Assessment of intra-urban variability in indoor air quality and its impact on children’s health

The results from a number of studies suggest that children living close to busy roads may have impaired respiratory health. The study reported here was designed specifically to test the hypothesis that exhaust from traffic has an impact on indoor air quality and children’s respiratory health. Children living at three different locations in a suburban area in India were enrolled in the study, and the concentrations of indoor air quality parameters were measured at selected households during the period March 2006–February 2007 using portable air quality monitors. Respiratory symptoms were identified by means of a questionnaire completed by parents and from the results of a pulmonary function test (PFT) carried out using an electronic Spiro Meter. The logistic regression model revealed associations between respiratory symptoms and traffic-related indoor air pollutants among our study population. The prevalence of respiratory disorders was greater among children living in close proximity to traffic sources than among those living more distant from these sources, even after the adjustment of confounding factors. We also found intra-urban variability of indoor air quality and associated differences in respiratory symptoms. Our findings support the hypothesis that traffic has an impact on indoor air quality and that it is associated with children’s health. The findings from this study have important policy and program implications, including the need for public information campaigns designed to inform people about the risks of exposure to traffic exhausts.     

Does binge eating disorder impact weight-related quality of life?

OBJECTIVES: To determine whether binge eating disorder (BED) impacts weight-related quality of life in obese individuals seeking weight loss treatment and to investigate the role of psychological symptoms, BMI, and demographic variables in the relationship between BED and weight-related quality of life. RESEARCH METHODS AND PROCEDURES: Three hundred seventeen women (BMI = 37.6) and 213 men (BMI = 41.3) completed questionnaires on admission into an intensive residential lifestyle modification program. Weight-related quality of life was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). The presence of BED was determined using the Questionnaire on Eating and Weight Patterns-Revised. Psychological symptoms were assessed using the Beck Depression Inventory and the global severity index of the Symptom Checklist 90-R. RESULTS: BED prevalence in this sample was 17.9%. Participants with BED, in comparison with those without BED, were more likely to be women (75.8% vs. 56.3%, p < 0.001), younger (45.0 vs. 49.7 years, p = 0.003), white (98.9% vs. 91.7%), heavier (BMI = 42.0 vs. 38.5, p = 0.002), psychologically distressed, and more impaired on total IWQOL-Lite (51.5 vs. 65.3, p < 0.001) and all IWQOL-Lite subscales. However, after controlling for demographic variables, BMI, and psychological symptoms, BED was not independently associated with weight-related quality of life. DISCUSSION: The association between BED and impairment in quality of life that has been previously reported in the literature may largely be accounted for by differences between those with and without BED on demographic variables, BMI, and psychological symptoms. BED does not seem to independently impact weight-related quality of life.     

Managed care regulations: impact on quality?

Over the last decade, the general public and providers have become increasingly concerned about the quality of care provided by managed care organizations. This article focuses on state and federal legislative proposals to protect quality, and the potential tradeoffs involved with increased regulatory oversight of managed care proposals. In enacting managed care legislation, policy makers should balance the costs potential with the extent to which proposed policies will protect consumers from harm, enhance the operation of the market, or affect quality of care, access to services or choice of providers.     

Does education buffer the impact of disability on psychological distress?

This paper investigates whether education buffers the impact of physical disability on psychological distress. It further investigates what makes education helpful, by examining whether cognitive ability and occupational class can explain the buffering effect of education. Two waves of the 1958 British National Child Development Study are used to test the hypothesis that the onset of a physical disability in early adulthood (age 23 to 33) has a smaller effect on psychological distress among higher educated people. In total 423 respondents (4.6%) experienced the onset of a physical disability between the ages of 23 and 33. We find that a higher educational level cushions the psychology impact of disability. Cognitive ability and occupational class protect against the effect of a disability too. The education buffer arises in part because individuals with a higher level of education have more cognitive abilities, but the better social position of those with higher levels of education appears to be of greater importance. Implications of these findings for the social gradient in health are discussed.     

Does quality improvement implementation affect hospital quality of care?

The authors examined how the association between quality improvement (QI) implementation in hospitals and hospital clinical quality is moderated by hospital organizational and environmental context. The authors used Ordinary Least Squares regression analysis of 1,784 community hospitals to model seven quality indicators as a function of four measures of QI implementation and a variety of control variables. They found that forces that are external and internal to the hospital condition the impact of particular QI activities on quality indicators: specifically data use, statistical tool use, and organizational emphasis on Continuous Quality Improvement (CQI). Results supported the proposition that QI implementation is unlikely to improve quality of care in hospital settings without a commensurate fit with the financial, strategic, and market imperatives faced by the hospital.     

Has the impact of hormone replacement therapy on health-related quality of life been undervalued?

Previous economic evaluations of hormone replacement therapy (HRT) have restricted positive effects to alleviation of postmenopausal symptoms and negative effects to drug side effects. We studied the association between HRT use and postmenopausal women's valuation of both health-related quality of life and potential treatment side effects. Postmenopausal women with either a documented first vertebral fracture within the past 5 years or no history of osteoporotic fractures were recruited from Olmsted County, Minnesota, and from Dartmouth-Hitchcock Medical Center in New Hampshire to participate in a study to assess quality of life and women's attitudes toward osteoporosis prevention. Women's valuations of their current health and potential HRT-related side effects were quantified as quality-adjusted life years (QALYs) assessed by an automated utility assessment instrument (U-Titer) and the time tradeoff technique, by a vertical rating scale, and by estimated quality of well-being (QWB) scores. Health status was measured using the Medical Outcomes Study SF-36. Regression methods were used to assess the impact of current HRT use on health-related quality of life and valuation of side effects. There were 106 women with vertebral fracture and 180 with no history of hip, wrist, or vertebral fractures. Altogether, 116 (40.6%) women were currently taking HRT, 64 (22.2%) had taken HRT in the past, and 106 (37.1%) women had never taken HRT. Current HRT users had higher time tradeoff QALYs than never and past HRT users, with gains ranging from 15.0 to 83.7 days per year for current users relative to the others. Benefits were largest for women with a vertebral fracture and limitations in activities. The secondary QALY measures also showed significantly higher values for current HRT users compared with other women, as did SF-36 subscales for general health, physical function, role-emotional function, and vitality. There was substantial variability in women's perceptions of HRT side effects. Overall, the proportion of women willing to trade time to avoid bleeding was largest, at 95.5%, followed by breast tenderness, weight gain, and endometrial biopsy at 90.4%, 87.4%, and 82.7%, respectively. Current HRT users had higher health-related quality of life than past or never users according to all measures studied. Women's perceptions of potential side effects were highly variable and should be considered by physicians when prescribing an HRT regimen. If, as our results suggest, postmenopausal therapy has positive effects beyond the immediate postmenopausal years, previous economic studies may have underestimated the value of HRT.     

Does bruxism impact the quality of life of children and adolescents? A systematic review and meta-analysis

Background

This study evaluated the impact of bruxism on the quality of life of children and adolescents.

Methods

Electronic searches were performed in the PubMed (Medline), Scopus, Web of Science, Lilacs, Cochrane Library, and SIGLE databases. We included observational studies that evaluated general and/or oral health-related quality of life in children and adolescents, with and without bruxism. Methodological quality and risk of bias were evaluated using the Fowkes and Fulton tool. Two meta-analyses (MA) were performed. MA1 considered the mean score achieved by questionnaires, whilst MA2 considered the measure of association [odds ratio (OR)] between bruxism and quality of life.

Results

Seven studies were selected for qualitative synthesis. Three studies were selected for quantitative synthesis, which considered only oral health-related quality of life. In MA1 (three studies), the mean difference of the B-ECOHIS score was 2.12 (95% CI?=??0.095–4.377, p?=?0.061). MA2 (two studies) showed that bruxism is not associated with oral health-related quality of life in children and adolescents (OR?=?1.889, 95% CI?=?0.53–6.71, p?=?0.325).

Conclusion

Bruxism does not impact quality of life in children and adolescents. Further studies should consider other quality of life questionnaires to confirm the absence of association.

     

Microbiological quality of indoor air at the School of Building and Environmental Engineering at Białystok University of Technology

The investigation of microbiological rate of indoor air pollution on Faculty of Building and Environmental Engineering at Bia?ystok University of Technology were made by sedimentation method in accordance with Polish standards (PN-89/Z-04111/01,02,03). Six series of measurements were carried out from autumn 2002 to spring 2003. The results show bad microbiological quality of indoor air on Faculty of Building and Environmental Engineering at Bia?ystok University of Technology. It was found that the number of Staphylococcus, Actinomycetales as well as the total count of bacteria were too high and broke the Polish regulations of the clear air. Because of the students' and other workers' safety, monitoring of microbiological pollution of the indoor air must be done and existing emergency to improve the quality of the air must be lead.     

Simply the best? The impact of quality on choice of primary healthcare provider in Sweden

ObjectiveOne of the more important objectives with the patient choice reform, introducing non-price competition in Swedish primary healthcare, was to improve performance and quality of care. However, in order for choice to lead to quality improvements, citizens need to consider quality aspects in their choices of provider. We hypothesize that quality of care influences choice of provider and the objective of this study is to investigate if citizens are willing to make a trade-off between distance to chosen provider and quality of care.MethodsWe use conditional logit models to analyse if quality and other provider attributes influence choice of provider. The study population includes all citizens of Region Stockholm with at least one primary healthcare contact (N ~1.4 million).ResultsThe results show that distance is the most important factor in choosing a primary healthcare provider but that there seems to be a willingness to make a trade-off between distance and quality measures. However, other provider attributes, such as the Care Need Index of the registered population, seem to influence choice to a greater extent than quality.ConclusionThe results point in the same direction as the arguments behind the patient choice reform. However, the effects are marginal. To enhance quality competition, policy makers should consider making quality information at the provider level more accessible.     

What's driving Twin Cities air quality?

Air quality affects the health of patients, particularly those with asthma, COPD, cardiovascular disease, and other heart problems. Epidemiological studies show that common air pollution may have health effects in sensitive populations even when the air quality is within Environmental Protection Agency standards. In Minnesota, the main 2 pollutants of concern are ozone and fine particles. Emissions from motor vehicles are a major source of each. This article discusses these pollutants and reports on the work of the Minnesota Pollution Control Agency in measuring air quality and alerting the public about air-quality problems.     

Who suffers from indoor air pollution? Evidence from Bangladesh

In this paper, we investigate individuals' exposure to indoor air pollution. Using new survey data from Bangladesh, average hours spent by members of households in the cooking area, living area and outdoors in a typical day are combined with the estimates of pollution concentration in different locations in order to estimate exposure. We analyse exposure at two levels: differences within households attributable to family roles, and differences across households attributable to income and education. Within households, we relate individuals' exposure to pollution in different locations during their daily round of activities. We find high levels of exposure for children and adolescents of both sexes, with particularly serious exposure for children under 5 years. Among prime-age adults, we find that men have half the exposure of women (whose exposure is similar to that of children and adolescents). We also find that elderly men have significantly lower exposure than elderly women. Across households, we draw on results from a previous paper, which relate pollution variation across households to choices of cooking fuel, cooking locations, construction materials and ventilation practices. We find that these choices are significantly affected by family income and adult education levels (particularly for women). Overall, we find that the poorest, least-educated households have twice the pollution levels of relatively high-income households with highly educated adults. Our findings further suggest that young children and poorly educated women in poor households face pollution exposures that are four times those for men in higher income households organized by more highly educated women. Since infants and young children suffer the worst mortality and morbidity from indoor air pollution, in this paper we consider measures for reducing their exposure. Our recommendations for reducing the exposure of infants and young children are based on a few simple, robust findings. Hourly pollution levels in cooking and living areas are quite similar because cooking smoke diffuses rapidly and nearly completely into living areas. However, outdoor pollution is far lower. At present, young children are only outside for an average of 3 hours per day. For children in a typical household, pollution exposure can be halved by adopting two simple measures: increasing their outdoor time from 3 to 5 or 6 hours per day, and concentrating outdoor time during peak cooking periods.     

Does quality of marital sex decline with duration?

Does the quality of marital sex increase or decrease with marital duration? Previous research assumes that it decreases; however, there is no empirical evidence of declining quality of marital sex with duration in the literature. This study theoretically and empirically examines how the quality of marital sex changes with duration. Theoretically, two effects may influence the change of quality of marital sex: the effect of diminishing marginal utility (the marginal utility of consuming a good or service diminishes as the consumption of that good or service increases) and the effect of the investment in the marriage-specific human capital (including the "partner specific" skills that enhance the enjoyment of marital sex and the knowledge about the spouse's sexual preferences, desires, and habits). The quality of marital sex could either increase or decrease depending on which effect is dominant. The multivariate analysis of the National Health and Social Life Survey data shows that marital duration has a small and negative effect on the quality of marital sex. The gender difference in the quality of marital sex is discussed.     

Does investor-ownership of nursing homes compromise the quality of care?

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.     

Does overweight in childhood have an impact on adult health?

The consequences of overweight in childhood, including persistence into adulthood and as a risk factor for adverse health consequences, are of substantial concern given the recent upward trend in prevalence. A recent report on an historic cohort--a British 1947 birth cohort--is largely consistent with previous estimates of persistence of overweight. Long-term health consequences of obesity were not demonstrable in this study, likely owing to the small numbers of subjects who were overweight during post-World War II Britain.     

Does the effect of air pollution on pregnancy outcomes differ by gender? A systematic review

Gender is known to influence pregnancy outcomes. Recent studies have reported an association between air pollution exposure and adverse pregnancy outcomes, but gender differences have not been considered. In order to assess the current evidence of the interactive effects between gender and air pollution on pregnancy outcomes we undertook a systematic literature review. Using a comprehensive list of keywords, English language articles published between 1966 and 2005 were retrieved from major databases. Additional information on gender was obtained from the study authors. Studies were included if they contained well-defined measurements of ambient air pollutants, investigated pregnancy outcomes and reported estimates by gender. In total 11 studies were included. The quality of the studies was assessed using the framework in Systematic Reviews in Health Care Meta-analysis in context and Bracken's Guidelines. Of the 11 studies, four evaluated low birth weight (LBW); one each evaluated very low birth weight and fetal growth and six examined preterm birth (PTB). Females were at higher risk of LBW: adjusted odds ratios (AOR) ranged from 1.07 to 1.62. Males were at higher risk for PTB: AORs ranged from 1.11 to 1.20. In addition, there was some evidence to suggest that the effect of air pollution on LBW is differential by gender; however, the evidence was available only from four studies. This is the first systematic review to consider gender effect. Further high quality studies are needed to establish whether these findings prevail.     

Does the edge effect impact on the measure of spatial accessibility to healthcare providers?

Background

Spatial accessibility indices are increasingly applied when investigating inequalities in health. Although most studies are making mentions of potential errors caused by the edge effect, many acknowledge having neglected to consider this concern by establishing spatial analyses within a finite region, settling for hypothesizing that accessibility to facilities will be under-reported. Our study seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application.

Methods

This study was carried out in the department of Nord, France. The statistical unit we use is the French census block known as ‘IRIS’ (Ilot Regroupé pour l’Information Statistique), defined by the National Institute of Statistics and Economic Studies. The geographical accessibility indicator used is the “Index of Spatial Accessibility” (ISA), based on the E2SFCA algorithm. We calculated ISA for the pregnant women population by selecting three types of healthcare providers: general practitioners, gynecologists and midwives. We compared ISA variation when accounting or not edge effect in urban and rural zones. The GIS method was then employed to determine global and local autocorrelation. Lastly, we compared the relationship between socioeconomic distress index and ISA, when accounting or not for the edge effect, to fully evaluate its impact.

Results

The results revealed that on average ISA when offer and demand beyond the boundary were included is slightly below ISA when not accounting for the edge effect, and we found that the IRIS value was more likely to deteriorate than improve. Moreover, edge effect impact can vary widely by health provider type. There is greater variability within the rural IRIS group than within the urban IRIS group. We found a positive correlation between socioeconomic distress variables and composite ISA. Spatial analysis results (such as Moran’s spatial autocorrelation index and local indicators of spatial autocorrelation) are not really impacted.

Conclusion

Our research has revealed minor accessibility variation when edge effect has been considered in a French context. No general statement can be set up because intensity of impact varies according to healthcare provider type, territorial organization and methodology used to measure the accessibility to healthcare. Additional researches are required in order to distinguish what findings are specific to a territory and others common to different countries. It constitute a promising direction to determine more precisely healthcare shortage areas and then to fight against social health inequalities.

     

Does investor ownership of nursing homes compromise the quality of care?

OBJECTIVES: Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. METHODS: We analyzed 1998 data from state inspections of 13,693 nursing facilities.We used a multivariate model and controlled for case mix, facility characteristics, and location. RESULTS: Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. CONCLUSIONS: Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.