Health status, Neighbourhood effects and Public choice: Evidence from France

Observation of socioeconomic statistics between different neighbourhoods highlights significant differences for economic indicators, social indicators and health indicators. The issue faced here is determining the origins of health inequalities: individual effects and neighbourhood effects. Using National Health Survey and French census data from the period 2002-2003, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors called: "economic and social condition", "mobility" and "generational" and show that these contextual factors are correlated with individual SRHs. Since the 80s, different French governments have formulated public policies in order to take into account the specific problems of disadvantaged and deprived neighbourhoods. In view to concentrating national assistance, the French government has created "zones urbaines sensibles" (ZUS) [Critical Urban Areas, CUA]. Our research shows that in spite of implementing public policy in France to combat health inequalities, by only taking into account the CUA criterion (the fact of being in a CUA or not), many inequalities remain ignored and thus hidden.Health, Neighbourhood Effect, Housing policy

Cost-effectiveness analysis of malaria chemoprophylaxis for travellers to West-Africa

BACKGROUND: The importation of malaria to non-endemic countries remains a major cause of travel-related morbidity and a leading cause of travel-related hospitalizations. Currently they are three priority medications for malaria prophylaxis to West Africa: mefloquine, atovaquone/proguanil and doxycycline. We investigate the cost effectiveness of a partial reimbursement of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers to high risk areas of malaria transmission compared with the current situation of no reimbursement. METHODS: This study is a cost-effectiveness analysis based on malaria cases imported from West Africa to Switzerland from the perspective of the Swiss health system. We used a decision tree model and made a literature research on the components of travel related malaria. The main outcome measure was the cost effectiveness of malaria chemoprophylaxis reimbursement based on malaria and deaths averted. RESULTS: Using a program where travellers would be reimbursed for 80% of the cost of the cheapest malaria chemoprophylaxis is dominant (i.e. cost saving and more effective than the current situation) using the assumption that currently 68.7% of travellers to West Africa use malaria chemoprophylaxis. If the current usage of malaria chemoprophylaxis would be higher, 82.4%, the incremental cost per malaria case averted is € 2'302. The incremental cost of malaria death averted is € 191'833.The most important factors influencing the model were: the proportion of travellers using malaria chemoprophylaxis, the probability of contracting malaria without malaria chemoprophylaxis, the cost of the mefloquine regimen, the decrease in the number of travellers without malaria chemoprophylaxis in the reimbursement strategy. CONCLUSIONS: This study suggests that a reimbursement of 80% of the cost of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers from Switzerland to West Africa is highly effective in terms of malaria cases averted and is cost effective to the Swiss health system. These data are relevant to discussions about the cost effectiveness of malaria chemoprophylaxis reimbursement for vulnerable groups such as those visiting friends and relatives who have the highest risk of malaria, who are least likely to use chemoprophylaxis

Determination of chlorinated solvents in industrial water and wastewater by DAI–GC–ECD

A very simple and quick analytical method, based on direct aqueous injection, for determination of halogenated solvents in refinery water and wastewater, is described. There is a need to determine halogenated solvents in refinery water streams, because they may originate from several processes. There is also a need to develop methods enabling VOX to be determined in samples containing oil fractions. The method described enables simultaneous determination of 26 compounds with low detection limits (sub-μg L−1) and excellent precision, especially for highly halogenated solvents. The matrix effects of four types of sample were evaluated—the method seemed to be relatively insensitive to variations in matrix composition. Deuterated 1,2-dichloroethane was used as internal standard and surrogate compound in quantitative analysis; application of isotopically labelled compounds is rarely reported when non-mass spectrometric detectors are used for analysis. Analysis of real samples showed that the most frequently detected compounds were dichloromethane and 1,2-dichloroethane

Reproductive Outcomes Following Ectopic Pregnancy: Register-Based Retrospective Cohort Study

Using Scottish national registry data, Sohinee Bhattacharya and colleagues investigate pregnancy outcomes following ectopic pregnancy in comparison to livebirth, miscarriage, or termination in a first pregnancy

SRH and HrQOL: does social position impact differently on their link with health status?

<p>Abstract</p> <p>Background</p> <p>Self-rated Health (SRH) and health-related quality of life (HRQoL) are used to evaluate health disparities. Like all subjective measures of health, they are dependent on health expectations that are associated with socioeconomic characteristics. It is thus needed to analyse the influence played by socioeconomic position (SEP) on the relationship between these two indicators and health conditions if we aim to use them to study health disparities. Our objective is to assess the influence of SEP on the relationship between physical health status and subjective health status, measured by SRH and HRQoL using the SF-36 scale.</p> <p>Methods</p> <p>We used data from the French National Health Survey. SEP was assessed by years of education and household annual income. Physical health status was measured by functional limitations and chronic low back pain.</p> <p>Results</p> <p>Regardless of their health status, people with lower SEP were more likely than their more socially advantaged counterparts to report poor SRH and poorer HRQoL, using any of the indicators of SEP. The negative impact of chronic low back pain on SRH was relatively greater in people with a high SEP than in those with a low SEP. In contrast, chronic low back pain and functional limitations had less impact on physical and mental component scores of quality of life for socially advantaged men and women.</p> <p>Conclusions</p> <p>Both SRH and HRQoL were lower among those reporting functional limitations or chronic low back pain. However, the change varied according SEP and the measure. In relative term, the negative impact of a given health condition seems to be greater on SRH and lower on HRQoL for people with higher SEP in comparison with people with low SEP. Using SRH could thus decrease socioeconomic differences. In contrast using HRQoL could increase these differences, suggesting being cautious when using these indicators for analyzing health disparities.</p

Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial

Background: Previous psychological and pharmacological interventions have primarily focused on depression disorders in populations with cardiovascular diseases (CVDs) and the efficacy of anxiety disorder interventions is only more recently being explored. Transdiagnostic interventions address common emotional processes and the full range of anxiety and depression disorders often observed in populations with CVDs. The aim of CHAMPS is to evaluate the feasibility of a unified protocol (UP) for the transdiagnostic treatment of emotional disorders intervention in patients recently hospitalized for CVDs. The current study reports the protocol of a feasibility randomized controlled trial to inform a future trial. Methods/Design: This is a feasibility randomized, controlled trial with a single-center design. A total of 50 participants will be block-randomized to either a UP intervention or enhanced usual care. Both groups will receive standard CVD care. The UP intervention consists of 1) enhancing motivation, readiness for change, and treatment engagement; (2) psychoeducation about emotions; (3) increasing present focused emotion awareness; (4) increasing cognitive flexibility; (5) identifying and preventing patterns of emotion avoidance and maladaptive emotion-driven behaviors (EDBs, including tobacco smoking, and alcohol use); (6) increasing tolerance of emotion-related physical sensations; (7) interoceptive and situation-based emotion-focused exposure; and (8) relapse prevention strategies. Treatment duration is 12 to 18 weeks. Relevant outcomes include the standard deviation of self-rated anxiety, depression and quality of life symptoms. Other outcomes include intervention acceptability, satisfaction with care, rates of EDBs, patient adherence, physical activity, cardiac and psychiatric readmissions. Parallel to the main trial, a nonrandomized comparator cohort will be recruited comprising 150 persons scoring below the predetermined depression and anxiety severity thresholds. Discussion: CHAMPS is designed to evaluate the UP for the transdiagnostic treatment of emotional disorders targeting emotional disorder processes in a CVD population. The design will provide preliminary evidence of feasibility, attrition, and satisfaction with treatment to design a definitive trial. If the trial is feasible, it opens up the possibility for interventions to target broader emotional processes in the precarious population with CVD and emotional distress.Phillip J. Tully, Deborah A. Turnbull, John D. Horowitz, John F. Beltrame, Terina Selkow, Bernhard T. Baune, Elizabeth Markwick, Shannon Sauer-Zavala, Harald Baumeister, Suzanne Cosh and Gary A. Witter

Rates and controls of the air-sea flux of bromoform (CHBr3): a review and synthesis

Bromoform (CHBr3) is the largest single source of atmospheric organic bromine and therefore of importance as a source of reactive halogens to the troposphere and lower stratosphere. The sea-to-air flux, originating with macroalgal and planktonic sources, is the main source for atmospheric bromoform. We review bromoform's contribution to atmospheric chemistry, its atmospheric and oceanic distributions and its oceanic sources and sinks. We have reassessed oceanic emissions, based on published aqueous and airborne concentration data, global climatological parameters, and information concerning coastal and biogenic sources. The goals are to attempt an estimate of the global source strength and partly to identify key regions that require further investigation. The sea-to-air flux is spatially and temporally variable with tropical, subtropical and shelf waters identified as potentially important source regions. We obtain an annual global flux of bromoform of ∼10 Gmol Br yr−1 (3–22 Gmol Br yr−1). This estimate is associated with significant uncertainty, arising from data precision and coverage, choice of air-sea exchange parameterizations and model assumptions. Anthropogenic sources of ∼0.3 (to 1.1) Gmol Br yr−1 (as CHBr3) can be locally significant, but are globally negligible. Our estimate of the global oceanic source is three to four times higher than recent estimates based on the modeling of atmospheric sinks. The reasons for this discrepancy could lie with the limited regional and temporal data available and the broad assumptions that underlie our flux calculations. Alternatively, atmospheric sink calculations, often made on the basis of background CHBr3 levels, may neglect the influence of strong but highly localized sources (e.g., from some coastal and shelf regions). The strongly variable and poorly characterized source of CHBr3, together with its short atmospheric lifetime, complicates model-based estimation of the distribution of reactive Br resulting from its atmospheric degradation. An integrated program of marine and atmospheric observations, atmospheric modeling and mechanistic studies of oceanic bromoform production is required to better constrain present and future Br delivery to the atmosphere

Composés organohalogènes issus de la chloration de l'eau de mer: aspects chimiques et écotoxicologiques

*INRA INAPG Laboratoire de Chimie Analytique Paris Diffusion du document : INRA INAPG Laboratoire de Chimie Analytique Paris Diplôme : Dr. Ing

Évaluation des performances d'un appareil de dosage des composés organohalogénés par microcoulométrie et comparaison avec la technique chromatographique

Dans le cadre d'études sur la chloration des circuits de refroidissement des centrales nucléaires, des essais ont été réalisés au laboratoire sur un appareil de dosage par microcoulométrie. Ils ont permis d'évaluer ses performances (pourcentage de recouvrement, domaine de linéarité, limites de détection) pour la mesure des composés organiques halogénés extractibles (EOX) et purgeables (POX) en utilisant différents trihalométhanes dilués respectivement dans de I'hexane et dans de l'eau déminéralisée. Dans ces conditions ce mode de dosage est juste et précis, les limites de détection sont relativement faibles. Une comparaison entre les résultats d'analyse de trihalométhanes contenus dans des échantillons d'eau de mer faiblement chlorée, obtenus par chromatographie en phase gazeuse (méthode séparative) et microcoulométrie (méthode globale) a été réalisée. Cette comparaison s'est révélée très décevante pour la microcoulométrie aux niveaux de concentration en composés organohalogénés étudiés. La microcoulométrie en mode POX ou EOX n'est pas adaptée à la mesure quantitative de THM à bas niveau (<30 µg/l) en eau de mer