A tentative step towards healthy public policy

More consistent attention to implementing healthy public policy, and amassing the evidence for it, are urgently required

Mathematical modelling of health impacts

Mathematical modelling is seldom applied to research of global measures of health or health inequalities mainly because of the lack of studies of interventions necessary to underpin modelling research

What do we need for robust and quantitative health impact assessment?

Health impact assessment (HIA) aims to make the health consequences of decisions explicit. Decision-makers need to know that the conclusions of HIA are robust. Quantified estimates of potential health impacts may be more influential but there are a number of concerns. First, not everything that can be quantified is important. Second, not everything that is being quantified at present should be, if this cannot be done robustly. Finally, not everything that is important can be quantified; rigorous qualitative HIA will still be needed for a thorough assessment. This paper presents the first published attempt to provide practical guidance on what is required to perform robust, quantitative HIA. Initial steps include profiling the affected populations, obtaining evidence from for postulated impacts, and determining how differences in subgoups' exposures and suscepibilities affect impacts. Using epidemiological evidence for HIA is different from carrying out a new study. Key steps in quantifying impacts are mapping the causal pathway, selecting appropriate outcome measures and selecting or developing a statistical model. Evidence from different sources is needed. For many health impacts, evidence of an effect may be scarce and estimates of the size and nature of the relationship may be inadequate. Assumptions and uncertainties must therefore be explicit. Modelled data can sometimes be tested against empirical data but sensitivity analyses are crucial. When scientific problems occur, discontinuing the study is not an option, as HIA is usually intended to inform real decisions. Both qualitative and quantitative elements of HIA must be performed robustly to be of value

Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children

Background: Almost half of global child deaths due to acute lower respiratory infections (ALRIs) occur in sub-Saharan Africa, where three-quarters of the population cook with solid fuels. This study aims to quantify the impact of fuel type and cooking practices on childhood ALRI mortality in Africa, and to explore implications for public health interventions. Methods: Early-release World Health Survey data for the year 2003 were pooled for 16 African countries. Among 32 620 children born during the last 10 years, 1455 (4.46%) were reported to have died prior to their fifth birthday. Survival analysis was used to examine the impact of different cooking-related parameters on ALRI mortality, defined as cough accompanied by rapid breathing or chest indrawing based on maternal recall of symptoms prior to death. Results: Solid fuel use increases the risk of ALRI mortality with an adjusted hazard ratio of 2.35 (95% CI 1.22 to 4.52); this association grows stronger with increasing outcome specificity. Differences between households burning solid fuels on a well-ventilated stove and households relying on cleaner fuels are limited. In contrast, cooking with solid fuels in the absence of a chimney or hood is associated with an adjusted hazard ratio of 2.68 (1.38 to 5.23). Outdoor cooking is less harmful than indoor cooking but, overall, stove ventilation emerges as a more significant determinant of ALRI mortality. Conclusions: This study shows substantial differences in ALRI mortality risk among African children in relation to cooking practices, and suggests that stove ventilation may be an important means of reducing indoor air pollution

Model of the mechanical response of short flax fiber reinforced polymer matrix composites

AbstractNatural-fiber-reinforced short-fiber composites are finding more applications lately, therefore there is a need for estimation of the mechanical properties of such composites based on the properties of the constituents. The fibers themselves also possess complicated internal structure, resulting in anisotropy of their properties. Taking into account the internal structure of bast fiber, we evaluate the elastic properties of a composite unit cell, consisting of a fiber of average length and matrix according to the fiber volume fraction in the composite. The unit cell properties are used to estimate the stiffness of a misaligned short-fiber composite by means of orientation averaging. The results obtained are compared with the experimental stress-strain diagrams of short flax fiber/polypropylene matrix composite. Usually the mechanical response of short-fiber/polymer matrix composite is non-linear due to the inelastic matrix behavior. Accounting for the non-linear deformation of the matrix in the unit cell by modeling it as an elastic-plastic material, we also estimate its non-linear response under uniaxial loading