Encounters with unemployment in occupational health care: Nurses' constructions of clients without work

This study explores occupational health nurses' encounters with unemployed clients in Finland. It involved setting up and evaluating a new service, Career Health Care, that resembled occupational health care, except that clients were recruited from among job seekers who were participating in one of three active labour market policy measures: vocational training, subsidised employment in the public sector, or participatory training for entering the labour market. Our main interest focused on nurses' perceptions of the unemployed and their professional practices in the context of Career Health Care. The analysis revealed four overlapping discourses with regard to clients: the client as a casualty of unemployment, the client as unemployed but active, the client as a deviant in the labour market, and the client as a skilled user of the system. Each discourse had implications for professional practice. The risk of negative stereotyping and consequent exclusion from services is discussed here. In conclusion, we stress the complexity of providing health services that can match the increasing diversity of contemporary labour market trajectories.     

Characteristics of health impact assessments reported in Australia and New Zealand 2005–2009

Objective : To describe the use and reporting of Health Impact Assessment (HIA) in Australia and New Zealand between 2005 and 2009. Methods : We identified 115 HIAs undertaken in Australia and New Zealand between 2005 and 2009. We reviewed 55 HIAs meeting the study's inclusion criteria to identify characteristics and appraise the quality of the reports. Results : Of the 55 HIAs, 31 were undertaken in Australia and 24 in New Zealand. The HIAs were undertaken on plans (31), projects (12), programs (6) and policies (6). Compared to Australia, a higher proportion of New Zealand HIAs were on policies and plans and were rapid assessments done voluntarily to support decision‐making. In both countries, most HIAs were on land use planning proposals. Overall, 65% of HIA reports were judged to be adequate. Conclusion : This study is the first attempt to empirically investigate the nature of the broad range of HIAs done in Australia and New Zealand and has highlighted the emergence of HIA as a growing area of public health practice. It identifies areas where current practice could be improved and provides a baseline against which future HIA developments can be assessed. Implications: There is evidence that HIA is becoming a part of public health practice in Australia and New Zealand across a wide range of policies, plans and projects. The assessment of quality of reports allows the development of practical suggestions on ways current practice may be improved. The growth of HIA will depend on ongoing organisation and workforce development in both countries.     

Effective professional practice: protocol for a systematic review of health professionals' management of obesity

While much attention has been paid to interventions to help overweight and obese people lose weight, relatively little is known about the contribution of health professionals to obesity reduction. As in other clinical areas, variations in the provision of health care for overweight and obese people may affect health outcomes. In this area in particular, there is reason to believe that practice may be adversely affected because of some providers' negative attitudes towards the patient group.
This work aims to identify strategies that are effective in improving health professionals' management of obesity or the delivery of health care services for overweight and obese people. In contrast to recent systematic reviews of patient-targeted approaches, this review focuses specifically on interventions designed to improve health professionals' practice. It is undertaken in association with the Cochrane Effective Practice and Organisation of Care (EPOC) Group. The protocol for this review is described.     

Social capital in its place: using social theory to understand social capital and inequalities in health

Social capital has been controversially linked to public health benefits, particularly as an explanation for the relationship between economic inequalities and health. This paper focuses on social capital in this context, particularly a recent emphasis on social capital in neighbourhoods and growing use of Bourdieu's social theory in empirical investigations. A review of some of this work is used to suggest the need for a more coherent theoretical approach to using Bourdieu and to introduce an ethnographic study of social connections in New Zealand. Forty-six residents of, a rural town, a deprived city suburb, or an affluent suburb, volunteered to be interviewed about their social connections. Their talk was transcribed and analysed in terms of everyday practice. The results of this study suggest that social connections are not necessarily located in neighbourhoods, and that social capital will be better understood in a broader social context which includes competition for resources between deprived and non-deprived groups, and the practices of all citizens across neighbourhoods. When considering social capital, an exclusive focus on deprived neighbourhoods as sites for research and intervention is not helpful.     

Retrofitting houses with insulation to reduce health inequalities: aims and methods of a clustered, randomised community-based trial

This paper describes the purpose and methods of a single-blinded, clustered and randomised trial of the health impacts of insulating existing houses. The key research question was whether this intervention increased the indoor temperature and lowered the relative humidity, energy consumption and mould growth in the houses, as well as improved the health and well-being of the occupants and thereby lowered their utilisation of health care. Households in which at least one person had symptoms of respiratory disease were recruited from seven predominantly low-income communities in New Zealand. These households were then randomised within communities to receive retrofitted insulation either during or after the study. Measures at baseline (2001) and follow-up (2002) included subjective measures of health, comfort and well-being and objective measures of house condition, temperature, relative humidity, mould (speciation and mass), endotoxin, beta glucans, house dust mite allergens, general practitioner and hospital visits, and energy or fuel usage. All measurements referred to the three coldest winter months, June, July and August. From the 1352 households that were initially recruited, baseline information was obtained from 1310 households and 4413 people. At follow-up, 3312 people and 1110 households remained, an 84% household retention rate and a 75% individual retention rate. Final outcome results will be reported in a subsequent paper. The study showed that large trials of complex environmental interventions can be conducted in a robust manner with high participation rates. Critical success factors are effective community involvement and an intervention that is valued by the participants.     

Environmental justice and health: a study of multiple environmental deprivation and geographical inequalities in health in New Zealand

There is an increasing interest in the unequal socio-spatial distribution of environmental ‘goods’ and ‘bads’ and the associated implications for geographical inequalities in health. Until recently, research in this area has focused on solitary environmental characteristics and has been hindered by the absence of geographically-specific measures that recognise the multifactorial nature of the physical environment. However, recent work in the United Kingdom has developed an area-level multivariate index of health-related physical environmental deprivation that captures both pathogenic and salutogenic environmental characteristics. Applications of this index have demonstrated that, at the national level, multiple environmental deprivation increased as the degree of income deprivation rose. Further, after adjusting for key confounders, there was a significant association between multiple environmental deprivation and the health outcomes of local residents. In the current study we tested the methods developed in the UK to create the New Zealand Multiple Environmental Deprivation Index (NZ-MEDIx) for small areas across the country (n = 1860). We considered whether socially disadvantaged places in New Zealand had higher levels of multiple environmental deprivation, and if environmental disadvantage exerted an influence on health after adjustment for key confounders such as socioeconomic status. We found that although neighbourhoods with higher levels of multiple environmental deprivation tended to have greater social disadvantage, this association was not linear. Further, multiple environmental deprivation tended to exert a modest effect on health that was independent of the age, sex and socioeconomic structure of the population. These findings demonstrate that it is possible to develop an index of multiple environmental deprivation in an alternative national context which has utility in epidemiological investigations.     

Measuring health system performance: A new approach to accountability and quality improvement in New Zealand

In February 2014, the New Zealand Ministry of Health released a new framework for measuring the performance of the New Zealand health system. The two key aims are to strengthen accountability to taxpayers and to lift the performance of the system's component parts using a ‘whole-of-system’ approach to performance measurement. Development of this new framework – called the Integrated Performance and Incentive Framework (IPIF) – was stimulated by a need for a performance management framework which reflects the health system as a whole, which encourages primary and secondary providers to work towards the same end, and which incorporates the needs and priorities of local communities. Measures within the IPIF will be set at two levels: the system level, where measures are set nationally, and the local district level, where measures which contribute towards the system level indicators will be selected by local health alliances. In the first year, the framework applies only at the system level and only to primary health care services. It will continue to be developed over time and will gradually be extended to cover a wide range of health and disability services. The success of the IPIF in improving health sector performance depends crucially on the willingness of health sector personnel to engage closely with the measurement process.     

我国青少年健康素养基于性别差异的Meta分析

系统评价性别与我国青少年健康素养的关系,为提高我国青少年健康素养提供科学的循证依据.方法 利用计算机检索中国知网、万方、维普、中国生物医学文献数据库等,检索词为主题/篇名/关键词/摘要(初中生/学生/高中生/大学生/青少年/新生)and健康素养.应用Meta Analyst Beta 3.13软件对符合纳入标准的文献进行Meta分析,检索时间至系统更新到2014年6月.结果 共纳入11篇文献,总体健康素养应用固定效应模型分析,其效应值为OR=0.920,95% CI=0.843 ~1.004.在基本技能方面、科学健康观方面男生要优于女生,效应值分别为OR=0.875,95% CI=0.776~0.987;OR=0.539,95% CI=0.471~0.617.而在健康方式与行为、基本知识和理念及传染病预防、慢性病预防、基本医疗及安全与急救方面性别间差异无统计学意义.结论 应针对不同性别青少年特征进行有针对性的健康教育,提高青少年健康素养.     

Health-related quality of life: gender differences in childhood and adolescence

Summary. Objectives: To assess whether gender and age differences can be found in different aspects of health-related quality of life (HRQOL) of children and adolescents, and to what extent these results correspond to theoretical and empirical findings from developmental psychology. Methods: A newly developed HRQOL questionnaire was completed by 3 710 youths aged nine to 17 years in seven European countries. The “Kidscreen 52” questionnaire consists of 10 scales operationalising aspects of the physical, psychological and social dimensions of HRQOL. With the use of ANOVA and effect sizes, the influence of age and gender on aspects of HRQOL is reported. Results: Children report a very good quality of life largely independent of gender. After 12 years, HRQOL decreases in the majority of aspects. In the physical and psychological dimensions, a stronger decrease is found for females than for males. Conclusions: Children have higher HRQOL than adolescents in many aspects. With increasing age, HRQOL is frequently worse for females than for males. Examination of the individual aspects leads to a differentiation of the results with relevance for public health.

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Zusammenfassung. Gesundheitsbezogene Lebensqualit?t: Geschlechtsunterschiede in Kindheit und Jugend Fragestellung: Die Studie geht der Frage nach, in welchen Aspekten der gesundheitsbezogenen Lebensqualit?t (HRQOL) von Kindern und Jugendlichen Geschlechts- und Altersunterschiede zu finden sind und wie weit sie damit theoretischen und empirischen entwicklungspsychologischen Erkenntnissen entsprechen. Methode: Ein neu entwickelter HRQOL-Fragebogen wurde von 3 710 Kindern und Jugendlichen von neun bis 17 Jahren aus sieben europ?ischen L?ndern beantwortet. Der “Kidscreen 52”-Fragebogen besteht aus 10 Skalen, welche Aspekte der physischen, psychischen und sozialen Dimensionen der HRQOL operationalisieren. Der Einfluss von Alter und Geschlecht auf die verschiedenen HRQOL-Aspekte wird mit Hilfe von ANOVA und Effektst?rken detailliert berichtet. Ergebnisse: Kinder bis zum Alter von etwa 12 Jahren berichten weitgehend unabh?ngig vom Geschlecht über eine sehr gute Lebensqualit?t. Danach sinkt die Lebensqualit?t in der Mehrheit ihrer Aspekte. In der k?rperlichen und psychischen Dimension ist für die weiblichen Jugendlichen eine st?rkere Abnahme zu beobachten als für die m?nnlichen Jugendlichen, was bei den ?lteren Jugendlichen zu einem bedeutend weniger guten Befinden der jungen Frauen führt. Schlussfolgerung: Die HRQOL von Kindern ist in vielen Aspekten h?her als jene der Jugendlichen, mit zunehmendem Alter ist die HRQOL von weiblichen Jugendlichen h?ufig weniger gut als jene der m?nnlichen Jugendlichen. Eine Betrachtung der einzelnen Aspekte führt zu einer Differenzierung der Ergebnisse mit konkreter Relevanz für Public Health.

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Résumé. Qualité de vie en lien avec la santé: différences entre les sexes chez les enfants et les adolescents Objectifs: Analyser l’effet du genre et de l’age sur différents aspects de la qualité de vie en lien avec la santé (HRQOL). Voir dans quelle mesure ces résultats correspondent à des connaissances théoriques et empiriques issues de la psychologie développementale. Méthodes: 3 710 enfants et adolescents de neuf à 17 ans de sept pays européens ont répondu à un questionnaire indiquant la HRQOL. Cet instrument, ?Kidscreen 52?, se compose de 10 échelles qui mesurent des aspects des dimensions physiques, psychiques et sociales de la HRQOL. L’influence de l’age et du sexe sur les différents aspects de HRQOL est analysée à l’aide de ANOVA. Résultats: Les enfants rapportent une qualité de vie très bonne jusqu’à l’age de 12 ans environ, indépendamment du sexe. Ensuite la qualité de vie baisse. En ce qui concerne les aspects physiques et psychiques, une diminution plus forte est observée chez les jeunes femmes que chez les jeunes hommes. La qualité de vie est ensuite nettement moins bonne chez les jeunes femmes plus agées. Conclusion: La HRQOL des enfants est globalement meilleure que celle des adolescents. Avec l’age, la HRQOL est fréquemment moins bonne pour les jeunes femmes que pour les jeunes hommes. Il faut tenir compte de ces différents aspects pour des actions de santé publique.

     

孕妇学校健康教育对母婴健康的影响

目的:探讨孕妇学校健康教育对母婴健康的重要作用。方法:选取在孕妇学校接受过健康教育的产妇160例为实验组,并选取同期未进行健康教育的150例产妇为对照组,进行对照分析。结果:就妊娠结局、顺产率、剖宫产率、母乳喂养成功率和母婴患病情况等方面进行比较,差异有统计学意义(P0.01)。结论:开展孕妇学校健康教育在提高孕产妇的自我保健意识、降低剖宫产率、提高纯母乳喂养率和保障母婴健康等诸方面有重要现实意义。     

School differences in adolescent health and wellbeing: Findings from the Canadian Health Behaviour in School-aged Children Study

The goal of this study was to assess the relationship between student- and school-level factors and student health and wellbeing outcomes, and to estimate the variability present at each of the student and school levels for each of three selected health-related outcomes.     

The pervasive effects of racism: experiences of racial discrimination in New Zealand over time and associations with multiple health domains

Self-reported experience of racial discrimination has been linked to a range of health outcomes in various countries and for different ethnic groups. This study builds on previous work in New Zealand to further investigate the prevalence of self-reported experience of racial discrimination by ethnicity, changes over time and associations with multiple health measures. The study uses data from the 2002/03 (n=12,500) and 2006/07 (n=12,488) New Zealand Health Surveys, nationally representative population-based surveys of adults (15+ years). Reported experience of racial discrimination was measured in both surveys and covered 5 items: experience of an ethnically motivated physical or verbal attack; and unfair treatment because of ethnicity by a health professional, in work, or when gaining housing. Ethnicity was classified as Maori, Pacific, Asian or European. Health indicators included measures of: mental health (SF36 mental health scale, psychological distress, doctor diagnosed mental health condition); physical health (self-rated health, SF36 physical functioning scale, cardiovascular disease); and health risk (smoking, hazardous drinking, excess body fat). Logistic regression was used to examine changes in prevalence of reported experience of racial discrimination over time and associations with health. Reported experience of racial discrimination increased between 2002/03 (28.1% ever) and 2006/07 (35.0% ever) among Asian peoples but remained largely unchanged for other ethnic groupings (Maori 29.5%, Pacific 23.0%, European 13.5%). Experience of racial discrimination was associated with all negative health measures except excess body fat. Where there were significant associations, a dose-response relationship was also evident. We conclude that racial discrimination experienced across a range of settings has the potential to impact on a wide range of health outcomes and risk factors. While ongoing research is needed to understand the multifarious nature of racism and the pathways by which it leads to poor health, it is feasible to monitor experiences of racial discrimination in national surveys.     

Residential instability during adolescence and health and wellbeing in adulthood: A longitudinal outcome-wide study

Although prior research suggests that residential instability during adolescence can have long-term impacts on health and wellbeing, few studies have identified a robust comparison group and considered a broad set of outcomes. To address these knowledge gaps, we examined the associations between residential instability during adolescence and a wide range of adult health and wellbeing outcomes using an outcome-wide design in the National Longitudinal Study of Adolescent to Adult Health. We defined residential instability as two or more moves between Waves I and II (ages 13–18 years). We assessed outcomes at ages 33–43 years (Wave V) in nine domains: biomarkers, physical health, health behaviors, psychological distress, psychological wellbeing, social behaviors, social wellbeing, trauma/victimization, and socioeconomic attainment. Results of doubly-robust targeted maximum likelihood estimation, adjusting for pre-exposure values of the outcome variables and cofounders (Wave I), showed little evidence of an association for certain outcomes, all of which disappeared after accounting for multiple comparisons. Our results suggest that residential instability in adolescence does not lead to worse health and wellbeing in adulthood, but rather, outcome differences between groups are due to pre-existing differences prior to residential instability in adolescence.     

镇江市中小学生营养与健康状况分析

目的 分析镇江市中小学生营养健康状况，为采取有效干预措施及制订相关营养策略提供科学依据。方法 整群收集1998～2003年镇江市城区中小学生健康体检资料，用SPSS11．0软件进行统计分析。结果 6年来营养不良率（以轻度为主）、肥胖率分别为28．15％、11．33％；营养不良呈下降趋势、肥胖呈上升趋势；贫血率平均为22．77％，贫血主要发生在12～16岁；男生及高中、初中学段高血压率具有逐年增高趋势；视力低下率女生〉男生，小学〈初中〈高中，差异均具有显著意义。肺活量呈逐年下降趋势。结论 中小学生营养健康问题不容忽视，应针对性地采取综合预防控制措施。     

Discourses of disease: representations of tuberculosis within New Zealand newspapers 2002-2004

This paper critically examines the ways that tuberculosis (TB) has been represented in the print media in New Zealand over recent years (2002-2004). Our broad contention is that, notwithstanding its biomedical reality, TB is socially constructed by, and through, human experience. Further, public health practitioners depend, to a large extent, on the media to alert the public to threats of disease and opportunities for protection. However, the messages conveyed are sometimes neither helpful nor accurate. In our analysis of TB coverage in three major daily newspapers in New Zealand, we enumerate and classify references to the disease, as well as undertake a discursive analysis of the revealed themes. Of the 366 texts we retrieved in the database search, we selected 120 for in-depth analysis. Our examination indicated the importance of bovine TB within the national consciousness, the stigmatised character of TB and the association between TB and immigrants. We observe that newspaper 'stories' in general, and commentaries by public health officials in particular, are invariably offered on a 'case by case' basis. We conclude that this specificity in time and place avoids more challenging discourses linking TB with deeply embedded determinants of health such as the strong link between TB and poverty.     

Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong

Purpose: To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes.

Methods: A cross-sectional questionnaire survey of 3355 participating secondary school students (response RATE = 98%).

Results: Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care.

Conclusions: This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students’ attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers.     

"An integral part of the children's education": placing sun protection in Auckland primary schools

Links between ozone depletion, sun exposure and the incidence of melanoma in later life have focussed public health attention on risk management, including attempts to curtail children's exposure to sunlight. Schools are potentially valuable sites in sun protection efforts, as they may combine behavioural messages with protective environments. In this paper, we outline the sun-related attitudes and policies of a random sample of 20 Auckland primary schools, and situate them within the framework of the new public health. We observe that while the state requires schools to provide students with a safe environment, there is no explicit guidance on what this means in terms of sun protection. Accordingly, schools' responses vary according to the perceptions and priorities of individual principals. We conclude that while school spaces are being transformed through the public health focus on the risks of UV exposure, the neoliberal educational landscape in New Zealand appears ambiguous in its support for health promotion.