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PubMed2006

Prevalence and risk factors for allergic rhinitis in primary school children.

OBJECTIVE: Allergic rhinitis is a common chronic illness of childhood. The aim of the study was to evaluate the prevalence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Istanbul. METHODS: A total of 2500 children aged between 6 and 12 years in randomly selected six primary schools of Istanbul were surveyed by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire between April and May 2004. RESULTS: Of them 2387 (1185 M/1202 F) questionnaires were appropriately completed by the parents with an overall response of 95.4%. The prevalence of physician-diagnosed allergic rhinitis was 7.9% (n=189). A family history of atopy (aOR=1.30, 95% CI=1.00-1.68), frequent respiratory tract infection (aOR=1.36, 95% CI=1.08-1.70) and sinusitis (aOR=2.29, 95% CI=1.64-3.19), antibiotic use in the first year of life (aOR=1.26, 95% CI=1.01-1.57), cat at home in the first year of life (aOR=2.21, 95% CI=1.36-3.61), dampness at home (aOR=1.31, 95% CI=1.04-1.65) and perianal redness (aOR=1.26, 95% CI=1.01-1.57) were significant for increased risk for allergic rhinitis. Frequent consumption of fruits and vegetables were inversely, and frequent consumption of lollipops and candies were positively associated with allergic rhinitis symptoms. CONCLUSION: Our study reconfirmed that family history of atopy, frequent respiratory tract infections, antibiotics given in the first year of life, cat at home in the first year of life, dampness at home, perianal redness and dietary habits are important independent risk factors for AR. Researchers worldwide should be focused to these factors and try to develop policies for early intervention, primary and secondary preventions for allergic diseases.

Anti-Bacterial Agents↗
PubMed2006

Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight.

The American Dietetic Association (ADA), recognizing that overweight is a significant problem for children and adolescents in the United States, takes the position that pediatric overweight intervention requires a combination of family-based and school-based multi-component programs that include the promotion of physical activity, parent training/modeling, behavioral counseling, and nutrition education. Furthermore, although not yet evidence-based, community-based and environmental interventions are recommended as among the most feasible ways to support healthful lifestyles for the greatest numbers of children and their families. ADA supports the commitment of resources for programs, policy development, and research for the efficacious promotion of healthful eating habits and increased physical activity in all children and adolescents, regardless of weight status. This is the first position paper of ADA to be based on a rigorous systematic evidence-based analysis of the pediatric overweight literature on intervention programs. The research showed positive effects of two specific kinds of overweight interventions: a) multicomponent, family-based programs for children between the ages of 5 and 12 years, and b) multicomponent, school-based programs for adolescents. Multicomponent programs include behavioral counseling, promotion of physical activity, parent training/modeling, dietary counseling, and nutrition education. Analysis of the literature to date points to the need for further investigation of promising strategies not yet adequately evaluated. Furthermore, this review highlights the need for research to develop effective and innovative overweight prevention programs for various sectors of the population, including those of varying ethnicities, young children, and adolescents. To support and enhance the efficacy of family- and school-based weight interventions, community-wide interventions should be undertaken; few such interventions have been conducted and even fewer evaluated.

Adolescent↗
PubMed2006

Impact and implications of disruptive behavior in the perioperative arena.

BACKGROUND: There is a growing concern about the role of human factor issues and their effect on patient safety and clinical outcomes of care. Problems with disruptive behaviors negatively affect communication flow and team dynamics, which can lead to adverse events and poor quality outcomes. STUDY DESIGN: A 25-question survey tool was used to assess the status and significance of disruptive behaviors around perioperative services in a large metropolitan academic medical center. Results were analyzed and compared with those from a national databank to identify areas of concern and opportunities for improvement. RESULTS: Disruptive behaviors were a common occurrence in the perioperative setting. These types of behaviors were most prevalent in attending surgeons. Disruptive behaviors increased levels of stress and frustration, which impaired concentration, impeded communication flow, and adversely affected staff relationships and team collaboration. These events were perceived to increase the likelihood of medical errors and adverse events and to compromise patient safety and quality of care. CONCLUSIONS: Disruptive behaviors in the perioperative arena have a significant impact on team dynamics and communication flow, which can have a negative impact on patient care. Organizations need to recognize the prevalence and significance of disruptive behaviors and develop policies and processes to address the issue. Key areas of focus include recognition and awareness, organizational and cultural commitment, implementation of appropriate codes of behavior policies and procedures, and provision of education and training programs to discuss contributing factors and tools to build effective communication and team collaboration skills.

Academic Medical Centers↗
PubMed2006

Cattle-rangeland management practices and perceptions of pastoralists towards rangeland degradation in the Borana zone of southern Ethiopia.

A survey was conducted in the Borana pastoral areas of southern Ethiopia to assess current livestock production systems, rangeland management practices and the perceptions of the pastoralists towards rangeland degradation. This information is considered vital to future pastoral development planning and interventions. Data were collected from a total of 20 villages that were identified from 5 peasant associations, namely Did Yabello, Moyatte, Did Harra, Dubuluk and Melbana. The average household size in the study area was 7.23. The majority of the pastoralists relied on both livestock and crop farming. The average livestock holding per household was 14 cattle, 10 goats, 6 sheep and 2 camels. Livestock holdings, with the exception of camels, has shown a declining trend over time. The two most important traditional rangeland management strategies adopted by the pastoralists included burning and mobility, but since 1974/75 burning has no longer been practised. With regard to mobility, the livestock herding falls in two categories, namely: home based and satellite herding. The former involves the herding of milking cows, calves and immature animals (<2 years) close to the encampments. The latter constitutes the herding of bulls and immatures (>2 years) further away from the encampments. Based on the pastoralists' perceptions, the major constraints on livestock production in descending order, were recurrent drought, feed and water scarcity, animal diseases, predators and communal land ownership. All the respondents considered the condition of the rangelands to have declined dramatically over time. In the past most development policies were based on equilibrium theories that opposed the communal use of the rangelands and traditional range management practices. The way in which the pastoral system affects the rangeland ecosystem functioning is contentious to this theory and the 'tragedy of the commons'. There was also a perceived problem of bush encroachment and the ban on traditional burning practices and recurrent droughts were seen as aggravating factors to this invasion process. The increasing practice of crop cultivation on the rangelands was identified as a serious threat to future livestock production and traditional resource management practices. Suggestions for possible interventions to improve the productivity and sustainable use of these rangelands are made.

Adult↗
PubMed2006

Urban Australians using recycled water for domestic non-potable use--an evaluation of the attributes price, saltiness, colour and odour using conjoint analysis.

Recycled water use in urban areas is viewed as one part of the solution to Australia's water shortage. The effectiveness of policies designed to promote recycled water systems depends on the acceptance by the community of the price, colour, odour and salt content of the recycled water. In Australia and other countries, limited research has been conducted that investigates community attitudes to and willingness to pay for recycled water, especially in urban settings. Community acceptance of recycled water and the economic feasibility of such projects have not been widely evaluated, even though the long-term feasibility of many projects is dependent on such information. This paper examines the attitudes of an urban Australian community living at Mawson Lakes in South Australia, to using recycled water for non-potable domestic purposes. Conjoint analysis (CA) was used to evaluate participant's (n=136) preferences for various attributes of recycled water (colour, odour, salt content and price) for various uses (garden watering, toilet flushing and clothes washing). The analysis was used to estimate the respondent's willingness to pay (WTP) for quality increases for each of the attributes. Differences in WTP were investigated according to various demographic variables including income and education. Results indicate that for garden watering having 'low salt levels' is the most important attribute of recycled water, for clothes washing 'colourless' is the most important attribute, and for toilet flushing a 'low price' was the most important attribute. Respondents were willing to pay for increases in the quality of recycled water. The amount they were willing to pay varied depending on applied use and the attribute in question. Respondents were most willing to pay for an increase in quality of recycled water when used for clothes washing (willing to pay Australian dollars (A$) 0.07/cubic meter (m(3)) for removal of colour, A$0.065 per cubic meter for an increase in quality of recycled water from 'salty' to 'low salt,' and A$ 0.06/m(3) for removal of odour (1A$=0.75 US $ and 0.62 euro, August 24, 2005)). Segmentation of the price attribute by demographic sectors reveals that those in the higher income bracket, higher education sector, middle age group, and who are male, had a higher marginal valuation on price. The results of this study provide important information for recycled water retailers and water policy developers, helping achieve greater economic feasibility for future recycled water projects, to the satisfaction of the communities involved.

Australia↗
PubMed2005

The commercial harvest of devil's claw (Harpagophytum spp.) in southern Africa: the devil's in the details.

Devil's claw is the common name for two species in the genus Harpagophytum. Their root extracts contain the iridoid glycoside, harpagoside, which has been found to be effective in the treatment of degenerative rheumatoid arthritis, osteoarthritis, tendonitis, kidney inflammation, and heart disease. Most of the world's supply comes from Namibia, with lesser amounts from South Africa and Botswana. In 2002, the peak year of export, 1018 tonnes of dried tubers were exported from southern Africa, representing the harvest of millions of plants. In 2001, sales in Germany were estimated at 30 M euros, accounting for 74% of the prescriptions for rheumatism. Harvest has improved income levels in marginalized communities but it has also raised questions of sustainability. In 2000, recommendations were made to the Convention on the International Trade in Endangered Species (CITES) to add devil's claw to Appendix II. In 2004, the proposal was formally withdrawn due to the efforts of the range states to address sustainability issues. Replacing wild collection with cultivation has generated a debate on the positive and negative effects on harvester income and rural farmers. Successful cultivation efforts have involved micropropagation techniques and growing the plant without water or fertilizers. The governments of the main range states are working with local communities to develop policies and regulations to protect the species and to determine a sustainable harvest.

Africa↗
PubMed2006

Primary health care for refugees and asylum seekers: a review of the literature and a framework for services.

OBJECTIVES: This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group. REVIEW: Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers. CONCLUSIONS: The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.

Community Health Nursing↗
PubMed2006

Accreditation of sleep disorders programs.

The accreditation of a sleep program ensures a high quality of care for the patient who has a sleep disorder. With more sleep laboratories becoming available, accreditation may be the best single way for a consumer to determine the adequacy of the facility. The process for accreditation requires the sleep program to develop policies and procedures that meet rigorous national and local standards. By adhering to protocols that have been proven to outline the optimal care for any given disorder associated with sleep, the provider of that care can assure the public that the program will deliver the appropriate treatment for these problems.

Accreditation↗
PubMed2006

High outpatient visits among people with intellectual disabilities caring in a disability institution in Taipei: a 4-year survey.

Few studies reported in the literature have addressed the long-term trend of the use of medical care for people with intellectual disabilities (ID) in institutions. The subject cohort in this study was made of 168 individuals with ID in a public residential facility from 1999 to 2002 in Taipei, Taiwan. The average age of participants was 19.3 years, and their average stay in an institution was 6.6 years. The average annual outpatient visit of the study participants was 18.2 in the previous 4 years. It was found that they had more medical visits than the general population. Nearly 20.8-34.5% (average 29.0%) of the participants utilized more than 25 visits annually which was defined as high outpatient visit users. This group of high outpatient users consumed more than half of the total annual outpatient care visits in the past 4 years. In the full model of Generalized Estimating Equations to compare the high and non-high outpatient users, the factor of individuals with ID dwelling in the institution were more likely to be high outpatient care users than individuals who were only accepting institutional day care services (OR=6.29, 95% CI=1.35-29.30). The present study provides general information of high outpatient utilization and its determinants of people with ID and provides evidence for medical care decision makers dealing with policy development for people with ID care in institutions.

Adolescent↗
PubMed2004

Spatial analysis of annual air pollution exposure and mortality.

The aim of this study was to relate ambient air pollution levels to mortality in Auckland, New Zealand. We used urban airshed modelling and GIS-based techniques to quantify long-term exposure to ambient air pollution levels and associated mortality. After adjusting for age, sex, ethnicity, socio-economic status, and urban/rural domicile there was a 1.3% (95%CI: 1-1.5%) increase in non-external cause mortality, and 1.8% (95%CI: 1.5-2.1%) increase in circulatory and respiratory causes per 1 microg/m(3) increase in annual average NO(2). Based on these exposure-response relationships and applying an annual average threshold of 13 microg/m(3), the average annual (for 1996-1999) number of people estimated to die from non-external causes and circulatory and respiratory causes attributable to air pollution in Auckland is 268 (95% range: 227-310) (3.9% of total all cause deaths) and 203 (95% range: 169-237) (5.9% of total circulatory and respiratory deaths) per year, respectively. The number of attributable deaths found in this study are consistent with a previous New Zealand risk assessment using a different methodology, and is approximately twice the number of people dying from motor vehicle accidents in the region, which is on average (1996-1999) 103 per year. The GIS-based exposure maps identify high exposure areas for policy developers and planners in a simple and realistic manner. Taken together with overseas studies the study provides additional evidence that long-term exposure to poor air quality, even at levels below current standards, is a hazard to the public health.

Air Pollutants↗
PubMed2004

A time-series analysis of mortality and air temperature in Greater Beirut.

The literature on the association between health and weather in the temperate to semi-arid cities of the Eastern Mediterranean is scarce. The quantification of the relationship between temperature and daily mortality can be useful for developing policy interventions such as heat-warning systems. A time-series analysis of total daily mortality and weather data for the city of Beirut was carried out. The study covered the period between 1997 and 1999. Poisson auto-regressive models were constructed, with mean daily temperature and mean daily humidity as explanatory variables. Delayed effects, up to 2 weeks, were accounted for. The regression models were used next to assess the effect of an average increase in temperature on yearly mortality. The association between temperature and mortality was found to be significant. A relatively high minimum-mortality temperature (TMM) of 27.5 degrees C was calculated. A 1 degrees C rise in temperature yielded a 12.3% increase (95% confidence interval: 5.7-19.4%) and 2.9% decrease (95% confidence interval: 2-3.7%) in mortality, above and below TMM, respectively. Lag temperature variables were found to be significant below TMM but not above it. Where the temperature change was less than 0.5 degrees C, annual above-TMM losses were offset by below-TMM gains, within a 95% confidence interval. TMM for Beirut fell within the range usually associated with warm climates. However, the mild below-TMM and steep above-TMM slopes were more typical of cities with temperate to cold climates. Our findings suggest that heat-related mortality at moderately high temperatures can be a significant public health issue in countries with warm climates. Moreover, at the projected climate change over the next 50 years, heat-related losses are unlikely to be offset by cold-related gains.

Adolescent↗
PubMed2004

What lies beneath?--issues in the representation of air quality management data for public consumption.

Policy developments in the UK and the European Union (EU) now require local authorities to engage the general public within the whole process of local air quality management (AQM). Indeed, this is considered to be one of the means by which air quality issues can gain public support and help ensure future improvements. One of the outcomes of this is that data sets associated with air quality management must now be disseminated to nonscientific audiences. This is a problematic task for a number of reasons. One of these relates to the fact that air quality data are complex and variable, yet the public demand representations that are clear and unambiguous. Another important issue is associated with the increasing use of geographical information systems (GIS) and mapping tools, which allow data to be generated and summarised in many different ways without due regard to the effects that the choice of methodology can have on the way data are interpreted. The variation in information obtained using different techniques can represent a problem, but is also an opportunity to further explore data sets and to draw out specific information for complementary air quality management tasks. However, at present, the lack of a well-grounded methodology and guidance for handling and representing the spatial aspects of data sets means that consistency between areas and authorities is not maintained. Such a situation fosters ambiguity at several levels, from the individual's perception of public health-related information to an Authority's rationale for the selection of air quality management areas (AQMAs). This paper investigates a number of issues relating to spatial data generation and representation in the field of air quality management, particularly in relation to emissions inventory data. The examples are UK based, but the issues raised are applicable to other examples and areas. One case study examines the difference in information gained through a number of common mapping techniques and shows how different 'problems' can be identified merely as an artefact of the dissemination technique itself. To further illustrate the difficulties and conflicts faced in representing and explaining these data in a practical context, reference is then also made to the methods recently considered by an example London authority. The paper concludes with a call for the development of a more standardised method for representing different types of air quality management-related data, which may help to overcome these problems in the future.

Air Pollutants↗
PubMed2006

Pharmacogenetics: the bioethical problem of DNA investment banking.

Concern about the ethics of clinical drug trials research on patients and healthy volunteers has been the subject of significant ethical analysis and policy development--protocols are reviewed by Research Ethics Committees and subjects are protected by informed consent procedures. More recently attention has begun to be focused on DNA banking for clinical and pharmacogenetics research. It is, however, surprising how little attention has been paid to the commercial nature of such research, or the unique issues that present when subjects are asked to consent to the storage of biological samples. Our contention is that in the context of pharmacogenetic add-on studies to clinical drug trials, the doctrine of informed consent fails to cover the broader range of social and ethical issues. Applying a sociological perspective, we foreground issues of patient/subject participation or 'work', the ambiguity of research subject altruism, and the divided loyalties facing many physicians conducting clinical research. By demonstrating the complexity of patient and physician involvement in clinical drug trials, we argue for more comprehensive ethical review and oversight that moves beyond reliance on informed consent to incorporate understandings of the social, political and cultural elements that underpin the diversity of ethical issues arising in the research context.

Biological Specimen Banks↗
PubMed2004

The migration of doctors and nurses from South Pacific Island Nations.

Little is known of the structure of the international migration of skilled health professionals. Accelerated migration of doctors and nurses from the Pacific island states of Fiji, Samoa and Tonga to the Pacific periphery is part of the globalization of health care. The findings from a recent survey of 251 doctors and nurses from the three island countries are reported here. Key determinants of both present migration status and future migration intentions were analyzed using econometric methods. Nurses' and doctors' propensities to migrate are influenced by both income and non-income factors, including ownership of businesses and houses. Migrants also tend to have more close relatives overseas, to have trained there, and so experienced superior working conditions. Migration propensities vary between countries, and between nurses and doctors within countries. Tongan nurses have a higher propensity to migrate, mainly because of greater relative earnings differentials, but are also more likely to return home. The role of kinship ties, relative income differentials and working conditions is evident in other developing country contexts. Remittances and return migration, alongside business investment, bring some benefits to compensate for the skill drain. National development policies should focus on encouraging return migration, alongside retention and recruitment, but are unlikely to prevent out migration.

Adult↗
PubMed2005

Determinants of child morbidity in Latin America: a pooled analysis of interactions between parental education and economic status.

Diarrhea and respiratory infections account for more than two-fifths of all deaths among children under five. Parental education and economic status are well-known risk factors for child morbidity, but little is known about whether education and economic status operate synergistically or independently to influence children's health. Confirming the presence and direction of such interactions is important to better target education and development policies. Our objective is to test for interactions between parental education and economic status in predicting the risk of diarrhea and respiratory illness among children under five, before and after adjusting for key proximate risk factors. We pool 12 Demographic and Health Surveys (DHS) and nine Living Standards Measurement Surveys (LSMS) from Latin America, creating two large databases. Quintiles of economic status are constructed from principal components asset indices. We use logistic regression to analyze episodes of diarrhea and respiratory illness, and interactions between economic quintile and maternal and paternal education are evaluated via likelihood ratio tests. We find that mother's education and quintile interact synergistically in the DHS data, while results are inconclusive in the LSMS data. The effect of increasing maternal education appears to be more protective for children in wealthy families than for children in poor families. Conversely, improvements in economic status reduce health risks more for children whose mothers are better educated. Father's education is protective and operates independently of economic status. Our findings imply that poverty alleviation efforts occurring in concert with programs to educate women and girls will be more effective for improving children's health than either approach alone.

Adult↗
PubMed2006

Responding to global infectious disease outbreaks: lessons from SARS on the role of risk perception, communication and management.

With increased globalisation comes the likelihood that infectious disease appearing in one country will spread rapidly to another, severe acute respiratory syndrome (SARS) being a recent example. However, although SARS infected some 10,000 individuals, killing around 1000, it did not lead to the devastating health impact that many feared, but a rather disproportionate economic impact. The disproportionate scale and nature of this impact has caused concern that outbreaks of more serious disease could cause catastrophic impacts on the global economy. Understanding factors that led to the impact of SARS might help to deal with the possible impact and management of such other infectious disease outbreaks. In this respect, the role of risk--its perception, communication and management--is critical. This paper looks at the role that risk, and especially the perception of risk, its communication and management, played in driving the economic impact of SARS. It considers the public and public health response to SARS, the role of the media and official organisations, and proposes policy and research priorities for establishing a system to better deal with the next global infectious disease outbreak. It is concluded that the potential for the rapid spread of infectious disease is not necessarily a greater threat than it has always been, but the effect that an outbreak can have on the economy is, which requires further research and policy development.

Communicable Diseases↗
PubMed2007

Trauma systems.

The major goal of a trauma system is to enhance the community health. This occurs through a process of assessment, policy development, and ongoing assurance. This can be achieved by (1) identifying risk factors in the community and creating solutions to decrease the incidence of injury, (2) providing optimal care during the acute and the late phase of injury, including rehabilitation, and (3) maintaining the objective to decrease overall injury-related morbidity and mortality and years of life lost. Disaster preparedness also is an important function of trauma systems, and using an established trauma system network facilitates the care of victims of natural disasters or terrorist attacks.

Emergency Medical Services↗
PubMed2005

Compliance with HIPAA regulations: ethics and excesses.

HIPAA regulations have been seen by many physicians as providing innumerable administrative hoops that require jumping through with no clear benefit for individual patients. Although this article has not comprehensively explored the requirements of HIPAA regulations, it has focused on the issues of "incidental disclosures" that are so important to the daily interactions of physicians and patients. Through the use of illustrative cases, it has been shown that HIPAA regulations frequently are based on well-accepted ethical principles. Although one should never conclude that changing something from an ethical responsibility to a legal responsibility makes it more important, there is no question that HIPAA regulations have forced physicians to consider more carefully how confidential information may be transmitted to others. As such, physicians should look on HIPAA regulations as largely supporting the use of professional judgment in providing good quality medical care. Although not all aspects of HIPAA are grounded in ethical practices, the overall thrust of the HIPAA regulations is consistent with the ethical practice of medicine and surgery. As a result of this general alignment of the legal and ethical requirements, more attention should be directed by physicians at using good judgment in deciding how to disclose private information, rather than adopting an unreasonable approach that confidentiality may never be breached. As Lo and colleagues have very appropriately pointed out: In the context of inadvertent disclosure, the legal risks of good practice are very low. Physicians should work with risk managers and practice administrators to develop policies that promote good communication in patient care, while taking appropriate steps to protect patient privacy. By adopting such an approach to HIPAA, physicians can abide by the regulations while maintaining high ethical standards and minimizing the impact of the new requirements on physician-patient relationships.

Ethics, Clinical↗