Evaluating the alcohol environment: community geography and alcohol problems.
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Chemical embryology was born in 1931 with the publication of Chemical Embryology by Joseph Needham. In the following two decades it became an innovative research project aiming at the description of the construction of the embryological structure and differentiation in biochemical terms. This research programme produced a vast amount of experimental evidence and theories on the chemical dynamics of the embryo: particularly chemical characterization of the zygote and the developing embryo, the chemical exchanges between the nucleus and the cytoplasm, the significance of subcellular structures, and the role and distribution of nucleic acids within the cell. From the 1950s on, a large part of these results came to be integrated into the empirical basis of molecular biology. However, the shift from chemical embryology to molecular embryology was not just a semantic shift but a deep theoretical change, produced by the introduction of a new model of scientific explanation, based on the transmission and expression of genetic information and opposed to the biochemical definition of life.
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BACKGROUND: Alcohol consumption is still a major public health problem in France. A recent survey in the general population provided an overall picture of regional differences of alcohol consumption and demonstrated the difficulty encountered in comparing declarative data and economic and health data. METHODS: A method based on standardisation was applied to control the effects of age and gender in order to demonstrate regional differences in daily alcohol intake and episodes of drunkenness during the year as well as differences in weekly alcohol intake. A hierarchical clustering was performed based on these indicators in order to obtain a regional map. RESULTS: Three classes of regions were distinguished. The first group included regions where the prevalence of drunkenness or alcohol intake was particularly high (Brittany, Pays de la Loire, Burgundy, Alsace, Franche-Comté, Rhône-Alpes). The second group included regions where daily consumption was frequent and rather high in quantity (Limousin, Auvergne, Aquitaine, Midi-Pyrénées, Languedoc-Roussillon). The third group included regions where daily intake and drunkenness were exceptional. These results were compared with external data: household data, alcohol-related mortality data, medical consultation data. In some regions in southwestern France or northern France, results showed a poor fit between economic and social data. CONCLUSION: Measuring the quality of declarative data on alcohol consumption is essential for public health decision-makers. Comparing economic and sanitary data remains a difficult task. Differences related to the source of the data lead to very different concepts of the problem, requiring in-depth knowledge and new hypotheses to correctly interpret such differences. Further work is needed to better ascertain the different aspects of the problem of alcohol consumption in France. For example, general population surveys might include more precise questions for identifying excessive drinkers or questions on economic data related to alcohol (e.g. purchasing practices).
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BACKGROUND: Socioeconomic status appears to be an important predictor of coronary angiography use after acute myocardial infarction. One potential explanation for this is that patients with lower socioeconomic status live in neighbourhoods near nonteaching hospitals that have no catheterization capacity, few specialists and lower volumes of patients with acute myocardial infarction. This study was conducted to determine whether the impact of socioeconomic status on angiography use would be lessened by considering variations in the supply of services. METHODS: We examined payment claims for physician services, hospital discharge abstracts and vital status data for 47 036 patients with acute myocardial infarction admitted to hospitals in Ontario between April 1994 and March 1997. Neighbourhood income of each patient was obtained from Canada's 1996 census. Using multivariate hierarchical logistic regression and adjusting for baseline patient and physician factors, we examined the interaction among hospital and regional characteristics, socioeconomic status and angiography use in the first 90 days after admission to hospital for acute myocardial infarction. RESULTS: Within each hospital and geographic subgroup, crude rates of angiography rose progressively with increases in neighbourhood income. After adjusting for sociodemographic, clinical and physician characteristics, hospitals with on-site angiography capacity (adjusted odds ratio [OR] 1.88, 95% confidence interval [CI] 1.52-2.33), those with university affiliations (adjusted OR 1.60, 95% CI 1.27-2.01) and those closest to tertiary institutions (adjusted OR 1.57, 95% CI 1.32-1.87) were all associated with higher 90-day angiography use after acute myocardial infarction. However, the relative impact of socioeconomic status on 90-day angiography use was similar whether or not hospitals had on-site procedural capacity (interaction term p = 0.68), had university affiliations (interaction term p = 0.99), were near tertiary facilities (interaction term p = 0.67) or were in rural or urban regions (interaction term p = 0.90). INTERPRETATION: Socioeconomic status was as important a predictor of angiography use in hospitals with ready access to cardiac catheterization facilities as it was in those without. The socioeconomic gradient in the use of angiography after acute myocardial infarction cannot be explained by the distribution of specialists or tertiary hospitals.
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