Particulate matter (PM2.5) and carbon monoxide from secondhand smoke outside bars and restaurants in downtown Athens, Georgia

In the study described in this article, the authors' objective was to measure particles < or = 2.5 microm in aerodynamic diameter (PM2.5) and carbon monoxide (CO) in outdoor waiting areas and patios of restaurants and bars in downtown Athens, Georgia, where indoor smoking is banned. The authors also wanted to investigate whether the measured concentrations are directly associated with the number of cigarettes lit in these settings. Real-time PM2.5 and CO were monitored on four summer weekend afternoons/evenings in outdoor waiting areas or patios at five locations in Athens. In addition, smokers and pedestrians present or passing and motorized vehicles passing each sampling location were counted. PM2.5 levels were significantly higher than levels at the control location (all p-values > .001). Carbon monoxide levels outside the restaurant and bar sites did not differ significantly from the control. The results of the authors' study indicate that (1) secondhand smoke (SHS) leads to significant increases in PM2.5 outside of restaurants and bars; and (2) although CO can be used as a proxy for SHS in these outdoor environments, its levels remain relatively low.     

Occupational therapy students' contribution to occasions of service during practice placements in health settings

Introduction: Currently in the Australian higher education sector, the productivity benefits of occupational therapy clinical education placements are a contested issue. This article will report results of a study that developed a methodology for documenting time use during placements and investigated the productivity changes associated with occupational therapy clinical education placements in Queensland, Australia. Supervisors’ and students’ time use during placements and how this changed for supervisors compared to pre‐ and post‐placement is also presented. Methods: Using a cohort survey design, participants were students from two Queensland universities, and their supervisors employed by Queensland Health. Time use was recorded in 30 minute blocks according to particular categories. Results: There was a significant increase in supervisors’ time spent in patient care activities (F = 94.011_{2,12.37 df}, P < 0.001) between pre‐ and during placement (P < 0.001) and decrease between during and post‐placement (P < 0.001). Supervisors’ time spent in all non‐patient care activities was also significant (F = 4.580_{2,16 df}, P = 0.027) increasing between pre‐ and during placement (P = 0.028). There was a significant decrease in supervisors’ time spent in placement activities (F = 5.133_{2,19.18 df}, P = 0.016) from during to post‐placement. Students spent more time than supervisors in patient care activities while on placement. Discussion: A novel method for reporting productivity and time‐use changes during clinical education programs for occupational therapy has been applied. Supervisors spent considerable time in assessing and managing students and their clinical education role should be seen as core business in standard occupational therapy practice. This paper will contribute to future assessments of the economic impact of student placements for allied health disciplines.     

Nutritional status and associated factors among the elderly in Viçosa, Minas Gerais State, Brazil

This cross-sectional study in 2009 focused on the prevalence of underweight and overweight and associated factors in a sample of 621 elderly individuals in Vi?osa, Minas Gerais State, Brazil. Data were obtained through home interviews on nutritional status and socio-demographic and health conditions. Of the total sample, 53.3% were females. Median BMI was 26.40 kg/m2 (range = 15.20-46.82) and was lower for men than for women. Prevalence of overweight was high (45%; 95%CI: 40%-49%), decreased with age, was positively associated with female gender and history of arthritis/arthrosis, and was negatively associated with age 80 years or older and smoking. Prevalence of underweight was high in men (18.2%), increased with age, and was positively associated with worse self-rated health. The findings highlight the importance of health strategies that favor lifestyle changes and healthy eating habits.     

Social and biological determinants of iron deficiency anemia

This cross-sectional study aimed to identify the social and biological determinants of anemia in children enrolled in the Brazilian Income Transfer Program (PBF). The study evaluated 446 children (69.1% of the total enrolled) ranging from 6 to 84 months of age, of whom 262 were receiving the income transfer (60.2% of the beneficiaries) and 184 were not (87.6% of the non-beneficiaries). Testing for anemia was performed with the Hemocue portable hemoglobinometer, and the cutoff points were set at 11.0 and 11.5 g/dL, according to age bracket. The data were analyzed using Poisson hierarchical regression with robust variance for multivariate analysis. There was no difference in the anemia prevalence rates between the beneficiary and non-beneficiary groups. Risk factors for anemia were low paternal schooling, cesarean birth, consumption of untreated water, stunting, and age less than 24 months. Prevalence of anemia in the group of non-beneficiary children under two years of age was significantly higher than in the beneficiary group in the same age bracket, suggesting the importance of the PBF income transfer for preventing anemia in children.     

Monitoring access to out-of-hours care services in Scotland - a review

Objectives

Changes in the contractual responsibilities of primary care practitioners and health boards have resulted in a plethora of arrangements relating to out-of-hours healthcare services. Rather than being guaranteed access to a GP (usually either their own or another through a local GP co-operative), patients have a number of alternative routes to services. Our objective was to identify and assess the availability and adequacy of relevant standards, responsibilities and information systems in Scotland to monitor the impact of contractual changes to out-of-hours healthcare services on equity of access.

Design

Cross-sectional study.

Setting

All providers of primary care out-of-hours services in Scotland.

Participants

Not applicable.

Main outcome measures

First, identification and policy review of current standards and performance monitoring systems, data and information, primarily through directly contacting national and local organizations responsible for monitoring out-of-hours care, supplemented by literature searches to highlight specific issues arising from the review; and second, mapping of data items by out-of-hours provider type to identify overlap and significant gaps.

Results

In Scotland, data monitoring systems have not kept pace with changes in the organization of out-of-hours care, so the impact on access to services for different population groups is unknown. There are significant gaps in information collected with respect to workforce, distribution of services, service utilisation and clinical outcomes.

Conclusions

Since 2004 there have been major changes to the way patients access out-of-hours healthcare in the UK. In Scotland, none of the current systems provide information on whether the new services satisfy the key NHS principle of equity of access. There is an urgent need for a comprehensive review of data standards and systems relating to out-of-hours care in order to monitor and evaluate inputs, processes and outcomes of care not least in respect of access and fairness of distribution of resources.     

Methodology for measuring diversity in human populations

A population is considered diverse if it contains individuals with a wide variety of demographic and cultural characteristics or attributes. However, it is often difficult to compare the relative diversity of two groups. It is even more difficult to specifically measure or quantify the diversity of any single group. In this paper a three step process for measuring and quantifying diversity in a human populations is described. The measurement methodologies illustrated in an example using this process are based upon fractionalization techniques and mathematical information theory.     

Cardiovascular magnetic resonance tagging of the right ventricular free wall for the assessment of long axis myocardial function in congenital heart disease

Background

Right ventricular ejection fraction (RV-EF) has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function. We developed a cardiovascular magnetic resonance (CMR) tagging-based technique with a view to rapid and reproducible measurement of RV long axis function and applied it in patients with congenital heart disease.

Methods

We studied 84 patients: 56 with repaired Tetralogy of Fallot (rTOF); 28 with atrial septal defect (ASD): 13 with and 15 without pulmonary hypertension (RV pressure > 40 mmHG by echocardiography). For comparison, 20 healthy controls were studied. CMR acquisitions included an anatomically defined four chamber cine followed by a cine gradient echo-planar sequence in the same plane with a labelling pre-pulse giving a tag line across the basal myocardium. RV tag displacement was measured with automated registration and tracking of the tag line together with standard measurement of RV-EF.

Results

Mean RV displacement was higher in the control (26 ± 3 mm) than in rTOF (16 ± 4 mm) and ASD with pulmonary hypertension (18 ± 3 mm) groups, but lower than in the ASD group without (30 ± 4 mm), P < 0.001. The technique was reproducible with inter-study bias ± 95% limits of agreement of 0.7 ± 2.7 mm. While RV-EF was lower in rTOF than in controls (49 ± 9% versus 57 ± 6%, P < 0.001), it did not differ between either ASD group and controls.

Conclusions

Measurements of RV long axis displacement by CMR tagging showed more differences between the groups studied than did RV-EF, and was reproducible, quick and easy to apply. Further work is needed to assess its potential use for the detection of longitudinal changes in RV myocardial function.