Journal of public health medicine最新文献

In August 2000, health authorities in England and Wales became statutory consultees for permits issued to industry by the Environment Agency as part of the implementation of EU directives. This responsibility has since been delegated to Primary Care Trusts. To assess health authority responses to applications made under the Integrated Pollution Prevention and Control (IPPC) regulations, we collected data from public registers during the first 12 months of this new regulatory regime. There was evidence of 27 applications, of which 59 per cent had substantive comments from health authorities. There was wide variation in the length and content. Responses were from Consultants in Communicable Disease Control (57 per cent) or Directors of Public Health (43 per cent). Only two health authorities had a dedicated resource for responding to IPPC applications. Capacity and capability are lacking and require resources invested for consistent, effective public health input to the process of permitting potentially polluting industries.

Background: This cross-sectional study was carried out in a population-based setting in Worcestershire to investigate the relationship between social deprivation and other potential prognostic factors.

Methods: A total of 762 female patients diagnosed with primary breast cancer between 1 January 1998 and 31 December 1999 were selected. Breast cancer included all new cases of primary invasive breast cancer and ductal carcinoma in situ. A total of 753 patients were matched by their postcode of residence to enumeration district Townsend score and then divided into three groups based on Townsend quintiles (affluent n = 478; middle n = 157; deprived n = 118). Main outcome measures were relationships between social deprivation and tumour type, stage at presentation, oestrogen receptor status, tumour grade and treatment type.

Results: Compared with the most deprived women, affluent women were less likely to present with invasive ductal tumours (70.8 per cent versus 85.9 per cent, chi2 linear trend = 6.757, p = 0.009), tumours of higher grade (36.0 per cent versus 44.7 per cent, chi2 linear trend = 4.201, p = 0.040), and oestrogen receptor negative tumours (22.4 per cent versus 33.3 per cent, chi2 linear trend = 3.501, p = 0.061). There was no significant difference in stage or tumour size at presentation between deprivation groups. More deprived women with invasive tumours of less than 20 mm maximum diameter were significantly more likely to have mastectomies than affluent women (47.8 per cent versus 32.1 per cent, chi2 linear trend = 4.091, p = 0.043).

Conclusions: This study suggests that level of social deprivation is associated with tumour type, grade and oestrogen receptor status. There was also a suggestion that increased level of deprivation was associated with increased risk of potentially unnecessary mastectomies.

Background: Hypertension is a major risk factor for stroke and ischaemic heart disease. Most hypertension is detected opportunistically by general practitioners. Those who rarely use medical services are less likely to have their blood pressure (BP) measured. We hypothesized that open access self-reading BP measurement would detect previously unrecognized hypertension.

Methods: Self-reading sphygmomanometers were placed at 13 public sites in Exeter, Devon, United Kingdom. Machine use was determined by users completing a proforma and by direct observation of sites. Users whose BP reading was above an action level of 135/85 mmHg were asked to attend their general practice. General practitioner records were reviewed 6 months after machine use to identify diagnoses of hypertension. A random sample of users was interviewed, and local general practices were asked about effects on their workload.

Results: A total of 758 first time users completed a proforma fully, although direct observations suggested total use was much higher. Of the total, 221 (29.2 per cent) readings were above the action level. Eleven new hypertensives were found, 1.4 per cent (95 per cent confidence interval (CI 0.7-2.5) of the total users. User acceptability was high. All general practice replies were supportive.

Conclusion: Open access sphygmomanometry for detection of hypertension is feasible. This scheme led to the diagnosis of hypertension in 1.4 per cent of users, and allowed many people to measure their BP in a way convenient to them. Before recommending wider implementation we suggest a study examining if our results are transferable to other settings, and if this approach reduces inequalities and is cost-effective.

We report a cluster of patients developing photokeratitis as a result of exposure to unprotected UV-B light source. The incident occurred at a cattle livestock market auction where the light source protective covers of mercury vapour lamps were damaged because of vandalism. The incident was investigated by the District Council as a public health and safety issue. This report stresses the hazards of ultraviolet lamps routinely used in public places and the need for proper maintenance of these light sources.

Continuing inconsistent use of the term 'Asian' and its appearance for the first time in the 2001 Census justifies an examination of its utility in population and health research. Given the potential for 'Asian' to describe either persons with origins in the Indian subcontinent or those originating from continental Asia, there is a strong argument in studies employing ethnicity as a measure of broad historical processes of colonialism, migration, and discrimination for privileging 'South Asian' over this contested term. Where the focus is on ethnicity as personal identity, there is some evidence of the emergence of bicultural terms such as 'Asian British' and 'Scottish Asian' and of more limited use regionally of 'Asian' and qualified terms such as 'Hindu Asian'. However, such usage cannot be generalized to the acceptance of a pan-Asian identity. Further, the different meanings that attach to terms such as 'Asian' and 'Indian' in the USA and Canada in terms of the specificity of each country's historical process of ethnogenesis mean that, where international comparisons are being made, accurate description of the population is needed to explain the terminology.

Health impact assessment (HIA) has many advocates for its use to identify and optimize the health effects of non-healthcare interventions. It is an assessment of the health effects, positive and negative, of a project, programme, or policy. Expertise developed in the United Kingdom from a realization that health impacts are often overlooked during the planning stages of development projects but prior planning can avoid detrimental effects. Considering health impacts is now recommended in all continents; the focus has moved from less to more developed countries and upstream from projects to policies. Health impact assessment shares certain concepts and methods with risk assessment, environmental impact assessment, strategic environmental assessment, social impact assessment, and economic assessments. This paper describes the development of health impact assessment and its relation to these other forms of impact assessment.