Housing policy and aging--staying as long as possible in personal housing?

Housing elderly residents is a major concern in all European countries. The topic of this article is the development of a new preventive approach to housing older people in Denmark based on a comparative analysis of elderly people's needs and wishes to housing in old age carried out in 1996-97 for the Danish Council on Housing of the Elderly. The former well-established slogan "stay in your home as long as possible" will gradually be replaced by the new slogan "Move in time, while you can--and before others decide for you". About one-fifth of the present 60-year olds are looking for another living environment for ageing. This calls for a diversity in housing provision. A preventive policy should take into account a much needed mobility within the housing sector, the reduction of public expenditure by providing adequate housing suited for persons with disability and the rapid increase in the number of seniors who will in 15 years' time demand that their needs and wishes should be met.     

Does obesity contribute as much to morbidity as poverty or smoking?

The prevalence of obesity is increasing in America, but its impact on morbidity relative to other health risks is unclear. This paper compares the effects of overweight, poverty, smoking and problem drinking on occurrence of chronic conditions and health-related quality of life. The data were collected from a nationally representative household telephone survey of 9585 adults fielded in 1998, using self-reported measures of height and weight, poverty, smoking status, problem drinking, chronic conditions and SF-12 global scales. Regression analyses were used to estimate effects of health risk factors on morbidity. Thirty-six percent of adults are overweight but not obese (25< or =BMI<30) and another 23% are obese (BMI> or =30). Controlling for demographics, obesity is associated with more chronic conditions and worse physical health-related quality of life (P<0.01). Smoking history and poverty predict having chronic conditions, but their effect sizes are significantly smaller. Even after controlling for chronic conditions, obesity predicts physical health-related quality of life, in that case with an effect size similar to poverty. The effect of problem drinking is always smaller. Obesity is highly prevalent and associated with at least as much morbidity as are poverty, smoking and problem drinking. Nevertheless, the latter have achieved more consistent attention in recent decades in clinical practice and public health policy.     

The genetic conception of health: is it as radical as claimed?

The so-called new genetics is widely predicted to radically transform medicine and public health and deliver considerable benefits in the future. This article argues that, although it is doubtful that many of the promised benefits of genetic research will be delivered, an increasingly pervasive genetic worldview and expectations about future genetic innovations are profoundly shaping conceptions of health and illness and priorities in healthcare. Further, it suggests that debates about the normative and justice implications of new genetic technologies thus far have been constrained by bioethics discourse, which has tended to frame questions narrowly in terms of how best to ensure the protection and promotion of the rights and freedoms of the individual. Sociologists and other social scientists can help broaden debate in this field by exposing the assumptions underlying the genetic conception of health and exploring the implications of associated developments.     

Productivity costs before and after absence from work: as important as common?

Traditionally, production losses are estimated using the human capital or friction cost method. These methods base estimations of productivity costs on data on absence from work. For some diseases, like migraine, productivity losses without absence are occasionally calculated by estimating the production losses from reduced productivity at work. However, diseases typically only associated with absence may also be expected to cause reduced productivity before and after absence. In a previous study, Brouwer et al. concluded that productivity losses without absence are also very relevant in common diseases, like influenza, common cold or neck-problems. Studying a new sample of employees of a Dutch trade-firm (n = 51), who completed the questionnaire 'Ill and Recovered' upon return to work after absence due to illness, it was revealed that about 25% of the respondents experienced production losses before absence and about 20% of the respondents experience production losses after absence. This leads to an increase in estimated production losses of about 16% compared with only considering absence data. Current productivity costs estimates based solely on absence data may, therefore, underestimate real productivity costs. Compensation mechanisms in firms may reduce the underestimation.     

Pediatric emergencies in the office: are family physicians as prepared as pediatricians?

OBJECTIVE: Our objective was to assess the occurrence of pediatric emergencies in the offices of family physicians and pediatricians, the preparedness to respond, and the perceived importance of being prepared. STUDY DESIGN: We performed a cross-sectional random mail survey of physicians. POPULATION: Surveys were sent to 187 family physicians and 129 pediatricians practicing in North Carolina with 75% and 86% response rates, respectively. The 169 total respondents were in community practices regularly treating children and were included for analysis. OUTCOMES MEASURED: We measured the incidence of 8 types of pediatric emergencies, the availability of 11 items for resuscitation and stabilization, whether the physician had Pediatric Advanced Life Support (PALS) training in the previous 2 years, whether the office ever conducted a mock emergency, and beliefs about the importance of preparing for and providing emergency care to children. RESULTS: Six types of pediatric emergencies were seen in one third or more of all practices during the year. The average practice saw 4 or more pediatric emergencies in a year (family physicians = 3.8 vs pediatricians = 4.9, P <.001). Family physicians had fewer resuscitation and stabilization items than pediatricians (5.7 vs 8.6 items, P <.001) and were less prepared in terms of PALS training (19% vs 51%, P <.001). Those with PALS training were more likely to have an intraosseous needle and Broselow tape and to have conducted a mock code. Family physicians considered it is less important than pediatricians to provide such care or to be prepared to do so. CONCLUSIONS: Pediatric emergencies in the office are likely for either specialty. Family physicians may be less prepared, and they discount the importance of the problem and need for preparation.     

Patient education services as oppressor?

The education provided to women patients has been used historically to deliver messages of social and medical control. I suggest ethical standards of practice to tilt the balance toward use of education to serve women's perceived needs. Specific steps include standards and guidelines that specifically address appropriate gender differences in educational messages, regular elicitation from women of educational needs and satisfaction with educational services, and research that specifically tests the impact of patient education services on women and on men. More broadly, patient education must be legitimated as an essential service for which providers and institutions are accountable, and the predominately nonphysician providers who deliver it must be empowered to challenge current practice. Current work on health care as a gendered system suggests that patient education practice can rid itself of only some of the gender bias that exists.