Public Health RSS feed: Current Issue. Public Health is an international, multidisciplinary peer-reviewed journal. It publishes original papers, reviews and short reports on all aspects of the science, philosophy, and practice of public health. It is aimed at all public health practitioners and researchers and those who manage public health services and systems. This includes public health doctors, nurses, dentists, pharmacists, demographers, epidemiologists, health education and promotion specialists, environmental health specialists, and other specialists and scientists in the field of public health. It will also be of interest to anyone involved in provision of public health programmes, the care of populations or communities and those who contribute to public health systems in any way. Published monthly, Public Health considers submissions on any aspect of public health across age groups and settings. These include: • Public health practice and impact • Epidemiology (environmental & toxicological) - fundamental and applied • Need or impact assessments • Health service effectiveness, management and re-design • Health Protection including control of communicable diseases • Screening • Health promotion and disease prevention • Evaluation of public health programmes or interventions • Public health governance, audit and quality • Public health law • Public health policy and comparisons • Capacity in public health systems and workforce This is not an exhaustive list and the Editors will consider articles on any issue relating to public health. Public Health also publishes invited articles, reviews and supplements from leading experts on topical issues http://www.publichealthjrnl.com/?rss=yesElsevier Inc.en © 2012 The Royal Society for Public Health. Published by Elsevier Inc. All rights reserved. Public Health0033-35061265May 2012 © 2012 The Royal Society for Public Health. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.publichealthjrnl.com/article/PIIS0033350612001114/abstract?rss=yesAnyone visiting the UK over the last couple of years will have noticed the growth in ephemera with the slogan “Keep Calm and Carry On” emblazoned across the item. The slogan, which is set beneath the Crown cipher of King George VI on a red background, originated from a poster which was prepared by the UK Government in the dark days of 1939. Unusually, the poster itself was not seen at that time for a very simple reason. The expected invasion of the UK never materialised, so there was no need to issue the poster to encourage the British population to “keep calm and carry on” with their everyday lives irrespective of the new challenges and sacrifices that would have had to be made. Few people in the UK probably understand (or even care) about the origins of the poster or the slogan. Rather it has “gone viral” and become a vehicle for new messages, often for humorous effect. These can range from the simple motivational message (“Keep Calm and Drink Tea”), to the slightly more obscure (“Keep Calm, I'm The Doctor”), to the down-right surreal (“Keep Calm and Expecto Patromun”). As time has progressed, the slogan has become a means of drawing attention to political affiliations or events of great moment (“Calm Down you can still Marry Harry”).Keep calm and [insert action here]P. Mackie, F. Sim10.1016/j.puhe.2012.03.009Public Health 126, 5 (2012)2012-05-01Public Health2012-05-011265S0033-3506(12)X0005-2Editorial369370http://www.publichealthjrnl.com/article/PIIS0033350612000364/abstract?rss=yesSummary: Objectives: Several studies have reported a higher risk of suicide among the unemployed. Some individuals may be more prone to both unemployment and suicide due to an underlying health-related factor. In that case, suicide among the unemployed might be a consequence of health-related selection. This study aimed to investigate the relationship between unemployment and suicide, and the importance of previous sickness absence to this relationship.Study design: The study was based on 771,068 adults aged 25–58 years in Stockholm County in 1990–1991. Data on sickness absence in 1990–1991 and unemployment in 1991–1993 were collected from registers for each individual. Time and cause of death in 1994–1995 were obtained from Sweden’s Cause of Death Register.Methods: The association between sickness absence in 1990–1991 and unemployment in 1992–1993, and the association between unemployment in 1992–1993 and suicide in 1994–1995 was investigated using logistic regression.Results: Unemployment lasting for >90 days in 1992–1993 was associated with suicide in men in 1994–1995 [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.38–3.38], while unemployment lasting for ≤90 days in 1992–1993 was associated with suicide in women in 1994–1995 (OR 2.68, 95% CI 1.23–5.85). Higher levels of sickness absence were related to an increased risk of subsequent unemployment in both sexes. The higher prevalence of sickness absence among the unemployed attenuated the association between unemployment and suicide in both men and women.Conclusions: Unemployment is related to suicide. Individuals in poor health are at increased risk of unemployment and also suicide. The higher relative risk of suicide among the unemployed seems to be, in part, a consequence of exclusion of less healthy individuals from the labour market.Unemployment and suicide in the Stockholm population: A register-based study on 771,068 men and womenA. Lundin, I. Lundberg, P. Allebeck, T. Hemmingsson10.1016/j.puhe.2012.01.020Public Health 126, 5 (2012)2012-04-05Public Health2012-04-051265S0033-3506(12)X0005-2Original Research371377http://www.publichealthjrnl.com/article/PIIS0033350612000340/abstract?rss=yesSummary: Background: The extent to which the higher level of mortality seen in Glasgow compared with other UK cities is solely attributable to socio-economic deprivation has been the focus of much discussion recently. Some authors have suggested that poorer health in the city may be influenced by issues related to its history of religious sectarianism. In order to investigate this further, this study compared deprivation and mortality between Glasgow and Belfast, a similar post-industrial city, but one with a considerably more pronounced sectarian divide.Objectives: To compare the deprivation and mortality profiles of the two cities; to assess the extent to which any differences in mortality can be explained by differences in area-based measures of deprivation; and to examine whether these analyses shed any light on the ‘sectarianism’ hypothesis for Glasgow’s excess mortality relative to elsewhere in the UK.Study design and methods: Replicating the methodology of a recent study comparing deprivation and mortality in Glasgow, Liverpool and Manchester, rates of ‘income deprivation’ for 2005 were calculated for every small area across the two cities (average population size: 1810 in Belfast; 1650 in Glasgow). Standardized mortality ratios were calculated for the period 2003–2007 for Glasgow relative to Belfast, standardizing for age, gender and income deprivation decile.Results: While total levels of deprivation were slightly higher in Glasgow than in Belfast (24.8% of Glasgow’s population were income deprived in 2005 compared with 22.4% in Belfast), Belfast was more unequal in terms of its distribution of deprivation across the city. After standardizing for age, sex and deprivation, all-cause mortality in Glasgow was 27% higher for deaths under 65 years of age and 18% higher for deaths at all ages. Higher all-cause mortality in Glasgow was shown in the majority of sub-analyses (i.e. for most age groups, both sexes and across the majority of deprivation deciles). Analyses of particular causes of death showed significantly higher mortality in Glasgow relative to Belfast for all conditions examined except ‘external causes’. Notably higher mortality was evident for drug-related poisonings and alcohol-related causes among men in both cities. With a small number of exceptions, the results were very similar to those shown for Glasgow in comparison with Liverpool and Manchester.Conclusions: Area-based deprivation did not explain the higher mortality in Glasgow in comparison with Belfast. Belfast has a more profound history of sectarianism, and similar climatic conditions, to Glasgow. If these factors were to be important in explaining the high mortality in Glasgow, the question arises as to why they have not produced similar effects in Belfast.Shipyards and sectarianism: How do mortality and deprivation compare in Glasgow and Belfast?P. Graham, D. Walsh, G. McCartney10.1016/j.puhe.2012.01.018Public Health 126, 5 (2012)2012-04-05Public Health2012-04-051265S0033-3506(12)X0005-2Editors' Choice378385http://www.publichealthjrnl.com/article/PIIS0033350612000388/abstract?rss=yesSummary: Objective: To report on trends in mortality for asthma using all certified causes of death mentioned on death certificates (conventionally termed ‘mentions’), not just the underlying cause.Study design: Retrospective analysis using death certificate information and population data.Method: Analysis of mortality records in the Oxford region (mentions available from 1979 to 2007) and English national data (mentions available from 1995 to 2007). The data were considered in periods defined by different national rules for selecting underlying cause of death (1979–1983, 1984–1992, 1993–2000, 2001–2007), and were also analysed as single calendar years.Results: In Oxford, underlying cause mortality rates per million population in the four periods were 25, 32, 22 and 15, respectively. Rates for mentions were 44, 47, 41 and 29, respectively. Rule changes exaggerated the increase in underlying cause mortality in 1984–1992 (when 67% of asthma deaths were coded as underlying cause). Conversely, the decrease in underlying cause mortality for asthma by 2001–2007 is less than it seems (because just under 50% of asthma deaths in 2001–2007 were coded as underlying cause). Comparisons of trends in asthma and chronic obstructive airways disease (COPD) for individuals aged ≥55 years showed a decrease for both asthma and COPD in men; in women, a decrease in asthma and an increase in COPD was seen from the early 1990s.Conclusions: Approximately half of all deaths certified for asthma are missed when asthma mortality is analysed using underlying cause alone. The long-term decreasing trend in asthma mortality is real, and is not attributable to a trend in transferring certification from underlying to contributing cause. Nonetheless, caution is needed when comparing asthma deaths using underlying cause alone across periods that include changes to rules for the selection of underlying cause.Death rates for asthma in English populations 1979–2007: Comparison of underlying cause and all certified causesM.J. Goldacre, M.E. Duncan, M. Griffith10.1016/j.puhe.2012.01.022Public Health 126, 5 (2012)2012-04-20Public Health2012-04-201265S0033-3506(12)X0005-2Editors' Choice386393http://www.publichealthjrnl.com/article/PIIS0033350612000339/abstract?rss=yesThis article presents an overview of a partnership between public health teams in two primary care trusts in South East London, their local acute hospital trusts, and crime and disorder reduction partnerships to support the reduction of harm from violence. It discusses recent developments in violence prevention in emergency departments in the UK, and developments around outreach and case management, more common in the USA. It then outlines the elements of the violence prevention project being conducted in South East London.Maximizing the role of emergency departments in the prevention of violence: Developing an approach in South LondonG. Holdsworth, J. Criddle, A. Mohiddin, K. Polling, J. Strelitz10.1016/j.puhe.2012.01.017Public Health 126, 5 (2012)2012-03-30Public Health2012-03-301265S0033-3506(12)X0005-2Short Communication394396http://www.publichealthjrnl.com/article/PIIS0033350612000492/abstract?rss=yesSummary: Objectives: South Asians in developed countries such as the UK are at comparatively high risk of coronary heart disease for reasons which are not fully understood. One unexplored hypothesis is more infections in this ethnic group. This study assessed whether the prevalence of infections among South Asians differs from that among White populations of European origin in developed countries.Study design: Systematic review.Methods: Medline, Web of Science and Google Scholar databases were searched. In addition, reference lists and citations were reviewed.Results: Twenty-one studies reported prevalence rates and mean antibody levels of infection with 17 different pathogens or non-specific markers of infection. Among bacterial infections, higher rates of Escherichia coli and Mycobacterium tuberculosis infection were found in South Asians. No consistent differences were found for periodontal pathogens, Helicobacter pylori, Staphylococcus aureus, Chlamydia pneumoniae and Mycobacterium avium. For viral pathogens, higher rates of hepatitis A, hepatitis B and cytomegalovirus; and lower rates of herpes simplex, hepatitis C, human immunodeficiency virus and varicella zoster virus were found among South Asians. No difference was seen in the prevalence of hepatitis G virus in South Asians. Levels of non-specific markers of infection (total immunoglobulin G, endotoxin) were higher in South Asians.Conclusions: The number of studies was small. Differences in the prevalence of specific infections were found, but the current evidence is insufficient to support or reject the hypothesis under examination. Further studies are warranted.Might infection explain the higher risk of coronary heart disease in South Asians? Systematic review comparing prevalence rates with white populations in developed countriesD. Stefler, R. Bhopal, C.M. Fischbacher10.1016/j.puhe.2012.01.033Public Health 126, 5 (2012)2012-04-09Public Health2012-04-091265S0033-3506(12)X0005-2Review Article397409http://www.publichealthjrnl.com/article/PIIS0033350612000509/abstract?rss=yesSummary: Objectives: To examine the interaction between physical activity and abdominal obesity in relation to the Framingham Risk Score (FRS) for predicting the 10-year risk of coronary heart disease (CHD) using a representative sample of Korean adults.Study design: Cross-sectional study.Methods: Drawing from the 2007 Korean National Health and Nutrition Examination Survey (NHANES IV-1), data from 2112 adults aged 30–74 years were analysed. The risk of CHD was calculated according to the FRS, and odds ratios (ORs) were analysed for the at-risk group (probability > 10%) with multivariate logistic regression.Results: Compared with physically active men with a normal waist circumference (WC), inactive men with a large WC had an OR for CHD risk of 2.91 [95% confidence interval (CI) 1.63–5.22]. Compared with active women with a normal WC, inactive women with a large WC had an OR of 6.37 (95% CI 3.44–11.80). Among women with a normal WC, inactive women were at increased risk of CHD compared with active women (OR 2.16, 95% CI 1.19–3.93). Among active individuals, both men and women with large WCs were at increased risk of CHD compared with those with normal WCs.Conclusions: Abdominal obesity was associated with risk of CHD regardless of the level of physical activity. The 10-year risk of CHD associated with physical inactivity and abdominal obesity was much stronger in Korean women than in Korean men. While the importance of obesity control and physical activity is clear, future interventions should incorporate more targeted abdominal obesity prevention and control efforts, especially for women.Physical activity, abdominal obesity and the risk of coronary heart disease: A Korean national sample studyJ. Kim, H.-R. Han10.1016/j.puhe.2012.01.034Public Health 126, 5 (2012)2012-03-26Public Health2012-03-261265S0033-3506(12)X0005-2Original Research410416http://www.publichealthjrnl.com/article/PIIS0033350612000662/abstract?rss=yesSummary: Objectives: To identify the attitudes and beliefs associated with the uptake and adherence of physical activity among community-dwelling South Asians aged 60–70 years.Study design: A qualitative research study using an ethnographic approach.Methods: Focus groups and in-depth interviews were conducted to explore motivational factors associated with initiating and maintaining physical activity. Data analysis followed the framework approach.Results: Health, maintaining independence and social support were important in terms of initiating physical activity. Social support, psychosocial elements of activity, health and integrating physical activity within everyday activities were important for adherence to physical activity. The need for gendered physical activity sessions was important to initiating exercise among Muslim South Asians aged 60–70 years.Conclusion: Promoting active lifestyles and building physical activity in and around day-to-day activities are important strategies in increasing activity levels. However, the needs for culturally appropriate facilities, peer mentors who could assist those with language barriers, specific tailored advice, advice on integrating physical activity in everyday life and general social support could promote uptake and subsequent adherence among this population group.Attitudes and beliefs to the uptake and maintenance of physical activity among community-dwelling South Asians aged 60–70 years: A qualitative studyM. Horne, D.A. Skelton, S. Speed, C. Todd10.1016/j.puhe.2012.02.002Public Health 126, 5 (2012)2012-03-26Public Health2012-03-261265S0033-3506(12)X0005-2Original Research417423http://www.publichealthjrnl.com/article/PIIS0033350612000376/abstract?rss=yesIn 2006, primary care trusts (PCTs) in England were charged with the responsibility for commissioning dental services. Prior to that date, PCTs had little power to influence the location of National Health Service (NHS) practices. PCTs now have the responsibility for undertaking oral health needs assessments and commissioning dental services to meet the needs of their respective local populations. Additionally, PCTs need to improve oral health and address inequalities and inequities in oral health service provision.Dental practice populations: The effect of distance on the most socially deprived communities accessing dental care in the North East of EnglandD.P. Landes, R.D. Holmes10.1016/j.puhe.2012.01.021Public Health 126, 5 (2012)2012-02-23Public Health2012-02-231265S0033-3506(12)X0005-2Short Communication424426http://www.publichealthjrnl.com/article/PIIS003335061200073X/abstract?rss=yesSummary: More than 2 years after the start of pandemic H1N1, the world is fortunate that the impact, to date, has been moderate. An evaluation of the global response to the first wave of the pandemic is still ongoing. The results of an analysis of the situation in China is presented in order to gain a better understanding of the episode; to summarize the experiences in preparedness, control and mitigation of the pandemic; and to identify issues for further consideration and investigation in order to improve the response to possible next waves of the pandemic. China’s response shows how a huge challenge can be transformed into an opportunity, and may offer some valuable lessons to face another wave of the pandemic or other potential public health emergencies in the future, not only for China but also for the international community.Response to the first wave of pandemic (H1N1) 2009: Experiences and lessons learnt from ChinaW. Liang, L. Feng, C. Xu, N. Xiang, Y. Zhang, Y. Shu, H. Wang, H. Luo, H. Yu, X. Liang, D. Li, C.-K. Lee, Z. Feng, Y. Hou, Y. Wang, Z. Chen, W. Yang10.1016/j.puhe.2012.02.008Public Health 126, 5 (2012)2012-04-20Public Health2012-04-201265S0033-3506(12)X0005-2Review Article427436http://www.publichealthjrnl.com/article/PIIS0033350612000686/abstract?rss=yesSummary: Objective: To investigate the long-term impact of health education in intestinal helminth infection control in rural Bangladesh.Study design: Longitudinal study to compare knowledge, awareness and practice for intestinal helminths between four communities: two receiving health education and two not receiving health education.Methods: Parents of 1497 children aged between 2 and 8 years [781 (52.2%) received health education] were investigated by interview at baseline, endline (18 months) and follow-up (5 years).Results: Health education had a significant effect on the installment of tubewells and latrines, but only had a temporary effect on health knowledge.Conclusion: This long-term follow-up study showed the lack of sustainability of knowledge and awareness in the long-term after health education interventions.Short- and long-term impact of health education in improving water supply, sanitation and knowledge about intestinal helminths in rural BangladeshK. Minamoto, C.G.N. Mascie-Taylor, E. Karim, K. Moji, M. Rahman10.1016/j.puhe.2012.02.003Public Health 126, 5 (2012)2012-03-27Public Health2012-03-271265S0033-3506(12)X0005-2Original Research437440http://www.publichealthjrnl.com/article/PIIS0033350612000467/abstract?rss=yesSummary: Objectives: To explore the activities of the informal waste management sector in Nigeria, and barriers to integrating them in an inclusive waste management system.Study design: Literature review.Methods: A literature review was undertaken to evaluate the informal waste management system and formal waste management system in Nigeria and other developing countries with similar settings. Nine databases were searched and 34 studies met the following inclusion criteria: evaluation of the role of informal waste collectors, recycling and solid waste management in developing countries.Results: Most of the evaluated studies (97%, n = 33) acknowledged the significant environmental and socio-economic roles played by the informal waste collectors and scavengers in developing countries. The studies identified the following as barriers to inclusive waste management in Nigeria: repressive policy, unhygienic waste collection methods, lack of evidence to support activity, and low quality and quantity of secondary materials.Conclusions: Scavengers and other groups of informal recyclers see waste as a source of income and livelihood, whilst the general public see it as an aesthetic problem and see the people engaged in resource recovery as a social nuisance. Integrating their informal services with the formal waste management system is a potential tool to empower these people to increase their skills in resource recovery and improve their working and living conditions. Inclusive waste management is a process, and observable changes are taking place in some developing countries where waste pickers and informal waste collectors have become environmental agents. A major limitation to the integration of informal waste collectors and scavengers is the social acceptance of their activity as a viable source of income, and of themselves as environmental agents in the sustainability of virgin resources.Informal waste management system in Nigeria and barriers to an inclusive modern waste management system: A reviewO.O. Oguntoyinbo10.1016/j.puhe.2012.01.030Public Health 126, 5 (2012)2012-04-06Public Health2012-04-061265S0033-3506(12)X0005-2Review Article441447http://www.publichealthjrnl.com/article/PIIS0033350612000303/abstract?rss=yesSummary: This paper will explore the humanization value framework for research, policy and practice with regard to its relevance for public health, specifically the reduction of inequities in health. This proposed framework introduces humanizing values to influence research, policy and practice. The framework is articulated through eight specific constituents of what it is to be human. These dimensions are articulated as humanizing and dehumanizing dimensions that have the potential to guide both research and practice. The paper will then go on to consider these dimensions in relation to the emergent qualities of the potential ‘fifth-wave’ of public health intervention.The humanization dimensions outlined in this paper were presented as emerging from Husserl’s notion of lifeworld, Heidegger’s contemplations about human freedom and being with others, and Merleau-Ponty`s ideas about body subject and body object. Husserl’s ideas about the dimensions that make up ‘lifeworld’, such as embodiment, temporality and spatiality, underpin the suggested dimensions of what it is to be human. They are proposed in the paper as together informing a value base for considering the potentially humanizing and dehumanizing elements in systems and interactions. It is then proposed that such a framework is useful when considering methods in public health, particularly in relation to developing new knowledge of what is both humanizing and dehumanizing within research and practice.Can humanization theory contribute to the philosophical debate in public health?A. Hemingway10.1016/j.puhe.2012.01.014Public Health 126, 5 (2012)2012-03-02Public Health2012-03-021265S0033-3506(12)X0005-2Review Article448453http://www.publichealthjrnl.com/article/PIIS0033350612000352/abstract?rss=yesAt the UK Faculty of Public Health’s Annual Conference, held at the University of Birmingham in July 2011, I attended a workshop entitled ‘The new players in public health: can industry solve the big public health challenges?’ While listening to the excellent debate during this session, I was struck by the statistic quoted by one of the speakers that only about one-quarter of UK shoppers at supermarkets read nutrition labels on food products. These normally carry information on calorie, protein, carbohydrate and fat content of the foodstuff. Additional data on saturated fat, sugars, sodium, salt and fibre may also be recorded. These facts are given per 100 g and sometimes per food portion.Healthy supermarkets: Zoning for healthy food choicesR.L. Atenstaedt10.1016/j.puhe.2012.01.019Public Health 126, 5 (2012)2012-04-09Public Health2012-04-091265S0033-3506(12)X0005-2Letter to the Editors454455