Health in a 24-h society

With increasing economic and social demands, we are rapidly evolving into a 24-h society. In any urban economy, about 20% of the population are required to work outside the regular 0800-1700 h working day and this figure is likely to increase. Although the increase in shiftwork has led to greater flexibility in work schedules, the ability to provide goods and services throughout the day and night, and possibly greater employment opportunities, the negative effects of shiftwork and chronic sleep loss on health and productivity are now being appreciated. For example, sleepiness surpasses alcohol and drugs as the greatest identifiable and preventable cause of accidents in all modes of transport. Industrial accidents associated with night work are common, perhaps the most famous being Chernobyl, Three Mile Island, and Bhopal.     

The Meaning of Numbers in Health: Exploring Health Numeracy in a Mexican-American Population

BACKGROUND  

Health numeracy can be defined as the ability to use numeric information in the context of health. The interpretation and application of numbers in health may vary across cultural groups.     

Health care delivery in a sleep center

This report presents and describes measures developed for the tracking of care provided to patients referred for evaluation to a sleep clinic and center in a U.S. federal health facility. We provide qualitative and quantitative indicators, tracked for a two-year period of time, for system management, information flow, measures of consultation and subsequent identification of apneic activity (Respiratory Disturbance Index > 10) and treatment for sleep apnea, and the satisfaction with diagnostic testing and treatment. Measures of laboratory efficiency were generally stable, except for the time from the clinic visit to PSG and the time from PSG interpretation to the final written report. We have some evidence that patient satisfaction with CPAP/BiLevel care may vary with a change in a home health care provider. Also, there was a surprisingly high rate of replacement of masks during nasal CPAP therapy. Results indicate the feasibility of such an approach and identify certain areas for improvement in process and communication relevant to the management of sleep disordered breathing.     

Immigrant Respiratory Health: a Diverse Perspective in Environmental Influences on Respiratory Health

Purpose of Review

The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA.

Recent Findings

Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations.

Summary

Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person’s respiratory health are needed to begin to tackle these disparities.

     

Setting up a microcomputer in a small Occupational Health department

The cost of microcomputers has fallen dramatically in recent years with the result that many small Occupational Health (OH) departments have turned to computerization. Occupational Health physicians with little if any previous computing experience may be called upon to oversee the introduction of a computer into an OH department and subsequently decide upon relevant equipment purchase. This article discusses the necessary hardware and software which would allow the development of a powerful and worthwhile OH computer system for a modest outlay.     

Health Literacy as a Social Determinant of Health in Asian American Immigrants: Findings from a Population-Based Survey in California

Background

Asian American immigrants have a lower level of health literacy than non-Latino whites, but their level of health literacy and its impact on health outcomes may differ among subgroups.

Objective

We investigated the level of health literacy across five subgroups of Asian American immigrants and explored the association between health literacy and self-rated health status and symptoms of depression.

Design

We utilized a cross-sectional survey research design and a population-based sampling strategy using the 2007 California Health Interview Survey (CHIS).

Participants

We sampled 30,615 non-Latino whites and 3,053 Asian American immigrants (1,058 Chinese, 598 Koreans, 534 Filipinos, 416 South Asians, and 447 Vietnamese).

Main Measures

We used two questions as proxy measures to assess the level of health literacy in non-Latino whites and in both aggregated and disaggregated Asian American immigrant groups. We then investigated the effect of health literacy on two main health outcomes: self-rated health status and depression symptoms.

Key Results

The level of health literacy varied across the five subgroups of Asian American immigrants. Chinese, Korean, and Vietnamese groups had the lowest levels of health literacy, while Filipinos showed the highest level. Health literacy was positively correlated with health status in Chinese and Korean immigrants, and negatively correlated with depression symptoms in Korean and South Asian immigrants.

Conclusion

We found heterogeneity in health literacy among Asian American immigrants and found that health literacy had varying associations with health outcomes. The aggregated Asian American immigrant group results may mask the true health disparities that each Asian American immigrant group faces. Koreans were the only group found to have a significant association between the proxy for health literacy and both health outcomes. Further research is needed to better understand the causes of heterogeneity and to investigate health literacy as a critical determinant of immigrant health.KEY WORDS: health literacy, health status, depression, Asian American immigrants, health disparity     

International Trends in Health Expectancies: a Review

Abstract. Are we living longer but in worse health? Are the increases in life expectancy at older ages in developed countries occurring because we are keeping sick or disabled people alive longer or because we are saving people from death but leaving them in states of disability and handicap? This question was addressed in a symposium entitled International Trends in Health Expectancies. This review paper summarises the international evidence presented at that symposium on trends in health expectancies in developed countries. Health expectancies provide a powerful tool for monitoring the health of older populations, testing hypotheses about the evolution of health, and developing public policy. The available international evidence of time series of health expectancies for older people suggests that increases in disability prevalence began in the late 1960s and 1970s at the time when mortality rates at older ages began to decline significantly, but that these increases were confined to the less severe end of the disability spectrum. There is no evidence of expansion of morbidity based on more severe measures of disability prevalence. Recently emerging evidence from Europe and North America suggests that disability prevalence rates among older people may be starting to decline and we may actually be starting to see compression of morbidity in low mortality populations.     

Health care professionals in a heart failure team

A heart failure team that treats heart failure patients often faces the challenge of managing multiple conditions requiring multiple medications and life style changes in an older patient group. A multidisciplinary team approach can optimally diagnose, carefully review and prescribe treatment, and educate and counsel patients and their families about medication use and life style changes. In this paper the possible role of the pharmacist, dietician, physical therapist, psychologist, primary care provider and social worker in heart failure management is discussed.