Nutrition—an essential component of health and health care.

Nutrition and medicine interface in a variety of ways and combine to serve as a dynamic force in health as well as in disease. A conceptual understanding of this interrelationship is critical to the continued and effective development of clinical nutrition in medical education. The physician may play an important role in critical-care medicine, long-term health care, research, education, and preventive medicine. While there is great potential for the physician to impact on nutrition status in both health and disease, there is clear evidence that greater emphasis needs to be placed on providing adequate nutrition training for every physician.     

Discontinuities between maternity and child and family health services: health professional’s perceptions

Background

Case management interventions have been widely used in the care of frail older people. Such interventions often contain components that may act both independently of each other and interdependently, which makes them complex and challenging to evaluate. Qualitative research is needed for complex interventions to explore barriers and facilitators, and to understand the intervention’s components. The objective of this study was to explore frail older people's and case managers’ experiences of a complex case management intervention.

Methods

The study had a qualitative explorative design and interviews with participants (age 75-95 years), who had received the case management intervention and six case managers who had performed the intervention were conducted. The data were subjected to content analysis.

Results

The analysis gave two content areas: providing/receiving case management as a model and working as, or interacting with, a case manager as a professional. The results constituted four categories: (1 and 2) case management as entering a new professional role and the case manager as a coaching guard, as seen from the provider’s perspective; and (3 and 4) case management as a possible additional resource and the case manager as a helping hand, as seen from the receiver’s perspective.

Conclusions

The new professional role could be experienced as both challenging and as a barrier. Continuous professional support is seemingly needed for implementation. Mutual confidence and the participants experiencing trust, continuity and security were important elements and an important prerequisite for the case manager to perform the intervention. It was obvious that some older persons had unfulfilled needs that the ordinary health system was unable to meet. The case manager was seemingly able to fulfil some of these needs and was experienced as a valuable complement to the existing health system.     

Marginal employment and health in Britain and Germany: does unstable employment predict health?

This study examines the possible health impact of marginal employment, including both temporary and part-time employment schemes. It addresses three research questions: (1) Are employed people with a fixed-term contract or no contract more likely to report poor health than those who hold jobs with permanent contracts? (2) Are part-time employed respondents (even when they hold jobs with permanent contracts) more likely to report poor health than full-time workers? (3) Does change in employment stability (i.e., from employment with permanent contract to fixed-term or no contract employment and vice-versa) have an impact on health status? Logistic regression models were used to analyze panel data from Britain and Germany (1991-1993), available in the Household Panel Comparability Project data base. We included 10,104 respondents from Germany and 7988 from Britain. A single measure of perceived health status was used as the dependent variable. Controlling for background characteristics, the health status of part-time workers with permanent contracts is not significantly different from those who are employed full-time. In contrast, fulltime employed people with fixed-term contracts in Germany are about 42 per cent more likely to report poor health than those who have permanent work contracts. In Britain, only part-time work with no contract is associated with poor health, but the difference is not statistically significant. We conclude that monitoring the possible health effects of the increasing number of marginal employment arrangements should be given priority on the social welfare research agenda.     

Children's bone health, calcium and vitamin D--how much do nurses and health visitors know?

Two focus groups of health visitors, practice nurses and community nursery nurses were held to find out how much health visitors and nurses know about children's bone nutrition, and whether they are able to identify dietary sources of these nutrients. Results showed that these professionals spend a significant part of their time giving nutritional advice about children and young people and answering questions on a range of dietary matters. They were well informed about the importance for bone health of calcium, vitamin D, exercise and a healthy, balanced diet. The biggest misconception was that dairy products in the UK contain vitamin D. Most of the professionals knew that bone strength develops quickly during childhood, and some that it does so in adolescence but few were aware that 90% of the full genetic potential for bone strength is achieved before adulthood. The groups reported confusion over the Government's initiatives for vitamin D supplements, and lack of guidance from Primary Care Trusts on making Healthy Start vitamins available at clinics for mothers and babies. Overall, health visitors and nurses have a good knowledge of bone health but there are gaps and more educational resources are needed, including on dietary sources of vitamin D. The Government needs to give clear guidelines about its initiatives for vitamin D supplements for mothers and children aged under five years. It is disappointing that the Dairy Council's 3-a-Day message on meeting essential calcium needs through three daily servings of dairy foods has not got through.     

Contrasting children and women’s health and the determinants of health in a small-sized city

Contrasts that exist in urban infrastructure and accessibility of public health and social services between suburban and urban districts of mega-cities have been well defined. There has been less research in small-sized cities (population under 500,000). This cross-sectional study was done on 1,728 ever-married reproductive-aged women living in Manisa, Turkey, in the year 2000. The probability proportion to size cluster sampling approach was used in the sample selection. Data were collected for women and 7,016 inhabitants of the interviewed households. The data were collected from the women by face to face interviews. Suburban areas (illegally occupied public land called “Gecekondu” dwellings) in Manisa differ from other urban regions (legal settlements of the city) on socioeconomic factors including household occupancy, adult literacy, social class, rates of religious marriages, unemployment, health insurance coverage, migration, cultural segregation, and social status of women. Some traditional practices were also highly prevalent in gecekondu families, where poverty is more common. Although gross fertility rate (GFR), total fertility rate (TFR), and percent decrease of the TFR were higher for gecekondu women than urban women, total wanted fertility rate (TWFR) was lower. In urban neighborhoods, prevalence of contraceptive use was higher, and the infant and child mortality rates were lower; however, when rates were adjusted for mother’s age, education and number of births, the differences turned out to be nonsignificant. Women living in urban areas receive better antenatal care, child immunization services, and professional health delivery assistance and services in a health facility; these services are very scarce in gecekondu districts. Health status of gecekondu populations can be improved by social and economic support and by making health services more available and accessible, especially maternity and child health services.     

Do health behaviors mediate the association between social capital and health?

INTRODUCTION: There is increasing evidence that social capital is important for people's health. However, there is still considerable disagreement about the specific pathways that links social capital to health. This study investigates the hypothesis that the association between social capital and health is mediated by people's health behaviors. METHOD: Data from the 2002 Health Survey for England (n = 7394) were used and analyzed from a multilevel perspective. The association between social capital and self-rated health were examined before and after controlling for smoking, alcohol intake, and fruit/vegetable consumption. RESULTS: Social capital was found to be associated with self-rated health, as well as with the different health behaviors. In addition, the health behaviors were significantly related to self-rated health. However, controlling for smoking, alcohol intake, and fruit/vegetable consumption did not substantially affect the association between social capital and self-rated health. CONCLUSIONS: The results demonstrate that social capital and support are important determinants of self-rated health and health behaviors. But only limited support was found for the hypothesis that health behaviors mediate the association between social capital and health.     

Do risk factors and health behaviours contribute to self-ratings of health?

This study examined the relative importance of five risk factors and health behaviours (namely dietary habits, leisure time exercise, smoking, alcohol consumption and body mass index) on self-ratings of health among the Swedish adult population. The data come from the 1991 Swedish Level of Living Survey, a face-to-face survey interview based on a sample representative of the Swedish population aged between 18 and 75 years (n = 5306). The analyses were carried out using logistic regression analysis. With the exception of the consumption of dietary fat, all the risk factors and health behaviours studied were associated with self-rated health. When they were adjusted for health problems and functional limitations most of the associations weakened or disappeared altogether, but smoking and use of vegetables in the diet were still associated with self-rated health. Self-ratings of young adults (18-34 years) were found to be related to body mass index even when health problems were adjusted for, with both obesity and underweight contributing to less than good self-rated health. The results indicate that risk factors and health behaviours do not, in general, directly contribute to self-ratings of health. Instead, their effect is mediated by more specific health problems and their functional consequences. However, smoking and not consuming vegetables, as well as obesity and underweight among young respondents, were found to have an independent association with self-rated health. This may reflect the effects of health problems not captured by our indicators of ill health, but may also indicate that risk factors and risky behaviours are considered to have an effect on one's perceived health even in the absence of health consequences.     

Is church attendance associated with Latinas' health practices and self-reported health?

OBJECTIVES: To evaluate (a) the relation between frequency of church attendance, self-rated health, and health behaviors controlling for potential confounders and (b) the influence of acculturation on church attendance and health behaviors. METHODS: Physical activity and dietary patterns, demographics, and acculturation levels were compared among Latinas who attended church frequently, infrequently, and not at all. RESULTS: Church attendance was independently and positively associated with healthier dietary and physical activity behaviors, but not with self-rated health. Acculturation attenuated the relation between physical activity and church attendance. CONCLUSION: Latinas' health behaviors and self-rated health may be related to other variables that explain the salutary effects of church attendance.     

Do Latino immigrants link self-rated health with BMI and health behaviors?

OBJECTIVES: To assess the association between self-rated health, obesity, and self-reported health behaviors of Latino immigrants METHODS: Two hundred two Latino immigrants (mean age=31.63, SD=8.30, 54% female) participated in a 15-minute interview and height and weight measurements. RESULTS: Participants reporting good to excellent health reported engaging in physical activity during the past month (P<.05), eating more fruits and vegetables (P<.001 and P<.01 respectively), and watching less television (P<.01) than did those who reported fair to poor health. Self-rated health was not associated with BMI. CONCLUSIONS: Greater attention to Latinos' self-perception of health in relation to weight is needed to develop interventions to improve health status.     

Socioeconomic differences in health: how much do health behaviors and health insurance coverage account for?

As evidence accumulates that both unhealthy behaviors and inadequate access to health care are responsible in part for poor health, there is a tendency to attribute the differences in health status between the poor and the affluent to the higher prevalence of unhealthy behaviors and inadequate access to health care among people of low socioeconomic status (SES). The purpose of this study is to determine quantitatively how much health behaviors and health insurance coverage account for the SES disparity in health. The study employed secondary analysis of data collected through the Kentucky Behavioral Risk Factor Surveillance System for 2000. After adjusting for health behaviors and health insurance coverage, the differences in health among different levels of SES (measured by education and income) remained strong and significant. Health behaviors and health insurance coverage accounted for 10-16% of the socioeconomic differences in health.     

El Niño and human health

The El Niño-Southern Oscillation (ENSO) is the best known example of quasi-periodic natural climate variability on the interannual time scale. It comprises changes in sea temperature in the Pacific Ocean (El Niño) and changes in atmospheric pressure across the Pacific Basin (the Southern Oscillation), together with resultant effects on world weather. El Niño events occur at intervals of 2-7 years. In certain countries around the Pacific and beyond, El Niño is associated with extreme weather conditions that can cause floods and drought. Globally it is linked to an increased impact of natural disasters. There is evidence that ENSO is associated with a heightened risk of certain vector-borne diseases in specific geographical areas where weather patterns are linked with the ENSO cycle and disease control is limited. This is particularly true for malaria, but associations are also suggested in respect of epidemics of other mosquito-borne and rodent-borne diseases that can be triggered by extreme weather conditions. Seasonal climate forecasts, predicting the likelihood of weather patterns several months in advance, can be used to provide early indicators of epidemic risk, particularly for malaria. Interdisciplinary research and cooperation are required in order to reduce vulnerability to climate variability and weather extremes.     

Economics and ethics in public health?

The topic suggests a conflict between ethics and economy in medical care. It is often argued that today's welfare state in affluent societies with their social insurance systems makes it easier for the doctor to translate ethical demands into reality without being hampered by economic restrictions. Both doctors and patients took advantage of this system of medical care by mingling social guarantees for health with the doctor's income. Hence, medical expenses expanded rapidly, additionally promoted by technical progress in medicine. This entailed a proportionate increase in medical expenses in relation to personal income, especially wage income. Budgets of state authorities were streamlined or deficits became larger. This state of affairs was promoted further by mechanisms of distribution of national income in accordance with the slogan "less state, more market". While national income continued to grow, although at a slower rate, the number of jobless persons grew continually and thus also the social expenses, this was not due, as is usually assumed and pretended, to an economic crisis. Society and economy are facing a crisis of distribution of national income under conditions of technical progress as a job killer, making economic production more productive and efficient. Not taking into account the new challenge of social market economy--the German innovation in market economy creating the economic miracle after World War II--reforms of the system of medical care took place and are still continuing along market principles, particularly the latest German reform law leading to individual contracts between patients and their doctors in respect of cost charging. However, marketing principles promote economy in medicine, but they do not promote medical ethics. Further German guidelines for medical care should take stock of past experiences. There will be more competition in the "growing market of medical care" (private and public) and this will need--as economic experience has shown and economists have affirmed--new organisational devices to ensure better outcomes for the individual patient as a consumer and the doctors as suppliers. More responsibility should be given to the different suppliers of collective security in medical care (private or social systems of insurance). No individual patient as a mere consumer has a genuine chance in handling contracts with doctors carefully who are considered to be "gods in white" according to a popular German saying. These consumers have only a slight chance when arguing in courts of justice for the performance of contracts. Diagnosis and therapy, the system of doctors who treat members of statutory social insurance schemes (National Health general practitioners in the U.K.) and doctors as "free entrepreneurs" in the growing market of medical care should be separated due to the different rules of charging costs and offering medical care. "Classless medical care" does not have a better chance by applying market principles. The same is true for ethics versus economy. Doctors as "free entrepreneurs" must learn that markets will not guarantee reimbursement of costs but react to supply and demand. Hence, regulation of medical care by economic instruments creates better chances even for ethics in medical care against economy.