DETERMINE Working document #4 'Economic arguments for addressing social determinants of health inequalities'

The Institute of Public Health in Ireland (IPH) is a partner in the European project DETERMINE, building on its previous involvement in the Closing the Gap project in 2004-2006. In Year 2 the DETERMINE project  focused on identifying and exploring economic arguments to support action on social determinants of health inequalities.  Working document #4 'Economic arguments for addressing social determinants of health inequalities' presents the findings.

DETERMINE Working Document #1 'Policies and actions addressing the social determinants of health inequalities: examples of activity at EU member state level in Europe'

The Institute of Public Health in Ireland (IPH) is a partner in the European project DETERMINE, building on its previous involvement in the Closing the Gap project in 2004-2006. In the first year of the project (2007-2008) 15 DETERMINE partners identified policies and actions that have taken place within countries, and at the EU level, to address Social Determinants of Health Inequalities. These policies and actions were identified via a questionnaire, which also identified structures and tools/mechanisms being used in the country to support a 'health in all policy' approach.

Home Accident Prevention Strategy

The overall aim of the strategy is “To reduce the number of accidental deaths and injuries in the home.” OBJECTIVES OF THE STRATEGY The key objectives are: • to reduce home accidents, particularly in those most at risk; • to raise awareness of the causes of home accidents and promote effective preventative measures to reduce such accidents; • to promote and facilitate effective training, skills and knowledge in home accident prevention across all relevant organisations, groups and individuals. These objectives will be met through integrated and effective approaches including: • education and information programmes to promote home safety, and promote a change in public behaviour towards home accident prevention; and • the use of evidence based practice, models of good practice, and by evaluating home accident prevention initiatives. OUTCOMES If successful, implementation of this strategy will lead to a reduction in the number of home accidents and contribute to the outcome “reduction in preventable deaths and diseases and improvement in wellbeing” set out in the Northern Ireland Priorities and Budget 2004-2006.

Premiar y financiar proyectos de calidad revierte positivamente en el paciente y en el hospital: disminución de la infección causada por catéter venoso central en pacientes no críticos

Objectiu: Avaluar una intervenció dirigida a la reducció d‘infeccions relacionades amb els catèters venosos centrals (IRC). Mètodes: Estudi pre-postintervenció, 2004-2006. Població d'estudi: pacients portadors de catèter venós central (CVC). La intervenció va consistir en conèixer la situació bassal, identificar factors de risc, i en el segon període realitzar diverses intervencions. Resultats: Es van analitzar 175 i 200 CVC en el període pre i postintervenció, respectivament. Es va observar una incidència de IRC de 20% durant el període preintervenció i de 5,5% en el període post-intervenció (p&0,001). Conclusió: La aplicació de mesures de prevenció ha aconseguit una disminució d’aquestes del 72,5%.

Missed appointments in an adolescent outpatient clinic: descriptive analyses of consultations over 8 years.

Missed appointments represent an important medical and economical issue. Few studies on the subject are reported in the literature, particularly regarding adolescents. Our aim was to characterize missed and cancelled appointments in a multidisciplinary outpatient clinic for adolescents, to assess the effectiveness of a policy aimed at reducing missed appointments by introducing payment for those missed appointments not cancelled in advance, and to compare the rates between staff and resident physicians. A total of 32,816 consultations (representing 35 patients aged 12-20 years, 82.4% females) between 1999 and 200 were analysed. The missed appointment rate was 11.8% whilst another 10.9% were cancellations. Females cancelled more than males (11.3% vs. 8.4%, AOR 1.31, 99% CI 1.08-1.59), but there was no difference for missed appointments (11.6% vs. 12.3%, AOR 0.88, 99% CI 0.61-1.08). April and June to October (vacation months) were associated with more missed appointments. Globally mornings had higher rates of missed appointments than afternoons (13.6% vs. 11.2%, AOR 1.25, 99% CI 1.11-1.40). There was a slight difference in missed appointment rates between staff physicians and residents (10.4%; 11.8%, AOR 1.20, 99% CI 1.08-1.33). Missed appointment rates before and after the new policy on missed appointments were similar (1999-2003: 11.9%; 2004-2006: 11.6%, AOR 0.96, 99% CI 0.83-1.10). Conversely, cancellation rates increased from 8.4% (1999-2003) to 14.5% (2004-2006) (AOR 1.83, 99% CI 1.63-2.05). Attendance rates among adolescents show variations depending on vacation and school hours. Being attentive to these factors could help prevent missed appointments. Although having to pay for missed appointments does not increase attendance, it increases cancellations with the advantage that the appointment can be rescheduled.

Analysis of Pleistocene paleodrainage evolution in the Po Basin (Italy) by multivariate statistical techniques

In order to obtain a high-resolution Pleistocene stratigraphy, eleven continuouslycored boreholes, 100 to 220m deep were drilled in the northern part of the PoPlain by Regione Lombardia in the last five years. Quantitative provenanceanalysis (QPA, Weltje and von Eynatten, 2004) of Pleistocene sands was carriedout by using multivariate statistical analysis (principal component analysis, PCA,and similarity analysis) on an integrated data set, including high-resolution bulkpetrography and heavy-mineral analyses on Pleistocene sands and of 250 majorand minor modern rivers draining the southern flank of the Alps from West toEast (Garzanti et al, 2004; 2006). Prior to the onset of major Alpine glaciations,metamorphic and quartzofeldspathic detritus from the Western and Central Alpswas carried from the axial belt to the Po basin longitudinally parallel to theSouthAlpine belt by a trunk river (Vezzoli and Garzanti, 2008). This scenariorapidly changed during the marine isotope stage 22 (0.87 Ma), with the onset ofthe first major Pleistocene glaciation in the Alps (Muttoni et al, 2003). PCA andsimilarity analysis from core samples show that the longitudinal trunk river at thistime was shifted southward by the rapid southward and westward progradation oftransverse alluvial river systems fed from the Central and Southern Alps.Sediments were transported southward by braided river systems as well as glacialsediments transported by Alpine valley glaciers invaded the alluvial plain.Kew words: Detrital modes; Modern sands; Provenance; Principal ComponentsAnalysis; Similarity, Canberra Distance; palaeodrainage

Prevalence and genotyping of hepatitis C virus in blood donors in the state of Pará, Northern Brazil

Given the scarcity of epidemiological information on hepatitis C virus (HCV) infection in Northern Brazil, we determined the prevalence and genotypic frequency in blood donors in the state of Pará (PA). Blood samples from all of the blood donors at the Fundação HEMOPA (blood bank of PA) from 2004-2006 were screened for the presence of antibodies to anti-HCV and samples seroreactive to anti-HCV were further tested for HCV RNA using real-time PCR. In total, 116 HCV-RNA samples were genotyped, based on maximum likelihood phylogenetic analyses, using BioEdit, Modelgenerator, PHYML and FigTree software. The population consisted of 242,726 volunteers who donated blood from 2004-2006; the most common subgroup was males between the ages of 18-29 years old (37.30%). Within the whole group, 1,112 blood donors (0.46%) had indeterminate or positive serology; among these, 28.78% were males whose ages ranged from 18-29 years. A diagnosis of chronic HCV infection was confirmed for 304 donors (60.20% males; 66.45% were 30-49 years old), resulting in a prevalence of HCV RNA in 0.13% of the samples (304 of 242,726). HCV genotyping revealed a high frequency of genotype 1 (108/116) followed by genotype 3 (8/116). This study found HCV infection to be relatively infrequent in PA; genotype 1 was most commonly isolated. This information can help guide prevention and control policies aimed at efficient diagnosis and control measures.

Description of Lutzomyia (Helcocyrtomyia) tolimensis, a new species of phlebotomine sandfly (Diptera: Psychodidae) from Colombia

A description is presented of Lutzomyia tolimensis sp. nov., a new species of the subgenus Helcocyrtomyia, series sanguinaria. It was collected in dwellings, peridomestic environment and in nearby forest patches located in the foothills of the Andean Central Cordillera, where in 2004-2006 occurred the largest epidemic ever recorded of leishmaniasis in Colombia. The male of this species is differentiated from other members of the series sanguinaria based on the following combination of characters: (i) base of coxite with 0-3 subequal setae, (ii) spines of gonostyle organized in positions 2.1.2, (iii) spines inserted on distal half of gonostyle and (iv) relationship of alar indices. The female is recognized principally by the following characters: (i) palpomere V longer than III, (ii) length of labro-epipharynx and (iii) relationship of the alar indices.

Annual Report for the Iowa Department of Administrative Services, Fiscal Year 2008

Annual Report for the Iowa Department of Administrative Services, Fiscal Years 2004-2006

Prevalence of overweight and obesity among migrants in Switzerland: association with country of origin.

Migrants tend to present higher overweight and obesity levels, but whether this relationship applies to all nationalities has seldom been studied. The present study aimed to assess the prevalence of overweight and obesity according to nationality in adults. Cross-sectional population-based samples. Five-year nationwide interview surveys (Swiss Health Surveys - SHS) from 1992 to 2007 (n 63 766) and a local examination survey (CoLaus Study in Lausanne 2004-2006, n 6743). Participants were separated into Swiss, French, German, Italian, Portuguese, Spanish nationals, those from the former Republic of Yugoslavia and from other European and other countries. Compared with Swiss nationals, German and French nationals presented a lower prevalence of overweight and obesity, whereas nationals from Italy, Spain, Portugal and the former Republic of Yugoslavia presented higher levels. Adjusting the SHS data for age, gender, education, smoking, leisure-time physical activity and survey year, a lower risk for overweight and obesity was found for German (OR = 0·80, 95 % CI 0·70, 0·92) and French (OR = 0·74, 95 % CI 0·61, 0·89) nationals, whereas higher risks were found for participants from Italy (OR = 1·45, 95 % CI 1·33, 1·58), Spain (OR = 1·36, 95 % CI 1·15, 1·61), Portugal (OR = 1·25, 95 % CI 1·06, 1·47) and the former Republic of Yugoslavia (OR = 1·98, 95 % CI 1·69, 2·32). Similar findings were observed in the CoLaus Study for Italian (OR = 1·63, 95 % CI 1·29, 2·06), Spanish (OR = 1·54, 95 % CI 1·17, 2·04) and Portuguese (OR = 1·49, 95 % CI 1·16, 1·91) participants and for those from the former Republic of Yugoslavia (OR = 5·34, 95 % CI 3·00, 9·50). Overweight and obesity are unevenly distributed among migrants in Switzerland. Migrants from Southern Europe and from the former Republic of Yugoslavia present higher prevalence rates. This suggests that preventive messages should be tailored to these specific populations.

Ética medio ambiental: una revisión de la ética antropocéntrica

Los problemas medio ambientales dependeránsiempre de la comprensión antropológica quese asuma, de la idea del ser humano como parte de un medio ambiente que lo integra. El hombre, como único animal racional, debe pensar las acciones que está llevando a cabo, la crisis medio ambiental y energética a la que está sometiendo al planeta, y pensar también cómo deberá actuar en el futuro.

Sujeciones físicas y ética. ¿Binomio obligado?

Mi interés por este tema surgió tras la lectura de un artículo que hablaba de las sujeciones físicas en personas de edad avanzada. En el mismo se hacía referencia a un programa denominado "Desatar al anciano y al enfermo de Alzheimer" que promovido por CEOMA (Confederación Española de Organizaciones de Personas Mayores) ycoordinado por el Dr. Burgueño, se planteabaconocer el estado de la cuestión en el panorama del Estado Español. Decidí conocer cual era la realidad en el Hospital donde trabajo y para ello elegí una unidad de agudos, donde los ingresos mayoritarios correspondían a personas mayores. Laidea era realizar un estudio de percepción social entre familiares de aquellas personas que ingresaban y que padecían algún tipo de demencia, con un doble objetivo:- Cuantificar las sujeciones.- Conocer la opinión de los familiares de los pacientes ingresados sobre su utilización.

La importancia del sufrimiento

La capacidad para experimentar sufrimientoes determinante en la delimitación de la esfera moral. No estamos ante un criterio arbitrario porque la moral surge de nuestra preocupación por determinados daños que nos parecen injustos. El interés básico de evitar el sufrimiento siempre ha sido objeto de preocupación de la ética. Generalmentetodas las teorías protegen la promoción deeste tipo de interés individual de una u otra forma. No hay que entenderlo como una propiedad biológica más porque estamos ante una característica previa que sí está definitivamente ligada al ámbito de lo moral.

Calagem em latossolo amarelo distrófico da amazônia e sua influência em atributos químicos do solo e na produtividade de culturas anuais

A produção agrícola contínua na região amazônica requer a correção da acidez dos solos, o que exige a avaliação do efeito dos corretivos em experimentos de longa duração. O objetivo deste trabalho foi avaliar a influência do calcário e seu efeito residual sobre os atributos do solo e a produtividade de culturas anuais, em Latossolo Amarelo distrófico textura média da Amazônia. No período de 2003 a 2008, foram conduzidos dois experimentos no nordeste do Pará, um no município de Terra Alta e outro no município de Tracuateua. O delineamento experimental utilizado foi em blocos ao acaso com uma testemunha e 10 doses de calcário entre 0,1 e 2 Mg ha-1 em Terra Alta e quatro doses entre 1 e 4 Mg ha-1 em Tracuateua, aplicadas em 2003. Neste último local, nas subparcelas foram avaliadas, em cada ano, duas variedades de cada cultura (milho e feijão-caupi) utilizadas na sucessão. Em Terra Alta, foram realizados quatro cultivos de milho (2003-2006) e três de feijão-caupi (2004-2006), em rotação. As maiores produtividades de grãos de milho em Terra Alta foram obtidas com doses de calcário em torno de 1 Mg ha-1, enquanto para o feijão-caupi a dose foi inferior a esse valor. Em Tracuateua, a resposta do feijão-caupi ao calcário só iniciou-se em 2005, com produtividade máxima obtida com a aplicação de 1 Mg ha-1 de calcário, observando-se diferença entre as variedades. O aumento da produtividade média das culturas esteve associado ao aumento dos teores de Ca + Mg e à redução da saturação por Al no solo. Em ambos os locais houve diminuição dos teores de Ca + Mg e aumento da saturação por Al no solo, com o tempo após a aplicação do calcário, sendo mais acentuados em Tracuateua. Para o milho, plantado em 2007 e 2008 em Tracuateua, as respostas foram lineares até a dose residual de 4 Mg ha-1 de calcário. A observação conjunta dos resultados sugere que a dose apropriada de calcário para milho, nesses solos, deverá reduzir a saturação por Al para um valor menor que 11 %. Para feijão-caupi, a saturação por Al tolerada pelas variedades avaliadas esteve entre 13 e 32 %, devendo-se considerar, portanto, a variedade utilizada.

Efeitos em longo prazo da aplicação de gesso e calcário no sistema de plantio direto

Os efeitos da calagem e da gessagem são amplamente conhecidos na literatura, mas a sua magnitude em relação aos efeitos no perfil do solo é dependente do tempo após a aplicação desses insumos. Dessa maneira, o objetivo deste trabalho foi avaliar em longo prazo a aplicação conjunta de gesso e calcário nos atributos químicos de um solo em rotação de culturas, no sistema de plantio direto. O experimento foi conduzido em uma propriedade rural no município de Jaguariaíva, PR, em um Latossolo Vermelho-Amarelo distrófico típico, de textura areia franca, durante os anos de 2002 a 2008. O experimento foi conduzido em blocos ao acaso sob esquema fatorial com 10 tratamentos, sendo cinco doses de gesso agrícola (0; 1,5; 3,0; 6,0; e 12,0 Mg ha-1) e duas doses de calcário (0 e 3,42 Mg ha-1), com três repetições. Foram avaliadas no decorrer dos 72 meses as espécies aveia-preta-comum (2004, 2006 e 2007), milho (2005/2006), trigo (2003) e soja (2003/2004, 2004/2005, 2006/2007 e 2007/2008). Realizaram-se amostragem e análise de solo nos anos de 2005 e 2008 até 100 cm de profundidade e de tecido foliar da soja, na safra de 2007/2008. A aplicação de calcário corrigiu o pH, aumentou a concentração de Ca e Mg e diminuiu o Al, nas camadas superficiais do solo. O gesso proporcionou incremento no pH e nas concentrações de Ca e S em profundidade, lixiviou Mg e não lixiviou o K. A calagem elevou a produtividade do milho, da soja (uma das quatro safras avaliadas) e da aveia- preta. O gesso favoreceu a produtividade do milho e do trigo e a da soja, somente quando houve deficiência hídrica. Quando, no entanto, não houve deficiência hídrica, altas doses de gesso prejudicaram a produtividade de grãos de soja por indução de deficiência de Mg.