Women, Debt & Health; a Joint report of The Women’s Health Council and MABS

Women, Debt & Health; a Joint report of The Women’s Health Council and MABS The main aims of the â?~Women, Debt and Healthâ?T project were to:- explore whether women attending the MABS service commonly discuss health during their money advice and budgeting consultations;- investigate whether women attending MABS identifi ed links between their debt or financial difficulties and their health; and- document the types of health issues experienced by MABS clients.- A secondary aim of the research was to explore the need for, and nature of, further research in this area. Click here to download PDF 1.1mb

Health Inequalities and the Living Wage

Evidence Review 6 - Health inequalities and the living wage Briefing 6 - Health inequalities and the living wage This pair of documents, commissioned by Public Health England, and written by the UCL Institute of Health Equity, address the role of a minimum income in improving health. These papers provide a summary of evidence on the health impacts of living on a low income. They assess the evidence around how the living wage addresses low incomes, health and health inequalities. The living wage is an hourly minimum wage, optional for employers, calculated according to the basic cost of living. Local authorities and other organisations that have implemented the living wage for their staff are presented as case study interventions to show how it is possible, the challenges faced and how they were overcome and any reported income, health and business benefits. The full evidence review and a shorter summary briefing are available to download above. This document is part of a series. An overview document which provides an introduction to this and other documents in the series, and links to the other topic areas, is available on the ‘Local Action on health inequalities’ project page. A video of Michael Marmot introducing the work is also available on our videos page.

A Study of the Epidemiology of AIDS in Ireland and an Evaluation of an AIDS Education Programme in Second-level Schools

Second-level school students have been identified by the Minister for health as a priority group for education on AIDS. An education programme was accordingly initiated in 1988 in Community Care Area 1 in South county Dublin. This report evaluates this education intervention by means of pre- and post- intervention questionnaires. The questionnaire examined knowledge and attitudes of students relevant to AIDS. The results showed that the level of knowledge of students living in this area was high prior to intervention. The education programme succeeded in improving some aspects of knowledge and also influenced some attitudes of the students. A study of the epidemiology of Aids in Ireland reveals that the epidemic is at a relatively early stage with a consequent rapid doubling time of 9-10 months. In comparison with most developed countries Ireland has a high proportion of AIDS cases occurring among intravenous drug abusers and directly related to this a high number of HIV infected children. Examination of the literature reveals that behaviour change has occurred most noticeably among the homosexual/bisexual risk group. There is some evidence that the comprehensive programmes can achieve change in the behaviour of intravenous drug abusers. There are very few reports linking behaviour change among adolescents and young adults to education programmes. Much of the available literature relates to changes in knowledge and attitudes. International recommendations on the nature of the ideal health education intervention on AIDS are reviewed. The importance of a comprehensive health education programme which incorporates AIDS education and which commences early in youth is noted. The role of the community physician in relation to education programmes and other aspects of monitoring and management of the AIDS epidemic is discussed.This resource was contributed by The National Documentation Centre on Drug Use.

Histological and histochemical evaluation of human oral mucosa constructs developed by tissue engineering

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues is very common. In this context, tissue engineering techniques may provide a source of autologous tissues available for transplant in these patients. In this work, we developed a new model of artificial oral mucosa generated by tissue engineering using a fibrin-agarose scaffold. For that purpose, we generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal oral mucosa using enzymatic treatments. Then we determined the viability of the cultured cells by electron probe quantitative X-ray microanalysis, and we demonstrated that most of the cells in the primary cultures were alive and had high K/Na ratios. Once cell viability was determined, we used the cultured fibroblasts and keratinocytes to develop an artificial oral mucosa construct by using a fibrin-agarose extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral mucosa controls. The epithelium of the oral substitutes had several layers, with desmosomes and apical microvilli and microplicae. Both the controls and the oral mucosa substitutes showed high suprabasal expression of cytokeratin 13 and low expression of cytokeratin 10. All these results suggest that our model of oral mucosa using fibrin-agarose scaffolds show several similarities with native human oral mucosa.

Compliance with guidelines-recommended processes in pneumonia: impact of health status and initial signs

Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose <6 hours and oxygen assessment. Antibiotic adherence was 72.6%, first dose <6 h was 73.4% and oxygen assessment was 90.2%. Antibiotic adherence was negatively associated with a high Charlson score (Odds ratio [OR], 0.91), confusion (OR, 0.66) and tachycardia ≥100 bpm (OR, 0.77). Delayed first dose was significantly lower in those with tachycardia (OR, 0.75). Initial oxygen assessment was negatively associated with fever (OR, 0.61), whereas tachypnea ≥30 (OR, 1.58), tachycardia (OR, 1.39), age >65 (OR, 1.51) and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care.

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation.

BACKGROUND The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients.

Multifunctional ligands for application in Alzheimer’s Disease: molecular modelling and biological evaluation

Projecte de recerca elaborat a partir d’una estada a la University of British Columbia, Canadà, entre 2010 i 2012 La malaltia d'Alzheimer (MA) representa avui la forma més comuna de demència en la població envellida. Malgrat fa 100 anys que va ser descoberta, encara avui no existeix cap tractament preventiu i/o curatiu ni cap agent de diagnòstic que permeti valorar quantitativament l'evolució d'aquesta malaltia. L'objectiu en el que s'emmarca aquest treball és contribuir a aportar solucions al problema de la manca d'agents terapèutics i de diagnosi, unívocs i rigorosos, per a la MA. Des del camp de la química bioinorgànica és fàcil fixar-se en l'excessiva concentració d'ions Zn(II) i Cu(II) en els cervells de malalts de MA, plantejar-se la seva utilització com a dianes terapèutica i, en conseqüència, cercar agents quelants que evitin la formació de plaques senils o contribueixin a la seva dissolució. Si bé aquest va ser el punt de partida d’aquest projecte, els múltiples factors implicats en la patogènesi de la MA fan que el clàssic paradigma d’ ¨una molècula, una diana¨ limiti la capacitat de la molècula de combatre aquesta malaltia tan complexa. Per tant, un esforç considerable s’ha dedicat al disseny d’agentsmultifuncionals que combatin els múltiples factors que caracteritzen el desenvolupament de la MA. En el present treball s’han dissenyat agents multifuncionals inspirats en dos esquelets moleculars ben establers i coneguts en el camp de la química medicinal: la tioflavina-T (ThT) i la deferiprona (DFP). La utilització de tècniques in silico que inclouen càlculs farmacocinètics i modelatge molecular ha estat un procés cabdal per a l’avaluació dels millors candidats en base als següents requeriments: (a) compliment de determinades propietats farmacocinètiques que estableixin el seu possible ús com a fàrmac (b) hidrofobicitat adequada per travessar la BBB i (c) interacció amb el pèptid Aen solució.

Health correlates of overweight and obesity in adults aged 50 years and over: results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

QUESTIONS UNDER STUDY: To examine the association between overweight/obesity and several self-reported chronic diseases, symptoms and disability measures. METHODS: Data from eleven European countries participating in the Survey of Health, Ageing and Retirement in Europe were used. 18,584 non-institutionalised individuals aged 50 years and over with BMI > or = 18.5 (kg/m2) were included. BMI was categorized into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9) and obesity (BMI > or = 30). Dependent variables were 13 diagnosed chronic conditions, 11 health complaints, subjective health and physical disability measures. For both genders, multiple logistic regressions were performed adjusting for age, socioeconomic status and behaviour risks. RESULTS: The odds ratios for high blood pressure, high cholesterol, diabetes, arthritis, joint pain and swollen legs were significantly increased for overweight and obese adults. Compared to normal-weight individuals, the odds ratio (OR) for reporting > or = 2 chronic diseases was 2.4 (95% CI 1.9-2.9) for obese men and 2.7 (95% CI 2.2-3.1) for obese women. Overweight and obese women were more likely to report health symptoms. Obesity in men (OR 0.5, 95% CI 0.4-0.6), and overweight (OR 0.5, 95% CI 0.4-0.6) and obesity (OR 0.4, 95% CI 0.3-0.5) in women, were associated with poorer subjective health (i.e. a decreased risk of reporting excellent, very good or good subjective health). Disability outcomes were those showing the greatest differences in strength of association across BMI categories, and between genders. For example, the OR for any difficulty in walking 100 metres was non-significant at 0.8 for overweight men, at 1.9 (95% CI 1.3-2.7) for obese men, at 1.4 (95% CI 1.1-1.8) for overweight women, and at 3.5 (95% CI 2.6-4.7) for obese women. CONCLUSIONS: These results highlight the impact of increased BMI on morbidity and disability. Healthcare stakeholders of the participating countries should be aware of the substantial burden that obesity places on the general health and autonomy of adults aged over 50.

Field Demonstration and Laboratory Evaluation of Foamed Asphalts - Muscatine County, HR-233, 1985

In view of the energy, environmental, and economic advantages of the foamed asphalt process using local aggregates in cold mixes and the promising results from Research Project HR-212, a 4.2-mile section of county road in Muscatine County was built with foamed asphalt and local aggregates during August-September 1983. Extensive laboratory evaluation was carried out on five plant mixes representing foamed mixes used in the nine test sections, a laboratory prepared foamed mix, and a laboratory prepared hot mix similar to Plant Mix 1. The foamed mixes were compacted, cured under 15 curing conditions and tested for bulk specific gravity, Marshall stability at 77° F and at 140° F, cured moisture content, resilient modulus and effects of moisture damage due to freeze-thaw cycles, water soaking, and vacuum saturation. In addition, four sets of 83 core samples were taken at 1 to 15 months and tested for moisture content, specific gravity, Marshall stability, and resilient modulus. In summary, the test road has performed satisfactorily for almost two years. The few early construction problems encountered were to be expected for experimental projects dealing with new materials and technologies. Overall results to date are encouraging and foamed asphalt mixes have proved to have the potential as a viable base material in areas where marginal aggregates are available. It is hoped and expected that performance evaluation of the test sections will be continued and that more foamed asphalt trial projects will be constructed and monitored so that experiences and findings from this project can be verified and mix design criteria can be gradually established. For future foamed asphalt projects it is recommended that anti-stripping additives, such as hydrated lime, be added in view of the potential moisture susceptibility of foamed mixes observed in the laboratory evaluation.

A road map toward a globally harmonized approach for occupational health surveillance and epidemiology in nanomaterial workers

OBJECTIVE: Few epidemiological studies have addressed the health of workers exposed to novel manufactured nanomaterials. The small current workforce will necessitate pooling international cohorts. METHOD: A road map was defined for a globally harmonized framework for the careful choice of materials, exposure characterization, identification of study populations, definition of health endpoints, evaluation of appropriateness of study designs, data collection and analysis, and interpretation of the results. RESULTS: We propose a road map to reach global consensus on these issues. The proposed strategy should ensure that the costs of action are not disproportionate to the potential benefits and that the approach is pragmatic and practical. CONCLUSIONS: We should aim to go beyond the collection of health complaints, illness statistics, or even counts of deaths; the manifestation of such clear endpoints would indicate a failure of preventive measures.

Demonstration and Field Evaluation of Alternative Portland Cement Concrete Pavement Reinforcement Materials, HR-1069, 2003

Transverse joints are placed in portland cement concrete pavements to control the development of random cracking due to stresses induced by moisture and thermal gradients and restrained slab movement. These joints are strengthened through the use of load transfer devices, typically dowel bars, designed to transfer load across the joint from one pavement slab to the next. Epoxy coated steel bars are the materials of choice at the present time, but have experienced some difficulties with resistance to corrosion from deicing salts. The research project investigated the use of alternative materials, dowel size and spacing to determine the benefits and limitations of each material. In this project two types of fiber composite materials, stainless steel solid dowels and epoxy coated dowels were tested for five years in side by side installation in a portion of U.S. 65 near Des Moines, Iowa, between 1997 and 2002. The work was directed at analyzing the load transfer characteristics of 8-in. vs. 12-in. spacing of the dowels and the alternative dowel materials, fiber composite (1.5- and 1.88-in. diameter) and stainless steel (1.5-in. diameter), compared to typical 1.5-in. diameter epoxy-coated steel dowels placed on 12-in. spacing. Data were collected biannually within each series of joints and variables in terms of load transfer in each lane (outer wheel path), visual distress, joint openings, and faulting in each wheel path. After five years of performance the following observations were made from the data collected. Each of the dowel materials is performing equally in terms of load transfer, joint movement and faulting. Stainless steel dowels are providing load transfer performance equal to or greater than epoxy-coated steel dowels at the end of five years. Fiber reinforced polymer (FRP) dowels of the sizes and materials tested should be spaced no greater than 8 in. apart to achieve comparable performance to epoxy coated dowels. No evidence of deterioration due to road salts was identified on any of the products tested. The relatively high cost of stainless steel solid and FRP dowels was a limitation at the time of this study conclusion. Work is continuing with the subject materials in laboratory studies to determine the proper shape, spacing, chemical composition and testing specification to make the FRP and stainless (clad or solid) dowels a viable alternative joint load transfer material for long lasting portland cement concrete pavements.

Field and Laboratory Evaluation of Precast Concrete Bridges, TR-440, 2001

Recent data compiled by the National Bridge Inventory revealed 29% of Iowa's approximate 24,600 bridges were either structurally deficient or functionally obsolete. This large number of deficient bridges and the high cost of needed repairs create unique problems for Iowa and many other states. The research objective of this project was to determine the load capacity of a particular type of deteriorating bridge – the precast concrete deck bridge – which is commonly found on Iowa's secondary roads. The number of these precast concrete structures requiring load postings and/or replacement can be significantly reduced if the deteriorated structures are found to have adequate load capacity or can be reliably evaluated. Approximately 600 precast concrete deck bridges (PCDBs) exist in Iowa. A typical PCDB span is 19 to 36 ft long and consists of eight to ten simply supported precast panels. Bolts and either a pipe shear key or a grouted shear key are used to join adjacent panels. The panels resemble a steel channel in cross-section; the web is orientated horizontally and forms the roadway deck and the legs act as shallow beams. The primary longitudinal reinforcing steel bundled in each of the legs frequently corrodes and causes longitudinal cracks in the concrete and spalling. The research team performed service load tests on four deteriorated PCDBs; two with shear keys in place and two without. Conventional strain gages were used to measure strains in both the steel and concrete, and transducers were used to measure vertical deflections. Based on the field results, it was determined that these bridges have sufficient lateral load distribution and adequate strength when shear keys are properly installed between adjacent panels. The measured lateral load distribution factors are larger than AASHTO values when shear keys were not installed. Since some of the reinforcement had hooks, deterioration of the reinforcement has a minimal affect on the service level performance of the bridges when there is minimal loss of cross-sectional area. Laboratory tests were performed on the PCDB panels obtained from three bridge replacement projects. Twelve deteriorated panels were loaded to failure in a four point bending arrangement. Although the panels had significant deflections prior to failure, the experimental capacity of eleven panels exceeded the theoretical capacity. Experimental capacity of the twelfth panel, an extremely distressed panel, was only slightly below the theoretical capacity. Service tests and an ultimate strength test were performed on a laboratory bridge model consisting of four joined panels to determine the effect of various shear connection configurations. These data were used to validate a PCDB finite element model that can provide more accurate live load distribution factors for use in rating calculations. Finally, a strengthening system was developed and tested for use in situations where one or more panels of an existing PCDB need strengthening.

Short-term follow-up of exercise training program and beta-blocker treatment on quality of life in dogs with naturally acquired chronic mitral valve disease

This study aimed to evaluate the effects of carvedilol treatment and a regimen of supervised aerobic exercise training on quality of life and other clinical, echocardiographic, and biochemical variables in a group of client-owned dogs with chronic mitral valve disease (CMVD). Ten healthy dogs (control) and 36 CMVD dogs were studied, with the latter group divided into 3 subgroups. In addition to conventional treatment (benazepril, 0.3-0.5 mg/kg once a day, and digoxin, 0.0055 mg/kg twice daily), 13 dogs received exercise training (subgroup I; 10.3±2.1 years), 10 dogs received carvedilol (0.3 mg/kg twice daily) and exercise training (subgroup II; 10.8±1.7 years), and 13 dogs received only carvedilol (subgroup III; 10.9±2.1 years). All drugs were administered orally. Clinical, laboratory, and Doppler echocardiographic variables were evaluated at baseline and after 3 and 6 months. Exercise training was conducted from months 3-6. The mean speed rate during training increased for both subgroups I and II (ANOVA, P>0.001), indicating improvement in physical conditioning at the end of the exercise period. Quality of life and functional class was improved for all subgroups at the end of the study. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level increased in subgroup I from baseline to 3 months, but remained stable after training introduction (from 3 to 6 months). For subgroups II and III, NT-proBNP levels remained stable during the entire study. No difference was observed for the other variables between the three evaluation periods. The combination of carvedilol or exercise training with conventional treatment in CMVD dogs led to improvements in quality of life and functional class. Therefore, light walking in CMVD dogs must be encouraged.