The cost of health care and health insurance in Australia: some problems associated with the fee-for-service system

This paper reviews the health care system and the supporting health insurance framework in Australia. The importance of the health insurance mechanism is stressed in relation to the maintenance and growth of private fee-for-service medicine. The Medical Benefits Schedule, which is the negotiated basis for medical fees under insurance, is examined for the logic implicit in the fee structure. The high rewards for procedural medicine relative to consulting are suggested as part of the basis of the rapid growth in hospital admissions. It is also argued that the refund schedule has helped to determine the nature of the medical specialist manpower pool. Other problems associated with the complex nature of the refund schedule, such as fraud and wasteful over-servicing, are identified and discussed. It is asserted that the health insurance system and refund schedule are partly determining the nature of medical service provision and inducing inequities in the financing and delivery of medical care in Australia.     

Natural anticarcinogens, carcinogens, and changing patterns in cancer: some speculation

Over the past two decades, marked shifts have occurred in cancer mortality in the United States, the United Kingdom, and the Federal Republic of Germany. Stomach cancer mortality has declined sharply, while brain cancer and multiple myeloma increased nearly twofold for persons ages 75 to 84. Total cancer incidence in the United States, excluding lung cancer, has risen 27% since 1950, adjusted to the aging of the population. The origins of these trends are not known. The diet in the developed countries includes a number of naturally occurring, powerful anticarcinogens and carcinogens. To evaluate the role of these substances in the prevention and causation of human cancer, this paper reviews existing toxicologic and epidemiologic data. These data indicate that naturally occurring substances in food influence cancer initiation, promotion, progression, and demotion by a number of mechanisms, including (1) covalent binding to DNA of naturally occurring anticarcinogenic compounds to block the initiation of carcinogenesis; (2) induction of biotransforming enzymes such as cytochrome P450 and mixed-function oxidase (MFO) which can reduce carcinogenicity; (3) inhibition of tumor promotion by compounds such as retinol, tocopherol, and organosulfates found in garlic, onions, fruits, and vegetables; and (4) physical alteration of carcinogens by food constituents or by food preparation and handling so as to alter carcinogenicity. Systems have been proposed for estimating the relative ranking for humans of individually tested, experimental carcinogens, including some constituents of food. While qualitatively useful, such systems as the HERP Index do not take into account important interactions among naturally occurring and synthetic constituents in foods, nor do they permit examination of the possible role of evolved resistance. Common mixtures in food must be tested for carcinogenicity in human tissue cultures and in long-term rodent bioassays. Such studies need to examine whether the action of synthetic organic carcinogens may be inhibited by potent naturally occurring anticarcinogens.     

离子色谱在环境、食品及生化分析中的应用

离子色谱(IC)是高效液相色谱(HPLC)的一种。离子色谱已经成为无机阴离子和部分有机离子的最主要的分析方法。应用的范围也从常规无机阴、阳离子分析发展到对更复杂的有机化合物分析。离子色谱是目前同时测定多种阴离子的快速、灵敏而准确的分析手段。其应用已经渗透到众多的领域。分析的对象已经从开始阶段仅仅分析水中常见阴、阳     

Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum

OBJECTIVE: To identify dietary patterns in women who are planning immediate pregnancy in preconception, weeks 6, 10, 26 and 38 of pregnancy, and 6 months postpartum, and to describe how particular lifestyles, the body mass index (BMI) and sociodemographic factors are associated to these patterns. DESIGN: Longitudinal study throughout the reproductive cycle of food consumption carried out in a Spanish Mediterranean city. SETTING: Faculty of Medicine and Health Sciences, Rovira i Virgili University. SUBJECTS: In total, 80 healthy female volunteers who were planning immediate pregnancy. INTERVENTIONS: A seven-consecutive-day dietary record was used to evaluate the dietary intake. Exploratory factor analysis was used to identify the main dietary patterns in each of the periods. Fitted multiple linear regression models were used to study the associations between the lifestyle and sociodemographic variables, and each dietary pattern. RESULTS: The 'sweetened beverages and sugars' pattern was identified from preconception to 6 months postpartum and the 'vegetables and meat' pattern to the end of pregnancy. The 'sweetened beverages and sugars' pattern is positively associated with smoking and negatively associated with physical activity before conception and in the first trimester of pregnancy. The 'vegetables and meat' pattern is negatively associated with the BMI during the preconception period and positively associated with age in weeks 10 and 38 of pregnancy. It is shown that the patterns do not change significantly throughout the period studied. CONCLUSIONS: We have identified two stable dietary patterns from preconception to postpartum. The 'sweetened beverages and sugars' pattern is associated with habits of risk for the health of the pregnant woman and her offspring. SPONSORSHIP: 'Comisión Interministerial de Ciencia y Tecnología' (CICYT: ALI89-0388) and 'Instituto de Salud Carlos III', RCMN (C03/08), Madrid, Spain'.     

Drinking patterns and problems in emergency services in Poland

AIMS: To examine drinking patterns and problems in emergency services in Poland, where both alcohol consumption and the health care system have undergone enormous recent change. METHODS: A probability sample of 734 emergency service patients was breathalyzed and interviewed in a large public hospital in Warsaw, Poland. RESULTS: 2.5% of the sample was breathalyzer positive; all were male and injured. Injured males were significantly more likely to report heavy problem drinking than non-injured, but no differences were found for females. Among injured males who reported drinking prior to the event, close to 50% reported feeling drunk, and over 75% attributed a causal association of their drinking with injury. CONCLUSIONS: These data point to substantial alcohol-involvement on the part of injured males in this population, and suggest emergency services may be a productive venue for identifying those patients who would benefit from a brief intervention.     

Polychlorinated biphenyls associated with fine particles (PM25) in the urban environment of Chile: concentration levels,and sampling volatilization losses

Polychlorinated biphenyls (PCBs) were measured in fine particles (PM25, particles smaller than 2.5 microm in diameter) collected in two urban areas of Chile, Santiago and Temuco, during August and October 1998. A diffusion denuder sampling system was used for the collection of 19 samples. The concentrations of total PCBs (47 congeners) ranged from 672 to 1,790 pg/m3 in the city of Temuco and from 1,159 to 2,750 pg/m3 in Santiago. These concentrations are moderately higher than those observed in other urban areas around the world. High amounts of PCBs may volatilize from fine particles during aerosols sampling using conventional high-volume samplers. Average volatilization losses, determined by the diffusion denuder system, varied between 54 and 97%, showing a strong dependence on partial pressure of individual PCB congeners and air temperature. Overall, our results suggest that measurements of PCBs in the particulate phase of the atmosphere, by using conventional high-volume samplers, might be significantly underestimated because of volatilization losses. The underestimation of PCB and other toxic semivolatile organic compound (SOC) levels associated with fine particles in the urban environment may have consequences to the estimation of health risk posed by inhalation.     

The eating patterns and problems of homeless women

While inadequate nutrition has been identified as a factor affecting the health of the homeless, there has been little research to identify the extent to which inadequate nutrition is a problem. The goal of this paper is to document the eating patterns and problems of single homeless women and to locate the determinants of nutritional adequacy in their diets. Our findings are based on a random sample of 84 single homeless women using hostels and drop-in centers. For 85.5% of the women food was provided primarily by hostels and supplemented by the drop-ins. When their daily food intake was compared to the Canada's Food Guide recommendations, the average number of servings in each of the four food groups was below the recommended. The women in our sample indicated that their problems with food consumption were rooted in their poverty and further analysis indicated that the provision of food by social agencies was an important factor in the nutritional adequacy of their diets. Hostels and drop-in centers not only provide shelter, they have also assumed most of the responsibility for feeding the homeless. It is their poverty which burdens these women and structures their eating patterns.     

Diversity, inequality and official data: some problems of method and measurement in Britain

This paper reviews the ways in which diversity and inequality are represented in the major sources of health data in Britain. It examines how identities linked to disability, ‘race’, class and sexuality are represented in official statistics and national surveys. The paper argues that (1) the methods of data-collection and data-analysis result in the exclusion of minority group experiences and (2) the measures of social position mask and misrepresent dimensions of inequality that the new social movements have sought to make visible. Illustrations of these processes are given.