Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults

Background. This study aimed to investigate relationships between environmental aesthetics, convenience, and walking companions and walking for exercise or recreation and to investigate differences in these relationships by sex and by reported physical and mental health. Methods. Analyses of cross-sectional self-report data from a statewide population survey of 3,392 Australian adults were used. Results. Men and women reporting a less aesthetically pleasing or less convenient environment were less likely to report walking for exercise or recreation in the past 2 weeks. Those respondents, particularly women, reporting no company or pet to walk with were also less likely to walk for exercise or recreation. Associations with environmental and social influences were observed for men and women reporting both good and poor physical and mental health. Conclusions. Perceived environmental aesthetics and convenience and walking companions are important correlates of walking for exercise among urban Australians. Acknowledging the cross-sectional nature of these data, findings support a case for evaluation of environmental policies to promote physical activity. (C) 2001 American Health Foundation and Academic Press.

Co-morbidity between alcohol, tobacco and cannabis use: reply to David Fergusson

No abstract

Cannabis use and cancer (Editorial)

No Abstract

Human response to environmental noise: The role of perceived control

Negative impacts of noise exposure on health and performance may result in part from learned helplessness, the syndrome of deficits typically produced by exposure to uncontrollable events. People may perceive environmental noise to be uncontrollable, and several effects of noise exposure appear to parallel learned helplessness deficits. In the present socioacoustic survey (N = 1,015), perceived control over aircraft noise correlated negatively with some effects of noise (though not others). Furthermore, these effects were better predicted by perceived control than by noise level. These observational data support the claim that learned helplessness contributes to the effects of noise exposure.

Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries

Access to basic health services was affirmed as a fundamental human right in the Declaration of Alma-Ata in 1978. The model formally adopted for providing healthcare services was primary health care (PHC), which involved universal, community-based preventive and curative services, with substantial community involvement. PHC,did not achieve its goals for several reasons, including the refusal of experts and politicians in developed countries to accept the principle that communities should plan and implement their own heathcare services. Changes in economic philosophy led to the replacement of PHC by Health Sector Reform, based on market forces and the economic benefits of better health. It is time to abandon economic ideology and determine the methods that will provide access to basic healthcare services for all people.

A qualitative study of Australian GPs' attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD)

Background. The importance of general practice involvement in the care of attention-deficit/hyperactivity disorder (ADHD) is increasing due to the rising numbers of patients who present with the disorder. It has been suggested by consensus bodies that GPs should be identifying and referring patients at the severe end of the ADHD spectrum and managing those with less severe symptoms. However, GPs' views of their role in ADHD care are unknown. Objective. Our aim was to explore the attitudes and practices of Australian GPs towards the diagnosis and management of ADHD. Methods. We conducted a series of focus groups to explore GPs' beliefs regarding the causes of ADHD, their perceived role in ADHD diagnosis and management and their views on the role of behaviour therapies and pharmacotherapies in ADHD management. The subjects were 28 GPs in six focus groups. Results. GPs in this study did not want to be the primary providers of care for patients with ADHD. Participants indicated a preference to refer the patient to medical specialists for diagnosis and treatment of ADHD, and expressed low levels of interest in becoming highly involved in ADHD care. Concerns about overdiagnosis and misdiagnosis of the disorder, diagnostic complexity, time constraints, insufficient education and training about the disorder, and concerns regarding misuse and diversion of stimulant medications were the reasons cited for their lack of willingness. Conclusions. The Australian GPs in this study identify a role for themselves in ADHD care which is largely supportive in nature, and involves close liaison with specialist services.

Triggers of subarachnoid hemorrhage - Role of physical exertion, smoking, and alcohol in the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS)

Background and Purpose - Unaccustomed strenuous physical exertion can trigger myocardial infarction, but little is known about the mechanisms precipitating subarachnoid hemorrhage (SAH). Methods - We identified all cases of first-ever SAH among the combined populations (2.8 million) of 4 urban centers in Australia and New Zealand. Information on the type, time, and intensity of exposures in the 26 hours before the onset of SAH was ascertained by structured interviews. We used the case-crossover technique to assess the risk of SAH associated with transient exposures of moderate to extreme physical exertion, heavy cigarette smoking, and binge alcohol consumption. Results - We registered 432 first-ever cases of SAH (62% women; mean age, 56.5 years). A definite time of onset of SAH was established for 393 patients (91%), and information on the levels of physical activity in the preceding 26 hours was obtained in 338 ( 78%). Of these patients, 19% engaged in moderate to extreme exertion (greater than or equal to5 metabolic equivalents) in the 2 hours before SAH, which was associated with a tripling in the risk of SAH (odds ratio [OR], 2.7; 95% CI, 1.6 to 4.6). There was no evidence of any association between heavy cigarette smoking or binge drinking and risk of SAH in the subsequent 2 hours ( OR, 1.1; 95% CI, 0.4 to 3.7; and OR, 0.41; 95% CI, -infinity to 5.3). Habitual exercise did not appear to alter the risk of SAH associated with moderate to extreme exertion. Conclusions - Moderate to extreme physical exertion tripled the risk of SAH, but there was no association between transient heavy smoking or binge drinking and risk of SAH. These data suggest that heavy physical activity may trigger SAH.

A randomized trial comparing hormone replacement therapy (HRT) and HRT plus calcitriol in the treatment of postmenopausal osteoporosis with vertebral fractures: Benefit of the combination on total body and hip density

We report a prospective, randomized, multi-center, open-label 2-year trial of 81 postmenopausal women aged 53-79 years with at least one minimal-trauma vertebral fracture (VF) and low (T-score below 2) lumbar bone mineral density (BMD). Group HRT received piperazine estrone sulfate (PES) 0.625 - 1.25 mg/d +/- medroxyprogesterone acetate (MPA) 2.5 - 5 mg/d,- group HRT/D received HRT plus calcitriol 0.25 mug bd. All with a baseline dietary calcium (Ca) of < I g/d received Ca carbonate 0.6 g nocte. Final data were on 66 - 70 patients. On HRT/D, significant (P < 0.001) BNID increases from baseline by DXA were at total body - head, trochanter, Ward's, total hip, inter-trochanter and femoral shaft (% group mean Delta 4.2, 6.1, 9.3. 3.7. 3.3 and 3.3%, respectively). On HRT, at these significant Deltas were restricted to the trochanter and sites. si Wards. Significant advantages of HRT/D over HRT were in BMD of total body (- head), total hip and trochanter (all P = 0.01). The differences in mean Delta at these sites were 1.3, 2.6 and 3.9%. At the following, both groups Improved significantly -lumbar spine (AP and lateral), forearm shaft and ultradistal tibia/fibula. The weightbearing, site - specific benefits of the combination associated with significant suppression of parathyroid hormone-suggest a beneficial effect on cortical bone. Suppression of bone turnover was significantly greater on HRT/D (serum osteocalcin P = 0.024 and urinary hydroxyproline/creatinine ratio P = 0.035). There was no significant difference in the number of patients who developed fresh VFs during the trial (HRT 8/36, 22%; HRT/D 4/34, 12% - intention to treat); likewise in the number who developed incident nonvertebral fractures. This Is the first study comparing the 2 treatments in a fracture population. The results indicate a significant benefit of calcitriol combined with HRT on total body BMD and on BNID at the hip, the major site of osteoporotic fracture.

Vaginal douching and vaginal substance use among sex workers in KwaZulu-Natal, South Africa

A local cultural practice that may enhance sexually transmitted infections (STIs) and HIV transmission is vaginal douching and vaginal substance use. These activities also have potential implications for the acceptability of HIV-prevention strategies such as the use of condoms and vaginal microbicides. We aimed to establish the prevalence, determinants and reasons for these practices among sex workers in KwaZulu-Natal, South Africa. A structured questionnaire was administered to 150 sex workers, who were being screened for a vaginal microbicide-effectiveness trial in the province. The questionnaire sought information on the frequency, reasons for and nature of vaginal douching and vaginal substance use and was drawn up on the basis of findings from a pilot study. Seventy per cent (95% CI: 62.0-77.2%) of the sex workers were HIV positive and on average they had five sexual partners per day. Vaginal douching and vaginal substance use were common among the sex workers. Vaginal douching was reported by 97% (n = 146) of the respondents and 94% reported vaginal substance use for 'dry sex'. A combination of traditional remedies, patent medicines, antiseptics and household detergents was used to clean and make the vagina dry and tight. The primary reasons reported for dry sex were to increase men's sexual pleasure (53%) and to attract clients and generate more money (20%). Sixty-five per cent of the women reported the practice of douching mainly for hygienic purposes and 13% for the prevention and treatment of sexually transmitted infections. Douching and dry-sex practices may increase women's risk of HIV and STI infection, and may have implications for the acceptability and development of HIV-prevention barrier methods such as microbicides and the use of condoms. These barrier methods may enhance or reduce sexual pleasure for men and women who engage in the practice of vaginal douching and vaginal substance use for 'dry sex'.

Active and passive smoking and the risk of subarachnoid hemorrhage - An international population-based case-control study

Background and Purpose - This study was undertaken to better clarify the risks associated with cigarette smoking and subarachnoid hemorrhage (SAH). Methods - The study included 432 incident cases of SAH frequency matched to 473 community SAH-free controls to determine dose-dependent associations of active and passive smoking ( at home) and smoking cessation with SAH. Results - Compared with never smokers not exposed to passive smoking, the adjusted odds ratio for SAH among current smokers was 5.0 (95% confidence interval [CI], 3.1 to 8.1); for past smokers, 1.2 ( 95% CI, 0.8 to 2.0); and for passive smokers, 0.9 ( 95% CI, 0.6 to 1.5). Current and lifetime exposures showed a clear dose-dependent effect, and risks appeared more prominent in women and for aneurysmal SAH. Approximately 1 in 3 cases of SAH could be attributed to current smoking, but risks decline quickly after smoking cessation, even among heavy smokers. Conclusions - A strong positive association was found between cigarette smoking and SAH, especially for aneurysmal SAH and women, which is virtually eliminated within a few years of smoking cessation. Large opportunities exist for preventing SAH through smoking avoidance and cessation programs.

Transport-Regional Equity Issue Revisited

Almeida E. S. de, Haddad E. A. and Hewings G. J. D. Transport-regional equity issue revisited, Regional Studies. The objective of this paper is to analyse the relationship between transport and regional equity in Minas Gerais, Brazil. Furthermore, the existence of a trade-off between economic performance and regional equity is investigated as well. To do so, the paper develops a spatial computable general equilibrium model based on Brocker and Schneider`s approach of 2002 to implement comparative static analysis, explicitly incorporating iceberg transportation costs. Four activities are modelled, namely production, final demand, transportation and exports. Two production factors are assumed: labour and other factors. The model has 12 domestic regions and three external regions. Four counterfactual experiments are developed based on decreases in transportation costs due to a `distance shortening`. The main findings indicate that if the transport infrastructure improvement is focused only among poor regions, the promotion of regional equity is insignificant. If the transport infrastructure improvement links are concentrated among rich regions, there is an increase in regional income inequalities. However, if the improvements are targeted to the roads linking poor regions and rich ones, there is greater promotion of regional equity. The same result will occur when improvements are made to all road links of the state. [image omitted] Almeida E. S. de, Haddad E. A. et Hewings G. J. D. La question du rapport entre le transport et l`equilibre regional vue sous un jour nouveau, Regional Studies. Cet article cherche a analyser le rapport entre le transport et l`equilibre regional en Minas Gerais au Bresil. En outre, on examine la presence d`un echange entre la performance economoique et l`equilibre regional. Pour le faire, on construit un modele geographique de l`equilibre general a utiliser sur ordinateur fonde sur l`approche de Brockner et Schneider en 2002 afin de mettre en oeuvre une analyse statique comparative qui comprend explicitement les frais de transport iceberg. On modelise quatre activites, a savoir, la production, la demande finale, le transport et l`exportation. On fait deux suppositions quant aux facteurs de production: la main-d`oevre et d`autres facteurs. Le modele embrasse douze regions internes et trois regions externes. On fait quatre experiences paradoxales fondees sur la baisse des frais de transport due a une `reduction des distances`. Les principaux resultats indiquent que si l`amelioration de l`equipement de transport ne porte que sur les regions defavorisees, la promotion de l`equilibre regional s`avere negligeable. Si l`amelioration de l`equipement de transport focalise les regions riches, il s`avere un creusement des ecarts des revenus regionaux. Cependant, si les ameliorations ciblent les routes qui relient les regions defavorisees aux regions riches, il s`avere une plus grande promotion de l`equilibre regional. Il en va de meme pour la situation ou on a apporte des amenagements a toutes les liaisons routieres de l`etat. Modele geographique de l`equilibre general a utiliser sur ordinateur Equilibre regional Peformance economique Frais de transport Almeida E. S. de, Haddad E. A. und Hewings G. J. D. Die Wiederaufnahme der Frage von Verkehrswesen im Verhaltnis zu regionaler Fairness, Regional Studies. Dieser Aufsatz beabsichtigt, die Beziehung zwischen Verkehrswesen und regionaler Fairness in Minas Gerais (Brasilien) zu analysieren und zugleich auch das Vorkommen von Einbussen entweder bei wirtschaftlicher Leistung der regionaler Fairness zu untersuchen. Zu diesem Zwecke wird ein auf dem Ansatz von Brocker und Schneider (2002) aufbauendes raumliches komputables allgemeines Gleichgewichtsmodell entwickelt, um vergleichende statistische Analysen durchzufuhren, wobei verborgene `Eisberg`-Transportkosten ausdrucklich berucksichtigt werden. Es werden vier Unternehmenstatigk eiten aufgefuhrt: Herstellung, Nachfrage, Transportwesen und Exporte, und zwei Produktionsfaktoren vorausgesetzt: Arbeitskrafte und andere Faktoren. Das Modell umfasst zwolf Inlandsregionen und drei externe Regionen. Es werden vier gegensatzliche Experimente entwickelt, die auf einer Abnahme der Transportkosten infolge einer `Verkurzung der Entfernungen` beruhen. Die Hauptbefunde weisen darauf hin, dass die Forderung regionaler Fairness unbedeutend bleibt, wenn die Verbesserungen der Transportinfrastruktur sich nur auf minderbemittelte Regionen konzentrieren; werden die Verbesserungen der Verbindungen der Transportinfrastruktur in wohlhabenden Regionen durchgefuhrt, so nehmen regionale Einkommensunterschiede zu. Wenn die Verbesserungen jedoch auf Strassen abzielen, die wohlhabende Regionen mit weniger bemittelten verbinden, wird regionale Fairness starker gefordert. Das gleiche Ergebnis wird sich einstellen, wenn Verbesserungen an allen Strassenverbindungen des Staates vorgenommen werden. Raumliches, komputables, allgemeines Gleichgewichtsmodell Regionale Fairness Wirtschaftsleistung Transportkosten Almeida E. S. de, Haddad E. A. y Hewings G. J. D. Revisando el tema de la igualdad del transporte en las regiones, Regional Studies. El objetivo de este documento es analizar la relacion entre el transporte y la igualdad regional en Minas Gerais, Brasil. Asimismo investigamos la existencia de una compensacion entre el rendimiento economico y la igualdad regional. Para ello desarrollamos un modelo de equilibrio general computable y espacial basado en el enfoque de Brocker y Schneider en 2002 para hacer un analisis estatico y comparativo, explicitamente incorporando los costes ocultos de transporte. Se modelan cuatro actividades: la produccion, la demanda final, el transporte y las exportaciones. Suponemos que existen dos factores de produccion: mano de obra y otros factores. En este modelo, existen doce regiones internas y tres regiones externas. Desarrollamos cuatro experimentos contrafactuales basados en la disminucion de los costes de transporte debido a una `acortamiento de las distancias`. Los principales resultados indican que si la mejora de la infraestructura del transporte se centra solo entre las regiones mas pobres, el fomento de la igualdad regional es insignificante. Si los enlaces de la mejora de la infraestructura del transporte se concentran en las regiones ricas, aumentan las desigualdades de ingresos regionales. Sin embargo, si se mejoran los enlaces de carreteras entre las regiones pobres y ricas, se fomenta mejor la igualdad regional. El mismo resultado ocurre cuando se mejoran los enlaces de todas las carreteras del estado. Modelo de equilibrio general computable y espacial Igualdad regional Rendimiento economico Costes de transporte.