作为社会转型表征的中国城市新移民

  目的  构建城市新移民健康相关社会资本评价指标体系,作为进一步评价城市新移民健康相关社会资本的评估工具。  方法  采用文献法和专题小组讨论,初步形成城市新移民健康相关社会资本评价指标体系框架,使用Delphi法遴选评价指标,应用层次分析法确定指标权重。  结果  两轮专家咨询的积极系数分别为97.1 % 和94.1 %,权威系数为0.85,协调系数分别为0.14和0.27（P < 0.05）。结合界值法和专家意见删减调整后最终建立了包括个体、家庭、社区、工作单位和宏观社会在内的5个一级指标、23个二级指标、50个三级指标及其权重构成的指标体系,权重分别为0.15～0.28、0.13～0.36、0.18～0.55。  结论  所构建评价指标体系具有较好的科学性和适用性,可为城市新移民健康相关社会资本的测量和评价提供参考。     

Bypassing proximal health care facilities for acute care: a survey of patients in a Ghanaian Accident and Emergency Centre

Objective To characterise the population that presents to the Accident and Emergency Centre (AEC) at Komfo Anokye Teaching Hospital (KATH) and to identify risk factors associated with bypassing proximal care facilities. Methods A structured questionnaire was verbally administered to patients presenting to the AEC over 2 weeks. The questionnaire focused on the use of health care resources and characteristics of current illness or injury. Measures recorded include demographics, socioeconomic status, chief complaint, transportation and mobility, reasons for choosing KATH and health care service utilisation and cost. Results The total rate of bypassing proximal care was 33.9%. On multivariate analysis, factors positively associated with bypassing included age older than 38 years (OR: 2.18, P 0.04) and prior visits to facility (OR 2.88, P 0.01). Bypassers were less likely to be insured (OR 0.31, P 0.01), to be seeking care due to injury (OR 0.42, P 0.03) and to have previously sought care for the problem (OR 0.10, P < 0.001). Conclusions Patients who bypass facilities near them to seek care at an urban AEC in Ghana do so for a combination of reasons including familiarity with the facility, chief complaint and insurance status. Understanding bypassing behaviour is important for guiding health care utilisation policy decisions and streamlining cost‐effective, appropriate access to care for all patients.     

Rehabilitation of undernourished children in Tanzania using locally available food

The rehabilitative effects of a long‐term feeding trial in Tanzania with moderately undernourished children are reported. It lasted 88 weeks and involved 49 children. Food consisted of locally available cereals (maize), legumes (beans), and vegetables for 74 weeks, supplemented by animal protein for 14 weeks. Children stayed in a day‐care center for 6 days of the week, and were medically supervised and treated, if necessary. In addition to anthropometric measurements, biochemical tests were carried out at regular intervals, and previous diseases and vaccinations were ascertained.

Forty‐one children grew faster than, and 6 about parallel to, the Baganda standard for the first 74 weeks. While for the former no growth acceleration was observed in the meat diet period (weeks 75–88), the latter group grew faster than the Baganda standard during that period. Methionine supplementation of the diet did not seem to produce any noticeable growth improvements.     

Lipid and lipoprotein changes after long-term weight reduction: the influence of gender and body fat distribution.

This study was designed: 1) to evaluate the effect of weight loss on body fat distribution, 2) to determine whether indices of body fat distribution can be considered as a prognostic indicator for the ability to lose weight and 3) to evaluate whether a change of body fat distribution is associated with changes in plasma glucose, lipids and lipoproteins in both sexes in order to evaluate a gender difference.

63 obese subjects (41 women and 22 men) were treated on an outpatient basis with an energy-reduced, protein-enriched low calorie diet (3150-4200 kJ/day) for a 6-month period. They were divided in different groups according to gender and body fat distribution using the waist-to-hip circumference ratio.

Body fat topography can be altered by dieting, but not by more than it increases when a person gains weight. Body fat distribution seems to be a significant prognostic indicator for the ability to lose weight in women but not in men. Although body weight and the waist-to-hip circumference decreased significantly, no relationships were found between percent decrease in these parameters and percent changes in plasma glucose, lipids and lipoproteins.

We conclude that an important caloric deficit may lead to a series of metabolic improvements but that gender and the type of fat distribution are important confounding factors in the prediction of metabolic success.     

Providence School Asthma Partnership: School-based Asthma Program for Inner-City Families

Over 3 years, 972 families participated in an after-school asthma program at their child's school. Parents and children attended concurrent 2¹/₂ -hour workshops. Parents were 74% Latino; 45% non-English speaking, with 77% of children on Medicaid. Asthma symptoms were significantly reduced, from multiple times per week to less than once per week on average. Oral steroid use decreased to one third of baseline use. Hospital days decreased from 11% to 2%; emergency visits decreased 35% to 4%; and school days missed decreased 48% to 20%. This program has now become sustainable with both private and Medicaid insurance coverage.     

Enrolling Adolescents in Asthma Research: Adolescent,Parent, and Physician Influence in the Decision-making Process

Background. The factors influencing family decisions to participate in adolescent asthma research are not well understood. Legal and ethical imperatives require adolescent research participation to be voluntary. While parents and adolescents often agree about research decisions, disagreements may also occur with relative frequency. Physician recommendations are also known to influence research participation decisions. Little attention has been given to how these dynamics may affect adolescents' involvement in decisions to participate in research. Objective. To examine the influence of family and physician-investigator relationships and recommendations on adolescent asthma clinical research participation decisions. Methods. A statewide community sample of 111 adolescents 11 to 17 years of age, with a diagnosis of asthma, and their parents participated in this study. Adolescents received a medical evaluation from an asthma specialist and then the family was offered participation in a hypothetical asthma clinical trial. By random assignment, the research study was presented by either the same or an unknown asthma specialist, and half the families in each group also received affirmative recommendations from the asthma specialist to participate in the hypothetical asthma clinical trial. Parents and adolescents made initial private decisions about participating in the trial. Then, following a family discussion of the clinical trial, a final research participation decision was made. Results. Thirty-three percent of parents and adolescents initially disagreed about the research participation decision. When disagreements occurred, final decisions followed the parents' initial views except when the physician-investigator was known and a recommendation was made. Families with initial disagreement about participating were less likely to enroll when the investigator was unknown or when no recommendation was made. Adolescents who initially disagreed with parents' views were less likely to concur with the final research participation decision, felt less comfortable, and were less likely to feel they influenced the decision. Conclusions. Parents' views on research decisions take precedence over adolescents' views in most circumstances. Physician-investigator relationships may reduce parental resistance to participation and enhance adolescent decision-making autonomy when research participation is desired by the adolescent.     

Patterns of Inpatient and Outpatient Care for Asthma in Erie and Niagara Counties,Western New York State

We surveyed cognitively normal teens with and without chronic illness regarding the perceived physical and social impact of various chronic diseases including asthma.

The overall physical impact of asthma was perceived equivalently to diabetes and arthritis, but less than epilepsy, Down's syndrome, leukemia, and human immunodeficiency virus infection. However, asthma was rated to more commonly cause physical disability (p < 0.001) and restrict activities (p < 0.0005). The social impact of asthma was perceived equivalently to diabetes, but more favorably than the other chronic diseases surveyed. Specifically, teens with asthma were perceived as having fewer behavior problems, being more honest, popular, and fun to be around, but less adept at sports. Only 6 of 149 (4%) teens surveyed expressed any degree of reluctance to befriend peers with asthma.     

Behavioral Self-Management

While behavioral treatments have been increasingly utilized with older patients, they have almost entirely involved operant, rather than self-management, approaches. In the present paper, differences between operant and self-control behavioral approaches are discussed. A case example is presented of the successful use of a behavioral self-management treatment with an elderly patient with severe agitation. The potential utility of the self-management approach with older patients is discussed.     

Time use clusters of New Zealand adolescents are associated with weight status,diet and ethnicity

Objective : To describe New Zealand adolescent time use clusters and correlate cluster profiles. Methods : Data were from the cross‐sectional 2008/2009 National Survey of Children and Young People's Physical Activity and Dietary Behaviours, which surveyed a random sample of 10–16 year‐old New Zealanders (study subset n=679). Time use data were collected using the Multimedia Activity Recall for Children and Adults, and collapsed into 17 age‐adjusted variables for sex‐specific cluster analysis. Cluster associations with socio‐demographic, anthropometric, physical activity and dietary variables were analysed. Results : Three time use clusters were discovered for both boys and girls. For boys, the Techno‐active cluster was characterised by high levels of team sports and TV; the Quiet movers cluster by transport (active and passive) and quiet time; and the Social studious cluster by reading, study activities and social interaction. The boys’ clusters were associated with ethnicity. The girls’Social sporty cluster was characterised by sports and social interaction; the Screenie tasker cluster by TV, computer, chores and work; and the Super studious cluster by reading, study and school‐based activities. The girls’ time use cluster membership was associated with weight status and serves of extra foods. Conclusions : Distinct sex‐specific time use clusters and correlate profiles exist among NZ adolescents. Implications : These findings may assist the development of targeted time use interventions to improve adolescent health and well‐being.     

Contraceptive medicalisation,fear of infertility and teenage pregnancy in Brazil

In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people's lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy. Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised. Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientific discourses on teenage pregnancy.