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PubMed1991

The Australian food and nutrition system: a basis for policy formulation and analysis.

The Australian food and nutrition system can be seen as composed of four subsystems: production; processing and distribution; consumption; and nutrition. The production subsystem has a large number of producers and is largely export-oriented. Processing is domestically focused, with a low level of innovation and a relatively high concentration of ownership. Export activity in this subsystem involves mostly low value-added products. Ownership of food stores is highly concentrated and their influence on innovation in food processing is increasing. The food service industry has many outlets and is growing rapidly. Most food consumption and decisions about it are made in the context of households. Nutrition is now known to be a causal factor in a wide range of chronic degenerative diseases. Improved nutrition, an important avenue for improving the health of Australians, requires coordinated activities across a number of sectors and would be facilitated by a national food and nutrition policy. An understanding of the food and nutrition system will facilitate formulation and analysis of such a policy.

Agriculture↗
PubMed1999

The human-horse relationship: how much do we know?

Human relationships or interactions with horses have varied throughout history depending on human needs, but it is horses' ability to carry a human individual that has had perhaps the greatest impact on their relationship with man. Despite our long association with the horse, there have been few studies on human-horse relationships. There is little historical evidence on individual relationships with horses but indications of strong human-horse relationships have been noted in mounted societies, such as North American Plains Indians. Riding a horse has traditionally been associated with power, and was reserved for the ruling elite in many areas. Demographic data suggest that human relationships with horses may have changed in recent times. Although the lack of land and the relatively high cost of horse care may reduce the possibility of ownership for many people, the availability of riding establishments and increases in leisure time mean that riding is no longer restricted to the upper classes. There is a wide range in type and intensity of potential interactions with horses, indicating that human-horse relationships are likely to vary considerably. Some people appear to sacrifice a great deal in order to own a horse. However, the motivation behind these activities and the process by which an individual assesses personal costs of ownership versus their perceived benefits remains to be studied. Future research should focus on characterising the human-horse relationship, and the degree of individual and cultural variation. A greater understanding of horse owner perceptions of 'costs' versus 'benefits' may also increase our understanding of the relationship and the economic importance of horses in society.

Animal Husbandry↗
PubMed1996

Avian exposure and risk of lung cancer in women in Missouri: population based case-control study.

OBJECTIVE: To investigate the association, previously reported in three European studies, between ownership of pet birds and the risk of lung cancer. DESIGN: A population based case-control study with a structured questionnaire administered by telephone. SETTING: Missouri, a midwestern state in the United States with a population of about 5 million. SUBJECTS: All newly diagnosed cases of primary lung cancer in women aged 30-84 years in Missouri from 1 January 1993 to 31 January 1994 reported to the state cancer registry were invited to participate (n = 652); and 629 population based controls. MAIN OUTCOME MEASURES: Odds ratios were computed in relation to whether or not the study subject ever kept pet birds, the type of bird kept, and several measures of intensity or duration of exposure. Odds ratios were adjusted for smoking. RESULTS: The odds ratio (95% confidence interval) for the development of lung cancer associated with keeping pet birds was 0.84 (0.65 to 1.09). The results were similar for the type of pet bird kept, the number of birds kept, the location of the bird in the house, and the duration of ownership. CONCLUSION: The keeping of pet birds carries no excess risk for the development of lung cancer.

Adult↗
PubMed2001

Impact on malaria morbidity of a programme supplying insecticide treated nets in children aged under 2 years in Tanzania: community cross sectional study.

OBJECTIVE: To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission. DESIGN: Community cross sectional study. Annual, cross sectional data were collected at the beginning of the social marketing campaign (1997) and the subsequent two years. Net ownership and other risk and confounding factors were assessed with a questionnaire. Blood samples were taken from the children to assess prevalence of parasitaemia and haemoglobin levels. SETTING: 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania. PARTICIPANTS: A random sample of children aged under 2 years. MAIN OUTCOME MEASURES: The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia (classified as a haemoglobin level of <80 g/l). RESULTS: Ownership of nets increased rapidly (treated or not treated nets: from 58% to 83%; treated nets: from 10% to 61%). The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys. Overall, the prevalence of anaemia in the study population decreased from 49% to 26% in the two years studied. Treated nets had a protective efficacy of 62% (95% confidence interval 38% to 77%) on the prevalence of parasitaemia and of 63% (27% to 82%) on anaemia. CONCLUSIONS: These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting.

Bedding and Linens↗
PubMed2002

Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study.

OBJECTIVE: To examine premature mortality in adults in relation to socioeconomic conditions in childhood and adulthood. DESIGN: Nationally representative birth cohort study with prospective information on socioeconomic conditions. SETTING: England, Scotland, and Wales. STUDY MEMBERS: 2132 women and 2322 men born in March 1946 and followed until age 55 years. MAIN OUTCOME MEASURES: Deaths between 26 and 54 years of age notified by the NHS central register. RESULTS: Study members whose father's occupation was manual at age 4, or who lived in the worst housing, or who received the poorest care in childhood had double the death rate during adulthood of those living in the best socioeconomic conditions. All indicators of socioeconomic disadvantage at age 26 years, particularly lack of home ownership, were associated with a higher death rate. Manual origins and poor care in childhood remained associated with mortality even after adjusting for social class in adulthood or home ownership. The hazard ratio was 2.6 (95% confidence interval 1.5 to 4.4) for those living in manual households as children and as adults compared with those living in non-manual households at both life stages. The hazard ratio for those from manual origins who did not own their own home at age 26 years was 4.9 (2.3 to 10.5) compared with those from non-manual origins who were home owners. CONCLUSIONS: Socioeconomic conditions in childhood as well as early adulthood have strongly influenced the survival of British people born in the immediate post war era.

Adult↗
PubMed2004

Effect of a flow chart on use of blood transfusions in primary total hip and knee replacement: prospective before and after study.

PROBLEM: A suspected high proportion of unnecessary blood transfusions occur in patients undergoing total joint replacement. DESIGN: Prospective before and after study evaluating the impact of a one page flow chart aimed at reducing the use of blood transfusions. SETTING: Orthopaedic tertiary care centre in Winterthur, Switzerland. 208 patients underwent primary total joint replacement of hips or knees during the control period (October 1998 to September 1999) and 217 during the intervention period (October 1999 to September 2000). KEY MEASURES FOR IMPROVEMENT: Proportion of patients receiving allogeneic blood transfusions. STRATEGIES FOR CHANGE: A simple one page flow chart, which summarised graphically the perioperative decision pathways for anaemic patients, was placed in all charts of patients undergoing total joint replacement and handed out to medical staff from 4 October 1999 onwards. The implementation of the flow chart focused on its endorsement by chief physicians and the development of a sense of "ownership" among physicians and nurses. EFFECTS OF CHANGE: The proportion of patients receiving allogeneic blood decreased from 35.0% to 19.8% (absolute difference -15.2%, 95% confidence interval -23.3 to -7.0%). The percentage of patients donating and receiving autologous blood also decreased. This led to overall savings of about 23,000 pounds sterling (42,470 dollars; 34,441 euros) (103.50 pounds sterlingper patient undergoing total joint replacement). Differences became more pronounced after adjustment for confounding factors. LESSONS LEARNT: Allogeneic blood transfusions in primary hip and knee replacement surgery may be reduced cost effectively by implementing a one page flow chart. Five key elements may have contributed: simplicity; wide distribution; no requirement for major changes; endorsement by local opinion leaders; and development of a sense of ownership. These elements may be used in other contexts to achieve sustained change of clinical practice.

Aged↗
PubMed2004

Cohort study of sibling effect, infectious diseases, and risk of atopic dermatitis during first 18 months of life.

OBJECTIVES: To determine whether early infectious diseases could explain the association between number of siblings and other markers of microbial exposure and the development of atopic dermatitis before the age of 18 months. DESIGN: Cohort study. Information on atopic dermatitis, infectious diseases occurring before 6 months of age, number of siblings, early day care, pet keeping, farm residence, and background factors was collected in telephone interviews. SETTING: Danish national birth cohort. PARTICIPANTS: 24,341 mother-child pairs. MAIN OUTCOME MEASURES: Incidence rate ratios of atopic dermatitis. RESULTS: 13,070 children (54%) had at least one clinically apparent infectious disease before 6 months of age. At age 18 months, 2638 (10.8%) of the children had had atopic dermatitis. The risk of atopic dermatitis increased with each infectious disease before 6 months of age (incidence rate ratio 1.08, 95% confidence interval 1.04 to 1.13). The risk of atopic dermatitis decreased with each additional exposure to three or more siblings, day care, pet ownership, and farm residence (0.86, 0.81 to 0.93). CONCLUSIONS: Early infections do not seem to protect against allergic diseases. The protective effect of number of siblings, day care, pet ownership, and farm residence remained after adjustment for clinically apparent infectious diseases, suggesting that the effect is established independently early in life.

Age Distribution↗
PubMed1995

Injury surveillance in children--usefulness of a centralised database of accident and emergency attendances.

OBJECTIVE: To assess the usefulness of a centralised injury database in monitoring progress towards nationally set health targets for the reduction of childhood injuries. SETTING: West Glamorgan County, Wales. METHODS: Analysis was undertaken of data held in the West Glamorgan injury database which amalgamates population data with data from the three hospital units covering a population of 370,000. All first attendances due to a new injury in children aged 0-14 occurring in 1993 were analysed, with subgroup analysis for injuries occurring in the home and injuries resulting in fractures. Standardised injury ratios were compared with the distance travelled, car ownership, and Townsend index of deprivation at the ward level, using multiple linear regression. RESULTS: A total of 10,117 first time visits due to injuries were recorded, representing a rate of 182 injuries/1000 children aged 0-14 in West Glamorgan County. Distance from home to the accident and emergency departments was inversely correlated with total injury attendances, and injuries occurring at home, but not with injuries resulting in fractures. Visit rates for any type of injury were not associated with local car ownership rates or deprivation indices. CONCLUSIONS: Proximity to accident and emergency departments is a strong determinant of the use of the service by children with overall injuries, and injuries occurring at home. The lack of a significant association between travel distance and injuries resulting in fractures suggests that it is more meaningful to use a centralised database of accident and emergency department attendances to monitor the more severe spectrum of childhood injuries in assessing progress towards national targets for their reduction. The absence of an association between severe injuries and local socioeconomic factors suggests that national targets for the reduction of socioeconomic differentials in childhood injuries may need to be reassessed. These databases are also useful in generating information to direct preventive strategies and to target resources to areas of greatest need.

Accident Prevention↗
PubMed1997

An international study of the exposure of children to traffic.

OBJECTIVES: To examine the extent of international differences in children's exposure to traffic as pedestrians or bicyclists. DESIGN: Children's travel patterns were surveyed using a parent-child administered questionnaire. Children were sampled via primary schools, using a probability cluster sampling design. SETTING: Six cities in five countries: Melbourne and Perth (Australia), Montreal (Canada), Auckland (New Zealand), Umeå (Sweden), and Baltimore (USA). SUBJECTS: Children aged 6 and 9 years. MAIN OUTCOME MEASURES: Modes of travel on the school-home journey, total daily time spent walking, and the average daily number of roads crossed. MAIN FINDINGS: Responses were obtained from the parents of 13423 children. There are distinct patterns of children's travel in the six cities studied. Children's travel in the three Australasian cities, Melbourne, Perth and Auckland, is characterised by high car use, low levels of bicycling, and a steep decline in walking with increasing car ownership. In these cities, over a third of the children sampled spent less than five minutes walking per day. In Montreal, walking and public transport were the most common modes of travel. In Umeå, walking and bicycling predominated, with very low use of motorised transport. In comparison with children in the Australasian and North American cities, children in Umeå spend more time walking, with 87% of children walking for more than five minutes per day. CONCLUSIONS: There are large international differences in the extent to which children walk and cycle. These findings would suggest that differences in 'exposure to risk' may be an important contributor to international differences in pedestrian injury rates. There are also substantial differences in pedestrian exposure to risk by levels of car ownership-differences that may explain socioeconomic differentials in pedestrian injury rates.

Australia↗
PubMed2001

Dog bite and injury prevention--analysis, critical review, and research agenda.

OBJECTIVES: To analyze Australian dog bite injury data and make international comparisons; to review risk and protective factors relating to the dog, injured person, and environment; and to recommend action for prevention and research. METHODS: Australian dog bite injury data, complemented by detailed Victorian and regional data from routine health records and vital statistics, were analyzed to determine incidence, severity, nature, circumstances, and trends. International comparison data were extracted from published reports. Risk and protective factor studies were selected for review from electronic and bibliographic searches where data were recent, sample sizes substantial, and bias limited. RESULTS: The Australian dog bite death rate (0.004/100,000) is lower than both the United States (0.05-0.07/100,000) and Canadian rates (0.007/100,000). Victorian hospitalized trend rates were stable between 1987 and 1998, but there was a decline for children <5 years (p=0.019) corresponding with a reduction in dog ownership. Children 0-4 years have the highest rate of serious injury, particularly facial. Adults have longer hospitalizations, most frequently for upper extremity injury. Risk factors include: child, males, households with dogs, certain breeds, male dogs, home location, and leashed dog. CONCLUSIONS: Dog bite rates are high and it may therefore be assumed that current preventative interventions are inadequate. Responsible dog ownership, including separating young children from dogs, avoiding high risk dogs, neutering, regulatory enforcement, and standardized monitoring of bite rates are required. Controlled investigations of further risk and protective factors, and validated methods of breed identification, are needed.

Animals↗
PubMedDate not supplied

Biomedical publishing and the internet: evolution or revolution?

The Internet is challenging traditional publishing patterns. In the biomedical domain, medical journals are providing more and more content online, both free and for a fee. Beyond this, however, a number of commentators believe that traditional notions of copyright and intellectual property ownership are no longer suited to the information age and that ownership of copyright to research reports should be and will be wrested from publishers and returned to authors. In this paper, it is argued that, although the Internet will indeed profoundly affect the distribution of biomedical research results, the biomedical publishing industry is too intertwined with the research establishment and too powerful to fall prey to such a copyright revolution.

Authorship↗
PubMed1985

Socioeconomic status and risk of multiple myeloma.

A case control study was conducted to test the hypothesis that socioeconomic status is positively associated with multiple myeloma incidence. One hundred and fifty-three myeloma cases and 459 controls were identified at the Duke University Medical Center at Durham, North Carolina. Study members were interviewed regarding indicators of socioeconomic status. The association of myeloma with family income (current and highest), education, occupation, home ownership, dwelling size, and an index of crowding in the home was examined by estimating relative risks. Among these indicators, only home ownership showed any association with multiple myeloma incidence (RR = 1.6, 95% CI: 1.0-2.6). The association of multiple myeloma with socioeconomic status that has been seen in earlier studies may have been due to underascertainment of disease in less advantaged groups. This association is disappearing as access to health care becomes more uniform across socioeconomic groups.

Aged↗
PubMed1992

Prediction of general practice workload from census based social deprivation scores.

STUDY OBJECTIVE: The aim was to compare the ability of census based social deprivation scores devised by Jarman, Carstairs, and Townsend to predict workload in general practice. DESIGN: This was a prospective study of 140,050 patients registered with general practices over one year from 1 July 1981 (Third National Morbidity Survey). Main outcome measures were workload score for each patient, defined as a weighted sum of consultations at the surgery and consultations elsewhere, excluding preventive procedures. SETTING: 25 general practices in England and Wales. MAIN RESULTS: In multivariate analyses the Jarman, Carstairs, and Townsend indices all predicted workload, but the Townsend index was the best predictor, with both housing tenure and car ownership being strong predictors of workload. The overcrowding and geographical mobility variables used in the Jarman index did not predict increased workload. The weighting assigned to children under five by the Jarman index underestimated the additional workload this group generated. CONCLUSIONS: For identifying social pressures on general practice workload the Jarman index is less valid than other census based scores because it fails to include car ownership and housing tenure. A more rational scheme for compensating general practitioners would directly weight the capitation fee for children aged under five years and allocate current deprivation payments according to the Townsend index or a similar score. This would redistribute resources from London to deprived areas in northern England.

Adolescent↗
PubMed2003

Healthcare redesign: meaning, origins and application.

Healthcare organisations are using redesign to tackle variation in the quality of care and improve public satisfaction. It is represented as a radical challenge to traditional assumptions and practices which involves thinking through the best process to achieve speedy and effective patient care, identifying delays, unnecessary steps, or potential for error, and redesigning the process to improve the quality of care. This paper explores the meaning of redesign using practical illustrations. It examines its theoretical origins, particularly total quality management (TQM)/continuous quality improvement (CQI) and re-engineering, and assesses evidence which may inform its application. This evidence suggests that clinical ownership and senior management support will be essential. Redesign seeks to balance the more gradual approach of TQM with the organisation-wide lateral thinking of re-engineering. An incremental negotiated approach seems more likely to ensure clinical ownership, but carries a risk that QI will remain small scale with little impact on the wider organisation. Inclusion of some re-engineering techniques may help to overcome this difficulty. Evidence suggests that most QI techniques achieve only partial success. This may pose difficulties for redesign, which has generated high political expectations that it can solve long term problems in health care.

Consumer Behavior↗
PubMed1999

Store tobacco policies: a survey of store managers, California, 1996-1997.

OBJECTIVE: To identify store tobacco policies and retailer perception and beliefs that may have contributed to changes in compliance with youth access laws in California. DESIGN: In the winter of 1996-7, a cross sectional, follow up telephone survey was conducted of California store managers whose stores were anonymously surveyed for illegal tobacco sales in the summer of 1996 (that is, 1996 Youth Tobacco Purchase Survey, YTPS). SETTING: A simple random sample of stores from a list of California stores likely to sell tobacco, used in the 1996 YTPS. PARTICIPANTS: 334 managers (77%) of the 434 stores surveyed in 1996 responded to the survey. After eliminating stores that stopped selling tobacco or were under new management or ownership, 320 responses of store managers were included in the analysis. The stores were analysed by type of ownership: chain, which included corporate managed (n = 61); franchise owned (n = 56); and independent (n = 203). MAIN OUTCOME MEASURES: Responses of store managers were linked with the 1996 YTPS outcomes. Manager responses were compared by chi2 tests. Logistic regression analyses were conducted to identify store factors associated with illegal tobacco sales. RESULTS: A lower likelihood of illegal sales rate was associated with the chain stores when compared with the independent stores (odds ratio (OR) = 0.4, 95% confidence interval (CI) 0.2 to 0.9). A lower likelihood of illegal tobacco sales was found in stores that implemented tobacco related activities in the previous year such as changing tobacco displays (OR = 0.5, 95% CI 0.2 to 0.9) or adding new warning signs (OR = 0.7, 95% CI 0.4 to 1.2). Store managers' beliefs that youth were sent to their stores to do compliance checks also resulted in a lower likelihood of illegal sales (OR = 0.7, 95% CI 0.4 to 1.1). CONCLUSIONS: Store tobacco youth access policies, and managers' beliefs about the extent of youth access enforcement in the community, are important in reducing illegal tobacco sales to minors.

Adolescent↗
PubMedDate not supplied

Informatics in radiology (infoRAD): survey of personal digital assistant use in radiology.

There has been widespread adoption of personal digital assistants (PDAs) within medicine in recent years. However, information on the prevalence and usage of these devices among radiologists is limited. A survey was designed and mailed to randomly selected members of the Radiological Society of North America to determine the percentage of PDA users, their use patterns, and the types of applications that they would like to see in the future. The use patterns of attending radiologists were compared with those of trainees (residents and fellows). Overall usage was also compared with the relevant findings in two surveys of internal medicine users. It was found that slightly less than one-half of respondents used PDAs on a daily basis, a finding that was comparable to that in the internal medicine surveys. However, less than one-quarter of PDA users had radiology-specific applications installed on their devices, whereas a greater percentage of internal medicine users had software such as drug databases and clinical references on their PDAs. Radiology trainees had a higher rate of both PDA ownership and radiology application usage than did attending radiologists. It is likely that, as PDA hardware becomes more powerful, with higher display resolution, better wireless networking capabilities, and greater memory capacity, PDA ownership as well as radiology application usage will increase.

Computers, Handheld↗
PubMed2001

Correlation between molecular and conventional genealogies in Aicuña: a rural population from Northwestern Argentina.

Aicuña is a village in the northwest of Argentina, located about 300 km south of La Rioja city, in the province of La Rioja. The population of Aicuña derives from a founder couple established in the uninhabited Aicuña valley in the early years of the 17th century. Due to land ownership litigation, the descendants maintained a well-documented genealogy that extends for 12 generations, comprising more than 8,000 individuals. From the historical pedigree of Aicuña, we selected 14 males with direct patrilineal descent from the 2 most ancient male founders, and 23 donors (9 females and 14 males) with direct matrilineal descent from the most ancient female founder. All 3 founders lived in the 17th century. We collected DNA from buccal swabs and characterized the mitochondrial DNA (mtDNA) and Y haplotypes using 14 Y-specific markers, 11 mtDNA polymorphic markers and sequencing of the mt hypervariable regions 1 and 2. We found four different Y haplotypes: Y1 and Y2 haplotypes of European origin corresponding to the founder ancestors Francisco Páez de Espinoza and Apolinario Ormeño, which were shared by 6 and 3 donors, respectively. Three males selected as Ormeño patrilineal descendants showed a different Y haplotype (Y3), probably originated by erroneous paternity registration due to illegitimacy. The remaining case (haplotype Y4), also assumed to belong to the Ormeño lineage, was probably also due to an erroneously registered paternity. Twenty-two donors showed an association of mtDNA markers corresponding to the Amerindian haplotype A2. The founder of this matrilineage could be traced back for more than 14 generations. The haplotype B of one remaining female did not correspond with the historical pedigree and could be due to an error in the genealogy registration. Our results showed an 85% agreement between conventional and molecular genealogies, with mtDNA markers being Amerindian, and Y markers being European. The methodology used in this report is a tool which could potentially be employed as a precedent for land ownership by Aicuña villagers and Amerindian populations.

Argentina↗
PubMedDate not supplied

Survival from childhood leukemia depending on socioeconomic status in Athens.

One hundred and twenty children first diagnosed as having acute leukemia between 1988 and 1992 in Athens, Greece, were followed until May 15, 1993. The socioeconomic status of the children's families was assessed by means of paternal occupation, paternal schooling, maternal schooling, ownership of a car, ability to choose a private medical facility and freedom in the choice of the attending physician. The analysis was done by proportional-hazards modelling, controlling for age and gender. All six socioeconomic indicators, alternatively evaluated, showed that fatality rates were higher in the lower socioeconomic groups, although nominal statistical significance was reached for only one of them. With respect to family ownership of a private car, the fatality rate ratio between children of families who own a car and children of families who do not was 0.29 with a 95% confidence interval of 0.13-0.62 (p = 0.002). These results suggest that in Greece, socially disadvantaged children have a less favorable survival from childhood leukemia.

Acute Disease↗