Endocrine disruption due to estrogens derived from humans predicted to be low in the majority of U.S. surface waters

In an effort to assess the combined risk estrone (E1), 17β-estradiol (E2), 17α-ethinyl estradiol (EE2), and estriol (E3) pose to aquatic wildlife across United States watersheds, two sets of predicted-no-effect concentrations (PNECs) for significant reproductive effects in fish were compared to predicted environmental concentrations (PECs). One set of PNECs was developed for evaluation of effects following long-term exposures. A second set was derived for short-term exposures. Both sets of PNECs are expressed as a 17β-estradiol equivalent (E2-eq), with 2 and 5 ng/L being considered the most likely levels above which fish reproduction may be harmed following long-term and short-term exposures, respectively. A geographic information system-based water quality model, Pharmaceutical Assessment and Transport Evaluation (PhATE?), was used to compare these PNECs to mean and low flow concentrations of the steroid estrogens across 12 U.S. watersheds. These watersheds represent approximately 19% of the surface area of the 48 North American states, contain 40 million people, and include over 44,000 kilometers of rivers. This analysis determined that only 0.8% of the segments (less than 1.1% of kilometers) of these watersheds would have a mean flow E2-eq concentration exceeding the long-term PNEC of 2.0 ng/L; only 0.5% of the segments (less than 0.8% of kilometers) would have a critical low flow E2-eq exceeding the short-term PNEC of 5 ng/L. Those few river segments where the PNECs were exceeded were effluent dominated, being either headwater streams with a publicly owned treatment works (POTW), or flowing through a highly urbanized environment with one or several POTWs. These results suggest that aquatic species in most U.S. surface waters are not at risk from steroid estrogens that may be present as a result of human releases.     

Returns to entering the medical profession in the U.K.

This paper examines the idea that medical professions in the United Kingdom have, as a result of restrictive practices of various kinds, managed to obtain rates of return to their education and training well above those achieved in other professions. It concludes that after making various adjustments, in particular allowing for differences in hours worked, the returns obtained are in most cases not very different from those for other professions. With the exception of dentists there is therefore no clear-cut evidence from earnings data alone of restrictive practices in the medical professions.     

U.S.-incurred costs of wild poliovirus infections in a camp with U.S.-bound refugees--Kenya, 2006

Routine predeparture vaccinations are not required for U.S.-bound refugees, a policy that potentially leaves U.S. communities vulnerable to importation of vaccine-preventable diseases. During October-December 2006, an outbreak of poliomyelitis associated with wild poliovirus type 1 (WPV1) occurred in a camp occupied by refugees awaiting resettlement to the United States. This report describes the costs of domestic and international activities borne by U.S. federal and state governments, U.S.-funded organizations, and U.S. voluntary agencies during their response to this outbreak. Requiring predeparture polio vaccinations for U.S.-bound refugees might reduce the risk for poliovirus importation and reduce the costs associated with responses to polio outbreaks among refugees.     

Assessing the risk to U.K. children from carbendazim residues in apple products

We present a detailed study into the effects that uncertainty and variability have on the levels of dietary exposure of young children to carbendazim in a range of apple products, including raw apples, apple juice and processed apple foods. It is estimated that exposure is greater than the provisional EU acute reference dose of 0.02 mg/kg-bw/day on 0.29% of person days, although there is large uncertainty in the true number. The contribution from apple juice consumption appears to be significant. The issues presented are common to many dietary risk analysis problems, and the methods could be applied to any food group and chemical of interest.     

Assessing the Risk to U.K. Children from Carbendazim Residues in Apple Products

Abstract

We present a detailed study into the effects that uncertainty and variability have on the levels of dietary exposure of young children to carbendazim in a range of apple products, including raw apples, apple juice and processed apple foods. It is estimated that exposure is greater than the provisional EU acute reference dose of 0.02 mg/kg-bw/day on 0.29% of person days, although there is large uncertainty in the true number. The contribution from apple juice consumption appears to be significant. The issues presented are common to many dietary risk analysis problems, and the methods could be applied to any food group and chemical of interest.     

Using colorectal trends in the U.S. to identify unmet primary care needs of vulnerable populations

Background

Colorectal cancer screening (CRC) disparities have worsened in recent years.

Objective

To examine progress toward Healthy People 2010 goals for CRC screening among ethnic/racial groups, including disaggregated Latino groups.

Methods

Multivariate logistic regressions examined associations between ethnicity/race and primary outcomes of self-reported guideline-concordant CRC screenings considering time trends for 65,947 respondents of the Medical Expenditure Panel Survey from 2000 to 2007 age 50-years and older from six groups (non-Latino White, non-Latino Black, Puerto Rican, Cuban, Mexican, and Other Latino). We also tested for modification effects by education, income, and health insurance.

Results

Most groups approached Healthy People 2010 CRC screening rate goals, including non-Latino Whites (47%), non-Latino Blacks (42%) and Puerto Ricans (40%), while Mexicans remained disparately lower (28%). Higher education, income and insurance coverage, partially attenuated this lower likelihood, but Mexican rates remained significantly lower than non-Latino Whites for receiving endoscopy in the past 5 years {OR(95% CI) = 0.68(0.59-0.77)} and having received any CRC screening {0.70(0.62-0.79)}.

Conclusions

Among ethnic/racial groups examined, only Mexicans met healthcare disparity criteria in CRC screening. Findings suggest that healthcare equity goals can be attained if resources affecting continuity of care or ability to pay for preventive services are available, and targeted populations are adequately identified.     

Class matters: U.S. versus U.K. measures of occupational disparities in access to health services and health status in the 2000 U.S. National Health Interview Survey.

To inform current debates over whether occupational class is causally linked to health inequities, the authors used data from the 2000 U.S. National Health Interview Survey to compare occupational disparities in access to health services, socioeconomic resources, and health status, using (1) the United Kingdom's new National Statistics Socio-Economic Classification (NS-SEC), premised on type of labor contract (salaried vs. hourly wage) and class position (employer, self-employed, supervisory and non-supervisory employee), and (2) the conventional U.S. occupational categories, premised on status and skill. Analyses included all working-age adults (age 25 to 64) for whom data on occupation and race/ethnicity were available (N = 22,500). Risk of inadequate access to health services, poverty, and low education were two times greater for persons in NS-SEC class 5 versus class 1, compared with blue-collar versus white-collar, and for both measures persons with the worst health status were in jobs that afforded the least access to health care. Controlling for earned income and workplace health insurance markedly reduced health service disparities, especially for the NS-SEC measure, thereby implying structural characteristics of jobs are causally relevant for resources and benefits necessary to address health inequities in the United States.     

Faecal excretion of entero-pathogens in a Pakistani family returning to the U.K. after a visit to Rawalpindi

The family consisted of two parents and five children. While the father remained in Cardiff, the mother and all the children visited Rawalpindi, Pakistan, for 6 weeks to stay with relatives. Travel was by flight from Heathrow airport to Pakistan and by a short road journey to Rawalpindi. Mrs M. — the mother — as a guest, did no cooking on the holiday. The house which they were living in had a piped water supply, thought to be treated. There was no flush toilet but a commode was available and was emptied daily. All the children had gastro-enteritis symptoms for 2-3 days after arrival. Ru M. — a daughter — had the most severe illness and was treated by a local doctor. Diarrhoea in the three girls persisted on return to U.K. A faecal swab from Ru M. showed her to be excreting S. typhi (degraded Vi phage type). She was admitted to hospital. Faecal samples from the remaining members of the family were taken and examined for entero-pathogens. The father, Fa. M., who had not left Cardiff, had negative stools and remained free from infection. All other family members were excreting one or more entero-pathogens, including a Campylobacter sp., three types of Sh. flexneri and one type of Sh. boydii. A subsequent faecal sample revealed that one of the male children, A.M., was excreting S. typhi phage type B2. The two typhoid infections were apparently unconnected.     

A statistical analysis of data on exposure to xylene at selected workplaces in the U.K.

The results of sampling surveys carried out by the Health and Safety Executive (HSE) during 1987–1988 at a random selection of 49 premises, where xylene was used, are reported. A total of 465 personal exposure samples were collected, from which 369 8-h time weighted average (TWA) exposures were calculated. These had a geometric mean (GM) of 2.2 ppm (GSD, ± 2.9; range, < 1–202 ppm). At that time HSE already had data for personal exposure to xylene in 122 premises collected between 1980 and 1987. These data yielded 511 8-h TWA personal exposures to xylene with a GM of 7.5 ppm (GSD, ±4.3; range, < 1–610 ppm). These GMs are significantly different (P < 0.01), suggesting that the pre-existing data were somewhat biased. This is discussed in the context of the use of these data in setting the Occupational Exposure Limits for xylene and the significance to standard setting of any bias in HSE data.     

Escherichia coli resistant to tetracyclines and to other antibiotics in the faeces of U.K. chickens and pigs in 1980.

A survey conducted in 1980, 9 years after the banning of the use of tetracyclines as feed additives in the U.K., indicated that table chickens and pigs were still a large reservoir of tetracycline-resistant Escherichia coli; the incidence of transferable tetracycline resistance was greater in chicken E. coli strains (68%) than in pig E. coli strains (20%). Large amounts of sulphonamide-resistant and of furazolidone-resistant E. coli were found in the faeces of chickens; E. coli resistant to both sulphonamides and streptomycin were common in the faeces of chickens and pigs. E. coli with transferable or mobilizable trimethoprim resistance were present in the faeces of most pigs and in the faeces of 10% of chickens.     

Experiences of African Immigrant Women Living with HIV in the U.K.: Implications for Health Professionals

In the U.K. immigrant women from Africa constitute an increasingly large proportion of newly diagnosed cases of HIV. A significant minority of these are refugees and asylum seekers. Very little is known about their experiences of living with HIV/AIDS, their psychosocial needs or their views of health care provision. This paper reports the results of a qualitative study that explored these issues by interviewing eight African women living with HIV in the British city of Nottingham. Women's ability to live positively with HIV was found to be strongly shaped by their migration history, their legal status, their experience of AIDS-related stigma and their Christian faith. Significantly, health services were represented as a safe social space, and were highly valued as a source of advice and support. The findings indicate that non-judgemental, personalised health care plays a key role in encouraging migrant African women to access psychosocial support and appropriate HIV services.     

Global asbestos justice: South African asbestos victims win right to sue Cape PLC in U.K. courts.

A ruling by Britain's House of Lords in July 2000 opened the doors of the English courts to foreign plaintiffs injured by the overseas operation of British companies and their subsidiaries. The ruling authorized 3,000 South African asbestos victims to continue their case in the U.K. courts against the multinational British company Cape PLC, which produced both raw asbestos and asbestos products in South Africa. The Lords sided with the asbestos victims in refusing to transfer the case to South Africa, as requested by Cape. This decision was a reversal of fortune for Cape and has implications for other British multinationals that may be called upon to defend their overseas actions domestically.     

Factors of patient satisfaction with medical services: the case of G.P. practices in the U.K.

This paper investigates whether factors previously identified in the literature are also important in the U.K. primary healthcare system. In a survey based on the SERVQUAL scale, 182 patients were personally interviewed. The analysis shows that the demographic variable age and gender are of little importance in determining satisfaction with G.P. services but the fundholding-non-fundholding divide is. For nearly every aspect of G.P. services the results clearly show that patients from fundholding surgeries are happier than patients from nonfundholding surgeries.     

Using the theory of planned behavior to predict safer sexual behavior by ghanaian immigrants in a large midwestern U.S. city

Ghanaian immigrant population in the United States is at a high risk for developing HIV/AIDS. This study uses the Theory of Planned Behavior to predict safer sexual behavior among Ghanaian immigrants in a large Midwestern city in the United States. A 55-item questionnaire was developed and tested for validity (face, content, and construct) and reliability (stability and test-retest). A total of 137 Ghanaian immigrants completed the questionnaire. The constructs of perceived behavioral control (p < 0.001) and subjective norm (p < 0.001) were significant predictors for intention to use condoms and they accounted for 38% of the variance. Behavioral intention for condom use (p < 0.001) was the significant predictor for condom use and it accounted for 21% of the variance. Health education interventions based on constructs of the Theory of Planned Behavior must promote consistent and correct use of condoms in this population.     

Quantifying the source of infection for HIV‐infected hemophiliacs in the U.K. from 1979 to 1984

There is considerable literature on the risk of HIV infection for individuals suffering from hemophilia A in the United Kingdom (U.K.) during the period 1979–1984 when the sources of Factor VIII clotting factor were contaminated with HIV. Toward the end of this period, several investigators reported HIV prevalence among hemophiliacs, often classified by the severity of disease and, to some extent, the source of the clotting factor with which individuals were infused. In the U.K., hemophilia A patients typically received clotting factor from the local National Health Service (NHS) supplies or from commercial product usually imported from the United States. Litigation on behalf of U.K. hemophiliacs, their survivors, and estates remains unresolved, cases in which it becomes important to quantify the fraction of U.K. hemophiliac HIV infections attributable to imported blood product. For HIV‐infected individuals who received Factor VIII from one source exclusively, the source of infection is clear, assuming no other risk factors. For patients who used both types of clotting factor, the source of infection is uncertain. For the U.K. as a whole, we produce quantitative estimates of the conditional probability of infection due to a specific source, based on HIV prevalence in groups exclusively exposed to a specific source and the percentage of clotting factor that was imported. With plausible estimates of these input parameters, an estimate of the conditional probability of infection due to imported product is 0.93 (95 per cent CI: 0.90–0.96). This estimate is relatively insensitive to changes in input parameters, but may vary over subgroups of hemophiliacs. Copyright © 2009 John Wiley & Sons, Ltd.