Dietary fibre and health: an overview

Summary Many studies have found that people on diets high in fibre have reduced risks of certain diseases such as cancers, coronary heart disease, obesity and possibly diabetes. Fibre is a collective term for a group of compounds, which differ in their chemical structure and physical properties and elicit a variety of physiological effects. Some health benefits linked to fibre consumption are well established (e.g. promoting a regular bowel habit) and others are becoming more firmly established. The effects of the various non‐digestible components are not always fully interchangeable, although there is considerable overlap, but they share an ability to pass undigested into the large bowel. This makes it important that fibre intake comes from a range of sources to ensure maximum health benefits. There are disagreements as to which plant‐derived compounds constitute ‘fibre’ and which analytical methodologies should be used to determine the fibre content of foods. This lack of a universal definition for these carbohydrates that resist digestion in the small intestine has led to complications in establishing and communicating consistent recommendations for the type and amounts of fibre components in the diet, as well as issues related to food labelling and health claims. Furthermore, current analytical methods may typically underestimate the fibre content of foods, using the definition advised by the European Food Safety Authority. Chemical nomenclature is necessary for a coherent and enforceable approach to the measurement of fibre (and related to this, product labelling), but reconciling chemical definitions for fibre with definitions that reflect physiological effects remains a major challenge. Progress in the application of the emerging evidence regarding dietary fibre and health is constrained by a need to resolve the definition and methodology issues. Most consumers are likely to be unaware of the more recent developments and the overlapping properties of different types of carbohydrate that resist digestion in the small intestine, and the particular sources of these carbohydrates. Long overdue is the translation of the growing knowledge about the physiological properties of carbohydrates, particularly non‐digestible carbohydrates, into clear and unambiguous public health messages. Many terms in common use stem from chemistry rather than physiology, and this makes derivation of health messages more difficult. Meanwhile in the UK, where the main sources of fibre are cereals and cereal products, followed by vegetables and potatoes, adults are not meeting the recommended 18 g of fibre per day (defined in the UK as non‐starch polysaccharide measured by the Englyst method). The recommended amount for the UK, established in 1991, is lower than elsewhere in the world and corresponds to about 24 g according to the method used by the Association of Official Analytical Chemists (the AOAC method). Reference values in other parts of the world are typically between 25 and 35 g (AOAC fibre). A diet rich in whole grains, pulses, fruit and vegetables will assist in meeting current fibre recommendations, but a growing number of other foods now contain carbohydrate‐derived ingredients that resist digestion.     

Workers' health: an overview and challenges

This article provides an overview of workers' health services in Brazil, the context of their emergence, their main guidelines as a social policy since 1980, and their development, identifying some difficulties for their implementation. In addition, the study points to some challenges for institutions and society as a whole in overcoming the crisis in this field.     

Older women and health: an overview

Older women's health issues are unique. There are more older women than ever before. They are living increasingly longer than men, yet they report more acute and chronic illness and disability than men. They are disproportionally represented in nursing homes, since many women are alone: twenty-five percent aged 70 or over have no living children and over 60 percent of older women are widowed, divorced, or single. Older women have fewer personal financial resources for health care than men. Health care reimbursement does not meet their needs for financial coverage of chronic outpatient and nursing home care. They face age and sex discrimination on the part of many health care providers and are subject to a growing tendency to be seen as "burdens" and "problems" in the American health care system.     

Women's mental health: an overview

Women often have different outcomes and experiences with mental illness compared to men. However, there is still a ‘gender-blind’ approach to the understanding and development of new treatments for mental illness. The emphasis is on: women and schizophrenia, depression in women and existing sex differences in anxiety disorders (including phobias, agoraphobia, panic disorder, generalised anxiety disorder and post-traumatic stress disorder). Utilizing gender differences in the onset, course and outcomes of mental illness may enable a better development of best outcomes for women with mental illness.     

Air pollution and health: bridging the gap from sources to health outcomes: conference summary

??Air Pollution and Health: Bridging the Gap from Sources to Health Outcomes,?? an international specialty conference sponsored by the American Association for Aerosol Research, was held to address key uncertainties in our understanding of adverse health effects related to air pollution and to integrate and disseminate results from recent scientific studies that cut across a range of air pollution-related disciplines. The Conference addressed the science of air pollution and health within a multipollutant framework (herein ??multipollutant?? refers to gases and particulate matter mass, components, and physical properties), focusing on five key science areas: sources, atmospheric sciences, exposure, dose, and health effects. Eight key policy-relevant science questions integrated across various parts of the five science areas and a ninth question regarding findings that provide policy-relevant insights served as the framework for the meeting. Results synthesized from this Conference provide new evidence, reaffirm past findings, and offer guidance for future research efforts that will continue to incrementally advance the science required for reducing uncertainties in linking sources, air pollutants, human exposure, and health effects. This paper summarizes the Conference findings organized around the science questions. A number of key points emerged from the Conference findings. First, there is a need for greater focus on multipollutant science and management approaches that include more direct studies of the mixture of pollutants from sources with an emphasis on health studies at ambient concentrations. Further, a number of research groups reaffirmed a need for better understanding of biological mechanisms and apparent associations of various health effects with components of particulate matter (PM), such as elemental carbon, certain organic species, ultrafine particles, and certain trace elements such as Ni, V, and Fe(II), as well as some gaseous pollutants. Although much debate continues in this area, generation of reactive oxygen species induced by these and other species present in air pollution and the resulting oxidative stress and inflammation were reiterated as key pathways leading to respiratory and cardiovascular outcomes. The Conference also underscored significant advances in understanding the susceptibility of populations, including the role of genetics and epigenetics and the influence of socioeconomic and other confounding factors and their synergistic interactions with air pollutants. Participants also pointed out that short- and long-term intervention episodes that reduce pollution from sources and improve air quality continue to indicate that when pollution decreases so do reported adverse health effects. In the limited number of cases where specific sources or PM_2.5 species were included in investigations, specific species are often associated with the decrease in effects. Other recent advances for improved exposure estimates for epidemiological studies included using new technologies such as microsensors combined with cell phone and integrated into real-time communications, hybrid air quality modeling such as combined receptor- and emission-based models, and surface observations used with remote sensing such as satellite data.     

Workers' health and safety in Australia: an overview

In this article we explore some of the precursors and background to the recent wave of administrative and legislative change in the field of occupational health and safety in Australia. The influences of the New Left and women's movement in the late 1960s and early 1970s are seen to be crucial in creating a climate in which the issue of workers' health could be raised. It is then argued that the labor movement has been fundamentally important in determining the shape and extent of reform. Current organizational and legal developments are described and discussed in the context of Australian society.     

Chronic illness management and health literacy: an overview

Poor literacy skills can severely compromise effective chronic illness management by the patient. Practitioners' awareness of the prevalence of low health literacy, or the ability to understand and appropriately act on healthcare instructions, among their patients is a first step toward making changes in the practice to ensure patients understand how to manage their chronic illnesses. Researchers and clinicians in the health literacy field gathered recently at a national health literacy conference and shared techniques used and studied in their practices to aid in more effective provider-patient communications and to help improve outcomes and successful patient management of their chronic illnesses.     

Companion animals and human health: an overview.

Domestic animals share our environment in a variety of ways. One of these ways is as companions in and around our homes. Although a wide variety of species are kept in households for this purpose, the great majority are dogs and cats. Sharing our environment with such animals has a profound effect on the health of the humans concerned. As keeping companion animals is a very widespread activity, about 50% of all households in the Western world have some sort of animal, the effects are far reaching.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

The Canadian health care system: an overview

Although health care is a provincial responsibility in Canada, universal hospital insurance was fully adopted by 1961; universal medical insurance followed 10 years later. Each province enacted universal insurance after the federal government offered to pay 50% of provincial hospital and medical care costs. Hospital insurance had wide public and provider support but universal medical care insurance was opposed by organized medicine. The federal government soon realized that it had no control over total expenditures and no mechanisms for controlling costs. In 1977 it enacted Bill C-37 which limited total federal contributions and made those contributions independent of provincial health care expenditures so that increased costs had to be met by the provinces. Since private health care insurance for universal benefits is prohibited by the federal terms of reference for health insurance, the provinces must raise the money by taxes and (in some provinces) premiums. Although prohibited by the terms of reference of the universal program, some provinces have adopted hospital user fees and are allowing their physicians to bill patients in excess of provincial fee schedules. The 1980s have seen increased confrontations between the federal and provincial governments and between the provinces and their providers. The issues are cost containment and control of the system. The provinces have two broad options. The first is more private funding through private insurance and user fees. The proposed new Canada Health Act will probably prohibit such charges. A second option involves greater control and management of the system by the provinces; this has already occurred in Quebec. Greater control is vigorously opposed by physicians and hospitals. The Canadian solution to health insurance problems in the past has been moderation. Extreme moves in either direction would represent a break with tradition, but they may prove to be unavoidable.     

Multiple health behavior change research: an introduction and overview

In 2002, the Society of Behavioral Medicine's special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable.     

2012年中国居民健康素养影响因素分析

  目的  了解江苏省南京市居民慢性病防治素养水平状况及影响因素,为制定针对性的健康素养干预策略和措施提供依据。  方法  于2016年10 — 12月,采用多阶段分层与人口规模成比例抽样（PPS）方法,在南京市12个行政区随机抽取15～69岁居民9 168人进行问卷调查。  结果  2016年南京市居民慢性病防治健康素养水平为10.9 %（95 % CI = 8.8 %～13.4 %）,低于全国平均水平（11.5 %）。多因素logistic回归分析显示,白领人员慢性病防治健康素养水平高于蓝领人员（14.6 % vs. 9.6 %;OR = 1.35,95 % CI = 1.04～1.75）;与低收入人群比较,中、高收入人群的慢性病防治健康素养水平较高[（11.0 % vs. 7.3 %;OR = 1.42,95 % CI = 1.03～1.95）;（14.1 % vs. 7.3 %;OR = 1.74,95 % CI = 1.04～2.92）]。  结论  2016年南京市居民慢性病防治健康素养水平较低,应以蓝领工作者和家庭人均收入较低人群为重点干预对象,以提高全体居民慢性病防治健康素养水平。