Shale gas development and cancer incidence in southwest Pennsylvania.

OBJECTIVE: To what extent does unconventional gas development lead to an increase in cancer incidence in heavily drilled Southwest Pennsylvania? STUDY DESIGN: Ecological study. METHODS: Data for urinary bladder, thyroid and leukaemia were abstracted from the Pennsylvania Cancer Registry (PCR). Cancer incidence among counties with high, moderate and minimal number of producing wells is compared before drilling activity and thereafter. Observed vs expected cases, standardized incidence ratio and 95% confidence intervals are presented. Data are presented by county, diagnosis and sex for the years 2000-2004, 2004-2008 and 2008-2012. The percent difference between the observed cases from 2000 to 2004 and 2008-2012 was calculated. RESULTS: The observed number of urinary bladder cases was higher than expected in both sexes in counties with shale gas activity. In counties with the fewest number of producing wells, the increase was essentially non-existent. The number of observed cases of thyroid cancer increased substantially among both sexes over the time period in all counties regardless of the number of wells drilled. The pattern for leukaemia was mixed among males and females and among the counties regardless of the extent of shale gas development activities. CONCLUSION: Potential risk factors other than shale gas development must be taken into account to explain the higher than expected cancer cases in counties with and without shale gas wells before and during unconventional shale gas activity.

The 'dirty downside' of global sporting events: focus on human trafficking for sexual exploitation.

OBJECTIVES: Human trafficking is as complex human rights and public health issue. The issue of human trafficking for sexual exploitation at large global sporting events has proven to be elusive given the clandestine nature of the industry. This piece examines the issue from a public health perspective. STUDY DESIGN: This is a literature review of the 'most comprehensive' studies published on the topic. METHODS: A PubMed search was done using MeSH terms 'human traffickings' and 'sex trafficking' and 'human rights abuses'. Subheadings included 'statistics and numerical data', 'legislation and jurispudence', 'prevention and control', and 'therapy'. Only papers published in English were reviewed. RESULTS: The search showed that very few well-designed empirical studies have been conducted on the topic and only one pertinent systematic review was identified. Findings show a high prevalence of physical violence among those trafficked compared to non-trafficked women. Sexually transmitted infections and HIV AIDS are prevalent and preventive care is virtually non-existent. CONCLUSION: Quantifying human trafficking for sexual exploitation at large global sporting events has proven to be elusive given the clandestine nature of the industry. This is not to say that human trafficking for sex as well as forced sexual exploitation does not occur. It almost certainly exists, but to what extent is the big question. It is a hidden problem on a global scale in plain view with tremendous public health implications.

The implications of unconventional drilling for natural gas: a global public health concern.

Unconventional drilling for natural gas by means of high volume horizontal hydraulic fracturing (fracking) is an important global public health issue. Given that no sound epidemiologic study has been done to assess the extent of exposure-related adverse health effects among populations living in areas where natural gas extraction is going on, it is imperative that research be conducted to quantify the potential risks to the environment and to human health not just in the short-term, but over a longer time period since many diseases (i.e., cancers) appear years after exposure. It should not be concluded that an absence of data implies that no harm is being done.

Treatment options for the menopausal woman.

Hormone replacement therapy (HRT) is not benign; its adverse effects can be as serious as the health threats it was designed to prevent. An element of trial and error exists when tailoring a patient treatment regimen. Lack of clinician knowledge and poor clinician-patient communication can result in incorrect or suboptimal HRT decisions. This article presents a comprehensive assessment of options for women entering menopause; recent epidemiologic findings and various HRTs are discussed.

Trends in birth rates: New York City 1970-1995.

Traditional means of assessing the problem of teen pregnancy have relied on national or state statistics. By using large geographic areas, usually comprised of a heterogeneous population, it is impossible to tell which subareas have more of a problem than others. This study focused on trends in teen birth rates at the health district level in New York City over a 25-year period to illustrate variations among ethnic groups. Teen birth rates were calculated based on vital statistics published by the New York City Department of Health. They were calculated as the number of births per 1,000 females in each of three age groups: under age 15, 15-17, and 18-19. Rates were calculated for the entire City, for four boroughs, and for selected health center districts. The decline in the birth rate among New York City teens is most significant in health districts populated by blacks. An exception is the noted increases in birth rates in districts populated predominantly by Hispanics. Data show substantial decreases among older teens compared to younger teens. Birth trends in small areas of New York City mirror trends seen nationwide. As migration changes the ethnic composition of small areas, it is important to monitor trends so that policies and programs can be targeted to those in need.

Focus on quality assessment: the need for evaluation.

There is growing concern among purchasers and consumers of health care as well as among regulators that managed care has meant that quality has been sacrificed in the name of cost saving. Employers, as major purchasers, should demand that the managed care organizations they utilize demonstrate high-quality/low-cost care.

The importance of measuring patient satisfaction.

Managed care has demonstrated its ability to contain costs. Its emergence as a dominant factor in the health care marketplace has raised concerns about measuring health care quality. As the field of quality assurance is evolving, it is becoming clearer that patient satisfaction surveys should be an integral component of assessing care.

Evaluate and communicate health care benefits.

Both employers and employees need appropriate information to make intelligent decisions about health care benefits. For employers, analysis of health care data offers an approach to monitoring quality care and can provide a tool for controlling costs. For employees, an education and communication strategy is probably the single most important factor influencing both program utilization and employee acceptance.

Managed competition and the health care crisis.

The politics of health care reform has created gridlock despite public support for control of increasing costs, expanded coverage, and greater patient satisfaction. Managed care has become the watchword for meeting such goals, despite serious doubts about its ability to succeed. The author examines the pitfalls of managed care, particularly in regard to cost containment and patient satisfaction.

Focus on adolescent pregnancy and childbearing: a bit of history and implications for the 21st century.

Early childbearing in the United States has roots in the past; is the focus of intense partisan debate at the present time; and will have demographic, social, and economic ramifications in the future. It is an extremely complex issue, for which its associated problems have no easy or simple answers. Early parenthood is viewed as a social problem that has defied public policy attempts to stem its growth. It has become the focus of concern primarily for three reasons: (1) sexual activity has increased sharply, most recently among the youngest teens; (2) out-of-wedlock childbearing has risen among all teenagers, regardless of age; and (3) the issue of welfare. A review of statistics highlights the problem and discussion focuses on means of mitigating the negative effects of early childbearing.

PIP: This article focuses on the issue of adolescent pregnancy and childbearing in the US, including the history of the problem and its implications for the 21st century. It is noted that early childbearing in the US has roots in the past, identifying changing marital patterns and more tolerant social norms as the catalysts for the increase in rates. The problem has been the focus of intense partisan debate primarily for three reasons: 1) sexual activity has increased sharply, more recently among the youngest teens; 2) out-of-wedlock childbearing has risen among all teenagers, regardless of age; and 3) the issue of welfare. In addition, the problem is expected to have demographic, social, and economic ramifications in the future. Based on a review of statistics, recommended means of mitigating the negative effects of early childbearing include the development of interventions to improve school experiences and to encourage pursuit of higher levels of education, as well as legitimizing the use of contraceptives and making them widely available.

Refusal of surgery in an insured population.

Among 195 people who did not have recommended elective surgery in which a second opinion was required, virtually all indicated they were not going to have the operation and did not want a second opinion. The extent to which this decision adversely affected their health status and well-being and the extent to which alternate treatments were tried are examined. The findings also highlight the discretionary nature of patient and physician decision making.

Prospective screening of diagnostic testing: a valuable tool.

The elimination of unneeded services is a key to reducing medical costs and enhancing quality of care. Diagnostic tests have been a target of efforts to reduce costs primarily because they are discretionary and often appear to be unnecessary. Believing that the concept of prior review for many diagnostic tests is a good one, this pilot study sought to evaluate prospectively the propriety of diagnostic tests ordered during the first half of 1989 on individuals insured through a major insurance carrier. A physician review found that 21% of the tests were deemed inappropriate, leading to the conclusion that prospective review can be an effective means of screening inappropriately ordered tests.

The effect of a second opinion program on hysterectomy performance.

Large regional variations in hysterectomy rates cannot be explained by gynecologic need alone, giving rise to concerns about unnecessary surgery. This study's population consists of women insured through a major insurance carrier in 1987 who were required to obtain a second opinion for an elective hysterectomy. Of the 1,698 women referred for a second opinion for a proposed hysterectomy, 135 (8.0%) were not confirmed for the surgery and a random sample of these women were selected for this study. While confirmation rates did not vary significantly among regions, surgical rates did. Women in the Northeast tended NOT to have surgery when not confirmed; women in the South and North Central regions who were not confirmed tended to have surgery. Among these women, some hysterectomies were performed for questionable reasons, i.e., symptoms did not warrant surgical intervention, no pathologic justification, or conservative treatment preferable.

Employee benefits in the 1980s.

The author reviews changes in the provision of health care benefits that have occurred in this decade and observes that the '80s could be labeled "the market-oriented era" in health care delivery. She stresses the importance of employee cooperation and involvement in any successful cost containment effort.

The effects of repeated mechanical trauma in the meat industry.

Meat handlers are more prone to traumatic hand lesions and wound infections than most other occupational groups. This paper deals with the carpal tunnel syndrome (CTS), which is thought to be a major occupationally related condition affecting thousands of workers engaged in repetitive hand motion tasks. The literature reveals a high prevalence of CTS among meat handlers. Additional epidemiological research is needed. Further, it is important to educate workers about the signs, symptoms, and causes of CTS.

Warts among meat handlers.

The Amalgamated Meat Cutters and Retail Food Store Employees, Local 342, which represents meat handlers in the greater New York City area, wanted to determine whether warts were a significant problem among their membership. Findings from a prevalence study showed that the proportion of meat handlers who reported having warts (23.1%) was significantly higher than that for non-meat handlers (9.9%). The younger meat handlers had warts more frequently than did their older co-workers; there were no differences between the sexes. No one particular brand or type of meat could be associated with warts. Statistical tests of association indicated that meat handlers were more likely to have warts because of their occupation. We found that the switch to the Cryovac meat-packing process may have increased the likelihood of warts, although further study is needed to test that association.

Second opinion for urologic surgery.

Second opinion elective surgery programs provide a mechanism to obtain consultation from a board-certified specialist by patients to whom an elective operation has been recommended. We focus on a second opinion program for urologic cases. Of 931 individuals who received a second opinion for urologic surgery the need was confirmed in 692 (74.3 per cent) and was not confirmed in 239 (25.7 per cent). The most common procedure not confirmed was transurethral resection of the prostate. Common reasons for nonconfirmation were the need for further testing, medication preferable to an operation and symptoms not severe enough to warrant an operation. Of patients confirmed for the need for surgery 28.2 per cent did not undergo an operation, while 33.0 per cent of those not confirmed did.