A randomized controlled study of a culturally sensitive behavioral intervention.

Sixty-seven Chinese American children (ages, 8–10 years; normal weight and overweight) and their families.

Anthropometry, blood pressure, measures of dietary intake, physical activity, knowledge and self-efficacy regarding physical activity and diet at baseline and 2, 6 and 8 months after baseline assessment.

Linear mixed modeling indicated a significant effect of the intervention in decreasing body mass index, diastolic blood pressure and fat intake while increasing vegetable and fruit intake, actual physical activity and knowledge about physical activity.

This interactive child-centred and family-based behavioral program appears feasible and effective, leading to reduced body mass index and improved overweight-related health behaviors in Chinese American children. This type of program can be adapted for other minority ethnic groups who are at high risk for overweight and obesity and have limited access to programs that promote healthy lifestyles.

Data came from the 2003, 2006 and 2007 Tobacco Use Supplement of the Current Population Survey. The analysis was limited to ever-smokers (n = 117,168). The outcome was number of years of daily smoking. Survival analysis was employed to predict smoking duration.

American Indians with 32 years had the highest median duration of smoking, followed by Blacks and ‘other’ races with 30 years, Whites with 28 years and Hispanics with 24 years. The difference in the duration of smoking between Blacks and Whites disappeared after adjusting for poverty. Individuals in poverty had a median duration of smoking of 40 years, while those with a family income of at least three times that of the poverty threshold had a median duration of 22 years. Median duration of smoking was 40 years among individuals without a high-school diploma and 18 years among those with a bachelors or higher degree.

This research revealed large variations in smoking duration between racial/ethnic and socioeconomic groups. Longer exposure to tobacco among groups that are already disadvantaged is likely to exacerbate existing health disparities.

Human Rights Commission of Pakistan (HRCP) systematically collected data on burns among women using newspaper reports from January 2004 till December 2005. We analyzed the aggregated data and estimated burn rates.

A total of 222 burn events were reported from 2004 to 2005; complete data were not available for all variables. Adults (≥18 years) constituted 74% (91/123) of cases with 95% (121/127) being married. Most burns were caused by bursting of stoves (34%; 64/189) or victims set-on fire (33%; n = 63/189). Burns using acids accounted for 13% (25/189). Husbands (52%; 51/98) and in-laws (23%; 23/98) were the perpetrators in known burn events. Burns were classified as accidental in half of cases (51%; 97/189) and related to domestic issues in a quarter (25%; 47/189). There were 49% of (92/189) burns that were reported as intentional. The mean annual rate of burns among women (15–64 years of age) was found to be 33 per 100 000.

Newspaper reports are good source of surveillance when information is otherwise limited. Majority of burns (51%) were classified as accidental while 49% were reported as intentional, though there is a limitation in the accuracy of reported accidental events. There is a dire need for systematic data collection and devising preventive strategies for this important public health problem that remains largely neglected in Pakistan.

In our analysis of two well-known large inpatient databases, we classified patients less than 18 years old as uninsured (self-pay) or insured (including Medicaid or private insurance). We adjusted for gender, race, age, geographic region, hospital type, admission source using regression models. In-hospital death was the primary outcome and secondary outcomes were hospital length of stay and total hospital charges adjusted to 2007 dollars.

The crude in-hospital mortality was 0.75% for uninsured versus 0.47% for insured children, with adjusted mortality rates of 0.74 and 0.46%, respectively. On multivariate analysis, uninsured compared with insured patients had an increased mortality risk (odds ratio: 1.60, 95% CI: 1.45–1.76). The excess mortality in uninsured children in the US was 37.8%, or 16 787, of the 38 649 deaths over the 18 period of the study.

Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance.

We used data from National Epidemiological Survey on Alcohol and Related Conditions in which 34 653 individuals aged 20–99 years were interviewed twice (2001–02 and 2004–05), with the second interview including the interpersonal support evaluation list. The association of perceived ISS with lifetime DSM-IV psychopathology and physical health from the past 12 months was investigated. We also tested whether this association changes as a function of number of traumatic events in accordance with the buffering hypothesis.

Low perceived ISS correlated with increased prevalence of major depressive disorder, generalized anxiety, social phobia and several physical health problems. There was a strong association between excellent self-perceived physical health and high social support.

There was evidence for both the main, beneficial effects of high perceived ISS and buffering, whereby increased perceived ISS ameliorated the pathogenic influence of exposure to traumatic life events on psychopathology. Current findings highlight the importance of perceived ISS in individuals' general mental and physical well-being, both in daily life and upon exposure to negative life events.

The CVD risk assessment service used near-patient testing and the Framingham risk equations administered by pharmacists to screen clients aged 40–70 without known CVD. Outcomes assessed included volume of activity, uptake by deprivation and ethnicity and onwards referral.

Complete data were available for 1130 of 1141 clients; 679 (60%) male, 218 (19%) smokers and 124 (11%) had a family history of CVD. Overall, 792 (70%) of clients were referred to their general practice: 201 (18%) at CVD risk of 20% or more, remainder with individual risk factor(s). Greater representation from Black (7.4%) and Asian (24.8%) communities and from average and less deprived quintiles than the affluent and most deprived was observed.

Community pharmacies can provide a CVD risk assessment service in a UK urban setting that can attract males and provide access for deprived communities and Black and Asian communities. A pharmacy service can support GP practices in identifying and managing the workload of around 30% of clients.

All patients diagnosed with lung cancer in Leicester between 1990 and 2005 were identified. Ethnicity was assigned using Nam Pechan software, deprivation by Townsend score. Using Poisson regression, incidence rate ratios (IRRs) were calculated to assess variations in incidence by ethnicity, deprivation and period of diagnosis.

Comparing patients diagnosed in 2000–2005 with those in 1990–1994, the risk of lung cancer increased in the SA men (IRR: 1.67 (95% CI: 0.99, 2.78)) whereas in the non-South Asian (NSA) men, it had fallen (IRR: 0.84 (95% CI: 0.76, 0.94)). Comparing patients diagnosed in 2000–2005 with those in 1995–1999 an increase continued in the SA men (IRR: 1.11 (95% CI: 0.71–1.74)). A significant rise was observed in the NSA women comparing those diagnosed from 2000–2005 to 1995–1999 (IRR: 1.16 (95% CI: 1.01, 1.33)).

Lung cancer is an important public health issue amongst SAs in Leicester and has increased significantly since the early 1990s, with rates sustained in the more recent years of 2000–2005. Changes in the rates of lung cancer in SA and NSA populations are likely to be due to changing smoking habits.

A detailed epidemiological and food tracing investigation was conducted to ascertain the aetiology.

Investigations revealed 11 incidents affecting 164 children between July and November 2007 in six nurseries operated by two companies. The symptoms included a transient rash around the mouth and hands of children who ate meals prepared on site by the nurseries. Consumption of the lunch main course appeared to be a strong aetiological factor. Expert opinion pointed to biogenic amines (e.g. histamine) as a possible cause for the symptoms displayed, but there was insufficient evidence to support testing of food samples.

The incident highlighted significant gaps in reporting of unexplained symptoms among children in nurseries, indicating that such incidents do not always come to the attention of public health authorities. Timely notification to HPUs will enable prompt investigation, increase the likelihood of identifying the cause and inform appropriate responses to prevent future incidents.

Using generalized estimating equations, we determined the prevalence and factors associated with being unable to access addiction treatment.

Between 1 July 2004 and 30 June 2006, 889 individuals completed at least one interview and were included in this analysis. At each interview, ~20% of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months. Being unable to access treatment was independently associated with recent incarceration, daily use of heroin and borrowing used syringes. In a secondary question, the majority of individuals reported waiting lists were the reason for being unable to access treatment.

Given the independent association between inability to access addiction treatment and elevated HIV risk behavior, these results suggest expanding addiction treatment may contribute significantly to HIV prevention efforts in this population.

To develop a model for examining the representativeness of practice networks.

Comparison of surveyed population, practice structure and prescribing characteristics with the national data using the Weekly Returns Service (WRS) for 2006 as an example of practice network. The population monitored was compared with the national PCT population. The practice postcode was linked to the Index of Multiple Deprivation and the distribution compared with the national equivalents. Doctor and practice-specific structural data (obtained by questionnaire) and practice-prescribing data were compared with the national equivalents. The significance of differences was evaluated using non-parametric tests.

The WRS population was closely matched with the national data by age, gender and deprivation index. Compared with the national equivalents, WRS practices, included more younger GPs, had a larger average list per GP and fewer practices with a list of less than 1499 per GP. Prescribing patterns were similar to their PCT equivalents excepting for small reductions of antibacterial prescribing (items 7% and cost 5%).

We demonstrate a low-cost model methodology for examining the representativeness of practice networks using independent data with minimum practice input.

Data were analysed for 100 000 subjects registered with 78 family practices in the UK General Practice Research Database; the numbers of consultations for RTI and associated antibiotic prescriptions were enumerated.

The consultation rate for RTI declined in females from 442.2 per 1000 registered patients in 1997 to 330.9 in 2006, and in males from 318.5 to 249.0. The rate of consultations for colds, rhinitis and upper respiratory tract infection (URTI) declined by 4.2 (95% CI 2.3–6.1) per 1000 per year in females and by 3.6 (2.3–4.8) in males. The rate of antibiotic prescribing for RTI was higher in females and declined by 8.5 (2.0–15.1) per 1000 in females and 6.7 (2.7–10.8) in males. For colds, rhinitis and URTI, the proportion of consultations with antibiotics was prescribed declined by 1.7% per year in females and 1.8% in males.

Decreasing frequency of consultation and antibiotic prescription for colds, rhinitis and ‘URTI’ continues to drive a reduction in the rate of antibiotic utilization for RTIs.

In-depth interviews were conducted among 20 high-risk individuals who were aged 65 and over or under 65 years with chronic diseases requiring influenza vaccination. Interviews were tape recorded and analysed following using grounded theory.

Most participants had insufficient knowledge about influenza and influenza vaccination. Their decisions in relation to vaccination were based on a number of factors, including salience of risk, influence of others, perception of the need for preventive health care and the availability of influenza vaccine.

These findings underscore the need to consider and understand factors underlying people's vaccination decisions to create an effective influenza vaccination programme.

A cross-sectional study of 3600 subjects aged 20–70 years was conducted by using a cluster sampling technique in an adult population residing in the north of Iran, in 2004. Weight, height, waist and hip circumference were measured and data concerning education level, demographic characteristics and physical activities were collected by interview. Logistic regression analysis was used to estimate the association between education and general obesity (body mass index ≥30) as well as abdominal obesity (waist circumference >88 cm in women and 102 cm in men).

The adjusted odds ratio (OR) for general obesity at education level of high school and college compared with illiterate and primary level was 0.55 [95% confidence interval (CI): 0.43–0.71]. A greater negative association was observed for education at university level (OR = 0.32, 95% CI: 0.22–0.47) irrespective to sex. However, with regard to abdominal obesity, after controlling for confounding factors, the adjusted OR for education at university level remained significant only in women but not in men.

The findings of this study indicate that education level is inversely associated with general obesity in both sexes but with abdominal obesity only in women.

Predictions for London were based on cancer registration data (1985–2003) and population projections up until 2024. The number of future cases and age-standardized incidence rates (ASRs) were projected using an age–period–cohort model developed for the analysis of cancer trends and projections in the Nordic countries. Estimates for England were taken from an earlier publication.

In London, ASRs for all cancers (excluding non-melanoma skin cancer) decreased for both sexes, whereas in England, ASRs decreased in males and increased slightly in females. In London, the number of cases for both sexes is predicted to increase from ~27 000 in 2002 to ~28 500 in 2022, an increase of 5%. In England, a greater increase is predicted, from ~224 000 in 2001 to ~299 000 in 2020, an increase of 33%.

Projections of the future burden of cancer are particularly sensitive to demographic population trends. They are likely to be different for cities compared with rural areas or entire countries.

Qualitative questionnaires were distributed to Year 12 (sixth form) students. The Framework approach was used to analyse the data, which were coded, and emergent themes identified.

In the absence of clear communication from official sources, many participants suggested that circulating rumours caused confusion and anxiety in the student population. Rumours were spread through informal networks in person or through text and MSN messaging. It was generally perceived that accurate information in this period would have been useful to allay potentially unfounded anxiety. Most students surveyed reported that they were sufficiently aware of the situation prior to receiving official announcements. The information provided by the HPA through the school was generally perceived as being useful, but it came too late.

In outbreak situations, rumours will spread rapidly in the absence of early communication, and this can be a significant cause of anxiety. The use of digital communication strategies should be considered, since they can seed dependable information that will disseminate rapidly through peer groups.

We extracted data for patients aged over 50 admitted from their ‘usual residence’ with a fall-related diagnosis from the Hospital Episode Statistics (HES) database.

Increasing age, people with severe co-morbidities and people who live in less deprived, predominantly white or rural areas, were more likely to be discharged to a different residence (all P-values < 0.001). We estimated that 88.3% of people from an area classified as most deprived, urban and >5% Asian would return home, compared with 78.0% from least deprived, village/isolated and all white area.

Further research is required to examine whether these patterns reflect appropriate care or alternatively that some sub-groups of society have less access to care homes than others. These factors may have public health implications for the equitable allocation of budgets for the provision of care for elderly patients discharged from hospital after a fall.

In order to learn lessons about the impact of earthquakes on health in China during the past century, we conducted a bilingual literature search of the publicly available health-related disaster databases published between 1906 and 2007.

Our search found that research was limited and there were major gaps in the published literature about the impact on health in the post-earthquake period. However, the experiences recorded were similar to those of other parts of the world. The available studies provide useful information about preparedness and rapid early response. Gaps identified included care of chronic disease.

Our literature review highlights the paucity of literature on the impact on health post-earthquake in China between 1906 and 2007. Disaster mitigation policies need to reflect the needs not only of the disaster-related impacts on health but also of the ongoing health needs of the chronically ill and to establish safeguards for the well-being of the vulnerable populations.

Over the 2 year period, 24 cases were notified in the Hunter New England Health area. These cases were reviewed by an expert panel to highlight key correctable issues in recognition and management of IMD.

The 24 patients were aged between 1 month and 70 years. Thirteen (54%) were children and 14 (58%) were women. Six (25%) cases developed complications, two being severe (one death, one limb amputations). These patients had risk factors for IMD. The emergency department average delay between assessment and administration of antibiotics was 57.8 min.

There were avoidable factors identified in both patients with a poor outcome. Length of delay in initiating antibiotic therapy has been associated with poor outcome, thus the delay in our series is of concern. The audit highlighted many potentially correctable issues in the medical, laboratory and public health management of IMD cases.

A systematic review of studies published between 1990 and 2007. Electronic databases were searched for published studies. Unpublished reports were identified from the national research register and experts.

Twenty studies were included. They suggest that intensive NHS treatments for smoking cessation are effective in helping smokers to quit. The national evaluation found 4-week carbon monoxide monitoring validated quit rates of 53%, falling to 15% at 1 year. There is some evidence that group treatment may be more effective than one-to-one treatment, and the impact of ‘buddy support’ varies based on treatment type. Evidence on the effectiveness of in-patient interventions is currently very limited. Younger smokers, females, pregnant smokers and more deprived smokers appear to have lower short-term quit rates than other groups.

Further research is needed to determine the most effective models of NHS treatment for smoking cessation and the efficacy of those models with subgroups. Factors such as gender, age, socio-economic status and ethnicity appear to influence outcomes, but a current lack of diversity-specific analysis of results makes it impossible to ascertain the differential impact of intervention types on particular subpopulations.

In 2005, all 61 general practitioners (GPs) in four municipalities in Copenhagen, Denmark, were invited to participate. Twenty-four GPs accepted and were cluster randomized to one of three groups: Group A, referral to group-based SC counselling (national model), n = 10; Group B, referral to internet-based SC programme (newly developed), n = 8; or Group C, no referral (‘do as usual’), n = 6. A total of 1518/1914 smokers were included, and 760 returned a questionnaire at 1-year follow-up.

The participating GPs reported significantly more SC counselling than GPs who refused participation (P = 0.04). Self-reported point abstinence was 6.7% (40/600), 5.9% (28/476) and 5.7% (25/442) in Groups A, B and C, respectively. Only 40 smokers attended group-based SC counselling, and 75 logged in at the internet-based SC programme. In cluster analyses, we found no significant additional effect of referral to group-based (OR: 1.05; 95% CI: 0.6–1.8) or internet-based SC programmes (OR: 0.91; 95% CI: 0.6–1.4).

We found no additional effect on cessation rates of GPs' referring to group-based SC counselling or internet-based SC programme. This finding might, to some degree, be explained by the short time used by the GPs on SC counselling and the selection of the participating doctors.

We compared admissions in 2007–08 with 2006–07 when the service was not available. We examined admissions in December to March, and in the 7- and 14-day post-alert periods. There were five alerts in 2006–07 and four in 2007–08. We compared practices using the service to varying extents with practices not using it.

Admission rate ratios for practices using the service were 0.98 [95% confidence interval (CI): 0.78–1.22] for December to March, and 0.82 (CI: 0.57–1.18) and 0.95 (CI: 0.72–1.26) for the 7- and 14-day post-alert periods, respectively. When we took into account the proportion of patients entered on the alerts system and the duration for which practices participated in the service, admission rate ratios for practices fully using the service were 1.11 (CI: 0.80–1.52), 1.22 (CI: 0.73–2.04) and 1.21 (CI: 0.82–1.78) for the three corresponding periods.

We failed to show that any change in admissions associated with the forecasting service was significant. More research on the effectiveness of the COPD forecasting service is needed.

We sought to examine the association of false-positive mammography with depressed mood among women in a screening population. Using data from a state-based mammography registry, women who completed a standardized questionnaire between 7 May 2001 and 2 June 2003, a follow-up questionnaire between 19 June 2003 and 8 October 2004 and who received at least one screening mammogram during this interval were identified. False positives were examined in relation to depressed mood.

Eligibility criteria were met by 13 491 women with a median age of 63.9 (SD = 9.6). In the study population, 2107 (15.62%) experienced at least one false positive mammogram and 450 (3.34%) met criteria for depressed mood. Depressed mood was not significantly associated with false positives in the overall population [OR = 0.96; 95% confidence interval (CI) = 0.72–1.28], but this association was seen among Non-White women (OR = 3.23; 95% CI = 1.32–7.91).

Depressed mood may differentially affect some populations as a harm associated with screening mammography.

Semi-structured interviews and focus groups with 109 health, social care and voluntary staff from three London Boroughs.

Few frontline staff were aware of the Plan. Most respondents did not perceive heatwaves to be a sufficiently frequent event to require prioritization within their routine summer workloads. They highlighted the complexities associated with defining vulnerability and identifying vulnerable individuals as well as barriers to implementation of the Plan. Respondents suggested a multi-faceted approach to interventions including a public health campaign, community engagement and increasing the responsiveness of statutory services.

The issues highlighted could hinder effective implementation of the Heatwave Plan. Ensuring continuity of care so that timely information can be recorded and disseminated may address the problems associated with shifting vulnerability. Best practice with respect to inter-sectoral collaboration should be identified and innovative multi-faceted interventions should be designed and evaluated.

Paper-based proformas were completed by TB nurses, and then analysed using EpiInfo/SAS statistical software.

Forty community contacts (11%) became cases, 45 (13%) were recommended chemoprophylaxis and 270 (76%) were discharged clear of infection. The highest transmission rate was among contacts exposed to two or more cases (29% became cases) and close contacts of sputum smear-positive cases (22%). Other risk factors were being male and exposure to drug-using cases or cases with prison links. The number needed to be screened (NNS) to detect one case was lowest [5 (95% CI: 4–8)] for contacts of sputum smear-positive pulmonary cases, although the NNS was still only 20 (95% CI:8–72) for casual contacts of smear-positive cases.

Transmission of disease to contacts was high (11%) compared with other documented outbreaks (0.7–2%). The results support recommended guidelines for contact tracing but also provide grounds to recommend, for outbreak cases, screening of casual contacts of smear-positive cases and contacts exposed to more than one case, drug users or prisoners.

In June 2005, a convenience sample of five countries was selected to evaluate the implementation of RED. Evaluation teams consisting of key partners conducted site visits to the national, district and health facility levels using standardized qualitative questionnaires.

RED was implemented in a similar manner in all five countries, i.e. starting with training and micro-planning. All RED components were implemented to some degree in the countries. Common implementation factors included development of plans, expanding outreach services (defined as services provided in sites outside fixed immunization sites), planning of supervisory visits and efforts to link with communities and utilize community volunteers. Monitoring tools such as wall charts and maps were observed and reportedly used.

Evaluation of the RED implementation process provided evidence of improvement in delivery of routine immunization services. The RED framework should continue to be used to strengthen the immunization delivery system to meet continuing new demands, such as the introduction of new vaccines and integrated delivery of other child survival interventions.

We examined medical records of all patients 1 year of age or older admitted to a Hong Kong hospital between 2003 and 2008 with confirmed salmonellosis diagnosis. Data were collected on length of stay, age, sex, comorbidities, antibiotics and other medication use, diagnostic tests completed, serotype and susceptibility characteristics of isolated and the circumstances of discharge from hospital. We used Cox proportional regression to determine the differences in lengths of stay and quantile regression for differences in hospital costs.

Median duration of hospitalization among QR salmonellosis patients was 1 day (33%; 95% CI: 13–47%) longer than those with QS salmonellosis, adjusting for confounders. Adjusted median costs were US $399 (35%) and 75th percentile costs were US $760 (43%) higher in the QR group than those in the QS group, indicating a greater difference among sicker patients.

The finding of substantially longer stays and higher costs associated with QR indicates that interventions that decrease QR prevalence will lead to significant savings for the health system in the management of hospitalized salmonellosis cases.

In-depth phone interviews were conducted with 24 parents (4 males) of 10–11-year-old children recruited from six primary schools in Bristol.

Parents perceived that a lack of appropriate spaces in which to be active, safety, traffic, the proximity of friends and older children affected children's ability to be independently physically active. The final year of primary school was perceived as a period when children should be afforded increased licence. Parents managed physical activity licence by placing time limits on activity, restricting activity to close to home, only allowing activity in groups or under adult supervision.

Strategies are needed to build children's licence to be independently active; this could be achieved by developing parental self-efficacy to allow children to be active and developing structures such as safe routes to parks and safer play areas. Future programmes could make use of traffic-calming programmes as catalysts for safe independent physical activity.

Injury and illness data were collected prospectively in the longitudinal Cambridge study in delinquent development at age 43–48. Hypotheses were that childhood predictors of antisocial behaviour and offending and antisocial behaviour at ages up to 32 would be associated with poorer health at age 48.

Childhood and parental predictors of offending, self-reported delinquency at age 32 and convictions were significantly associated with death and disability by age 48. A model comprising three factors: any antisocial behaviour and any parental risk factor at age 8–10 and any antisocial behaviour at age 27–32 best discriminated death or disability. Two factors: conviction between ages 10–18 and any antisocial behaviour at age 8–10 discriminated almost as well.

Death and disability by age 48 were strongly associated with antisocial behaviour at ages 8–10 and 27–32, convictions and impulsivity during adolescence and parental predictors of offending at age 8–10. Preventing childhood and adolescent antisocial behaviour and offending may also prolong life and prevent disability among those who would otherwise offend.

We conducted a retrospective analysis of the General Internal Medicine (GIM) inpatient service at our institution for years 2005 and 2006, which included 5088 patients under GIM care.

Weekend discharge rate was more than 50% lower compared with reference rates whereas Friday rates were 24% higher. Holiday Monday discharge rates were 65% lower than regular Mondays, with an increase in pre-holiday discharge rates. Teams that were on-call or that were on call the next day had 15% higher discharge rates compared with reference whereas teams that were post-call had 20% lower rates. Individual attending physicians and length of attending coverage contributed small variations in discharge rates. Resident scheduling was not a significant predictor of discharge rates.

Day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Introducing greater holiday and weekend capacity as well as reorganizing internal processes such as admitting and attending schedules may potentially optimize discharge rates.

A cross-sectional study among 120 patients was conducted in two primary health-care centers. The test of functional health literacy in adults, a 50-item reading comprehension and 17-item numerical ability test (score, 0–100) were administered. Chi-square test and logistic regression analyses were applied.

Inadequate and marginal health literacy existed in 43 participants (41.0%), and adequate health literacy was present in 62 participants (59.0%). Functional health literacy was significantly different by location, gender, age, marital status, employment, education, material status, self-perception of health and presence of chronic conditions. Based on the multivariate analysis, health literacy was significantly associated with the participant's age (odds ratio [OR], 4.86; 95% confidence interval [CI], 2.41–9.80; P = 0.000), level of education (OR, 4.48; 95% CI, 1.73–11.57; P = 0.002) and chronic conditions (OR, 1.90; 95% CI, 1.16–3.11; P = 0.010).

These results provide evidence that limitations in functional health literacy are widespread among primary health-care patients and encourage efforts for further monitoring. Low health literacy may impair a patient's understanding of health messages and limit their ability to attend to their medical problems.

We demonstrate the possibility of creating anonymous links between individual residences and the local environment using digital map data and a data linkage system.

Digital map data were used successfully to anonymously link 1.3 million addresses to the local environment. The data linkage system allows detailed environment data surrounding each residence to be linked both to each resident therein and to their medical records.

Local environment data specific to each house can be effectively and anonymously linked to the population registered with the National Health Service. Our integrated approach potentially enables flexible fine-scale, large-area observational studies of communities and health.

We evaluate the effect of keeping all encounters as compared with removing repeat encounters. Using the prospective space–time permutation scan statistic, we performed daily analyses on all encounters versus on episodes defined as encounters new within 2, 6 or 12 weeks. Data were taken from a Massachusetts Health Maintenance Organization (HMO) for the calendar year 1999 for four different syndromes.

We found extensive disagreement in the number of signals detected: 70, 68, 21 and 15 signals when using all encounters versus 15–20, 3, 4–5 and 0 signals when using only new episodes for lower respiratory, lower gastrointestinal, upper gastrointestinal and neurologic syndromes, respectively.

Using all encounters in syndromic surveillance may not only create too many signals but may also miss some signals by masking the anomalies generated by actual episodes. However, it is also possible to miss signals when using episodes.

Qualitative interviews of poultry farmers, retailers, market stall holders and consumers in Hong Kong (n = 20), Guangzhou (n = 25), Vietnam (n = 38) and Thailand (n = 40) were conducted using purposive sampling and analysed using ethnographic principles.

Each location produced three comparable themes: ‘viruses’: HPAI exemplified a periodic, natural, disease process therefore, deserving little concern. For some, science had ‘discovered’ something long known to farmers and lived with for generations. Others believe the virus to be new. Viral ecology was reasonably well understood among farmers, but less so by retailers and consumers; ‘husbandry practices’ included poor hygiene, overcrowding and industrial farming, modern commercial feed and veterinary drugs; ‘vulnerability factors’ included uncontrollable ‘external’ explanations involving the weather, seasonal changes, bird migrations and pollution.

Lay explanations were generally ecologically consistent. Nonetheless, beliefs that HPAI is a normal, recurrent process, external factors and roles of industrialized poultry rearing countered health worker claims of H5N1 seriousness for smallholders. These causal beliefs incorporate contemporary models of H5N1 ecology, but in a manner that contradicts public health efforts at control.

An observational study compared the accuracy of needs identification in samples of older people before and after SAP introduction. Participants, at risk of entering care homes, were interviewed using standardized measures. Needs elicited from interviews were compared with those from statutory social services assessments to ascertain the reliability of needs identification at both times. Inter-rater reliabilities were calculated using the kappa (k) statistic. A Chi-squared statistic tested the equality of kappa values pre- and post-SAP.

Most needs were identified more reliably after SAP introduction (range adjusted k = 0.05–0.58) than before (range adjusted k = –0.09 to 0.28), this being statistically significant for 9 out of 15 needs. Depression, and associated apathy, was an exception.

Statutory social services assessments better captured need following the introduction of the SAP. However, the extent to which these findings can be attributed to SAP introduction is limited by the introduction of multiple policy initiatives throughout the study period.

Review of official policies, supplemented with observation of practice and interviews with key informants (potential and actual donors and health workers) in Guizhou province in Southern China.

Interviewees perceived the transfusion system as a mutual social contract. However, some individuals were unwilling to donate because of concerns about health risks, the idea of transferring blood between people, wastage or profits being made from blood. Inappropriate incentives, including cash, were used to encourage donation. Recent reforms have increased confidence in donation and transfusion safety although concerns persist about misuse. There is a need to reduce unnecessary use of blood and its products.

China still relies heavily on blood supplies obtained through quota, purchase or use of incentives. There is scope to expand voluntary donation further. However, as a priority it will be necessary to reduce overuse.

Using hospital episode statistics (HES) data for men and women in England, the annual percentages of open and laparoscopic resections for colorectal cancer were calculated between 1997 and 2007.

A total of 182 191 patient spells containing a diagnosis of colorectal cancer plus either a procedure code for surgical resection of the large bowel and/or a laparoscopic procedure were identified: 177 537 (97.4%) were for open resection; 4193 (2.3%) for laparoscopic surgery; and for 461 (0.3%) the procedure was unclear. The annual number of open procedures performed remained stable, whereas the numbers of laparoscopic resections increased steadily.

Despite NICE guidance in 2000 recommending open surgery for colorectal cancer, there was a continuous increase in the laparoscopic approach in England, starting 3 years before the modified guidance supporting this technique. Whether NICE guidance was an effective deterrent and the guidelines protected patients cannot be determined from this retrospective study, but a similar staged approach for the adoption of other complex laparoscopic procedures is recommended.

We estimated the EQ-5D scores for respondents from the 2000–2003 Behavioral Risk Factor Surveillance System. We calculated QALYs and QALE lost to morbidity due to obesity/overweight, smoking, low income and chronic diseases.

The mean EQ-5D score for US adults was 0.870. The mean scores ranged from 0.826 (West Virginia) to 0.902 (Hawaii). Smoking contributed from 5.6 (Utah) to 12.3 (Kentucky) percent, obesity/overweight 5.4 (South Dakota) to 13.8 (Louisiana) percent, low income 16.6 (Hawaii) to 39.9 (South Carolina) percent and chronic diseases 8.7 (Minnesota) to 22.9 (Tennessee) percent of explainable QALYs lost. These risks contributed the greatest proportion of explainable QALYs and QALE lost in Kentucky, Tennessee and South Carolina.

We estimated the burden of disease contributed by selected risk factors. Currently, such data are unavailable but are needed to set targets for reducing modifiable health risks and eliminating health disparities among at-risk populations.

Data were collected from a random sample of 4046 Chinese aged 60 years and older in Zhejiang province. Based on the Andersen-Newman service utilization framework, multivariable logistic regression analysis was used to determine independent effects of these variables on the likelihood of having an unmet need for hospitalization service.

Overall, the prevalence of unmet need was 16.2% for hospitalization service. Among predisposing factors, only educational level was statistically significant. Individuals with higher education were less likely to report unmet needs. Among enabling factors, residential area, social support, personal yearly income and personal healthcare expenditure were strongly associated with the presence of unmet need. Those with less enabling resources (e.g. residing in rural areas) were more likely to report unmet need [Odds ratio (OR) = 1.5–6.5]. All the need factors, except for physical function, were strongly associated with the presence of unmet need. Seniors in poorer health (e.g. in fair or poor health) were more likely to report unmet need than their counterparts in better health (OR = 1.5–2.8).

In spite of relatively high insurance coverage rates, unmet need for hospitalization service remains high among the elderly people of Zhejiang province in China. Application of comprehensive intervention strategies such as conducting health education, creating social support, promoting community participation and promoting inter-sectional cooperation may be more effective in reducing unmet need for hospitalization service.