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Public Health Perspective (public + health_perspective)
Selected AbstractsBreast Cancer from a Public Health PerspectiveTHE BREAST JOURNAL, Issue 2 2004Richard R. Love MD Abstract: , By 2010, the majority of approximately 1.5 million annual new cases of breast cancer will be diagnosed in women in countries with limited resources. Public health approaches to medical problems emphasize the importance of practical, limited toxicity and very inexpensive interventions. While clinical trials in Western countries are testing the concept of breast cancer prevention, they are not defining useful public health approaches. Early detection of breast cancer using mammography, while effective, is a high-technology, expensive approach. Adjuvant systemic and radiation therapies are increasingly expensive; careful consideration of efficacy and cost-efficacy data appear warranted. Public health perspectives thus suggest that many current "standard" approaches to breast cancer in Western countries cannot help the majority of women in the world., [source] Mental health of children and adolescents in 12 European countries,results from the European KIDSCREEN studyCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 3 2008Ulrike Ravens-Sieberer Within the European Screening for and Promotion of Health-Related Quality of Life in Children and Adolescents,A European Public Health Perspective (KIDSCREEN) Study, emotional well-being and behaviour was examined in national representative samples of 22,000 children and adolescents aged 8 to 18. The proportion of children and adolescents showing signs of mental health problems (Strengths and Difficulties Questionnaire,SDQ) varied across countries and socio-demographic and socio-economic subgroups. Risk factors examined included adverse family climate, low socio-economic status, poor social support and decreased mental well-being of the parents. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Children and adolescents with mental health problems display distinctly impaired health-related quality of life (KIDSCREEN-10). Cross-cultural differences in the observed patterns of mental health problems were discussed. High-risk groups are cross-culturally characterized by poor social support and mental distress of parents. Strengthening social and familial resources should be a key objective, both in prevention and in interventions.,Copyright © 2008 John Wiley & Sons, Ltd. [source] Breast Cancer from a Public Health PerspectiveTHE BREAST JOURNAL, Issue 2 2004Richard R. Love MD Abstract: , By 2010, the majority of approximately 1.5 million annual new cases of breast cancer will be diagnosed in women in countries with limited resources. Public health approaches to medical problems emphasize the importance of practical, limited toxicity and very inexpensive interventions. While clinical trials in Western countries are testing the concept of breast cancer prevention, they are not defining useful public health approaches. Early detection of breast cancer using mammography, while effective, is a high-technology, expensive approach. Adjuvant systemic and radiation therapies are increasingly expensive; careful consideration of efficacy and cost-efficacy data appear warranted. Public health perspectives thus suggest that many current "standard" approaches to breast cancer in Western countries cannot help the majority of women in the world., [source] Pathological gambling: an increasing public health problemACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2001Article first published online: 7 JUL 200 Gambling has always existed, but only recently has it taken on the endlessly variable and accessible forms we know today. Gambling takes place when something valuable , usually money , is staked on the outcome of an event that is entirely unpredictable. It was only two decades ago that pathological gambling was formally recognized as a mental disorder, when it was included in the DSM-III in 1980. For most people, gambling is a relaxing activity with no negative consequences. For others, however, gambling becomes excessive. Pathological gambling is a disorder that manifests itself through the irrepressible urge to wager money. This disorder ultimately dominates the gambler's life, and has a multitude of negative consequences for both the gambler and the people they interact with, i.e. friends, family members, employers. In many ways, gambling might seem a harmless activity. In fact, it is not the act of gambling itself that is harmful, but the vicious cycle that can begin when a gambler wagers money they cannot afford to lose, and then continues to gamble in order to recuperate their losses. The gambler's ,tragic flaw' of logic lies in their failure to understand that gambling is governed solely by random, chance events. Gamblers fail to recognize this and continue to gamble, attempting to control outcomes by concocting strategies to ,beat the game'. Most, if not all, gamblers try in some way to predict the outcome of a game when they are gambling. A detailed analysis of gamblers' selfverbalizations reveals that most of them behave as though the outcome of the game relied on their personal ,skills'. From the gambler's perspective, skill can influence chance , but in reality, the random nature of chance events is the only determinant of the outcome of the game. The gambler, however, either ignores or simply denies this fundamental rule (1). Experts agree that the social costs of pathological gambling are enormous. Changes in gaming legislation have led to a substantial expansion of gambling opportunities in most industrialized countries around the world, mainly in Europe, America and Australia. Figures for the United States' leisure economy in 1996 show gross gambling revenues of $47.6 billion, which was greater than the combined revenue of $40.8 billion from film box offices, recorded music, cruise ships, spectator sports and live entertainment (2). Several factors appear to be motivating this growth: the desire of governments to identify new sources of revenue without invoking new or higher taxes; tourism entrepreneurs developing new destinations for entertainment and leisure; and the rise of new technologies and forms of gambling (3). As a consequence, prevalence studies have shown increased gambling rates among adults. It is currently estimated that 1,2% of the adult population gambles excessively (4, 5). Given that the prevalence of gambling is related to the accessibility of gambling activities, and that new forms of gambling are constantly being legalized throughout most western countries, this figure is expected to rise. Consequently, physicians and mental health professionals will need to know more about the diagnosis and treatment of pathological gamblers. This disorder may be under-diagnosed because, clinically, pathological gamblers usually seek help for the problems associated with gambling such as depression, anxiety or substance abuse, rather than for the excessive gambling itself. This issue of Acta Psychiatrica Scandinavica includes the first national survey of problem gambling completed in Sweden, conducted by Volberg et al. (6). This paper is based on a large sample (N=9917) with an impressively high response rate (89%). Two instruments were used to assess gambling activities: the South Oaks Gambling Screen-Revised (SOGS-R) and an instrument derived from the DSM-IV criteria for pathological gambling. Current (1 year) and lifetime prevalence rates were collected. Results show that 0.6% of the respondents were classified as probable pathological gamblers, and 1.4% as problem gamblers. These data reveal that the prevalence of pathological gamblers in Sweden is significantly less than what has been observed in many western countries. The authors have pooled the rates of problem (1.4%) and probable pathological gamblers (0.6%), to provide a total of 2.0% for the current prevalence. This 2% should be interpreted with caution, however, as we do not have information on the long-term evolution of these subgroups of gamblers; for example, we do not know how many of each subgroup will become pathological gamblers, and how many will decrease their gambling or stop gambling altogether. Until this information is known, it would be preferable to keep in mind that only 0.6% of the Swedish population has been identified as pathological gamblers. In addition, recent studies show that the SOGS-R may be producing inflated estimates of pathological gambling (7). Thus, future research in this area might benefit from the use of an instrument based on DSM criteria for pathological gambling, rather than the SOGS-R only. Finally, the authors suggest in their discussion that the lower rate of pathological gamblers obtained in Sweden compared to many other jurisdictions may be explained by the greater availability of games based on chance rather than games based on skill or a mix of skill and luck. Before accepting this interpretation, researchers will need to demonstrate that the outcomes of all games are determined by other factor than chance and randomness. Many studies have shown that the notion of randomness is the only determinant of gambling (1). Inferring that skill is an important issue in gambling may be misleading. While these are important issues to consider, the Volberg et al. survey nevertheless provides crucial information about gambling in a Scandinavian country. Gambling will be an important issue over the next few years in Sweden, and the publication of the Volberg et al. study is a landmark for the Swedish community (scientists, industry, policy makers, etc.). This paper should stimulate interesting discussions and inspire new, much-needed scientific investigations of pathological gambling. Acta Psychiatrica Scandinavica Guido Bondolfi and Robert Ladouceur Invited Guest Editors References 1.,LadouceurR & WalkerM. The cognitive approach to understanding and treating pathological gambling. In: BellackAS, HersenM, eds. Comprehensive clinical psychology. New York: Pergamon, 1998:588 , 601. 2.,ChristiansenEM. Gambling and the American economy. In: FreyJH, ed. Gambling: socioeconomic impacts and public policy. Thousand Oaks, CA: Sage, 1998:556:36 , 52. 3.,KornDA & ShafferHJ. Gambling and the health of the public: adopting a public health perspective. J Gambling Stud2000;15:289 , 365. 4.,VolbergRA. Problem gambling in the United States. J Gambling Stud1996;12:111 , 128. 5.,BondolfiG, OsiekC, FerreroF. Prevalence estimates of pathological gambling in Switzerland. Acta Psychiatr Scand2000;101:473 , 475. 6.,VolbergRA, AbbottMW, RönnbergS, MunckIM. Prev-alence and risks of pathological gambling in Sweden. Acta Psychiatr Scand2001;104:250 , 256. 7.,LadouceurR, BouchardC, RhéaumeNet al. Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?J Gambling Stud2000;16:1 , 24. [source] How ideology shapes the evidence and the policy: what do we know about cannabis use and what should we do?ADDICTION, Issue 8 2010John Macleod ABSTRACT In the United Kingdom, as in many places, cannabis use is considered substantially within a criminal justice rather than a public health paradigm with prevention policy embodied in the Misuse of Drugs Act. In 2002 the maximum custodial sentence tariff for cannabis possession under the Act was reduced from 5 to 2 years. Vigorous and vociferous public debate followed this decision, centred principally on the question of whether cannabis use caused schizophrenia. It was suggested that new and compelling evidence supporting this hypothesis had emerged since the re-classification decision was made, meaning that the decision should be reconsidered. The re-classification decision was reversed in 2008. We consider whether the strength of evidence on the psychological harms of cannabis has changed substantially and discuss the factors that may have influenced recent public discourse and policy decisions. We also consider evidence for other harms of cannabis use and public health implications of preventing cannabis use. We conclude that the strongest evidence of a possible causal relation between cannabis use and schizophrenia emerged more than 20 years ago and that the strength of more recent evidence may have been overstated,for a number of possible reasons. We also conclude that cannabis use is almost certainly harmful, mainly because of its intimate relation to tobacco use. The most rational policy on cannabis from a public health perspective would seem to be one able to achieve the benefit of reduced use in the population while minimizing social and other costs of the policy itself. Prohibition, whatever the sentence tariff associated with it, seems unlikely to fulfil these criteria. [source] Alcohol: No Ordinary Commodity , a summary of the second editionADDICTION, Issue 5 2010Alcohol, Public Policy Group ABSTRACT This article summarizes the contents of Alcohol: No Ordinary Commodity (2nd edn). The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America. In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol-related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink-driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services. Finally, the book addresses the policy-making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective. Overall, the strongest, most cost-effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink-driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence. [source] Saturday opening of alcohol retail shops in Sweden: an experiment in two phasesADDICTION, Issue 6 2005Thor Norström ABSTRACT Aim In February 2000, a trial started with Saturday opening of alcohol retail shops in certain parts of Sweden (phase I), and in July 2001, Saturday opening was extended to the whole country (phase II). The aim of this study is to assess the impact of phase II, and to probe previous results regarding phase I. Design Prior to February 2000, all alcohol monopoly outlets were closed on Saturdays. After this date, stores in an experimental area (six counties) were open on Saturdays. In the control area (seven counties) the shops remained closed. To prevent biases due to trade leakage, the experimental and control areas were separated by a buffer area (seven counties). Because continuous evaluations of the trial did not reveal any negative consequences, the Saturday opening was implemented in the whole of Sweden after 17 months. Data and methods The outcome measures included alcohol sales and indicators of assaults and drunk driving. The pre-intervention period covered the time period January 1995-January 2000, phase I of the post-intervention period February 2000,June 2001 (17 months), and phase II July 2001,July 2002 (13 months). The effects of the two phases were estimated through analyses of monthly data (auto-regressive integrated moving-average (ARIMA) modelling) depicting how sales and harm rates evolved in the experimental area compared to the control area during phase I as well as during phase II. Results The analysis uncovered a statistically significant increase in alcohol sales of 3.7% during phase I, and about the same increase during phase II (3.6%). There were no significant changes in any of the assault indicators, neither during phase I nor during phase II. There was a statistically significant increase in drunk driving (12%) during phase I, but no change during phase II. The analyses suggested that the increase during phase I was mainly due to a change in the surveillance strategy of the police. Conclusions The results lend support to the public health perspective in that the increased accessibility to alcohol rendered by Saturday opening also seems to have increased consumption. On the other hand, we could not detect any increase in alcohol-related harm. The question of whether this may be due to insufficient statistical power is discussed, together with some other methodological complications that were highlighted by the study. [source] Alcohol and mortality: methodological and analytical issues in aggregate analysesADDICTION, Issue 1s1 2001Thor Norström This supplement includes a collection of papers that aim at estimating the relationship between per capita alcohol consumption and various forms of mortality, including mortality from liver cirrhosis, accidents, suicide, homicide, ischaemic heart disease, and total mortality. The papers apply a uniform methodological protocol, and they are all based on time series data covering the post-war period in the present EU countries and Norway. In this paper we discuss various methodological and analytical issues that are common to these papers. We argue that analysis of time series data is the most feasible approach for assessing the aggregate health consequences of changes in population drinking. We further discuss how aggregate data may also be useful for judging the plausibility of individual-level relationships, particularly those prone to be confounded by selection effects. The aggregation of linear and curvilinear risk curves is treated as well as various methods for dealing with the time-lag problem. With regard to estimation techniques we find country specific analyses preferable to pooled cross-sectional/time series models since the latter incorporate the dubious element of geographical co-variation, and conceal potentially interesting variations in alcohol effects. The approach taken in the papers at hand is instead to pool the country specific results into three groups of countries that represent different drinking cultures; traditional wine countries of southern Europe, beer countries of central Europe and the British Isles and spirits countries of northern Europe. The findings of the papers reinforce the central tenet of the public health perspective that overall consumption is an important determinant of alcohol-related harm rates. However, there is a variation across country groups in alcohol effects, particularly those on violent deaths, that indicates the potential importance of drinking patterns. There is no support for the notion that increases in per capita consumption have any cardioprotective effects at the population level. [source] Evaluation of rayon swab surface sample collection method for Bacillus spores from nonporous surfacesJOURNAL OF APPLIED MICROBIOLOGY, Issue 4 2007G.S. Brown Abstract Aim:, To evaluate US Centers for Disease Control and Prevention recommended swab surface sample collection method for recovery efficiency and limit of detection for powdered Bacillus spores from nonporous surfaces. Methods and Results:, Stainless steel and painted wallboard surface coupons were seeded with dry aerosolized Bacillus atrophaeus spores and surface concentrations determined. The observed mean rayon swab recovery efficiency from stainless steel was 0·41 with a standard deviation (SD) of ±0·17 and for painted wallboard was 0·41 with an SD of ±0·23. Evaluation of a sonication extraction method for the rayon swabs produced a mean extraction efficiency of 0·76 with an SD of ±0·12. Swab recovery quantitative limits of detection were estimated at 25 colony forming units (CFU) per sample area for both stainless steel and painted wallboard. Conclusions:, The swab sample collection method may be appropriate for small area sampling (10 ,25 cm2) with a high agent concentration, but has limited value for large surface areas with a low agent concentration. The results of this study provide information necessary for the interpretation of swab environmental sample collection data, that is, positive swab samples are indicative of high surface concentrations and may imply a potential for exposure, whereas negative swab samples do not assure that organisms are absent from the surfaces sampled and may not assure the absence of the potential for exposure. Significance and Impact of the Study:, It is critical from a public health perspective that the information obtained is accurate and reproducible. The consequence of an inappropriate public health response founded on information gathered using an ineffective or unreliable sample collection method has the potential for undesired social and economic impact. [source] Associations and Interactions Between SNPs in the Alcohol Metabolizing Genes and Alcoholism Phenotypes in European AmericansALCOHOLISM, Issue 5 2009Richard Sherva Background:, Alcohol dependence is a major cause of morbidity and mortality worldwide and has a strong familial component. Several linkage and association studies have identified chromosomal regions and/or genes that affect alcohol consumption, notably in genes involved in the 2-stage pathway of alcohol metabolism. Methods:, Here, we use multiple regression models to test for associations and interactions between 2 alcohol-related phenotypes and SNPs in 17 genes involved in alcohol metabolism in a sample of 1,588 European American subjects. Results:, The strongest evidence for association after correcting for multiple testing was between rs1229984, a nonsynonymous coding SNP in ADH1B, and DSM-IV symptom count (p = 0.0003). This SNP was also associated with maximum number of drinks in 24 hours (p = 0.0004). Each minor allele at this SNP predicts 45% fewer DSM-IV symptoms and 18% fewer max drinks. Another SNP in a splice site in ALDH1A1 (rs8187974) showed evidence for association with both phenotypes as well (p = 0.02 and 0.004, respectively), but neither association was significant after accounting for multiple testing. Minor alleles at this SNP predict greater alcohol consumption. In addition, pairwise interactions were observed between SNPs in several genes (p = 0.00002). Conclusions:, We replicated the large effect of rs1229984 on alcohol behavior, and although not common (MAF = 4%), this polymorphism may be highly relevant from a public health perspective in European Americans. Another SNP, rs8187974, may also affect alcohol behavior but requires replication. Also, interactions between polymorphisms in genes involved in alcohol metabolism are likely determinants of the parameters that ultimately affect alcohol consumption. [source] Changes in the self-regulation guidelines of the US Beer Code reduce the number of content violations reported in TV advertisementsJOURNAL OF PUBLIC AFFAIRS, Issue 1-2 2010Thomas F. Babor From a public health perspective, alcohol advertising should not be directed at vulnerable groups, nor should it portray excessive drinking or other objectionable content such as illegal activity. To promote the responsible advertising of alcoholic beverages, alcohol industry groups have developed self-regulation guidelines that describe which types of content (and exposure markets) are unacceptable. In 2006 the US Beer Institute revised the content guidelines of the 1997 Beer Code. This study was designed to determine whether these changes made the revised Code more or less likely for expert judges to report guideline violations, and for alcohol advertisements to include otherwise inappropriate content from a public health perspective. Six alcohol advertisements known or suspected to have multiple content violations were rated by 139 experts selected on the basis of their expertise in public health, mental health, alcohol research and marketing. The ads were rated on two occasions with feedback about other viewers' ratings provided at the second rating. The data were collected by means of a computer-based rating program that used multiple items to evaluate the eight major content guidelines of the US Beer Code. The ratings were scored according to both the 1997 and the 2006 versions of the Beer Code. According to the 1997 criteria, raters identified an average of 26 guideline violations across the six ads; the number of violations was reduced to 18 when the 2006 criteria were applied. The difference was statistically significant and was primarily attributable to changes in guidelines dealing with the portrayal of illegal activity, humorous situations and the act of drinking. By removing or revising commonly violated guidelines, the 2006 Beer Code revision permits portrayal of previously objectionable ad content and increases the likelihood that risky drinking behaviours will be portrayed in US beer advertisements. Copyright © 2009 John Wiley & Sons, Ltd. [source] Towards a European registry of severe allergic reactions: current status of national registries and future needsALLERGY, Issue 6 2010M. Worm To cite this article: Worm M, Timmermans F, Moneret-Vautrin A, Muraro A, Malmheden Yman II, Lövik M, Hattersley S, Crevel R. Towards a European registry of severe allergic reactions: current status of national registries and future needs. Allergy 2010; 65: 671,680. Abstract The incidence of severe allergic reactions is largely unknown and information about triggering allergens, aggravating factors, demography of patients and medical care is lacking. A European wide registry could provide a powerful tool to improve the management of severe allergic reactions from both a medical and a public health perspective. Analysis of existing registries regarding the type and quality of data being collected was used to develop a plan for a pan-European registry, including the type of system to be used and the range of data to be entered. Surveillance will provide evidence for the efficacy of risk management measures and may identify the emergence of new allergenic foods, and aid monitoring of novel foods, ingredients and technologies. Patients need a clear indication of factors that may increase their risk of having an adverse reaction, which such a registry can help compile. Based on the collected data, food businesses will be able to develop educational programmes for allergen risk assessment and allergen risk communication. Finally, and most importantly preventive measures can be developed and government agencies receive population based data which may be relevant for legislative purposes. [source] Reduction of asthma burden is possible through National Asthma PlansALLERGY, Issue 4 2010M. Kupczyk To cite this article: Kupczyk M, Haahtela T, Cruz AA, Kuna P. Reduction of asthma burden is possible through National Asthma. Allergy 2010; 65: 415,419. Abstract Despite increase in understanding of asthma patomechanisms the practical actions to lessen asthma burden in the communities are far behind of scientific knowledge. There are still reports of uderdiagnosis and poor treatment leading to repeated severe exacerbations, often demanding emergency care and hospitalisation, which cause most of the economic burden both for families and society. From the public health perspective, the key issue is to implement the best standards of care in every-day practice. The problems are different in high income compared to low- and middle-income countries, and the solutions have to be tailored to each country needs and resources. We present here examples from Finland, Poland and Brazil, to show that asthma burden can be reduced using varied strategies in quite different societal, economical and health care environments. The experience from those interventions confirms that regardless of the health care system and its coverage, a major change for the better can be achieved by local efforts, systematic planning and networking to implement the best asthma practice. [source] A critical analysis of UK public health policies in relation to diet and nutrition in low-income householdsMATERNAL & CHILD NUTRITION, Issue 2 2006Pamela Attree phd Abstract Diet and nutrition, particularly among low-income groups, is a key public health concern in the UK. Low levels of fruit and vegetable consumption, and obesity, especially among children, have potentially severe consequences for the future health of the nation. From a public health perspective, the UK government's role is to help poorer families make informed choices within healthy frameworks for living. However, the question is , to what extent are such policies in accordance with lay experiences of managing diet and nutrition on a low-income? This paper critically examines contemporary public health policies aimed at improving diet and nutrition, identifying the underlying theories about the influences on healthy eating in poor families, and exploring the extent to which these assumptions are based on experiential accounts. It draws on two qualitative systematic reviews , one prioritizing low-income mothers' accounts of ,managing' in poverty; and the other focusing on children's perspectives. The paper finds some common ground between policies and lay experiences, but also key divergencies. Arguably, the emphasis of public health policy on individual behaviour, coupled with an ethos of empowered consumerism, underplays material limitations on ,healthy eating' for low-income mothers and children. Health policies fail to take into account the full impact of structural influences on food choices, or recognize the social and emotional factors that influence diet and nutrition. In conclusion, it is argued that while health promotion campaigns to improve low-income families' diets do have advantages, these are insufficient to outweigh the negative effects of poverty on nutrition. [source] Low-income mothers, nutrition and health: a systematic review of qualitative evidenceMATERNAL & CHILD NUTRITION, Issue 4 2005Pamela Attree phd Abstract Diet is a key issue for UK health policies, particularly in relation to poorer socio-economic groups. From a public health perspective, the government's role is to help low-income families to make healthy food choices, and to create the conditions to enable them to make healthy decisions. Arguably, however, current policy on nutrition and health is influenced by individualist and behavioural perspectives, which fail to take into account the full impact of structural factors on food choices. This paper draws on a systematic review of qualitative studies that prioritize low-income mothers' accounts of ,managing' in poverty, synthesizing a subset of studies that focus on diet, nutrition and health in poor families. Synthesis findings are explored in the context of dominant discourses concerning individual responsibility for health and gendered societal values concerning ,good' mothering. The paper concludes that a shift in emphasis in health policies, affording a higher priority to enabling measures that tackle the underlying determinants of health, would be advantageous in reducing nutritional inequities for low-income mothers and their children. [source] Persons, Places, and Times: The Meanings of Repetition in an STD ClinicMEDICAL ANTHROPOLOGY QUARTERLY, Issue 2 2007Lori Leonard In this article we work the tensions between the way clinical medicine and public health necessarily construct the problem of "repetition" in the context of a sexually transmitted disease (STD) clinic and the ways patients narrate their illness experiences. This tension,between clinical and epidemiological exigencies and the messiness of lived experience,is a recurring theme of work conducted at the intersections of epidemiology, anthropology, and clinical medicine. Clinically, repeated infections are a threat to the individual body and to "normal" biological processes like reproduction. From a public health perspective, "repeaters" are imagined to be part of a "core group" that keeps infections in circulation, endangering the social body. Yet patients' accounts are anchored in particular social histories, and their experiences rely on different time scales than those implicated in either of these types of readings. Extended analyses are provided of two such accounts: one in which repetition can be "read" as part of a performance of recovery, and one in which repetition is bound up in the effort to avoid becoming the involuntary subject of institutionally administered intervention. We argue the need to open up the category of repeaters to include the social and draw on work by Cheryl Mattingly to suggest that one way to do this in the context of the STD clinic might be to adopt forms of therapeutic practice that make use of interpretive, in addition to technical, skills. [source] Bioengineered tissues: the science, the technology, and the industryORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 3 2005T Ahsan Structured Abstract Authors ,, Ahsan T, Nerem RM Objective ,, The bioengineering of tissues and organs, sometimes called tissue engineering and at other times regenerative medicine, is emerging as a science, as a technology, and as an industry. The goal is the repair, replacement, and/or the regeneration of tissues and organs. The objective of this paper is to identify and discuss the major issues that have become apparent. Results ,, One of the critical issues is that of cell source, i.e. what will be the source of the cells to be employed? Another critical issue is the development of approaches for the fabrication of substitute tissues/organs and/or vehicles for the delivery of biological active molecules for use in the repair/regeneration of tissues. A third critical issue, one very much related to cell source, is that of immune acceptance. In addition, there are technological hurdles; there are additional issues such as the scale-up of manufacturing processes and the preservation of living-cell products for off-the-shelf availability. Although the initial products have been superficially applied skin substitutes, as this fledgling industry continues to evolve, it is beginning to focus on a wider range of more invasive and complicated products. From a public health perspective, the real opportunity may be in addressing chronic diseases, as well as the transplantation crisis (i.e. the tremendous disparity between patient need for vital organs and donor availability) and, equally important is the challenge of neural repair. Conclusion ,, These are the grand challenges, and the scientific community, business/private sector, and federal government must mobilize itself together in this emerging area to translate the benchtop science to the patient bedside. [source] Preterm delivery: a public health perspectivePAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2001Donald R. Mattison And his daughter-in-law, the wife of Phinehas, was pregnant near to giving birth, and got to hear the report that the ark of the true God was captured and that her father-in-law and her husband had died. At that she bowed herself and began giving birth, because her pangs came unexpectedly upon her. [source] Sunscreens: expectation and realizationPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 5 2009Brian Diffey Background: The technical performance of sunscreens has improved dramatically over the past 20 years, so have we now succeeded in delivering protection that meets consumers' expectations? Methods: From a public health perspective, the desire to prevent sunburn and protect against skin cancer are the two major drivers for using sunscreen. This review examines how well consumers can expect to realize these expectations. Results: Sunscreens are used regularly by a minority of people, even during recreational summer exposure. The failure of sunscreen to prevent sunburn is almost always due to the way that sunscreens are applied rather than technical failure of the product. The mismatch between the labelled protection (sun protection factor) and that delivered in practice is a contributory factor to this ,failure'. Sunscreens have been shown to be effective in reducing the incidence of squamous cell cancer and with promising benefits for basal cell cancer. However, the evidence that they are effective in melanoma remains lacking. Conclusion: The formulation and extinction of sunscreens have undoubtedly improved over recent years. Yet the notion that sunscreens provide unequivocal protection against the deleterious effects of sun exposure by everyone who uses them remains elusive. [source] Prevalence of neural tube defects in Australia prior to mandatory fortification of bread-making flour with folic acidAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2010Samanthi Abeywardana Abstract Objective: To establish baseline prevalence of neural tube defects (NTDs) prior to mandatory folic acid fortification in Australia. Method: Retrospective population based study. Data from the Australian Congenital Anomalies Monitoring System, for 1998,2005 were used to calculate birth prevalence including live/stillbirths of at least 20 weeks gestation or 400 g birthweight. Total prevalence and trends of NTD including terminations of pregnancy (TOPs) before 20 weeks were established using data from South Australia, Victoria and Western Australia because of the incomplete ascertainment in other states. Results: The birth prevalence of NTDs from 1998,2005, was 5/10,000 births. The total prevalence including TOPs was 13/10,000 births. A 26% declining trend in total prevalence was seen from 1992,2005, but the main decline occurred prior to 1998. Women who were Indigenous, socially disadvantaged, young, living in remote areas and had multiple gestations were more likely to give birth to babies with NTDs. Conclusion: The prevalence of NTD has been stable since 1998. Reporting of the birth prevalence alone underestimates the actual prevalence of NTD. Implications: From a public health perspective, future monitoring of NTD following implementation of fortification of bread-making flour with folic acid should include a mixed methods approach; reporting birth prevalence on national data and total prevalence on tri-state data. [source] Serum levels of 25-hydroxyvitamin D in mothers of Swedish and of Somali origin who have children with and without autismACTA PAEDIATRICA, Issue 5 2010Elisabeth Fernell Abstract Aim:, To analyse serum levels of 25-hydroxyvitamin D in mothers of Somali origin and those of Swedish origin who have children with and without autism as there is a growing evidence that low vitamin D impacts adversely on brain development. Method:, Four groups of mothers were invited to participate; 20 with Somali origin with at least one child with autism, 20 with Somali origin without a child with autism, 20 of Swedish origin with at least one child with autism and 20 with Swedish origin without a child with autism. Two blood samples were collected from each individual; during autumn and spring. Results:, Between 12 and 17 mothers from the different groups accepted to participate, both groups of mothers of Somali origin had significantly lower values of 25-hydroxyvitamin D compared with Swedish mothers. The difference of 25-hydroxyvitamin D between mothers of Somali origin with and without a child with autism was not significant. Conclusion:, Our findings of low vitamin D levels in Somali women entail considerable consequences in a public health perspective. The observed tendency, i.e. the lowest values in mothers of Somali origin with a child with autism was in the predicted direction, supporting the need for further research of vitamin D levels in larger samples of Somali mothers of children with and without autism. [source] Trends in the prevalence of low birth weight in Okinawa, Japan: a public health perspectiveACTA PAEDIATRICA, Issue 2 2009T Hokama Abstract Aim: To review the trends in low birth weight (LBW) in Japan and Okinawa and to discuss the public health implications of the trend. Methods: The statistical records of Japan and the Okinawa prefecture were reviewed to observe secular trends of LBW incidence rate and other health indicators. Literature researches were undertaken of English and Japanese language publications to complete the review. Results: The LBW rate in Japan declined until the 1970s, reaching a low point for the whole country in 1978,1979 when it was 5.2% (7.2% in Okinawa). In Okinawa the proportion of LBW declined from 8.1% in 1973 to 7.2 in 1978. Since 1980 the LBW rate has steadily increased to its current level of 9.3% in Japan and 10.9% in Okinawa. During this period, the prematurity rate has not increased and other indicators of child health have continued to improve. Conclusion: Japan is unique among developed countries in that the LBW rate has almost doubled in the past three decades and the rate in Okinawa is 20% greater than the mainland. The health costs of this trend include the neonatal care of LBW infants and the increased risk of chronic disease in later life. [source] Gastroschisis: International epidemiology and public health perspectives,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2008Eduardo E. Castilla Abstract Gastroschisis offers the intriguing epidemiological situation of a pandemic, strongly associated with very low maternal age. Identifying gastroschisis, and distinguishing it from the other abdominal wall defects, is theoretically easy but difficult in practice. The baseline birth prevalence of gastroschisis before the pandemic was approximately 1 in 50,000 births and has increased since between 10- and 20-fold. In many populations worldwide, it is still increasing. Such increasing prevalence and the association with very low maternal age are well proven, but the interaction between these two findings remains unknown. Geographic gradients (decreasing prevalence from North to South) are clear in Continental Europe and suggestive in Britain and Ireland. Gastroschisis seems more frequent in Caucasians compared to African Blacks and Orientals, and in Northern compared to Southern Europeans. These observations indicate the need for investigating gene,environment interactions. Since the global human situation is marked by inequalities among as well as within countries, the medical care and public health impact of gastroschisis varies widely among regions and social strata. The postnatal benefits of prenatal diagnosis of gastroschisis include family awareness; adequate planning of delivery with alerted obstetrical, pediatric, and surgical staff; optimal risk categorization, and personalized protocol for action. The increasing prevalence of gastroschisis combined with improved medical techniques to reduce morbidity and mortality are also increasing the burden and costs of this anomaly on health systems. © 2008 Wiley-Liss, Inc. [source] Cost of disorders of the brain in NorwayACTA NEUROLOGICA SCANDINAVICA, Issue 2010L. J. Stovner Stovner LJ, Gjerstad L, Gilhus NE, Storstein A, Zwart JA. Cost of disorders of the brain in Norway. Acta Neurol Scand: 2010: 122 (Suppl. 190): 1,5. © 2010 John Wiley & Sons A/S. Background,,, Little is known about the cost of neurological disorders in Norway. Objectives,,, To estimate the cost of disorders of the brain, including the main psychiatric, neurological and neurosurgical conditions in Norway. Methods,,, Most of the data are extrapolations from a large European cost study that collected the best available epidemiological and health economical evidence for the year 2004. Some epidemiological data are available from Norway, but very little on costs. Results,,, Brain disorders seemed to affect 1.5 million Norwegians in 2004, and the total cost amounted to 5.8 billion Euros. The most prevalent disorders are anxiety disorders and migraine, and the most costly are affective disorders, addiction and dementia. Migraine is the most costly of the purely neurological conditions, followed by stroke, epilepsy and Parkinson's disease. The indirect costs account for more than half of the total costs. Discussion,,, Although the different brain disorders are very dissimilar in appearance, from health economic and public health perspectives, it is relevant to view them as a whole, since many of them share important pathophysiological mechanisms. This means that new insights into one disorder can have relevance for many other disorders. Conclusion,,, As a result of the high impact on individuals and society, more resources should be allocated to treatment and research into brain disorders. [source] | ||||||||||||||||