What are the health costs of uranium mining? A case study of miners in Grants,New Mexico

Abstract

Background:

Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny.

Objectives:

This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico.

Methods:

Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs.

Results:

Total health costs ranged from $2·2 million to $7·7 million per excess death. This amounts to between $22·4 million and $165·8 million in annual health costs over the 1955–1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185·4 miners per 100?000, with a range of 1419·8–2974·3 per 100?000.

Conclusions:

Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.     

What are the health costs of uranium mining? A case study of miners in Grants,New Mexico

Background:

Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny.

Objectives:

This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico.

Methods:

Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs.

Results:

Total health costs ranged from $2.2 million to $7.7 million per excess death. This amounts to between $22.4 million and $165.8 million in annual health costs over the 1955–1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185.4 miners per 100 000, with a range of 1419.8–2974.3 per 100 000.

Conclusions:

Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.     

Mobile Phone Technology: A New Paradigm for the Prevention,Treatment, and Research of the Non-sheltered “Street” Homeless?

Individuals experiencing homelessness have disproportionately high rates of health problems. Those who perceive themselves as having greater access to their social support networks have better physical and mental health outcomes as well as lower rates of victimization. Mobile phones offer a connection to others without the physical constraints of landlines and, therefore, may make communication (e.g., access to one’s social support networks) more feasible for homeless individuals. This, in turn, could lead toward better health outcomes. This exploratory study examined mobile phone possession and use among a sample of 100 homeless men and women who do not use the shelter system in Philadelphia, PA. Interviews were comprised of the Homeless Supplement to the Diagnostic Interview Schedule, a technology module created for this investigation, and the substance use and psychiatric sections of the Addiction Severity Index. Almost half (44%) of the sample had a mobile phone. In the past 30 days, 100% of those with mobile phones placed or received a call, over half (61%) sent or received a text message, and one fifth (20%) accessed the Internet via their mobile phone. Participants possessed and used mobile phones to increase their sense of safety, responsibility (employment, stable housing, personal business, and sobriety or “clean time”), and social connectedness. Mobile phones could potentially be used by public health/health care providers to disseminate information to the street homeless, to enhance communication between the street homeless and providers, and to increase access for the street homeless to prevention, intervention, and aftercare services. Finally, this technology could also be used by researchers to collect data with this transient population.     

Cough Sound Analysis: A New Tool for the Diagnosis of Asthma?

A method of computerized cough sound analysis is described.The sounds of nocturnal and post-exercise coughs from a childwith asthma were compared with those from a child without asthma.The spectrographic patterns of voluntary cough at rest fromthe two children were similar. The pattern seen after exercisefrom the asthmatic child was different from the resting coughbut similar to that seen during recorded nocturnal cough. Incontrast the post-exercise cough from the non-asthmatic childwas similar to the cough seen at rest. Refinement of this methodof cough sound analysis may be useful in the diagnosis of asthmain young children.     

A Preliminary Study of New Parents,Sleep Disruption,and Driving: A Population at Risk?

Background Drowsy driving is estimated to be a causal factor in 2–16 % of vehicular crashes. Several populations are reported to be at high risk for drowsy driving accidents, including shift workers, teenage drivers, medical residents, and pilots. Although new parents are known to have significant sleep disruption, no study has investigated vehicular accidents or near miss accidents in this population. Methods A preliminary cross-sectional, anonymous survey of parents who had given birth within the previous 12 months. Participants were asked about their sleep, including validated measures of sleep disruption, their driving patterns, and information about near miss traffic accidents and actual crashes. Results Overall, 72 participants were enrolled. A large proportion of participants had poor sleep including approximately 30 % with daytime sleepiness, 60 % with poor daytime function and two-thirds with poor sleep quality. The mean sleep duration was only 6.4 h. Although most participants drove <100 miles per week, 22.2 % reported at least one near miss accident and 5.6 % reported a crash. Sleep problems were more common in those with near miss accidents and actual crashes than in those without. Of note, poor sleep quality was associated with a sixfold increase in near miss accidents even after accounting for other factors. Conclusion Poor sleep is common in new parents and we provide preliminary evidence that sleep disruption in this population is associated with near miss motor vehicle accidents. Drowsy driving results in thousands of unnecessary serious injuries and fatalities each year; raising public awareness that new parents are a high-risk group is important.     

What is the evidence of the experience of having a fall across the life course? A qualitative synthesis

BackgroundAlleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived.ObjectiveTo address the question: what is the evidence of the experience of having a fall across the life course?MethodA qualitative evidence synthesis with key electronic databases searched from 1990 to 2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of ‘incidents’ related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations.ResultsThe initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors' systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults' perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit ‘Fear.’ Consequences are related to notions of ‘Control’ and ‘Social standing.’ Recovery work involves ‘Adaptation,’ ‘Implications,’ ‘Social standing’ and ‘Control.’ ‘Explanation’ is sought.ConclusionsHow and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.     

Is There a Role for the Family and Close Community to Help Reduce the Risk of Postpartum Depression in New Mothers? A Cross-Sectional Study of Turkish Women

OBJECTIVES: Postpartum depression is an important and under-diagnosed problem. The aims of this study were (1) to compare the prevalence of depressive symptomology in Turkish mothers who were 1-3 months postpartum with the prevalence of depressive symptomology in mothers who had not been pregnant for at least 1 year, (2) to identify risk factors associated with depression in both groups, and (3) to examine the effect of postpartum depression on breastfeeding by the mothers. DESIGN: Cross-sectional study SETTING: Well-baby clinic PARTICIPANTS: 326 women enrolled in January 2001; 163 were 1-3 months postpartum, and 163 had not been pregnant in the previous year. RESULTS: The prevalence of depressive symptomology in the postpartum and non-postpartum groups was 17% (28/163) and 24.5% (40/163), respectively; this was not statistically significant (P = 0.102). When we compared mean Beck Depression Inventory (BDI) scores, the difference between the two groups was statistically significant (10.75 +/- 8.06 and 12.63 +/- 8.81, respectively, P = 0.045). Premenstrual tension and a history of depression were risk factors for depressive symptomology in both groups. Three or more births and a history of induced abortion were risk factors for depressive symptomology in the non-postpartum group. In the postpartum group, the effect of depression on breast-feeding was not statistically significant (P = 0.7). The generalisability of the study results to the community is limited. CONCLUSION: In this study, the prevalence of depressive symptomology in the postpartum and non-postpartum groups did not show a significant difference, but the prevalence of depressive symptomology was high in both groups. Postpartum depression did not have a negative effect on breast-feeding. Lower BDI scores in the postpartum period may be the result of the protective factors of motherhood which is a respected status for women in populations where the preservations of traditions and customs are valued.     

Explicit guidelines for qualitative research: a step in the right direction, a defence of the 'soft' option, or a form of sociological imperialism?

Within the context of health service research, qualitative research has sometimes been seen as a 'soft' approach, lacking scientific rigour. In order to promote the legitimacy of using qualitative methodology in this field, numerous social scientists have produced checklists, guidelines or manuals for researchers to follow when conducting and writing up qualitative work. However, those working in the health service should be aware that social scientists are not all in agreement about the way in which qualitative work should be conducted, and they should not be discouraged from conducting qualitative research simply because they do not possess certain technical skills or extensive training in sociology, anthropology or psychology. The proliferation of guidelines and checklists may be off-putting to people who want to undertake this sort of research, and they may also make it even more difficult for researchers to publish work in medical journals. Consequently, the very people who may be in a position to change medical practice may never read the results of important qualitative research.     

Association of lifestyle,inflammatory factors,and dietary patterns with the risk of suffering a stroke: A case–control study

Background: Lifestyle, including dietary patterns, could involve specific factors participating in inflammation that confer a higher risk of suffering a stroke. However, little attention has been apparently given to habitual food consumption in patients suffering a cerebrovascular event.

Objective: To assess the influence of dietary habits as well as other lifestyle-related variables on the risk of suffering a stroke.

Design: A case–control study was designed. Fifty-one cases (age: 59.1?±?9.1y.o; BMI; 30.8?±?3.4?kg/m²) and 51 controls (age: 61.1?±?9.1y.o; BMI; 30.4?±?3.6?kg/m²) were enrolled in the study. Anthropometric and body composition variables were measured. Dietary information was obtained from a validated food frequency questionnaire. Physical activity and lifestyle-related factors were assessed. Blood samples were drawn.

Results: Patients suffering a stroke showed higher prevalence of diabetes (30 vs. 7.7%; P?=?0.020) and hypertension (74.5 vs. 40.3%; P?P?=?0.024) than controls. Patients registered worse glucose and lipid profiles, higher levels of hepatic biomarkers, and higher blood cell counts than controls. Stroked patients showed lower adherence to a statistically derived healthy dietary pattern than controls (23.5 vs. 42.3%; P?=?0.017). A logistic regression model was built up considering hypertension, diabetes, smoking, physical activity, adherence to a ‘healthy dietary pattern’ and C-reactive protein concentration. The final model strongly associated with the risk of suffering a stroke (R²: 44.6%; P_model?Conclusion: Lifestyle variables such as physical activity, smoking habit, and a dietary pattern including foods with low inflammatory potential play an important role in the reduction of the risk of suffering a stroke.     

Syndromic Surveillance from a Local Perspective – A Review of the Literature

Objective

Review of the origins and evolution of the field of syndromic surveillance. Compare the goals and objectives of public health surveillance and syndromic surveillance in particular. Assess the science and practice of syndromic surveillance in the context of public health and national security priorities. Evaluate syndromic surveillance in practice, using case studies from the perspective of a local public health department.

Introduction

Public health disease surveillance is defined as the ongoing systematic collection, analysis and interpretation of health data for use in the planning, implementation and evaluation of public health, with the overarching goal of providing information to government and the public to improve public health actions and guidance [1,2]. Since the 1950s, the goals and objectives of disease surveillance have remained consistent [1]. However, the systems and processes have changed dramatically due to advances in information and communication technology, and the availability of electronic health data [2,3]. At the intersection of public health, national security and health information technology emerged the practice of syndromic surveillance [3].

Methods

To better understand the current state of the field, a review of the literature on syndromic surveillance was conducted: topics and keywords searched through PubMed and Google Scholar included biosurveillance, bioterrorism detection, computerized surveillance, electronic disease surveillance, situational awareness and syndromic surveillance, covering the areas of practice, research, preparedness and policy. This literature was compared with literature on traditional epidemiologic and public health surveillance. Definitions, objectives, methods and evaluation findings presented in the literature were assessed with a focus on their relevance from a local perspective, particularly as related to syndromic surveillance systems and methods used by the New York City Department of Health and Mental Hygiene in the areas of development, implementation, evaluation, public health practice and epidemiological research.

Results

A decade ago, the objective of syndromic surveillance was focused on outbreak and bioterrorism early-event detection (EED). While there have been clear recommendations for evaluation of syndromic surveillance systems and methods, the original detection paradigm for syndromic surveillance has not been adequately evaluated in practice, nor tested by real world events (ie, the systems have largely not ‘detected’ events of public health concern). In the absence of rigorous evaluation, the rationale and objectives for syndromic surveillance have broadened from outbreak and bioterrorism EED, to include all causes and hazards, and to encompass all data and analyses needed to achieve “situational awareness”, not simply detection. To evaluate current practices and provide meaningful guidance for local syndromic surveillance efforts, it is important to understand the emergence of the field in the broader context of public health disease surveillance. And it is important to recognize how the original stated objectives of EED have shifted in relation to actual evaluation, recommendation, standardization and implementation of syndromic systems at the local level.

Conclusions

Since 2001, the field of syndromic surveillance has rapidly expanded, following the dual requirements of national security and public health practice. The original objective of early outbreak or bioterrorism event detection remains a core objective of syndromic surveillance, and systems need to be rigorously evaluated through comparison of consistent methods and metrics, and public health outcomes. The broadened mandate for all-cause situation awareness needs to be focused into measureable public health surveillance outcomes and objectives that are consistent with established public health surveillance objectives and relevant to the local practice of public health [2].     

Metastasis,the New “C Word”

Patients dealing with stage IV disease have historically been isolated and marginalized much as the cancer community was many years ago before the “coming out” of Betty Ford and Happy Rockefeller. Only recently has there been an attempt to rectify this stigmatization and to give voice to these patients. With this recognition comes the obligation to find venues to serve this population. This piece reviews this history and sets the stage for advocacy and program development.     

A Comparison of the Effects of the Opioid Antagonists Naltrexone,Naltrindole, and β-Funaltrexamine on Ethanol Consumption in the Rat

The effects of the universal opioid antagonist naltrexone were compared to the δ-selective opioid antagonist naltrindole and the μ-selective opioid antagonist β-funaltrexamine on ethanol consumption in the absence of food or fluid deprivation using a limited access procedure in Wistar rats. Both naltrexone, at doses of 0.1, 0.25, 0.5, 1.0, 3.0, and 10 mg/kg, and β-funaltrexamine, at doses of 5.0 and 20.0 mg/kg, significantly decreased consumption of a 6% ethanol solution compared to saline control groups. Naltrindole, at doses of 5.0 and 15.0 mg/kg, failed to significantly reduce ethanol consumption. In addition, the highest doses of naltrexone, which antagonize δ as well as μ-opioid receptors, did not differ significantly from the lowest doses in their ability to reduce ethanol consumption. These data suggest that ethanol consumption using the limited access paradigm in the outbred rat is modulated by μ rather than δ-opioid receptors. Although this is not consistent with other data showing that δ antagonists decrease ethanol consumption, it is suggested that these difference may be related to the alcohol-preferring rats used in those experiments.     

Does planning pay off? A look at the experience of New Mexico's rural hospitals

When Medicare's prospective payment system (PPS) was implemented, hospitals faced the prospect of diminishing reimbursement. Added to other fundamental changes involving medical practice, consumerism, competition, and medical technology, hospitals had significant incentives to focus more attention on strategic planning. This article examines how rural hospitals altered their strategic planning in response to PPS and the extent to which planning is related to better performance. It presents results from a case study of rural New Mexico hospitals. The implications of these results for other hospitals are discussed by the authors.     

Coverage of Posttraumatic Stress Disorder in the New York Times, 1950–2012

Posttraumatic stress disorder (PTSD) is a mental health disorder that occurs for some individuals following a traumatic experience and that can cause significant health, mental health, and functioning problems. The concept of PTSD has multiple components (cause, reactions, and treatment), which provides for great variety in the experience of an individual with PTSD. Given this complexity, the news media's construction of PTSD is likely an important influence in determining how the public understands PTSD, but research has yet to investigate how the news media depict PTSD. This study addresses that gap in the literature by examining New York Times coverage of PTSD from 1950 to 2012. Results indicate that the number of PTSD articles during this time period increased, with coverage spikes related to U.S. military conflicts and the September 11, 2001, terrorist attacks. Almost half (49.14%) of all PTSD articles included military service as a PTSD cause. Military PTSD articles were more likely than civilian PTSD articles to depict the disorder as causing anger/irritability/rage, homicide/violence/rape, suicide, substance abuse, and home/work/relationship problems. PTSD news stories were almost always (94.8%) situated in the current time and most frequently (46.6%) used a community frame. Implications for public understanding of PTSD are discussed.     

Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives

In a survey of 568 physician members of the American College of Physician Executives (ACPE), most of whom had advanced management degrees (MBA, MMM, MPH), approximately 90% of respondents reported that their investment in the education was "worth it." The return on investment was independent of the quality of the academic institution, although primary care physicians stood to gain more relative to specialists. Salary comparisons showed that female physicians had approximately 20% lower incomes than male physicians, confirming the presence of a "glass ceiling" for female physician executives as seen in other medical specialties. These findings have implications for early and mid-career physicians and physician recruiters.