In the pink?

Most first-wave trusts produced annual reports to be proud of. But, as Ron Hodges discovered, the few which failed to meet the mark provide an object lesson in how not to do it.     

In the field of ionizing radiations, are the dosimetric data satisfactory?

The quantification of the dose is a key element for the surveillance of radiological exposures of the population. The objectives are the reduction as low as reasonably achievable of exposures, the assessment of the risk in complement to epidemiologic surveys and refining the dose/effect relationship. However, two difficulties should be highlighted: first, the dose delivered into organs or to the whole organism is not directly measurable and second, its translation into risk (cancer hazard, for instance) requires precautions. The questions associated with the development of a good dosimetry depend on metrology, modeling, investigations, management of databases, and give rise to debates with regard to the notion of realism and confidentiality of individual data. This activity experiences deep changes due, not only to the development of techniques and the increasing social demand, but also to changes to the regulations, in particular with the transposition of the European Directive for the protection of the patients (97/43, June 30, 1997) and of the Directive relating to the basic safety standards (96/29, May 13, 1996). Various types of situations are distinguished: professional exposure, public exposure (releases of facilities handling radioactive materials, natural sources, contaminated sites, nuclear test fallouts) and patients'exposure (radiology and radiotherapy). Recent investigations at European or domestic level are mentioned, the purpose of which is to evidence the benefits and lacks, if any, in the dosimetric monitoring for these various types of situations. As a conclusion, orientations are defined and some of them are already applied, following the above-mentioned investigations or works. As the two main sources of exposure for the population are medical (41%) and natural irradiations (58%), the effort of the reduction should first cover these two components. With regard to natural radioactivity, the main stake is to identify the sectors with a high radon potential and to implement the associated reduction means. With regard to patients'exposure, the emphasis should concern the development in radiodiagnostic, of the means required for systematically recording a dose indicator for every radiodiagnostic examination and any radiological operation. Finally, the exposure of workers, which only represents a component of the overall population exposure, should be subject to an on-going attention with regard to data centralization and accessibility.     

Are intrinsic motivational factors of work associated with functional incapacity similarly regardless of the country?

Background: Many psychosocial models of wellbeing at work emphasise the role of intrinsic motivational factors such as job autonomy, job complexity, and innovativeness. However, little is known about whether the employees of multinational enterprises differ from country to country with regard to intrinsic motivational factors, and whether these factors are associated with wellbeing similarly in the different countries. The purpose of this study was to examine the level of intrinsic motivational factors and their impact on functional incapacity in different countries in a multinational corporation. Methods: In 2000, data were collected from a globally operating corporation with a questionnaire survey. The participants were 13 795 employees (response rate 59%; 56% under age 45; 80% men; 61% blue collar employees), who worked in similar industrial occupations in five countries (Canada, China, Finland, France, and Sweden). Results: The Chinese employees reported higher autonomy and lower complexity at work than the employees from the other countries. After adjustment for age, sex, socioeconomic status, and physical work environment, job autonomy, and job complexity at work were associated with functional incapacity in most countries, whereas in China the impact was significantly stronger. In Finland and in China employees with low innovativeness at work were more prone to functional incapacity than corresponding employees in other countries. Conclusions: The level of intrinsic motivational factors varied between the Chinese employees and those in other countries. In line with theoretical notions, the relation between intrinsic motivational factors of work and functional incapacity followed a similar pattern in the different countries. However, these country specific results show that a culture specific approach to employee wellbeing should also be applied.     

Is decentralisation the real solution? A three country study

Decentralisation in the health care sector has been perceived in these last years as a means to revamp the performance of health care systems. Many European countries have undergone this process of delegating funding and/or management responsibilities to sub-layers of government. However, there has also been a recentralisation of health care systems in Nordic states, which typically had a highly decentralised model of service provision and funding. Three country cases will be analysed (Italy, Spain and Norway) and light will be shed on some possible difficulties that Italy and Spain might experience, given their present health decentralised structure. Moreover, there will be an analysis of the reasons that led to recentralisation of health care in Norway. The scope is to make people aware that decentralisation per se is not always successful. The three country cases highlight possible drawbacks that can arise from decentralisation.     

In search of the cancer candidate: can lay epidemiology help?

First published in 1991, the ideas embedded in ‘Lay epidemiology and the prevention paradox’ offered a novel and rational explanation for the lay public’s failure to fully engage with the lifestyle messages offered by health educators. During the course of a large ethnographic study in South Wales, Davison and colleagues described the emergence of what they termed the coronary candidate. Candidacy provides a ‘cultural mechanism’ that facilitates the estimation of risk for coronary heart disease. The model has rarely been applied to other major illnesses. This article presents findings from a study that sought to explore the lay epidemiology model, candidacy and cancer. In a series of in‐depth individual interviews, members of the lay public discussed their ideas about cancer, and what emerged was an explanatory hierarchy to account for cancer events. Yet the random and unpredictable nature of cancer was emphasised as well as a general reluctance to accept the idea of cancer candidacy.     

Immigration and the health of U.S. black adults: Does country of origin matter?

Previous work suggests that regional variation in pre-migration exposure to racism and discrimination, measured by a region's racial composition, predicts differences in individual-level health among black immigrants to the United States. We exploit data on both region and country of birth for black immigrants in the United States and methodology that allows for the identification of arrival cohorts to test whether there are sending country differences in the health of black adults in the United States that support this proposition. While testing this hypothesis, we also document heterogeneity in health across arrival cohorts and by duration of U.S. residence among black immigrants. Using data on working-age immigrant and U.S.-born blacks taken from the 1996-2010 waves of the March Current Population Survey, we show that relative to U.S.-born black adults, black immigrants report significantly lower odds of fair/poor health. After controlling for relevant social and demographic characteristics, immigrants' cohort of arrival, and immigrants' duration in the United States, our models show only modest differences in health between African immigrants and black immigrants who migrate from the other major sending countries or regions. Results also show that African immigrants maintain their health advantage over U.S.-born black adults after more than 20 years in the United States. In contrast, black immigrants from the Caribbean who have been in the United States for more than 20 years appear to experience some downward health assimilation. In conclusion, after accounting for relevant factors, we find that there are only modest differences in black immigrant health across countries of origin. Black immigrants appear to be very highly selected in terms of good health, although there are some indications of negative health assimilation for black immigrants from the Caribbean.     

In the name of the family? Against parents’ refusal to disclose prognostic information to children

Medicine, Health Care and Philosophy - Parents frequently attempt to shield their children from distressing prognostic information. Pediatric oncology providers sometimes follow parental request...     

Does country influence the health burden of informal care? An international comparison between Belgium and Great Britain

The aim of this paper is to determine whether the association between the provision of informal care and the health status of caregivers is affected by the country of residence. We focus on two European countries, Belgium and Great Britain, and develop a methodology, which consists of matching a subset of areas from Britain with areas in Belgium that are demographically and socioeconomically similar. These pairs of areas are then used as fixed effects in logistic regressions of poor health. This allows us to take into account the influence of area type on health and to remove the influence of these local contextual characteristics from the estimated country effects. Results suggest that, although caregiving is more prevalent in Britain, the health burden associated with heavy caregiving activities is lower in Britain than in Belgium. This may be explained by the better targeting of long-term home care policies towards more severely dependent patients in Britain than in Belgium.