in Guatemala and Russia, for which we have demonstrated possible exposure scenarios, with risks in the range of 1 in 1000. Conclusions The life-time cancer risks for acetaldehyde from alcoholic beverages greatly exceed the usual limits for cancer risks from the environment set between 1 : 10 000 and 1 : 1 000 000. Alcohol consumption has thus been identified as a direct source of acetaldehyde exposure, which in conjunction with other sources (food flavourings, tobacco) results in a magnitude of risk requiring intervention. An initial public health measure could be to reduce the acetaldehyde content in alcoholic beverages as low as technologically possible, and to restrict its use as a food flavour additive. [source] Using DCE and ranking data to estimate cardinal values for health states for deriving a preference-based single index from the sexual quality of life questionnaireHEALTH ECONOMICS, Issue 11 2009Julie Ratcliffe Abstract There is an increasing interest in using data derived from ordinal methods, particularly data derived from discrete choice experiments (DCEs), to estimate the cardinal values for health states to calculate quality adjusted life years (QALYs). Ordinal measurement strategies such as DCE may have considerable practical advantages over more conventional cardinal measurement techniques, e.g. time trade-off (TTO), because they may not require such a high degree of abstract reasoning. However, there are a number of challenges to deriving the cardinal values for health states using ordinal data, including anchoring the values on the full health,dead scale used to calculate QALYs. This paper reports on a study that deals with these problems in the context of using two ordinal techniques, DCE and ranking, to derive the cardinal values for health states derived from a condition-specific sexual health measure. The results were compared with values generated using a commonly used cardinal valuation technique, the TTO. This study raises some important issues about the use of ordinal data to produce cardinal health state valuations. Copyright © 2009 John Wiley & Sons, Ltd. [source] Should Australia introduce a vaccine injury compensation scheme?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5-6 2004D Isaacs Abstract: At least a dozen countries or states in the world have introduced vaccine injury compensation schemes. This paper argues that the Australian Government should introduce such a scheme, which may reduce litigation, and may improve consumer and provider confidence. The most important justification, however, is an ethical argument from justice and equity: introduction of a vaccine injury compensation scheme acknowledges the unique situation that routine childhood immunization is a public health measure, given and accepted in good faith, that may occasionally damage the recipient. [source] Mothers' Attachment Style, Their Mental Health, and Their Children's Emotional Vulnerabilities: A 7-Year Study of Children With Congenital Heart DiseaseJOURNAL OF PERSONALITY, Issue 1 2008Ety Berant ABSTRACT The long-term contribution of mothers' attachment insecurities to their own and their children's psychological functioning was examined in a 7-year prospective longitudinal study of children with Congenital Heart Disease (CHD). Sixty-three mothers of newborns with CHD participated in a three-wave study, beginning with the CHD diagnosis (T1), then 1 year later (T2), and again 7 years later (T3). At T1, the mothers reported on their attachment style and mental health. At T2, the mental health measure was administered again, along with a marital satisfaction scale. At T3, participants completed these two measures again, and their children reported on their self-concept and completed the Children's Apperception Test. Maternal avoidant attachment at T1 was the best predictor of deterioration in the mothers' mental health and marital satisfaction over the 7-year period, especially in a subgroup whose children had severe CHD. In addition, mothers' attachment insecurities (both anxiety and avoidance) at the beginning of the study were associated with their children's emotional problems and poor self-image 7 years later. [source] The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School GirlsJOURNAL OF SCHOOL HEALTH, Issue 6 2008Cheryl A. Vamos MPH ABSTRACT Background:, Human papillomavirus (HPV), the virus responsible for cervical cancer, is the most common viral sexually transmitted infection in the United States. A vaccine was approved in 2006 that is effective in preventing the types of HPV responsible for 70% of cervical cancers and 90% of genital warts. Proposals for routine and mandatory HPV vaccination of girls have become sources of controversy for parents of school-aged youth, legislators, members of the medical community, and the public at large. Methods:, The purpose of this article was to articulate the arguments used by advocates who either oppose or endorse routine, mandatory administration of the vaccine to school-aged girls, thereby assisting school health personnel in being effective participants in framing the relevant issues. Results:, Controversy is grounded in moral, religious, political, economic, and sociocultural arguments including whether concerns that the vaccine increases sexual risk taking, sends mixed messages about abstaining from sexual intercourse, usurps parental authority, and increases the potential for development of new health disparities are offset by the value of administering a cost-effective, age-appropriate public health measure targeting a life-threatening problem. Conclusions:, Careful consideration of the medical evidence and public health implications is critical but understanding the context of the debate is no less important to the task of responding to public concerns. School health personnel have a role in the discussion about HPV immunization. Being able to articulate the arguments presented herein can help authorities' responsiveness to parents and community groups as the dialogue about this particular health issue evolves further. [source] Programme and policy issues related to promoting positive early nutritional influences to prevent obesity, diabetes and cardiovascular disease in later life: a developing countries view,MATERNAL & CHILD NUTRITION, Issue 3 2005Noel W. Solomons MD Abstract Public health policy differs from programme insofar as the former is the expression of goals at a higher decision-making level (international, regional, national or provincial) and the latter involves the execution of intervention measures at the community or individual level. It has recently become fashionable to speak of ,evidence-based' policy. There is now ample evidence to suggest that early nutritional influences on chronic disease risk in later life are contributing to the acceleration of the overall worldwide epidemic of obesity and non-transmissible diseases. In developing countries, in which 80% of the world's population resides, the opportunities for preventive policy must be balanced against needs, cost and effectiveness considerations and the intrinsic limitations of policy execution. Not everyone in the population is at risk of suffering from any given negative condition of interest, nor will everyone at risk benefit from any given intervention. Hence, decisions must be made between universal or targeted policies, seeking maximal cost-efficiency, but without sowing the seeds of either discrimination or stigmatization with a non-universal application of benefits. Moreover, although large segments of the covered population may benefit from a public health measure, it may produce adverse and harmful effects on another segment. It is ethically incumbent on policy makers to minimize unintended consequences of public health measures. With respect to the particular case of mothers, fetuses and infants and long-term health, only a limited number of processes are amenable to intervention measures that could be codified in policy and executed as programmes. [source] The Sydney Medically Supervised Injecting Centre: a controversial public health measureAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2002Cate Kelly Background: Injecting drug use remains a major public health concern, particularly because of opiate overdose and transmission of blood-borne viruses. Sydney's Medically Supervised Injecting Centre (MSIC) opened on a trial basis in May 2001 in an effort to reduce the harms of drug use. In this report, we provide a brief overview of the reported public health impact of supervising injecting facilities (SIFs) and review the history and early process evaluations of the Sydney Centre. Methods Medline, Internet searches and perusal of bibliographies of articles were used to identify key English language publications on SIFs. These were supplemented by interview with the Medical Director of Sydney MSIC, Dr Ingrid van Beek. Discussion and conclusions: It is difficult to be certain of the public health impact of SIFs but evidence from overseas and Sydney's early process evaluations provide promise that they may make a positive contribution to health. [source] Reduced risk of acute poisoning in Australian cattle from used motor oils after introduction of lead-free petrolAUSTRALIAN VETERINARY JOURNAL, Issue 6 2010BG Burren Lead (Pb) poisoning of cattle has been relatively common in Australia and sump oil has been identified as an important cause of Pb toxicity for cattle because they seem to have a tendency to drink it. Lead-free petrol has been available in Australia since 1975, so the aim of this study was to assess the current risk to cattle from drinking used automotive oils. Sump or gear box oil was collected from 56 vehicles being serviced. The low levels of Pb found suggest that the removal of leaded petrol from the Australian market as a public health measure has benefited cattle by eliminating the risk of acute poisoning from used engine oil. [source] Water fluoridation as a marker for sociodental inequalitiesCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 2 2008Marilisa Carneiro Leão Gabardo Abstract,,, Objectives:, The aim of this study was to investigate the associations between the Human Development Index at city level (HDI-M) in the state of Paraná, Brazil, and the length of time of population exposure to water fluoridation (time span) with the respective mean decayed, missing and filled teeth (DMF-T) of schoolchildren in the state, looking at possible inequalities in these associations. Methods:, The HDI,M of 323 cities in the state of Paraná, Brazil, was correlated to the duration of exposure to water fluoridation, calculated in number of days. Correlation between the HDI-M and the DMF-T indexes for 12-year-old children was also performed. Results:, Correlations were statistically significant, showing that in the cities with a better HDI-M, water fluoridation had been implemented earlier (squared coefficient correlation of 22%). The fluoridation time span accounted for around 11% of the variance in the DMF-T indexes of the cities. The correlation indicated that locations with a better HDI-M had a better DMF-T, owing to the probable mediating effect of receiving fluoridation earlier. Furthermore, the cost of water fluoridation to benefit the population that has access to this public health measure has been estimated at USD 0.15 per capita/year. Conclusions:, It is possible to conclude that this low-cost measure is able to improve oral health status in general. Nevertheless, in the Brazilian areas studied, fluoridation seems to reflect existing social development inequalities, as it was first made available in more socially developed areas, thus bearing an influence on their higher DMF-T performance to date. [source] Epidemiological data on consumer allergy to p -phenylenediamineCONTACT DERMATITIS, Issue 6 2008Jacob Pontoppidan Thyssen Many women and men now dye their hair. p-Phenylenediamine (PPD) is a frequent and important component of permanent hair dye products; exposure to it may cause allergic contact sensitization, acute dermatitis, and severe facial oedema. To increase our understanding of PPD allergy, we reviewed published literature containing PPD patch test data from dermatitis patients and individuals in the general population. This was performed to estimate the median prevalence and the weighted average of PPD sensitization and thereby assess the burden of PPD-containing hair care products on health. Literature was examined using PubMed,MEDLINE, Biosis, and Science Citation Index. The median prevalence among dermatitis patients was 4.3% in Asia, 4% in Europe, and 6.2% in North America. A widespread increase in the prevalence of PPD sensitization was observed among Asian dermatitis patients. In Europe, a decrease in the 1970s was replaced by a plateau with steady, high prevalences ranging between 2% and 6%. The prevalence remained high in North America, although a decreasing tendency was observed. Contact allergy to PPD is an important health issue for both women and men. More stringent regulation and enforcement are required as public health measures to reduce the burden of disease that exposure to PPD has brought to populations. [source] Development without Institutions: Ersatz Medicine and the Politics of Everyday Life in Rural North IndiaCULTURAL ANTHROPOLOGY, Issue 3 2004Sarah Pinto In north India, unregulated medical practice is considered by many to be a sign of the failure of institutional rationality and "backward" quality of rural life. However, the work of self-made doctors can also be seen to engage key elements of institutional rationality as it is interwoven with the structure and ethos of development. This article explores what these practitioners and their work suggest about the imagination of institutions in rural India and the kinds of power this invokes. Through mimesis of key practices (namely, forms of talk and use of injections), self-made doctors tap into the authority of legitimate institutions to occupy lacunae in state health structures and redress (even as they reproduce) effects of privatization and repeated temporary health measures. At the same time, everyday elements of these practices demonstrate that institutional legitimacy can only be borrowed by those already in positions of authority (on the basis of caste status and political leadership), challenging ideals of equality that underlie health-related development efforts. [source] A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2009E DAVIS PHD This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP). Ninety-nine children aged 4 to 12 years with no prior horse riding experience and various levels of impairment (Gross Motor Function Classification System Levels I,III) were randomized to intervention (10wks therapeutic programme; 26 males, 24 females; mean age 7y 8mo [SD 2y 5mo] or control (usual activities, 27 males, 22 females; mean age 8y 2mo [SD 2y 6mo]). Pre- and post-measures were completed by 72 families (35 intervention and 37 control). Children's gross motor function (Gross Motor Function Measure [GMFM]), health status (Child Health Questionnaire [CHQ]), and QoL (CP QoL-Child, KIDSCREEN) were assessed by parents and QoL was assessed by children before and after the 10-week study period. On analysis of covariance, there was no statistically significant difference in GMFM, CP QoL-Child (parent report and child self-report), and CHQ scores (except family cohesion) between the intervention and control group after the 10-week study period, but there was weak evidence of a difference for KIDSCREEN (parent report). This study suggests that therapeutic horse riding does not have a clinically significant impact on children with CP. However, a smaller effect cannot be ruled out and the absence of evidence might be explained by a lack of sensitivity of the instruments since the QoL and health measures have not yet been demonstrated to be sensitive to change for children with CP. [source] Clustering of cardiovascular risk factors with diabetes in Chinese patients: the effects of sex and hyperinsulinaemiaDIABETES OBESITY & METABOLISM, Issue 3 2001Z. -R. SUMMARY Objective This study was designed to investigate factors which affect the clustering of cardiovascular risk factors with diabetes in Chinese patients. Research Design and Methods: Six hundred and fifty-four patients with diabetes were assessed comprehensively for diabetes complications and cardiovascular risk factors in a metropolitan hospital in Beijing, China. Insulin resistance and secretion were also evaluated by measurement of glucose and insulin levels before and after a meal tolerance test. Results were analysed according to patient groups stratified by the number of cardiovascular risk factors coexisting with diabetes. Results Cardiovascular risk factors were common in Chinese diabetic patients. The clustering of three or more of these factors with diabetes occurred more often than by chance alone and was associated with postprandial hyperinsulinaemia. Patients with a high number of risk factors were more prone to macrovascular events but did not have higher albuminuria. Using the commonly adopted lower threshold for diagnosing obesity and central obesity in women, there were more women with multiple risk factors. However, this disappeared if the same criteria were used for men and women. Even in the presence of diabetes, cardiovascular risk factors were inadequately controlled in most patients. Conclusions The concurrence of diabetes and other cardiovascular risk factors which constitute the metabolic syndrome is a common phenomenon in urban Chinese diabetic patients. It is associated with hyperinsulinaemia and possibly the female sex. This study emphasises the importance of public health measures to control cardiovascular risk factors in patients with diabetes. [source] The Mexican migration to the United States and substance use in northern MexicoADDICTION, Issue 4 2009Guilherme Borges ABSTRACT Aims To examine the impact of migration to the United States on substance use and substance use disorders in three urban areas of northern Mexico. Design Cross-sectional survey of immigration-related experiences and life-time and past-year alcohol and drug use, in a representative sample of respondents aged 12,65 years. Setting Interviews were conducted in the cities of Tijuana, Ciudad Juarez and Monterrey during 2005. Respondents were classified into three groups: (i) ,return migrants', (ii) ,relatives of migrants' and (iii) ,others in the general population'. Findings A total of 1630 completed interviews were obtained for a response rate of 70.5%. ,Return migrants' were more likely to have used alcohol, marijuana or cocaine at least once in their life-time and in the last 12 months, more likely to develop a substance use disorder and more likely to have a 12-month substance use disorder compared with ,others in the general population'. Among ,return migrants', longer length of time in the United States and type of work performed as an immigrant were related to higher prevalence of substance use. Among ,relatives of migrants', migration experiences were not associated with increased prevalence of substance use compared with ,others in the general population'. Conclusion This study found a link between migration to the United States and the transformation of substance use norms and pathology in Mexico. Future research on pre-migration involvement in substance use and data on the timing of events among return migrants is needed. Public health measures are likely to require cross-border coordination of research and service development. [source] The alcohol industry and trade agreements: a preliminary assessmentADDICTION, Issue 2009Donald W. Zeigler ABSTRACT Aims To review trade agreements, their relation to alcohol control policy and examine the role of the alcohol industry in supporting and attempting to influence trade policy. Methods Review of peer review, public health advocacy literature (both pro and con on free trade), business, press and government documents on trade agreements, assess current and potential challenges by trade agreements to alcohol control policy and investigate the means and extent of industry influence in trade agreements. Findings ,Free' trade agreements reduce trade barriers, increase competition, lower prices and promote alcohol consumption. However, international treaties, negotiated by free trade experts in close consultation with corporate lobbyists and without significant, if any, public health input, governments and corporations contain significant provisions that will result in increased alcohol consumption and may challenge public health measures of other nations as constraints on trade. Conversely, alcohol control measures seek to reduce access and consumption, raise prices and restrict advertising and product promotion. The prospect is for increased alcohol consumption and concomitant problems throughout the world. Conclusions Trade agreements challenge effective alcohol control policies. The alcohol industry seeks to influence agreements and can be expected to work through trade agreements to reduce tariffs, increase market access and seek to restrict effective domestic regulations. Further research is needed on the impact of trade agreements and the ongoing role of the industry. Advocates must recognize the inherent conflicts between unbridled free trade and public health, work to exclude alcohol from trade agreements, counter industry influence and protect alcohol control policies. [source] Italian validation of INQoL, a quality of life questionnaire for adults with muscle diseasesEUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2010V. A. Sansone Background and purpose:, A quality of life (QoL) questionnaire for neuromuscular diseases was recently constructed and validated in the United Kingdom in a sample of adult patients with a variety of muscle disorders. Preliminary results suggested it could be a more relevant and practical measure of QoL in muscle diseases than generic health measures of QoL. The purpose of our work was: (i) To validate INQoL in Italy on a larger sample of adult patients with muscle diseases (ii) to compare INQoL to SF-36. Methods:, We have translated into Italian and applied language adaptations to the original UK INQoL version. We studied 1092 patients with different muscle disorders and performed (i) test,retest reliability (n = 80); (ii) psychometric (n = 345), known-group (n = 1092), external criterion (n = 70), and concurrent validity with SF-36 (n = 183). Results:, We have translated and formally validated the Italian version of INQoL confirming and extending results obtained in the United Kingdom. In addition to good results in terms of reliability, known-group and criterion validity, a comparison with the SF-36 scales showed a stronger association between INQoL total index and SF-36 physical (r = ,0.72) than mental (r = ,0.38) summary health indexes. When considering comparable domains of INQoL and SF-36 with respect to an objective measure of muscle strength assessment (MMRC), regression analysis showed a stronger correlation using INQoL rather than SF-36 scores. Conclusions:, INQoL is recommended to assess QoL in muscle diseases because of its ability to capture physical limitations that are specifically relevant to the muscle condition. [source] The oral health consequences of chewing areca nutADDICTION BIOLOGY, Issue 1 2002C. R. Trivedy Its effects on dental caries and periodontal tissues, two major oral diseases, are less well researched. Areca-induced lichenoid lesions mainly on buccal mucosa or tongue are reported at quid retained sites. In chronic chewers a condition known as betel chewer's mucosa, a discoloured areca nut-encrusted change, is often found where the quid particles are retained. Areca nut chewing is implicated in oral leukoplakia and submucous fibrosis, both of which are potentially malignant in the oral cavity. Oral cancer often arises from such precancerous changes in Asian populations. In 1985 the International Agency for Research on Cancer concluded that there is limited evidence to conclude that areca chewing may directly lead to oral cancer. There is, however, new information linking oral cancer to pan chewing without tobacco, suggesting a strong cancer risk associated with this habit. Public health measures to quit areca use are recommended to control disabling conditions such as submucous fibrosis and oral cancer among Asian populations. [source] Predictors and correlates of edentulism in the healthy old people in Edinburgh (HOPE) studyGERODONTOLOGY, Issue 4 2008John M. Starr Objectives:, To determine the extent to which correlates of edentulism are explained by an association between tooth loss and cognitive ability. Methods:, Participants in the Healthy Old People in Edinburgh (HOPE) study aged 70 or more at baseline were assessed and health, cognitive, socio-economic and socio-environmental data collected on four consecutive occasions. It was noted whether the participant had any retained teeth and if not, the age when the last tooth was lost. Prior determinants of edentulism were investigated with binary logistic regression models. At the 9-year follow-up, associations with edentulism were examined using general linear models with edentulism as an independent factor. Results:, 201 participants were adequately tested, of whom 104 (51.7%) were edentulous. A logistic regression model that considered age, sex, education, social class, deprivation index of residence, objective distance from dentist, participant's estimate of distance from dentist and NART-estimated IQ (NARTIQ) found age (p = 0.032), occupational class (p = 0.019) and NARTIQ (p = 0.027) as significant predictors of edentulism. Cox's proportional hazards modelling found only NARTIQ (p = 0.050) to be correlated. Being edentulous was associated with poorer respiratory function but not hand grip strength (p = 0.23). Edentulous participants had lower self esteem scores (p = 0.020) and poorer dietary assessment scores (p = 0.028). Being edentulous was also associated with significantly lower mean scores on all cognitive testing, although these associations became non-significant after adjustment for NARTIQ and age. Conclusions:, In healthy older people, edentulism is associated with relative impairment of cognitive ability, although this association is explained by the fact that lower original intelligence predisposes to edentulism and poorer performance on cognitive tests in old age. Once original intelligence is adjusted for, tooth loss is not related to cognitive ability. Tooth loss is, however, associated with poorer status across a wide range of health measures: physical health, nutrition, disability and self-esteem. Establishing the degree to which these health outcomes are causally related to edentulism could usefully be factored into cost,benefit analyses of programmes designed to prevent tooth loss. [source] Measuring the effect of husband's health on wife's labor supplyHEALTH ECONOMICS, Issue 6 2006Michele J. SiegelArticle first published online: 31 JAN 200 Abstract A sizable proportion of women remain married well into late life and an increasing proportion of them participate in the labor force. Since women tend to marry men older than themselves and men tend to experience serious illnesses at younger ages than women, women frequently witness declining health in their husbands. This is likely to affect a wife's labor,leisure trade-off in offsetting ways. Prior studies have not sought to disentangle the effect of a husband's poor health on his wife's reservation wage from the income effect of his ill health. We argue that, if we control for husband's earnings, the coefficient of husband's health in models of his wife's labor force participation (and hours of work) will reflect, in part, her preference over whether to decrease her labor supply to provide health care for her husband or whether to instead increase it to purchase this care in the market. However, husband's earnings are likely to be endogenous in these models due to unobserved characteristics common to husbands and wives. We find that the estimated effect of husband's health depends on whether we instrument for husband's earnings and on the health measure used. This is indicative of the importance of using a variety of health measures and controlling for husband's earnings, and their endogeneity, in future research on the effect of husband's health on wife's labor supply. Copyright © 2006 John Wiley & Sons, Ltd. [source] The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural RegionHEALTH SERVICES RESEARCH, Issue 1 2005Thomas A. Arcury Objective. This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. Data Sources. A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. Study Design. This cross-sectional study used a three-stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check-up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. Data Collection Methods. Respondents answered standard survey questions. They located places in which they engaged health related and normal day-to-day activities; these data were entered into a geographic information system for analysis. Principal Findings. Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check-up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check-up and chronic care, but not to acute care visits. Conclusions. These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy. [source] Progress towards achieving new vaccine and vaccination goalsINTERNAL MEDICINE JOURNAL, Issue 7 2003G. Ada Abstract Viral and bacterial vaccines, especially for childhood use, are one of the most successful public health measures of the last two centuries and have a good safety record. However, there are still many diseases that are caused by infectious agents for which vaccines are not available. Our increasing ability to manipulate the immune system offers hope that, in the future, at least some of these infections may be prevented by vaccination. A surprising recent development is the use of vaccine technology to test whether a range of other generally non-communicable diseases can be prevented (or at least controlled) in this way. Investigation of these diseases is still mainly at the experimental level, however the list includes different types of cancers, allergies, drug addiction and neurodegenerative diseases. (Intern Med J 2003; 33: 297,304) [source] Oral self-care habits of dental and healthcare providersINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 4 2008Y Zadik Abstract:, Objective:, To evaluate the self-care level of dental and healthcare providers regarding prevention of oral diseases Methods:, Healthcare providers (dental assistants and surgeons, laboratory personnel, biologists, medics, paramedics, corpsmen, nurses, pharmacists, physicians, physiotherapists, psychologists, social workers, speech therapists, X-ray technicians) and non-health care providing adults (the general population) were asked to respond to a questionnaire regarding their routine measures for maintaining oral health Results:, Three hundred and twenty-six healthcare providers and 95 non-healthcare providers participated in the study. Regarding toothbrushing, flossing, undergoing periodic dental examinations and professional scaling/polishing, dental practitioners have better, but not perfect, maintenance habits than other healthcare providers. Non-dental healthcare providers have better dental habits than the general population, and nurses and medical practitioners have better dental habits than medics, paramedics, corpsmen and para-medical professionals. Among non-dental healthcare providers, nurses have a relatively high frequency of toothbrushing and flossing but a low frequency of periodic examinations and scaling/polishing. Generally, females reported significantly higher frequencies of toothbrushing and flossing than males did. The toothpaste selection of the participants was primarily influenced by dentists' recommendations, the flavour of the toothpaste, and its anti-malodour effect were the most dominant factors. Conclusion:, The compliance of health professionals, especially dental practitioners, with appropriate oral health measures is relatively high. However, the dental team cannot always assume that the dental patient, who also happens to be a healthcare provider, has meticulous oral habits. The dental hygienist and surgeon have to educate and motivate their patients, especially healthcare providers because of the influence of the latter on their own patients. [source] Comparison of Campylobacter jejuni genotypes from dairy cattle and human sources from the Matamata-Piako District of New ZealandJOURNAL OF APPLIED MICROBIOLOGY, Issue 5 2008B.J. Gilpin Abstract Aims:, To identify the prevalence and types of Campylobacter jejuni carried by dairy cattle and the extent of overlap of these types with those causing disease in humans. Methods and Results:, Faecal samples from 410 dairy cattle were collected from 36 farms in the Matamata-Piako district in New Zealand. Campylobacter jejuni was isolated on all 36 farms, with a prevalence of 51% (95% CI 45,57) in dairy cattle and 65% (95% CI 58,72) in calves. Eighty-nine of these isolates were typed using Penner serotyping and pulsed field gel electrophoresis and were compared with 58 human C. jejuni isolates from people resident within this study area. Conclusions:,Campylobacter jejuni were found in the faeces of over half of the dairy cows and calves examined. Twenty-one per cent of the bovine isolates and 43% of the human isolates formed indistinguishable clusters of at least one bovine and one human isolate. Significance and Impact of the Study:, While a direct link between bovine isolates and human cases was not demonstrated, the finding of indistinguishable genotypes among C. jejuni isolates from bovine and human sources confirms that dairy cows and calves are a potential source of human campylobacteriosis. Barriers to separate bovine faecal material from the general public are therefore important public health measures. [source] Osteoporosis and the Global Competition for Health Care Resources,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2004L Joseph Melton III Abstract Global aging superimposed on existing infectious diseases and trauma will aggravate competition for health care resources to diagnose and treat osteoporosis. Efforts to implement public health measures are needed, but the targeted approach to assessment and treatment of high-risk individuals must also be refined. Increases in the elderly population worldwide will cause a dramatic rise in osteoporotic fractures, but other age-related diseases will increase as well. Changes will be superimposed on existing public health problems (e.g., malaria, alcoholism), and these acute health care needs will take priority in some areas. Societies in most parts of the world may have to limit osteoporosis control to broad public health measures, and such efforts (e.g., calcium and vitamin D supplementation) should be supported. In these regions, clinical decision-making will generally be limited to treating patients with fractures (who presumably have already failed any public health measures in place), or in a few wealthy countries, to patients with low bone density identified by case-finding. Case-finding approaches will vary with the resources available, although unselective (mass) screening by bone densitometry is largely ineffective and unaffordable anywhere. The key to clinical decision-making on behalf of individuals will be an assessment of absolute fracture risk, and the tools needed to predict the risk of an osteoporotic fracture over the next 10 years are now being developed. These include bone density measures, but also incorporate other risk factors (e.g., fracture history, corticosteroid use), which may allow extension of fracture risk prediction to nonwhite populations and to men. Even with a universal risk prediction tool, cost-effective treatment thresholds will vary by country based on the level of fracture risk in the region and on the resources available for health care. To better compete for these resources, efforts should be made to lower the cost of osteoporosis interventions. Additionally, evidence is needed that these interventions are really effective in reducing fractures in the community. [source] SARS , a perspective from a school of nursing in Hong KongJOURNAL OF CLINICAL NURSING, Issue 2 2004David R. Thompson PhD Background., Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives., This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions., The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice., Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [source] Does controlling for comorbidity matter?AGGRESSIVE BEHAVIOR, Issue 3 2010DSM-oriented scales, violent offending in chicago youth Abstract Mental health problems have long been linked to antisocial behaviors. Despite an impressive body of literature demonstrating this relationship and claims that comorbidity matters, few studies examine comorbidity using multiple distinct mental health indicators, with most studies instead adopting single or composite mental health measures. This study tested separate and comorbid effects of five DSM-oriented mental health issues on self-reported violence using a community-based sample of Chicago youths from the Project on Human Development in Chicago Neighborhoods. Moreover, it utilized both primary caregiver and youth self-reports of psychopathology across four developmental stages of childhood and adolescence. When examined separately, the results indicated affective/depressive, anxiety, attention deficit hyperactivity, and oppositional defiant/antisocial personality problems independently predicted violence. When considering comorbidity, however, only oppositional defiant and antisocial personality problems significantly predicted violence at any stage, regardless of informant type. Implications for future studies and policy are discussed. Aggr. Behav. 36:141,157, 2010. © 2010 Wiley-Liss, Inc. [source] Utility of Infectious Disease Coding Sheets for Surveillance in a State Medical Examiner's Office,JOURNAL OF FORENSIC SCIENCES, Issue 4 2008Ph.D., Sarah L. Lathrop D.V.M. Abstract:, Medical examiners are often first to recognize unusual occurrences of fatal infectious diseases. Recognition of these deaths allows public health officials to institute appropriate public health measures. Therefore, we developed a simple method of identifying and tracking infectious disease deaths in a statewide medical examiner's office. One-page infectious disease forms were completed for 1566/1949 autopsies (80%) performed at the New Mexico Office of the Medical Investigator in 2004. In 241 cases one infectious disease was identified at autopsy and 58 cases had two infectious diseases. Fourteen of the infectious-diseases caused deaths involved diseases that are notifiable conditions in New Mexico. Pneumonia was the most commonly reported infectious process (47 deaths) followed by sepsis (25 deaths). Tracking infectious disease deaths highlighted the importance of recognizing these deaths, although hand-written entries were unstandardized. Preferably, a tracking system would be built into electronic databases at medical examiner and coroner's offices, expediting the identification of these diseases and contact of public health agencies. [source] Public health measures to control hepatitis B virus infection in the developing countries of the Asia,Pacific regionJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2000Ding-Shinn Chen Hepatitis B virus (HBV) infection is prevalent in the Asia,Pacific region and the disease burden caused by chronic HBV infection has been enormous. Although vaccination programmes have been implemented in the past decade, and there are extremely successful countries in the region, many countries still cannot afford a control program. These countries are often populous and highly endemic for HBV infection. To overcome this, aid from developed countries or private foundations should be actively sought. In the developing countries of this region, HBV infection in early childhood is the main cause of chronic HBV status, and thus universal vaccination of all infants is the best way to control HBV infection. Because of the expense and extra costs of screening pregnant women, the use of hepatitis B immune globulin may not be essential. To achieve the goal of universal infant vaccination, public education should be done in parallel with education of health professionals and control measures. The Asia,Pacific region has more people with chronic hepatitis B than any other part of the world, and control of HBV infection in this region will no doubt be the most important and challenging task to be taken in the beginning of the new millennium. [source] Molecular epidemiology of hepatitis A virus in a group of Portuguese citizens living in Lisbon areaJOURNAL OF MEDICAL VIROLOGY, Issue 5 2007L. Rodrigues Abstract Hepatitis A virus (HAV) is the most important cause of acute infectious hepatitis worldwide. In Portugal, due to improvements in sanitation epidemic outbreaks of HAV infection have become less frequent. This report is the first, to our knowledge that characterized HAV in Portugal. For the detection and molecular characterization of HAV cases in a group of Portuguese individuals in the Lisbon area, 31 serum samples were tested: 8 from symptomatic children from an acute hepatitis A outbreak in a Roma (Gipsies) community (2004,2005), and 22 from patients with acute HAV from sporadic cases (2005,2006). A sample of CSF involved in a case of meningitis was also included. IgM anti-HAV detection and nested reverse transcription (RT-PCR), with primers located at the VP1-P2a region, was undertaken to detect HAV genome. In positive samples, molecular characterization was followed by phylogenetic analysis. All samples (n,=,31) were positive for IgM anti-HAV. HAV RNA was found in 96.7% of cases. All isolates were classified as genotype I: 22 belonged to sub-genotype IA (73.3%), and 8 to sub-genotype IB (26.7%). All strains obtained from an acute HAV outbreak had sub-genotype IA, in which seven isolates (87.5%) had identical sequences. In HAV sporadic cases sub-genotypes IA and IB were identified, and this may reflect the co-circulation of these two sub-genotypes in Portugal. Molecular epidemiology of HAV infection in this group of Portuguese appears to be similar to other European countries. HAV phylogenetic studies can provide important information for the design of appropriate public health measures. J. Med. Virol. 79:483,487, 2007. © 2007 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||