American National Health Research Articles

Systematic review of Latin American national oral health surveys in adults.

Oral diseases represent a main public health problem worldwide. There is scarce information about oral health indicators in adults in middle-income countries in Latin America and Africa. To identify and describe national health surveys with national representative samples that included oral health assessment for adults in Latin America. A systematic review was conducted in scientific and regional bibliographic databases (PubMed, SciELO, Wos and Embase); this was complemented with searchings in grey literature (Google Scholar, Open Grey and government health organization websites), from August 2016 to May 2017 (from 2000 to date). Studies conducted, supervised or funded by Ministries of Health or National Health Institutes were included. Data extracted included country, year, methods, interview and dental examination. Two researchers independently performed search and data extraction. Results were discussed as a group. Only 5 countries in Latin America have developed national health surveys evaluating the dental status in adults, with overall national representative samples during 2000-2015: Brazil, Colombia, Panama, Chile and Uruguay. Main differences were observed in the type of dental indicators selected, measure of dental services access and the professional who performed the dental examination. While some dental surveys were specifically designed as oral health surveys (Brazil, Colombia, Panama and Uruguay) and the examination was performed by dentists, other surveys represent a module within a general health survey (Chile) and the examination was performed by nurses. There are a small number of Latin American countries that report research about dental status with national representation samples. Most of these studies have been conducted as national oral health surveys, and fieldwork was carried out by dentists. The development of oral health research in this part of the world should be promoted as these surveys provide relevant information to monitor oral health and evaluate the effectiveness of health programmes.

Type of dietary fat intakes in relation to all-cause and cause-specific mortality in US adults: an iso-energetic substitution analysis from the American National Health and Nutrition Examination Survey linked to the US mortality registry

Accumulating evidence indicates that saturated fat intake is related to mortality risk increase, whereas unsaturated fat intake is associated with reduced mortality risk. The aim of the present study was to estimate the mortality risk reduction related to a dietary change from saturated fat to mono- or polyunsaturated fat intake. The American National Health and Nutrition Examination Surveys conducted between 1999 and 2010 were linked to the 2011 national US death registry resulting in an observational prospective mortality study. Proportional hazards Cox models were used to evaluate the association between saturated, monounsaturated and polyunsaturated fat with all-cause and cause-specific mortality. Substitution analysis was conducted to estimate an iso-energetic substitution of 10 % of the energy from dietary fat intake applied to the substitution of saturated fat with an equal amount of energy from monounsaturated or polyunsaturated fat. The highest tertile intakes of saturated fat resulted in an increased risk (12 %) of all-cause and specific-cause mortality, whereas the highest tertile intakes of polyunsaturated fat resulted in a reduced risk (7 %) of all-cause and specific-cause mortality when compared with the corresponding lowest tertile. Iso-energetic substitution revealed that a substitution of 10 % of energy (from total fat) from saturated fat to an equal amount of energy from monounsaturated or polyunsaturated fat resulted in a significant reduction of the mortality risk ranging from 4 to 8 %. Iso-energetic substitution of saturated fat with monounsaturated and polyunsaturated fat reduced all-cause and specific-cause mortality in US adults.

Bariatric Surgery to Reduce Mortality in US Adults. A Public Health Perspective from the Analysis of the American National Health and Nutrition Examination Survey Linked to the US Mortality Register.

Type II obesity represents a major pandemic and public health threat in high-income countries. Type II obesity increases the risk of all-cause and specific-cause mortality, and it is widely acknowledged that bariatric surgery represents the only effective therapeutic option in these patients. The aim of the present study was to estimate US population attributable risk for all-cause and cause-specific mortality in type II obese subjects undergoing weight loss as resulting from bariatric surgery alone and supplemented with behavioral intervention. The American National Health and Nutrition Examination Survey linked to the US death registry updated to 2011 was used to estimate type II obesity prevalence and all-cause and specific cause of death for type II obese adults undergoing weight loss. Multivariate adjusted proportional hazard Cox models were used to estimate mortality risks. Statistical analyses were performed on the most updated version of the database (June 2017). A monotone positive trend for type II obesity was observed during the period 1999-2014 (p<0.001). According to trend analysis, the rate of type II obesity in US adults is expected to rise up to 8.5%. Two- to sevenfold increased risk of all-cause and specific-cause mortality was observed for type II obese participants when compared to type I obese and overweight participants. Population attributable risk for all-cause and specific-cause mortality for type II obese subjects undergoing weight loss was ranging between 6 and 34%. Bariatric surgery supplemented with behavioral intervention can result in a relevant reduction of mortality if extensively applied to the US population.

The relationships between insomnia, sleep apnoea and depression: findings from the American National Health and Nutrition Examination Survey, 2005-2008.

To determine the association between insomnia, obstructive sleep apnoea (OSA), and comorbid insomnia-OSA and depression, while controlling for relevant lifestyle and health factors, among a large population-based sample of US adults. We examined a sample of 11,329 adults (≥18 years) who participated in the National Health and Nutrition Examination Survey (NHANES) during the years 2005-2008. Insomnia was classified via a combination of self-reported positive physician diagnosis and high-frequency 'trouble falling asleep', 'waking during the night', 'waking too early', and 'feeling unrested during the day'. OSA was classified as a combination of a positive response to a physician-diagnosed condition, in addition to a high frequency of self-reported nocturnal 'snoring', 'snorting/stopping breathing' and 'feeling overly sleepy during the day'. Comorbid insomnia-OSA was further assessed by combining a positive response to either insomnia (all), or sleep apnoea (all), as classified above. Depressive symptomology was assessed by the Patient Health Questionnaire-9 (PHQ-9), with scores of >9 used to indicate depression. Odds ratios (ORs) and 95% confidence intervals (CIs) for sleep disorders and depression were attained from logistic regression modelling adjusted for sex, age, poverty level, smoking status and body mass index (BMI). Those who reported insomnia, OSA or comorbid insomnia-OSA symptoms reported higher rates of depression (33.6%, 22.2%, 27.1%, respectively), and consistently reported poorer physical health outcomes than those who did not report sleep disorders. After adjusting for sex, age, poverty level, smoking status and BMI (kg/m(2)), insomnia (OR 6.57, 95% CI 3.89-11.11), OSA (OR 5.14, 95% CI 3.14-8.41) and comorbid insomnia-OSA (OR 6.67, 95% CI 4.44-10.00) were associated with an increased likelihood of reporting depression. Insomnia, OSA and comorbid insomnia-OSA are associated with significant depressive symptomology among this large population-based sample of adults.

Levels of heavy metals in adolescents living in the industrialised area of Milazzo-Valle del Mela (northern Sicily).

In the Milazzo-Valle del Mela area, the presence of industrial plants and the oil refinery make local residents concerned for their health. For this reason, we evaluated the levels of heavy metals in 226 children aged 12–14 years, living in the 7 municipalities of the area. A control age-matched population (n = 29) living 45 km far from the industrial site was also enrolled. Arsenic, cadmium, chromium, mercury, nickel, and vanadium were analysed in 24 h urine samples, while lead concentration was evaluated in blood samples. A questionnaire regarding life style and risk perception was also administered. Adolescents from Milazzo-Valle del Mela had cadmium levels significantly higher compared to either controls (P < 0.0001) or the reference values of the European Germany Environmental Survey (GerES-IV) and the American National Health and Nutrition Examination Survey (NHANES). Furthermore, children had higher perception of living in a high-risk environment. The present data, for the first time, clearly indicate that adolescents living in Milazzo-Valle del Mela have increased body concentration of cadmium, which may be harmful to human health. These results deserve particular attention by the local and regional government to initiate prevention programmes in this susceptible population.

Appropriate And Inappropriate Fresh Frozen Plasma (Ffp) Use In Coagulation Disorders

AIMS:The aim of this study was to evaluate the usage of fresh frozen plasma (FFP) according to indications and to reduce inappropriate usage. Method: A two year retrospective study was conducted in Dr.S.C.G.M.C.and hospital blood bank . Based on the guidelines published by college of American pathologist,national health and medical research council and Australian society for blood transfusion FFP usage were categorized into appropriate and inappropriate.Pre and post transfusion INR/PT were recorded and the effect of FFP were studied in patients who received FFP Results:During two year study 1079 unit of FFP were used for 267 patients.out of 267 patients only 125(46.81%) request were appropriate and 142(53.19%) were inappropriate requests. Pregnant female with active labour suffering from severe anaemia with shock was the commonest reason for inappropriate FFP use.Out of 125 appropriate request 100 patients were compared by evaluating Pre and post transfusion PT/INR by using fully automated coagulometer. Conclusion: Inappropriate use of FFP not only increase the treatment costs , but also causes loss of productive power and exposes the patient to the unnecessary side effects of transfusion.inappropriate FFP transfusion should be prevented by means of educaton and awareness programme by establishing the hospital transfusion guidelines

Evaluation of fresh frozen plasma usage at a medical college hospital - A two year study

Aims: The aim of this is study was to evaluate the usage of fresh frozen plasma (FFP) according to indications and to reduce inappropriate usage. Methods: A two year retrospective study was conducted in Medical College Hospital blood bank. Based on the guidelines published by College of American Pathologists, National Health and Medical Research Council and Australasian Society for Blood Transfusion FFP usage were categorized into appropriate and inappropriate. Pre and post-transfusion INR/PT were recorded and the effect of FFP were studied in patients who received FFP. Results: During two years 1884 units of FFP were used for 945 patients. Only 454 (48%) requests were appropriate and 491 (52%) were inappropriate requests. Absence of bleeding or surgical intervention was the commonest reasons for inappropriate FFP use. Mean improvement in the pre-transfusion INR per unit of FFP was 0.75 (median 0.56, range 0–3.7) of which 33% showed significant improvement in the pre-transfusion INR. Conclusions: Our results showed a 48% appropriate and 52% inappropriate use of FFP in patients. Inappropriate FFP use could be reduced by educating the staff, by establishing the hospital transfusion guidelines, by regular evaluation of requistions and by conducting awareness programme among clinicians.

An investigation of the theoretical content of physical activity brochures

New evidence-based physical activity (PA) guidelines and recommendations for constructing messages supplementing the guidelines have been put forth. As well, recent reviews have identified theoretical constructs that hold promise as targets for intervention: self-regulation, outcome expectancies and self-efficacy. The purpose of this study was to examine the integration of messages targeting self-regulation, self-efficacy and outcome expectancies in existing physical activity brochures. Twenty-two PA brochures from Canadian and American National Health Organizations were assessed for their use self-efficacy, self-regulatory processes and outcome expectancies. Brochures were analyzed line-by-line using a modified version of the validated Content Analysis Approach to Theory-Specified Persuasive Educational Communication (CAATSPEC; Abraham, Southby, Quandte, Krahé, & van der Sluijs, 2007). Two independent raters coded a third of the brochures ( n = 7). Inter-rater reliability was acceptable for 17 of the 20 categories ( rs > .79). Discrepancies in all categories were discussed and agreement was reached. The remaining brochures were coded by one of the two raters. Usage of the three key theoretical constructs accounted for only 36.43% of brochure content (20.23% self-efficacy, 10.40% outcome expectancies, 5.80% self-regulation). Brochures lacked the use of a variety of theoretical strategies, specifically goal-setting, planning and verbal persuasion and rarely highlighted the affective benefits of physical activity. In the future brochures should aim to place increased emphasis on self-regulation, self-efficacy, and affective outcome expectancies.

Scaling of body composition to height: relevance to height-normalized indexes

Body weight scales to height with a power of ≈2, thus forming the basis of body mass index (weight/height(2)). The corresponding scaling of body composition to height has not been established in a representative sample of US adults. The aim of the study was to examine the scaling of weight, fat, fat-free mass, and bone mineral content to height. Adult non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican American National Health and Nutrition Examination Survey (NHANES) participants were included in allometric analyses if they had complete age, weight, height, and body-composition data as measured by dual-energy X-ray absorptiometry. Powers of height in allometric regression models were developed for each measure and adjusted for age. The analyses included 13,183 subjects (6699 NHW, 3015 NHB, and 3469 Mexican American). The scaling of weight to height across sex-race groups provided powers (mean ± SE) ranging from 1.85 ± 0.12 in Mexican American women to 2.48 ± 0.17 in Mexican American men. Powers of height for body composition similarly ranged widely and were often outside the 95% CI for a power of 2. Of the 3 body-composition measures, the mean age-adjusted powers of height rounded to 2 as the nearest integer in 16 of 18 sex-race groups. Adult weight and body composition scale to height with variable age-adjusted powers that are sometimes outside the 95% CI for a power of 2 but frequently round to 2 as the nearest integer. These observations have implications for developing height-adjusted body-composition indexes.

What explains the American disadvantage in health compared with the English? The case of diabetes

BackgroundMiddle-aged and older American men and women have almost twice the rate of diabetes of men and women in England. This differential was not explained by conventional risk factors including...

Palliative Care Development in South America: A Focus on Argentina

Many Latin American and Caribbean national health systems mainly focus on disease prevention, prenatal assistance, undernourishment, etc. They still do not have the conditions for developing palliative care (PC). In general, quality of life during the dying process is poor, with fragmented assistance, uncontrolled suffering, poor communication between professionals, patients, and families, and a great burden on family caregivers. The development of PC in the region started around 1981, but it is still not available to an acceptable number of patients.

Colombia and Cuba, contrasting models in Latin America's health sector reform

Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far-reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful--and radical--example of 'market-oriented' health care reform, and Cuba, which followed a highly 'conservative' path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign--especially North American--corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.

The editors' choice

The editors' choice

Occupational health psychology: an emerging discipline.

There is growing concern that rapidly changing patterns of work organization and employment pose risk for occupational illness and injury. In the present article, we assert that these changes create new needs and opportunities for research and practice by psychologists in the area of work organization and health. We begin with an historical overview of the contribution of psychologists to the occupational safety and health field, and to the study of work organization and health. We then describe new initiatives by the American Psychological Association and national health organizations in the United States and Europe to frame a new field of study--called "occupational health psychology"--that focuses on the topic of work organization and health. We conclude with a discussion of emerging research needs and trends within this field.

Accidents among children under two years of age in Great Britain

The object of this paper is to discuss the incidence and cause of accidents among young children. The material on which the study was based was collected in the course...

On being old and sick: the burden of health care for the elderly in Canada and the United States.

The debate over health care reform in the United States has drawn Canada under the microscope. Canada's health care system is frequently offered as a model for American national health insurance. Curiously absent from this policy discussion is any talk about the relative out-of-pocket costs of alternative models. In this paper, we provide data on these costs for American and Canadian elderly for medical, hospital, and ambulatory pharmaceutical use. Despite the fact that the elderly in America are generally viewed as facing fewer problems with access and out-of-pocket costs than younger Americans, their direct costs far exceed those of their Canadian counterparts. We also present data suggesting that, despite these greater costs, rates of growth in use of these services by American elderly have followed roughly the same pattern as those found in Canada. If Uncle Sam retired north of the border, being old and sick would also mean being wealthier and happier.

Lewis Hine's ‘Interpretative’ period: The American health care program and the New York state flood

Abstract Although much has been written about Lewis Hine's documentary photographs for the American Red Cross during World War I and the Southern Drought of 1931, there has been little assessment of his work for the American national public health program, nor his southern New York State flood Red Cross documentaries during the 1920s and 1930s.1 Hine's remaining Red Cross photographs can be examined in the context of American social history and the development of his later documentary work.

National health insurance: Some lessons from the Canadian experience

In the current American debate over national health insurance an examination of the Canadian governmental experience is very instructive. Canada is enough like the United States to make the effects of Canadian health insurance policies rather like a large natural experiment. The Canadian experience—universal government health insurance administered by the ten provinces with some fiscal and policy variations—can be used to predict the impact in the United States of proposed national health insurance plans on the medical care system, and the reaction of mass publics and national policymakers to these effects. The central purpose of the Canadian national health insurance was to reduce and hopefully eliminate financial barriers to medical care. In this it succeeded. But it also produced results which Canadian policymakers never anticipated: essentially unexpected side-effects on cost, quality, organization, and manpower distribution of the particular national health insurance program adopted. It should be cause for concern, the article concludes, that most of the prominent American national health insurance proposals resemble the Canadian program in failing to provide a single level of government with both the means and incentives to curb the inflationary effects of national health insurance. The lesson from Canada is that unless the system has very strong anti-inflationary mechanisms and incentives built into it, national health insurance will feed the fires of medical inflation despite great formal governmental authority to control it.