Community Health Workers and Community Voices: Promoting Good Health

Documents how CHWs address the problems of health disparities, poor access to care, and the rising cost of health care. Examines challenges that exist in expanding current CHW programs, and policy options around finance, workforce, and delivery of care

Contribution of Smoking to Excess Mortality in Harlem

The New York City neighborhood of Harlem has mortality rates that are among the highest in the United States. In absolute numbers, cardiovascular disease and cancer account for the overwhelming majority of deaths, especially among men, and these deaths occur at relatively young ages. The aim of this research was to examine self-reported smoking habits according to measures of socioeconomic status among Harlem men and women, in order to estimate the contribution of tobacco consumption to Harlem's remarkably high excess mortality. During 1992-1994, in-person interviews were conducted among 695 Harlem adults aged 18-65 years who were randomly selected from dwelling unit enumeration lists. The self-reported prevalence of current smoking was strikingly high among both men (48%) and women (41%), even among highly educated men (38%). The 21% of respondents without working telephones reported an even higher prevalence of current smoking (61%), indicating that national and state-based estimates which rely on telephone surveys may seriously underestimate the prevalence of smoking in poor urban communities. Among persons aged 35-64 years, the smoking attributable fractions for selected causes of death were larger in Harlem than in either New York City as a whole or the entire United States for both men and women. Tobacco consumption is likely to be one of several important mediators of the high numbers of premature deaths in Harlem. Am J Epidemiol 1998; 147: 250-

Estimating fishing effort from highly resolved geospatial data : focusing on passive gears

TM, JM and MJ appreciate the financial support provided by the University of St. Andrews Impact and Innovation Fund 2018. TM and MJ acknowledge financial support provided by the “Conserving Atlantic Biodiversity by Supporting Innovative Small-scale Fisheries Co-management” (CABFISHMAN) Project. This project is co-financed by the Interreg Atlantic Area Programme through the European Regional Development Fund. Project N°: EAPA_134/2018”.Increasing competition for marine space requires the appropriate development of indicators to best represent the use of marine areas and the value (whether economic, social and/or cultural) derived from such use. Fishers (the largest group of users) are often under-represented in marine spatial planning processes. Highly-resolved vessel tracking data provide opportunities to map the activities of fishing vessels at a level of detail never before available. Most effort mapping methods have focused on active gears such as trawls or dredges in large scale fisheries. For these fisheries, the time spent fishing at sea (hours) is usually a representative indicator of fishing effort, enabling a straightforward mapping of the most important fishing grounds. However, for passive gears generally used in small-scale fisheries, we show that spatial indicators of effort (here, length of vessel track) greatly outperform time-at-sea as an indicator of fishing effort. We further demonstrate and validate a method to estimate gear soak time from vessel tracking data and show how maps of effort that account for soak time can be different from those solely based on time spent fishing at sea. The development of adequate methods to quantify the spatial distribution of passive gear effort is particularly relevant to fisheries management because globally about a fifth of all catches (by weight) are landed by passive gears. Appropriate, fine scale effort maps will provide better tools for spatial planning to support sustainable fishing.Publisher PDFPeer reviewe

Using focus groups to design systems science models that promote oral health equity

Background While the US population overall has experienced improvements in oral health over the past 60 years, oral diseases remain among the most common chronic conditions across the life course. Further, lack of access to oral health care contributes to profound and enduring oral health inequities worldwide. Vulnerable and underserved populations who commonly lack access to oral health care include racial/ethnic minority older adults living in urban environments. The aim of this study was to use a systematic approach to explicate cause and effect relationships in creating a causal map, a type of concept map in which the links between nodes represent causality or influence. Methods To improve our mental models of the real world and devise strategies to promote oral health equity, methods including system dynamics, agent-based modeling, geographic information science, and social network simulation have been leveraged by the research team. The practice of systems science modeling is situated amidst an ongoing modeling process of observing the real world, formulating mental models of how it works, setting decision rules to guide behavior, and from these heuristics, making decisions that in turn affect the state of the real world. Qualitative data were obtained from focus groups conducted with community-dwelling older adults who self-identify as African American, Dominican, or Puerto Rican to elicit their lived experiences in accessing oral health care in their northern Manhattan neighborhoods. Results The findings of this study support the multi-dimensional and multi-level perspective of access to oral health care and affirm a theorized discrepancy in fit between available dental providers and patients. The lack of information about oral health at the community level may be compromising the use and quality of oral health care among racial/ethnic minority older adults. Conclusions Well-informed community members may fill critical roles in oral health promotion, as they are viewed as highly credible sources of information and recommendations for dental providers. The next phase of this research will involve incorporating the knowledge gained from this study into simulation models that will be used to explore alternative paths toward improving oral health and health care for racial/ethnic minority older adults

Prevalence and social correlates of cardiovascular disease risk factors in Harlem

http://deepblue.lib.umich.edu/bitstream/2027.42/55440/1/Diez Roux AV, Prevalence and social correlates of cardiovascular disease risk factors in Harlem, 1999.pd

Prognostic value of morphology and hormone receptor status in breast cancer - a population based study

We analysed the 5-year relative survival among 4473 breast cancer cases diagnosed in 1990-1992 from cancer registries in Estonia, France, Italy, Spain, the Netherlands and the UK. Among eight categories based on ICD-O codes (infiltrating ductal carcinoma, lobular plus mixed carcinoma, comedocarcinoma, 'special types', medullary carcinoma, not otherwise specified (NOS) carcinoma, other carcinoma and cancer without microscopic confirmation), the 5-year relative survival ranged from 66% (95% CI 61-71) for NOS carcinoma to 95% (95% CI 90-100) for special types (tubular, apocrine, cribriform, papillary, mucinous and signet ring cell); 27% (95% CI 18-36) for cases without microscopic confirmation. Differences in 5-year relative survival by tumor morphology and hormone receptor status were modelled using a multiple regression approach based on generalised linear models. Morphology and hormone receptor status were confirmed as significant survival predictors in this population-based study, even after adjusting for age and stage at diagnosis

Post-mortem findings and causes of death of harbour porpoises (Phocoena phocoena) stranded from 1990 to 2000 along the coastlines of Belgium and northern France

peer reviewedBetween the,ears 1990 and 2000, an attempt was made to determine the causes of death of 55 harbour porpoises stranded along the Belgian and northern French coasts. From 1990 to 1996, only five carcasses were collected as against seven in 1997, eight in 1998, 27 in 1999 and eight in 2000. The sex ratio was normal and most of the animals were juvenile. The most common findings were emaciation, severe parasitosis and pneumonia. A few cases of fishing net entanglement were observed. The main microscopical lesions were acute pneumonia, massive lung oedema, enteritis, hepatitis and gastritis. Encephalitis was observed in six cases. No evidence of morbillivirus infection was detected. Pneumonia was associated with bacteria or parasites, or both. The causes of death and the lesions were similar to those previously reported in other countries bordering the North Sea. The cause of the increased numbers of carcasses in 1999 was unclear but did not include viral epizootics or net entanglement. A temporary increase in the porpoise populatiou in the southern North Sea may have been responsible. (C) 2002 Elsevier Science Ltd. All rights reserved