Elemental mercury poisoning in occupational and residential settings

In its elemental form, mercury is the only metal that is in a liquid state at room temperature. It readily volatilizes at standard temperature and pressure, and its presence in open containers can result in biologically significant air concentrations in unventilated or poorly ventilated spaces. In recent years, elemental mercury has proven to be a potential source of toxicosis through either unintentional exposure or exposure resulting from inappropriate handling of liquid mercury acquired from school science laboratories or abandoned industrial facilities or warehouses. The shiny, silvery appearance of mercury in its liquid form makes it particularly enticing to children, and its insolubility in water and tendency to form beads when disturbed add to its mystique. This paper presents two case studies in which excessive exposure to elemental mercury vapor has resulted in adverse health effects in the exposed individuals: one in the workplace and one in a residential setting. These case studies serve to emphasize that primary care physicians, public health officials, and science educators need to recognize the potential risk posed by inhalation exposure to mercury vapors, and health practitioners need to be able to recognize the health signs and symptoms of such exposure. Public health professionals and those in charge of public and private education facilities should also be keenly aware of the necessity of prompt mitigation of human exposure should a spill or other mercury exposure scenario occur.     

浅析美国的孕前保健特点及对我国的启示

近年来,妇女孕前的健康状态被公认为是影响妊娠结局的重要因素之一,越来越多的国家开始关注孕前保健。本文从健康状况监测评估、健康教育与健康促进以及针对危险因素进行干预等3方面分析总结了美国孕前保健的现状及特点。在此基础上结合我国孕前优生项目的管理和实施状况,提出以下建议:一要强化政府职责、建立长效机制,二要依托计划生育服务网络体系,三要开展具有针对性的服务,四要拓展服务内涵。     

Macrolide-Resistant Mycoplasma pneumoniae,United States

Macrolide-resistant Mycoplasma pneumoniae (MRMP) is highly prevalent in Asia and is now being reported from Europe. Few data on MRMP are available in the United States. Using genotypic and phenotypic methods, we detected high-level MRMP in 13.2% of 91 M. pneumoniae­–positive specimens from 6 US locations.     

Migrating to electronic health record systems: A comparative study between the United States and the United Kingdom

The goal of this research is to compare the healthcare information technology (HIT)-related policies and infrastructures of two very differently-run countries: The United States (US) that owns the largest private healthcare system in the world, and the United Kingdom (UK) that has the largest public healthcare system worldwide. The paper specifically focuses on the differences between the two countries’ adoption of electronic healthcare record (EHR) systems, and their efforts toward interoperability, healthcare information security and privacy, and patient safety. Both authors on the paper are professionals in the HIT field and have firsthand experience designing and implementing electronic health record (EHR) systems. As a result, they both have a real-world grasp of HIT economics and the pressure of regulatory compliance. To complement their combined expertise and insight, the authors thoroughly reviewed the peer-reviewed and grey literature on healthcare policy. The paper’s findings suggest that although EHR implementation and adoption are on the rise in the US and the UK alike, both countries are facing considerable hurdles in executing their vision of establishing their respective nationwide EHR systems. To improve patient health and ensure patient safety, interoperability standards that enable seamless communication amongst differing healthcare systems and proper security and privacy regulations for data collection, data handling, and data sharing are paramount.     

The Impact of Funding Inpatient Treatments for COVID-19 on Health Equity in the United States: A Distributional Cost-Effectiveness Analysis

ObjectivesWe conducted a distributional cost-effectiveness analysis (DCEA) to evaluate how Medicare funding of inpatient COVID-19 treatments affected health equity in the United States.MethodsA DCEA, based on an existing cost-effectiveness analysis model, was conducted from the perspective of a single US payer, Medicare. The US population was divided based on race and ethnicity (Hispanic, non-Hispanic black, and non-Hispanic white) and county-level social vulnerability index (5 quintile groups) into 15 equity-relevant subgroups. The baseline distribution of quality-adjusted life expectancy was estimated across the equity subgroups. Opportunity costs were estimated by converting total spend on COVID-19 inpatient treatments into health losses, expressed as quality-adjusted life-years (QALYs), using base-case assumptions of an opportunity cost threshold of $150 000 per QALY gained and an equal distribution of opportunity costs across equity-relevant subgroups.ResultsMore socially vulnerable populations received larger per capita health benefits due to higher COVID-19 incidence and baseline in-hospital mortality. The total direct medical cost of inpatient COVID-19 interventions in the United States in 2020 was estimated at $25.83 billion with an estimated net benefit of 735 569 QALYs after adjusting for opportunity costs. Funding inpatient COVID-19 treatment reduced the population-level burden of health inequality by 0.234%. Conclusions remained robust across scenario and sensitivity analyses.ConclusionsTo the best of our knowledge, this is the first DCEA to quantify the equity implications of funding COVID-19 treatments in the United States. Medicare funding of COVID-19 treatments in the United States could improve overall health while reducing existing health inequalities.     

Prices for Innovative Pharmaceutical Products That Provide Health Gain: A Comparison Between Australia and the United States

ObjectivesPricing polices used in many countries are often viewed in the United States as a mechanism of price constraint. Support for this contention has arisen from pricing studies which demonstrate that the United States pays higher prices for many pharmaceutical products. No study to date, however, has examined the prices paid for pharmaceuticals that provide significant health gain, which might be expected to be lower where price constraints were operating. This study aimed to examine prices paid by federal government programs and agencies in Australia and the United States for pharmaceutical products that provide significant health gain.MethodsProducts identified by the US Food and Drug Administration and the Canadian Patented Medicines Prices Review Board as likely to confer significant health gains between 1999 and 2004 were identified. Australian and USfederal government prices ($US) and US average manufacturer prices (AMP), which do not include discounts or rebates, during the second quarter of 2006 were compared.ResultsOf 22 products for which comparisons were possible, Australian prices were higher than the US Federal Supply Schedule (FSS) prices for 14 (64%) products. When compared with AMP, Australian prices were higher for eight of the 22 products. Overall, Australian prices were higher on average by 4.2% when compared with the FSS and lower by 14.4% when compared with the AMP.ConclusionThese results suggest that Australian prices for medicines representing significant advances in therapy are similar to those paid under key US programs despite fundamental differences in policy contexts.     

Environmental Exposure and Fingernail Analysis of Arsenic and Mercury in Children and Adults in a Nicaraguan Gold Mining Community

Gold mining can release contaminants, including mercury, into the environment, and may increase exposure to naturally occurring elements such as arsenic. The authors investigated environmental and human tissue concentrations of arsenic and mercury in the gold mining town of Siuna, Nicaragua. The study involved 49 randomly selected households in Siuna, from whom a questionnaire along with environmental and fingernail samples were collected. Environmental samples indicated that mercury concentrations in drinking water, although generally low, were higher near the mine site. Arsenic concentrations were elevated in water and soil samples, but their distribution was unrelated to the mining site. Mercury concentrations in fingernail samples were correlated with residential proximity to the mine, drinking water concentrations, occupation, and, among children, with soil concentrations. Fingernail arsenic concentrations correlated with drinking water concentrations among adults who consumed higher levels, and with soil concentrations among children. Fingernail analysis helped to identify differential exposure pathways in children and adults. Mercury and arsenic uptake via soil exposure in children warrants further consideration.     

中美两国卫生部门管理虚假医疗广告的差异

通过分析美国虚假医疗广告的管理模式与我国在医疗广告的审准和医疗广告监督管理方面存在的差异,探讨卫生行政部门在虚假医疗广告管理中的责任,提出应加强对医疗虚假广告的事后检查和监督、发动消费者进行虚假医疗广告的监督、坚持严格的医疗广告事前管理,引导并组织建立独立的医疗广告自律机构,从而实现虚假医疗广告的有效管理。     

美国公共卫生绩效评价工具的研究进展及借鉴意义

评价工具是公共卫生绩效评价研究的重点内容。美国公共卫生学界在公共卫生绩效评价的理论框架和工具开发两个方面取得了较大的进展,形成了以公共卫生体系的概念模型、国家公共卫生绩效标准项目等为代表的重要成果。借鉴美国公共卫生绩效评价工具研究的经验,我国的公共卫生绩效评价研究应加强公共卫生体系研究的理论基础,并推动建立国家公共卫生绩效标准。     

Iodized Salt Sales in the United States

Iodized salt has been an important source of dietary iodine, a trace element important for regulating human growth, development, and metabolic functions. This analysis identified iodized table salt sales as a percentage of retail salt sales using Nielsen ScanTrack. We identified 1117 salt products, including 701 salt blends and 416 other salt products, 57 of which were iodized. When weighted by sales volume in ounces or per item, 53% contained iodized salt. These findings may provide a baseline for future monitoring of sales of iodized salt.     

Human Exposure and Health Effects of Inorganic and Elemental Mercury

Mercury is a toxic and non-essential metal in the human body. Mercury is ubiquitously distributed in the environment, present in natural products, and exists extensively in items encountered in daily life. There are three forms of mercury, i.e., elemental (or metallic) mercury, inorganic mercury compounds, and organic mercury compounds. This review examines the toxicity of elemental mercury and inorganic mercury compounds. Inorganic mercury compounds are water soluble with a bioavailability of 7% to 15% after ingestion; they are also irritants and cause gastrointestinal symptoms. Upon entering the body, inorganic mercury compounds are accumulated mainly in the kidneys and produce kidney damage. In contrast, human exposure to elemental mercury is mainly by inhalation, followed by rapid absorption and distribution in all major organs. Elemental mercury from ingestion is poorly absorbed with a bioavailability of less than 0.01%. The primary target organs of elemental mercury are the brain and kidney. Elemental mercury is lipid soluble and can cross the blood-brain barrier, while inorganic mercury compounds are not lipid soluble, rendering them unable to cross the blood-brain barrier. Elemental mercury may also enter the brain from the nasal cavity through the olfactory pathway. The blood mercury is a useful biomarker after short-term and high-level exposure, whereas the urine mercury is the ideal biomarker for long-term exposure to both elemental and inorganic mercury, and also as a good indicator of body burden. This review discusses the common sources of mercury exposure, skin lightening products containing mercury and mercury release from dental amalgam filling, two issues that happen in daily life, bear significant public health importance, and yet undergo extensive debate on their safety.     

Unintended pregnancy in the United States: incidence and disparities, 2006

Background

The incidence of unintended pregnancy is among the most essential health status indicators in the field of reproductive health. One ongoing goal of the US Department of Health and Human Services is to reduce unintended pregnancy, but the national rate has not been estimated since 2001.

Study Design

We combined data on women's pregnancy intentions from the 2006–2008 and 2002 National Survey of Family Growth with a 2008 national survey of abortion patients and data on births from the National Center for Health Statistics, induced abortions from a national abortion provider census, miscarriages estimated from the National Survey of Family Growth and population data from the US Census Bureau.

Results

Nearly half (49%) of pregnancies were unintended in 2006, up slightly from 2001 (48%). The unintended pregnancy rate increased to 52 per 1000 women aged 15–44 years in 2006 from 50 in 2001. Disparities in unintended pregnancy rates among subgroups persisted and in some cases increased, and women who were 18–24 years old, poor or cohabiting had rates two to three times the national rate. The unintended pregnancy rate declined notably for teens 15–17 years old. The proportion of unintended pregnancies ending in abortion decreased from 47% in 2001 to 43% in 2006, and the unintended birth rate increased from 23 to 25 per 1000 women 15–44 years old.

Conclusions

Since 2001, the United States has not made progress in reducing unintended pregnancy. Rates increased for nearly all groups and remain high overall. Efforts to help women and couples plan their pregnancies, such as increasing access to effective contraceptives, should focus on groups at greatest risk for unintended pregnancy, particularly poor and cohabiting women.     

Power and Persuasion in the Vaccine Debates: An Analysis of Political Efforts and Outcomes in the United States, 1998‐2012

Context

This article examines trends in state-level childhood vaccine policies in the United States from 1998 to 2012 and explains the trajectories for both vaccine-critical and proimmunization legislative efforts. Successful mobilization by vaccine critics during the height of the autism and thimerosal scares (roughly 1998 to 2003) yielded a few state-level expansions for the most permissive type of exemption from vaccine mandates for public school attendance, those based on personal beliefs. Vaccine-critical positions, however, have largely become discredited. How has vaccine critics’ ability to advance preferred policies and prevent the passage of unfavorable legislation changed over time?

Methods

We created a unique data set of childhood vaccine bills (n = 636), introduced from 1998 to 2012 across the 50 state legislatures, and coded them by type of effort (exemption, mandate, mercury ban, and information policies) and outcome. We then mapped out the trends in vaccine policies over time. In order to contextualize the trends we identified, we also reviewed numerous primary sources and conducted interviews with stakeholders.

Findings

In general, we found that vaccine critics’ legislative success has begun to wane. In only 20 bills in our data set were vaccine critics able to change policy in their preferred direction via the legislative process. Only 5 of those wins were significant (such as obtaining a new philosophical exemption to vaccine mandates), and the last of these was in 2007. Critics were more successful at preventing passage of proimmunization legislation, such as mandates for the human papillomavirus (HPV) vaccine.

Conclusions

Recent legislation in California, Oregon, and Washington that tightened philosophical exemptions by means of informational requirements suggests that vaccine politics may be entering another phase, one in which immunization supporters may be able to counter increasing opt-out rates, particularly in states with recent outbreaks and politicians favoring science-based policies.     

美国长期照护服务体系对中国的启示

本文综述了美国长期照护服务体系的服务机构、服务方式和服务提供者及其角色。美国长期照护服务机构可提供长期入住照护、短期入住照护、成人日间照护及居家照护服务,服务方式逐渐从机构服务向居家与社区服务转变。长期照护服务由正式照料者和非正式照料者共同提供,正式照料者提供有偿服务,非正式家庭照料者以女儿(29.3%)和配偶(21.2%)为主,随着居家和社区服务可用性增加,家庭照料者与有偿的正式照料者分担长期照护的可能性更大。美国长期照护服务体系结构完善,准入机制严格且系统,强调服务质量和效果评价,且重视老年人个人意愿,尊重其服务偏好和选择权利。基于美国的经验,我国在探索长期照护服务体系时,应以居家和社区照护为主,充分发挥社区卫生服务机构、社会和家庭的力量,注重服务机构和内容的多样化,建立完善和详细的服务使用评估标准,强调服务质量的有效性评价,体现人性化。     

Occupational and environmental medicine in the United States

The history and the current status of occupational and environmental medicine (OEM) research, educational resources, clinical practice patterns, and regulatory framework in the United States are reviewed. Current or anticipated changes in health-care financing, clinical practice patterns, occupational safety and health regulations and enforcement, and funding for research and medical education at the national level are already having an impact on OEM activities in this country. Received: 8 October 1997 / Accepted: 16 October 1997