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PubMed2004

Small area variations in infant mortality in England and Wales in the inter-war period and their link with socio-economic factors.

This paper considers the changing spatial pattern of infant mortality during the inter-war years (1921-1936) at Local Government District level in England and Wales. As well as vital statistics data for these areas, also available are 1921 and 1931 Census data on unemployment, housing, occupational structure and population density, with additional data on unemployment from 1927 to 1936 for the 62 counties in which Districts are located. The statistical analysis relating changing District mortality to these characteristics derives mortality gradients across categorical forms of the social indicators, and assesses impacts of model re-specification to allow for spatio-temporal correlation. Time varying gradients across unemployment, housing and policy status are then investigated with a view to assessing whether there was a widening in mortality inequalities in the regionalized economic depression of the 1930s.

Adolescent↗

PubMed2006

What is the association between sickness absence, mortality and morbidity?

This paper examines the area-level relationships in England and Wales between sickness absence ('incapacity benefit'), mortality and morbidity. It uses a random sample of incapacity benefit claims, and population counts of mortality and Census morbidity for local government districts. Although there is little correspondence between sickness absence claims by specific cause and mortality, all cause sickness absence has a strong relationship with all cause mortality (male r 0.74, p=0.00; female r 0.64, p=0.00) and it also has a very strong relationship with the Census measures of morbidity: LLTI (male r 0.98, p=0.00; female r 0.97, p=0.00) and 'not good health' (male r 0.99, p=0.00; female r 0.96, p=0.00). Incapacity benefit claims by all causes has the potential to provide an ongoing measure of area-level health in England and Wales.

Adolescent↗

PubMed2005

Maternal and child health and neighborhood context: the selection and construction of area-level variables.

BACKGROUND: Increasingly, maternal and child health researchers are employing the statistical approach of multilevel modeling analysis to simultaneously examine the relationship between contextual and individual determinants and maternal and child health outcomes. This review addresses the following questions: (1) What categories of neighborhood characteristics have been addressed? (2) How were those neighborhood characteristics operationalized? METHODS: A literature review identified 31 relevant articles published between January 1999 and March 2004. The articles were read with special attention toward the measurement of neighborhood characteristics. RESULTS: Twelve categories of neighborhood characteristics represented in the articles include income/wealth, employment, family structure, population composition, housing, mobility, education, occupation, social resources, violence and crime, deviant behavior and physical conditions. A wide diversity of approaches was used to measure these characteristics. The most widely utilized source of data was that of administrative records from the census or local government authorities. Although most authors provided theoretical explanations of their choice to examine broad neighborhood constructs, few were explicit about why certain indicators were selected to measure these constructs. CONCLUSIONS: There are theoretical, methodological and practical barriers in the measurement of the neighborhood context which must be addressed for the field to move forward. These barriers are discussed and recommendations are made for addressing them in future research.

Adolescent↗

PubMed2005

Healthcare reform involving the introduction of user fees and drug revolving funds: influence on health workers' behavior in southeast Nigeria.

OBJECTIVES: To assess the perceptions of health workers towards the drug revolving fund (DRF) scheme and the perceptions of the community members about health workers since the introduction of the DRF. METHODS: The study was conducted in four purposively selected local government areas (LGAs) in southeast Nigeria where the Bamako initiative DRF was operational. Data was collected using in-depth interviews with randomly selected health workers and exit interviews with patients who attended the health centers. RESULTS: There were differences between the ways the DRF affected health workers in the different LGAs. In general, the motivation of the health workers to deliver health services improved significantly largely because they had basic drugs to work with and they benefited from the drug gains accruing through the operations of the DRF. However, as time went on, some got de-motivated and their attentions became more focused on revenue generation and profit making through sale of own drugs at the expense of health of the people as no incentives were paid and salaries were delayed. Curative services were provided more than promotive and preventive services and drugs are prescribed irrationally. Patients showed wide spread dissatisfaction with fees charged, waiting time before being seen, and treatment instructions given to them. CONCLUSION: Governments need to focus not only on the provision of drugs and revenue generation but also on providing strong support for in-service training, monitoring and supervisory activities to improve health workers' attitude to work. The governments also need to explore incentives such as working condition and monetary incentives to motivate health workers to improve their performance so as to serve the consumers better.

Adult↗

PubMed2004

Annual variation of the angular distribution of the UV beneath public shade structures.

Local governments provide many shade structures at parks and sporting ovals for public use. However, the question remains of how effective are public shade structures at reducing biologically effective UV radiation throughout the year? Broadband measurements of the angular distribution of scattered UV beneath three specific public shade structures was conducted for relatively clear skies and for a solar zenith angle (SZA) ranging from 13 degrees to 76 degrees. The ultraviolet protection factors (UPF) for the shade structures ranged from 18.3 to 1.5 for an increasing SZA. Measurements showed that the horizontal plane received the highest SUV levels from the SZA of 28 degrees to 75 degrees, 42 degrees to 76 degrees, and 50 degrees to 76 degrees for the small, medium and large structures, respectively. This was due to the angle of the sun causing the shade created by the shade structure to be outside the structure. For the small shade structure, the measurements directed to the west were the highest levels in the shade after approximately 28 degrees. For the medium and large shade structures, the measurements directed to the west and south were the highest levels in the shade after roughly 42 degrees and 50 degrees, respectively.

Diffusion↗

PubMed2026

Exploring China's Clean Air Act and associated cardiovascular disease risk: a prospective, quasi-experimental, and causal inference modelling study.

BACKGROUND: Substantial improvements in air quality have been recorded following the implementation of China's Clean Air Act (CCAA) in 2013. However, the association between CCAA implementation and individual-level cardiovascular disease (CVD) risk remains unclear. We aimed to examine the long-term association between CCAA implementation and individual-level predicted CVD risk. METHODS: In this prospective, quasi-experimental study, we used data from the China Kadoorie Biobank, a prospective cohort study that recruited participants from five urban and five rural areas across China between 2004 and 2008, with three resurveys conducted after the baseline survey (in 2008, 2013-14, and 2020-21). We included 34 862 individuals (mean age 51·3 years) who participated in at least one resurvey and had no history of CVD at baseline. Participants were classified into intervention (n=25 497) and control (n=9365) groups based on the local government's targets for particulate matter reduction. We estimated the 10-year risk of incident CVD morbidity or mortality using a validated risk prediction model. We used a difference-in-difference model to assess the long-term association between CCAA implementation and predicted risk, with adjustments made for regional confounders and individual-level characteristics, including demographics, lifestyle factors, medical history, and indoor air pollution exposure. The relationship between changes in long-term exposure to PM2·5, PM10, and O3 and predicted risk after CCAA implementation was analysed using a linear model. The estimated risk differences associated with air pollutant changes were estimated based on the magnitude of changes and their corresponding effect sizes. FINDINGS: After the CCAA was implemented, PM2·5 and PM10 concentrations declined in both groups, but O3 concentrations increased. The intervention group showed a 3·95% (95% CI 3·18-4·72%) lower increase in predicted risk than the control group, with larger estimated differences under stricter enforcement. Between 2013 and 2021, each 10 μg/m3 change in PM2·5 concentration was positively associated with a 1·80 (1·34-2·27) percentage point change in predicted CVD risk, whereas each 10 μg/m3 change in PM10 concentration was associated with a 1·24 (0·84-1·63) percentage point change and each 10 μg/m3 change in O3 concentration with a 0·58 (0·33-0·83) percentage point change. Overall, the observed changes in air pollutants during the study period were associated with an average 6·6 percentage point reduction in predicted CVD risk. INTERPRETATION: The CCAA and improved air quality were associated with a slower increase in predicted CVD risk, supporting the necessity for stricter, multipollutant air quality policies to maximise public health benefits. FUNDING: National Natural Science Foundation of China, Kadoorie Charitable Foundation, Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Key R&D Program of China, Chinese Ministry of Science and Technology, and UK Wellcome Trust.

Journal Article↗

PubMed2005

Public health in practice: the three domains of public health.

This paper outlines a conceptual model for public health practice by proposing the three domains as a framework to organize and to deliver public health programmes. The model builds on the recognition that public health is everybody's business and therefore, needs a common definitional base. Different levels of skill and a wide range of contributions are needed if public health programmes are to make the most impact. The different domains of practice help to construct a basis for understanding the necessary elements of the public health system and their interactions. Using teenage pregnancy as a case study of a public health programme highlights the characteristics of the model. It demonstrates not only the importance of the role of directors of public health in taking a population-based overview, but also the need for multi-sectoral, multidisciplinary working. The relevance of the public health approach not only to primary care but also to the hospital-based sector becomes apparent, as does its relevance to communities, voluntary sector and local government. Integration of the three domains, a common definition and the framework for the public health system will support effective delivery of health improvement.

Models, Organizational↗

PubMed2006

Emergency medical service systems in Japan: past, present, and future.

Emergency medical services are provided by the fire defence headquarters of the local government in Japan. There is a one-tiered EMS system. Ambulances are staffed by three crew members trained in rescue, stabilisation, transport, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class One, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergency Life Saving Technician, ELST). ELSTs are trained in all aspects of BLS and some ALS procedures relevant to pre-hospital emergency care. Further development of an effective medical control system is imperative as the activities of ambulance crews become more sophisticated. A marked recent increase in the volume of emergency calls is another issue of concern. Currently, private services for transportation of non-acute or minor injury/illness have been introduced in some areas, and dispatch protocols to triage 119 calls are being developed.

Advanced Cardiac Life Support↗

PubMed2005

Inequities in healthcare seeking in the treatment of communicable endemic diseases in Southeast Nigeria.

This paper investigates the socio-economic inequities in healthcare seeking in the treatment of common communicable endemic diseases, with an emphasis on the use of primary health care (PHC) centres, where most endemic disease control activities take place. A questionnaire was used to collect information on occurrence of diseases and healthcare seeking from randomly selected households in four local government areas in Southeast Nigeria. Principal components analysis was used to create a socio-economic status (SES) index, which was divided into quartiles. The ratio of the values for the poorest quartile to that of the least poor quartile (bottom/top quartile) together with concentration indices for the variables under consideration was used as the measures of inequity. Logistic analysis was used to examine the determinants of use of PHC centres. The poorest quartile was more likely to use low-level providers (patent medicine dealers, shops, herbalists) and least likely to use the PHC centres. The concentration indices were -0.10, -0.06, -0.37, 0.11 and 0.04 for the use of herbalists, patent medicine dealers, community-health workers, PHC centres and hospitals, respectively. Also, the poorest quartile was more likely to lose person-days when ill. Logistic analysis showed that SES, availability of good services, proximity of the centres to the homes and polite health workers increased the use of the PHC centres. As such, improvement of quality of PHC services and improved geographic access could increase the overall use of PHC centres. Furthermore, in the long-term, a decrease in the amount of user fees, enhanced physical access and improved quality of services could decrease inequity in use of PHC centres and hospitals in the treatment of endemic diseases. The bottom/top quartile ratios and concentration indices produced similar results and hence both methods hence complement each other.

Adult↗

PubMed2005

Low linking social capital as a predictor of coronary heart disease in Sweden: a cohort study of 2.8 million people.

This study investigated the association between the recently minted concept of linking social capital and incidence of coronary heart disease (CHD). A follow-up study of 1,358,932 men and 1,446,747 women in Sweden aged 45-74 years was conducted between 1 January 1998 and 31 December 1999. Neighbourhood linking social capital was conceptualised as proportions of individuals voting in local government elections at neighbourhood level. The neighbourhood- and individual-level factors were analysed within a multilevel framework. Linking social capital was associated with CHD in both men and women beyond individual-level factors: in neighbourhoods with low linking social capital the odds ratios were 1.19 (CI = 1.14-1.24) and 1.29 (CI = 1.21-1.38) for men and women, respectively, after adjustment for age, country of birth, education, marital status, and housing tenure. The significant between-neighbourhood variance (i.e. the random intercept) showed significant differences in CHD incidence between neighbourhoods. Even in a relatively egalitarian society, as exemplified by the Swedish Welfare State, individual health is affected by differences between neighbourhoods in linking social capital. The use of linking social capital represents a novel conceptual advance in research on the association between CHD, one of the major causes of death in Western countries, and the multidimensional aspects of social capital.

Aged↗

PubMed2006

Socioeconomic inequalities in physical and mental functioning of Japanese civil servants: explanations from work and family characteristics.

Poor physical and mental functioning is more common among people of low socioeconomic status (SES) and those with disadvantaged work and family characteristics. This study aims to clarify whether the SES inequalities in functioning can be explained by the SES differences in work and family characteristics. The subjects were 3787 male and female civil servants, aged 20-65, working in a local government on the west coast of Japan. Logistic regression analysis was performed to examine (1) whether there were employment-grade (SES) differences in poor physical and mental functioning as measured by the Short Form 36 (SF-36) and (2) whether these SES differences were explained by work and family characteristics. In general, low control at work, high demands, low social support, short and long work hours, shift work, being unmarried, high family-to-work conflict and high work-to-family conflict were independently associated with poor physical and mental functioning in both men and women. In men, the age-adjusted odds ratio (OR) of low-grade employees for poor physical functioning was 1.93 (95% confidence interval: 1.38-2.69) in comparison to high-grade employees. The grade difference was mildly attenuated, when adjusted for work and family characteristics (OR = 1.72)(1.20-2.47). The age-adjusted OR of the low-grade employees for poor mental functioning was 1.88 (1.29-2.74). The grade difference was attenuated and no longer significant when adjusted for work and family characteristics (OR = 1.51)(0.99-2.31). Among women, there were no significant grade-differences in poor physical and mental functioning. Although longitudinal research is necessary to clarify the causal nature of these associations, improvements in SES differences in work and family characteristics may be important for reducing SES inequalities in physical and mental functioning among Japanese men. The different patterns of SES inequalities in health between men and women deserve further research.

Adult↗

PubMed2006

The association of smoking with perception of income inequality, relative material well-being, and social capital.

The aim of this study is to examine the association of smoking status with income inequality, relative deprivation, perception of relative material well-being and community-level social capital, controlling for individual-level indicators of social capital, and common socio-economic variables. Data were from telephone interviews of approximately 126 residents selected at random (using the Electronic White Pages) from each of 22 local government areas (LGAs) in the Melbourne metropolitan region, Victoria, Australia (total n = 2762). We used logistic regression to assess the association of covariates with smoking status. Being a smoker was associated with a higher level of perceived income inequality, lower perception of relative material well-being and living in a community with a lower degree of trust and safety. While the cross-sectional design of the study does not allow causal inferences, the results imply that smoking is less prevalent in communities that are more egalitarian and have a higher stock of social capital.

Adolescent↗

PubMed2006

Managing competition in the countryside: Non-profit and for-profit perceptions of long-term care in rural Ontario.

This paper contributes to the current debates surrounding private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit providers of long-term care in rural and small town settings. It focuses on the empirical case of Ontario, Canada where extensive restructuring of long-term care, under the rubric of managed competition, has been underway since the mid-1990s. In-depth interviews with 72 representatives from local governments, public health institutions and authorities, for-profit and non-profit organisations, and community groups during July 2003 to December 2003 form the platform for a qualitative analysis of the implications of managed competition as it relates to the provision of long-term care in the countryside. The results suggest that the introduction and implementation of managed competition has accentuated the problems of service provision in rural communities, and that the long-standing issues of caregiving in rural situations transcend the differences, perceived or otherwise, between for-profit and non-profit provision. Understanding the implications of market-oriented long-term care restructuring initiatives for providers, and their clients, in rural situations requires a re-focussing of research beyond the for- versus non-profit dichotomy.

Aged↗

PubMed2004

An overview on chronic arsenism via drinking water in PR China.

Chronic endemic arsenism via drinking water was first found in Taiwan in 1968, and reported in Xinjiang Province in mainland China in the 1980s. Arsenism has become one of the most serious endemic diseases in China in the last two decades. Up to now, the disease has been found in Inner Mongolia, Shanxi, Ningxia, Jilin and Qinghai provinces. According to the Chinese maximum limit standard of arsenic (As) in drinking water, over 2 millions people have been exposed to high arsenic and about 10,000 persons were diagnosed as arsenism patients. There are different As concentrations in the water of different sites, even in the same area. Most of the As concentrations range from 0.05 to 2.0mg/l. The incidence of arsenism increases as As concentrations in drinking water and the drinking time increase. The age distribution of patients with arsenism ranged from 3 to 80 years old with peak prevalence in adults. A dose-effect relationship between the status of arsenism and arsenic level and drinking time has been shown. New high-arsenic areas in China have been discovered during recent investigations. In order to reduce the adverse health effects of arsenism, the central and local governments of China have provided significant funds to change water levels of As and at the same time take general measures to "reduce arsenic intake, remove arsenic from the body and treat the patients". After the implementation of these control measures in certain regions, the clinical symptoms and signs of 30% of the patients were improved. There was no change in 52% of patients and only 18% of patients got worse. It is suggested that future work in the research and control of arsenism in China should include: (1) identify all the high arsenic areas in China, (2) study the association of arsenism with fluorosis, (3) determine individual susceptibility, (4) select biomarkers for diagnosis in the early stage of a arsenism, and (5) investigate the molecular mechanisms of carcinogenesis.

Adolescent↗

PubMed2005

Policy evaluation for the subsidy for influenza vaccination in elderly.

OBJECTIVE: In Japan, the subsidy of influenza vaccination for the elderly was introduced in November 2001. This paper examines its policy evaluation from the viewpoint of cost-benefit analysis. MATERIALS: The data of copayment of influenza vaccination, population and shot rate of the elderly are surveyed by telephone interview to the correspondents in the local governments of Tokyo metropolitan and other 12 big cities in Japan. The mortality due to pneumonia or influenza is obtained from Vital Statistics of Population. METHOD: At first, I examine the impact of amount of copayment, through its effect on shot rate, on the percentage of elderly receiving influenza vaccinations. Using these estimation results, benefit-cost ratio (BCR) is calculated. RESULTS: The estimated coefficient of copayment on shot rate is -0.007 and statistically significant. Shot rate significantly reduces pneumonia and influenza mortality and its magnitude is -0.0028. The obtained net benefit (NB) is 134.9 million yen or US$1.08 billion and benefit-cost ratio is 22.9 and its 95% confidence interval is [2.2, 43.7]. DISCUSSION: If copayment would be cut by a 1000 yen (US$8), it could avoid about 400 deaths in average big city. The benefit-cost ratio is quite high compared with the other countries or other vaccinations. CONCLUSION: We found the strong evidence in a sense of cost-benefit analysis in the subsidy for influenza vaccination in the elderly.

Aged↗

PubMed1999

Onchocerciasis in pre-primary school children in Nigeria: lessons for onchocerciasis country control programme.

There is limited data on the prevalence of onchocerciasis in young children in Nigeria, partly because treatment with the effective drug Ivermectin has been contra-indicated in children less than 5. As the risk of complications of onchocerciasis is related to duration and intensity of infection, it would be beneficial to know the prevalence in young children for design of control programmes. A study was therefore undertaken to determine the prevalence of onchocerciasis in 642 children 0-4 years old in a rain forest endemic community in South East Nigeria. The overall onchocerciasis prevalence (positive skin snips) for children 0-4 years old in three Local Government Areas in Enugu State, Eastern Nigeria was 15.7% with no significant difference in infection rates between male and female children. There was no detectable infection in children less than 1 year old. Characteristic onchocercal rash was identified in 11.1% of the children and presence of typical onchocercal subcutaneous palpable nodules in 4.6%. Total prevalence for adults in the same population was found to be 26.9%. This indicates that in onchocerciasis endemic communities, everybody may be at risk of infection irrespective of age.

Adult↗

PubMed1995

Validation of a food habits questionnaire: poor performance in male manual laborers.

OBJECT: To examine the reliability and validity of a food habits questionnaire developed by Kristal et al in male manual laborers. DESIGN: A cross-sectional baseline survey. SETTING: The community of Ottawa-Carleton, Canada. SUBJECTS: All people working in non-office-based positions for two local governments were invited to a heart-health screening clinic. Male subjects (n = 362) who met risk factor eligibility criteria were interviewed and entered into the study. MAIN OUTCOME MEASURES: The food habits questionnaire developed by Kristal et al was the main focus of analysis. Additional outcomes included a food frequency questionnaire and risk factors for cardiovascular disease. STATISTICAL ANALYSES: Reliability was assessed using Cronbach's alpha and Pearson correlation coefficients; confirmatory factor analysis was also done. Validity assessment included partial correlations. RESULTS: Low internal consistency was found for the five subscales of the questionnaire (alpha = .13 to .53). Confirmatory factor analysis did not reveal the postulated five-factor (subscale) structure. Correlation of the subscale scores with dietary fat intake was low (r = -.09 to -.23), and none of these associations were statistically significant after adjustment for age, body mass index, and education. An alternative scoring system that treated the questionnaire as a unidimensional behavioral checklist produced a higher internal consistency (alpha = .70) and significant correlation with dietary fat intake (r = -.27). CONCLUSIONS: The psychometric properties and scoring of the food habits questionnaire need to be explored in additional populations before the questionnaire is adopted for general use.

Adult↗

PubMed2000

Biological terrorism: understanding the threat, preparation, and medical response.

The thought of an outbreak of disease caused by the intentional release of a pathogen or toxin in an American city was alien just 10 years ago. Many people believed that biological warfare was only in the military's imagination, perhaps to be faced by soldiers on a far-away battlefield, if at all. Political factors--and possibly biotechnology--have changed that. As we enter the new millennium, national, state, and local governments in the United States are preparing for what is now called "not if, but when" biological terrorism. In contrast to the acute onset and first-responder focus with a chemical attack, in a bioterrorist attack, the physician and the hospital will be at the center of the fray. Whether the attack is a hoax, a small food-borne outbreak, a lethal aerosol cloud moving silently through a city at night, or the introduction of contagious disease, the physician who understands threat agent characteristics and diagnostic and treatment options and who thinks like an epidemiologist will have the greatest success in limiting the impact of the attack. As individual health-care providers, we must add the exotic agents to our diagnostic differentials. Hospital administrators must consider augmenting diagnostic capabilities and surveillance programs and even making infrastructure modifications in preparation for the treatment of victims of bioterrorism. Above all, we must all educate ourselves. If done correctly, preparation for a biological attack will be as "dual use" as the facility that produced the weapon. A sound public health infrastructure, which includes all of us and our resources, will serve this nation well for the control of disease, no matter what the cause of the disease.

Biological Warfare↗