Establishing the National Institute for Research in Environmental Health,India

ProblemMultiple environmental health issues resulting from pollution and climate change threaten public health in India.ApproachThe Government of India recognized the need for a permanent environmental health research institute; the Indian Council of Medical Research therefore established the National Institute for Research in Environmental Health in Bhopal in 2010. Scientists at the institute assessed the multiple long-term health effects of exposure to methyl isocyanate, and are now conducting research on a wide array of locally relevant environmental health issues.Local settingThe Union Carbide India Limited pesticide factory in Bhopal was the site of a methyl isocyanate gas leak in 1984, which affected half a million people. The Indian Council of Medical Research set up a coordinating unit in the immediate aftermath, which was upgraded to the Bhopal Gas Disaster Research Centre in 1986 and then the Centre for Rehabilitation Studies in 1995.Relevant changesScientists at the institute undertake environmental monitoring and health risk assessment studies among communities located near polluted areas, such as industrial areas. They are also assessing the training needs of practising physicians, with the aim of developing a curated curriculum to meet the deficiencies in environmental health education in the country.Lessons learntEnvironmental legislation was introduced in the wake of the disaster and a research institute in environmental health was established. Researchers at the institute have recognized the importance of engaging communities in environmental health research, as well as knowledge dissemination to relevant stakeholders.     

Establishing Environmental Criteria

Trends in respiratory cancer mortality from 1940 to 1969 in the United States and in England and Wales are compared. In the United States, male age-specific death rates have increased at a declining rate; female rates have increased dramatically since about 1955. In England and Wales, male rates have declined under 55, have flattened at ages 55 to 64, and have risen only in those aged 65 and over; female rates have increased markedly since about 1957. After allowing for cigarette smoking, an effect of air pollution was sought. There was a slightly greater decline in the lung cancer death rates among men aged 25 to 64 and women aged 45 to 54 in Greater London than in the rest of the country. This is in line with the greater decline in smoke pollution in London than elsewhere.     

Considerations on an Approach for Establishing a Framework for Bioactive Food Components

Bioactive food components have shown potential health benefits for more than a decade. Currently there are no recommended levels of intake [i.e., Dietary Reference Intakes (DRIs)] as there are for nutrients and fiber. DRIs for essential nutrients were based on requirements for each specific nutrient to maintain normal physiologic or biochemical function and to prevent signs of deficiency and adverse clinical effects. They were later expanded to include criteria for reducing the risk of chronic degenerative diseases for some nutrients. There are many challenges for establishing recommendations for intakes of nonessential food components. Although some nonessential food components have shown health benefits and are safe, validated biomarkers of disease risk reduction are lacking for many. Biomarkers of intake (exposure) are limited in number, especially because the bioactive compounds responsible for beneficial effects have not yet been identified or are unknown. Furthermore, given this lack of characterization of composition in a variety of foods, it is difficult to ascertain intakes of nonessential food components, especially with the use of food-frequency questionnaires designed for estimating intakes of nutrients. Various intermediary markers that may predict disease outcome have been used as functional criteria in the DRI process. However, few validated surrogate endpoints of chronic disease risk exist. Nonvalidated intermediary biomarkers of risk may possibly predict clinical outcomes, but more research is needed to confirm the associations between cause and effect. One criterion for establishing acceptable intermediary outcome indicators may be the maintenance of normal physiologic function throughout adulthood, which presumably would lead to reduced chronic disease risk. Multiple biomarkers of outcomes that demonstrate the same health benefit may also be helpful. It would be beneficial to continue to refine the process of setting DRIs by convening a workshop on establishing a framework for nonessential food components that would take into consideration intermediary biomarkers indicative of optimal health.     

Socioeconomic misclassification in Ontario's Health Care Registry

BACKGROUND: Addresses in some provincial health care registries are not systematically updated. If individuals are attributed to the wrong location, this can lead to errors in health care planning and research. Our purpose was to investigate the accuracy of socioeconomic classification based on addresses in Ontario's provincial health care registry. METHODS: The study setting was Toronto's inner city, an area with a population of 799,595 in 1996. We ordered enumeration areas by 1996 mean household income and divided them into five roughly equal income groups by population. We then assigned an income quintile to each individual using both the address from Ontario's provincial heath care registry and that from hospital discharge abstracts. We compared these two sets of income quintiles and also used them to generate quintile-specific rates of medical hospital admissions in the year 2000. RESULTS: Provincial registry and hospital-based addresses agreed on the exact enumeration area for 78.1% of individuals and for income quintile for 84.8% of individuals. Disagreement by more than one income quintile occurred for 7.4% of individuals. The two methods of assigning income quintiles yielded income-specific medical hospitalization rates and rate ratios that agreed within 1%. INTERPRETATION: Although address inaccuracy was found in Ontario's health care registry, serious socioeconomic misclassification occurred at a relatively low rate and did not appear to introduce significant bias in the calculation of hospital rates by socioeconomic group. Updating of addresses at regular intervals is highly desirable and would result in improved accuracy of provincial health care registries.     

Considerations for Establishing Successful Coronavirus Disease Vaccination Programs in Africa

The accelerated development of coronavirus disease (COVID-19) candidate vaccines is intended to achieve worldwide immunity. Ensuring COVID-19 vaccination is crucial to stemming the pandemic, reclaiming everyday life, and helping restore economies. However, challenges exist to deploying these vaccines, especially in resource-limited sub-Saharan Africa. In this article, we highlight lessons learned from previous efforts to scale up vaccine distribution and offer considerations for policymakers and key stakeholders to use for successful COVID-19 vaccination rollout in Africa. These considerations range from improving weak infrastructure for managing data and identifying adverse events after immunization to considering financing options for overcoming the logistical challenges of vaccination campaigns and generating demand for vaccine uptake. In addition, providing COVID-19 vaccination can be used to promote the adoption of universal healthcare, especially in sub-Saharan Africa countries.     

构建以健康管理为中心的社区卫生服务体系

实现我国医疗体制改革必须进行机制创新,建立以健康管理为中心的社区卫生服务体系正是我国社区医疗卫生机制创新的突破点。文章从健康管理的含义出发,论述了建立以健康管理为中心的社区医疗卫生服务体系的意义、方法、作用及实施措施,为建立新型的医疗卫生服务模式提供借鉴.     

Logistical Considerations in the Prepaid Health Industry

No abstract available for this article.     

杨海宇 外部环境设计前的重点考量

杨海宇对国外一家儿童医院的外部环境印象深刻--墙上爬着青青的藤蔓,紫色的小花在微风中轻轻摇曳,给人一片自然恬静的感觉.他们的绿化理念是"推开窗户就能见到绿色",努力营造一种与绿色没有距离的氛围,绿色环境不只是窗外的一幅画,而是让患者从视觉、嗅觉、听觉上与绿色融为一体.