Effects of individual and neighborhood socioeconomic status on the risk of all-cause mortality in chronic obstructive pulmonary disease: A nationwide population-based cohort study, 2002-2013.

BACKGROUND: Numerous previous studies have shown that individual socioeconomic status (SES) is associated with mortality in patients with chronic obstructive pulmonary disease (COPD), but few empirical studies have evaluated the effects of individual SES and neighborhood deprivation on mortality in COPD patients. METHODS: We performed a prospective cohort study to examine the effect of socioeconomic disparity on all-cause mortality in newly diagnosed COPD patients in a setting with universal health care coverage. We used representative population-based nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). We included patients who were at least 40 years old and newly diagnosed with COPD (N = 9275). To analyze the data, we utilized a frailty model and Cox's proportional hazard regression. RESULTS: A total of 1849 (19.9%) of the 9275 eligible participants died during the study period. Compared to high-income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for middle-income COPD patients who lived in advantaged and disadvantaged neighborhoods was 1.22 (95% CI, 1.03-1.43) and 1.36 (95% CI, 1.15-1.60), respectively. For low-income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than for patients who lived in advantaged neighborhoods (HR, 1.43; 95% CI, 1.17-1.74 vs. HR, 1.36; 95% CI, 1.11-1.66). There was no difference in the adjusted HRs for high-income patients who lived in advantaged and disadvantaged neighborhoods (HR, 1.01; 95% CI, 0.84-1.22). CONCLUSIONS: Socioeconomic disparity contributes to all-cause mortality in COPD patients and neighborhood deprivation exacerbates the effect of individual SES on all-cause mortality in COPD patients.

Etnobotânica de plantas medicinais em duas comunidades do município de Picuí, Paraíba, Brasil / Ethnobotanic of medicinal plants in two communities in the municipality of Picuí, Paraíba, Brazil

RESUMO O presente trabalho realizou um levantamento etnobotânico sobre a utilização de plantas medicinais no município de Picuí, Seridó Oriental, Estado da Paraíba, Brasil. Foi analisada uma área urbana (bairro monte santo) e uma rural (sítio massapê). As informações etnobotânicas foram obtidas através de formulários semiestruturados, contendo características socioeconômicas dos entrevistados, características das plantas e seus usos terapêuticos. Para a entrevista foi selecionado o adulto responsável pela residência, “chefe de família”, e utilizou-se a técnica da “bola de neve”. Foram citadas 37 famílias botânicas, 59 gêneros e 64 espécies. As espécies mais citadas foram Vernonia condensata Baker e Chenopodium ambrosioides L. e a família mais indicada foi Fabaceae. O hábito predominante foi o herbáceo, seguido do arbóreo; as partes da planta mais utilizadas foram as folhas e as cascas do caule; os principais modos de preparo dos remédios foram os chás e a água e/ou sumo. A planta com maior CUPc foi Vernonia condensata Baker (41,67%), sendo também uma das plantas com maior FRt junto a Chenopodium ambrosioides L., ambas com 19,6%. Esses resultados demonstraram que as populações estudadas ainda usam plantas medicinais com frequência, entretanto, a maioria das plantas utilizadas não é nativa da caatinga.

ABSTRACT This study conducted an ethnobotanical survey on the use of medicinal plants in the municipality of Picuí, Seridó of Paraíba, Brazil. An urban area (neighborhood monte santo) and a rural area (massapê farm) were analysed. The ethnobotanical information was obtained through semi-structured questionary containing socioeconomic characteristics of the respondents, characteristics of plants and their therapeutic uses. We selected an adult which was the responsible adult of the residence “householder” for the interview and used the technique of “snowball”. 37 plant families, 59 genera and 64 species were cited. The species most frequently cited were Vernonia condensata Baker and Chenopodium ambrosioides L. and the most mentioned family was Fabaceae. The predominant habit was the herbaceous, followed by woody, the parts of the plant which were most used are the leaves and bark of the stem, the main modes of preparation of the medicines were showers and water and / or lushness. The plant with the highest CUPc was Vernonia condensata Baker (41.67%), and it was also one of the plants with greatest FRt along with Chenopodium ambrosioides L., both with 19.6%. These results demonstrated that the studied populations still use medicinal plants often, however, most of the plants used is not native to the caatinga.

Compreendendo a relação entre saúde do ambiente e saúde humana em comunidades Quilombolas de Santa Catarina / The forest gives us health: relationships between environmental health and human health in Maroon communities of Santa Catarina

RESUMO Neste artigo investigamos a relação entre a saúde humana e saúde do ambiente em comunidades quilombolas do litoral de Santa Catarina, analisando a situação de saúde destas comunidades, as percepções sobre elementos que influenciam a saúde humana, as plantas medicinais conhecidas e o mapeamento de ambientes que trazem benefícios para a saúde. Foi realizado entrevistas e listagem-livre de plantas medicinais com 184 adultos (63 no Morro do Fortunato, 56 na Santa Cruz e 65 na Aldeia), e uma reunião comunitária para a realização do mapeamento participativo em cada comunidade. As comunidades quilombolas percebem diversas influências na saúde, sendo que os elementos de cuidado com o corpo foram os mais citados. A qualidade da água/ar e recreação/lazer foram os benefícios mais reconhecidos das áreas florestais para a saúde humana. Foram identificadas 152 espécies de plantas medicinais, sendo que as espécies mais citadas são plantas cultivadas e/ou que ocorrem espontaneamente próximo às moradias. O mapeamento de serviços ambientais revela áreas prioritárias para a saúde, que estão localizadas em florestas e próximo aos corpos d’água, ressaltando a importância de conservar estes locais e de construir estratégias para garantir o acesso a eles pelas comunidades.

ABSTRACT In this article we investigate the relationship between human health and environmental health in maroon communities of Santa Catarina, analyzing the health situation of these communities, the perceptions of elements that influence human health, medicinal plants known and mapping environments that bring health benefits. We conducted interviews and free-listing of medicinal plants with 184 adults (63 in Morro do Fortunato, 65 em Santa Cruz and 56 in Aldeia), and a community meeting for the realization of participatory mapping in each community. Maroon communities realize diverse influences on health, and the elements of care with the body were the most cited. The quality of the water/air and recreation/leisure were the most recognized benefits of forests to human health. 152 species of medicinal plants have been identified, and the most cited species are cultivated plants and/or occurring spontaneously near the houses. The mapping of environmental services reveals priority areas for health, which are located in forests and near the water bodies, emphasizing the importance of conserving these places and build strategies to ensure access to them by communities.

Plantas medicinais conhecidas na zona urbana de Cajueiro da Praia, Piauí, Nordeste do Brasil / Known medicinal plants found in the urban Cajueiro da Praia urban area, Piauí state, Northeast Brazil

RESUMO A utilização de plantas com fins medicinais para tratamento, cura e prevenção de doenças é considerada uma das mais antigas formas de prática medicinal da humanidade. O presente estudo teve como objetivo identificar as espécies de plantas medicinais usadas dentro da comunidade de Cajueiro da Praia, Piauí, bem como a parte da planta utilizada, o modo de preparo, a sua importância relativa, o valor de uso e o consenso em relação às propriedades terapêuticas das espécies citadas. Foram aplicadas 12 entrevistas semiestruturadas com especialistas locais indicados, utilizando o método de amostragem por “bola-de-neve” e a técnica de “turnê-guiada” para coleta das espécies citadas. Análises quantitativas tais como Valor de Uso, Importância Relativa e Fator de Consenso dos Informantes foram associadas à análises qualitativas. As coletas botânicas seguiram a metodologia usual. Foram citadas 43 espécies, distribuídas em 24 famílias botânicas, sendo Lamiaceae a mais representada em número de espécies (oito espécies), seguida de Euphorbiaceae, Fabaceae, Myrtaceae e Rutaceae (todas com três). Chenopodium ambrosioides L. (mastruz) obteve o maior valor de uso (VU=1,58), sendo portanto, a planta com elevado potencial de uso para a comunidade. Quanto ao uso terapêutico, observou-se que um maior número de espécies foi indicado no combate à gripe, seguido por má digestão. O IR demonstrou que planta mais versátil foi Chenopodium ambrosioides L. (mastruz), com IR=2, referido em cinco categorias de uso e o FCI apontou que os sistemas corporais que apresentam maior importância local são: sistema circulatório (FCI=0,57), seguido por lesões e consequências de causas externas (FCI=0,50), sistema endócrino (FCI=0,50) e respiratório (FCI=0,40). No âmbito geral, verificou-se que a diversidade de plantas medicinais conhecida e a obtenção das plantas na comunidade estudada sugerem uma correlação entre uso/conhecimento de plantas medicinais e disponibilidade das mesmas; que a flora medicinal é representada, em boa parte, por plantas exóticas cultivadas nos quintais e que a transmissão do conhecimento tradicional feito localmente e por via oral demonstra uma herança cultural na cidade.

ABSTRACT The use of medicinal plants for the purposes of treating, curing and preventing diseases is considered one of the oldest forms of humanity’s medical practices. This study aimed to identify the species of medicinal plants used in the Cajueiro da Praia community, Piauí state, the part of the plant used, the method of preparation, their relative importance, the use value and the consensus on the therapeutic properties of the species mentioned. 12 semi-structured interviews with indicated local experts were performed, using the “snow-ball” sampling method and the “guided tour” technique to collect the aforementioned species by a standardized method. Quantitative analyzes such as Use value, relative importance and informant consensus factor were performed alongside qualitative analyzes. 43 species belonging to 24 botanical families were cited, Lamiaceae being the most represented in number of species (eight species) followed by Euphorbiaceae, Fabaceae, Myrtaceae and Rutaceae (with three each). Chenopodium ambrosioides L. (mastruz) had the highest use value (UV = 1.58), and therefore was the plant with the highest potential for use by the community. For therapeutic use, it was observed that a greater number of species have been shown to combat influenza, followed by maldigestion. The RI showed that the most versatile plant was Chenopodium ambrosioides L. (mastruz) with RI = 2, found in five usage categories and the ICF pointed out that the bodily systems that have greater local importance are: the circulatory system (ICF = 0.57), followed by lesions and consequences by external causes (ICF = 0.50), the endocrine (ICF = 0.50), and the respiratory system (ICF = 0.40). Within the general framework, it was found that the diversity of known medicinal plants and plants obtained from the population studied, suggested a correlation between the use/knowledge of medicinal plants and the availability there of; the medicinal flora is largely represented by exotic plants that are grown in backyards andby the transmission of traditional knowledge made locally and orally demonstrates a cultural heritage in the city.

Levantamento etnobotânico de plantas medicinais em área de Caatinga na comunidade do Sítio Nazaré, município de Milagres, Ceará, Brasil / Ethnobotanical survey of medicinal plants in the Caatinga area in the community of Sitio Nazaré, Milagres, Ceará, Brazil

O presente trabalho teve como objetivo realizar um levantamento das plantas medicinais nativas no bioma Caatinga na comunidade do Sítio Nazaré, no município de Milagres, Ceará. Foram utilizadas entrevistas semiestruturadas com 100 informantes entre 25 a 85 anos registrando informações de 62 espécies medicinais sobre o uso, parte utilizada, indicação terapêutica, e formas de preparo dos remédios caseiros, além de coleta do material botânico e produção de exsicatas. As famílias com maior representatividade na pesquisa foram Fabaceae (16 spp.), Euphorbiaceae (7 spp.), Cucurbitaceae e Malvaceae (3 spp.), e as demais com duas ou uma espécie cada. Nas preparações dos remédios caseiros verificou-se que todas as partes da planta são utilizadas, predominando as raízes (33,77%) e as cascas (29,87%). Observaram-se várias formas de preparo, sendo o chá a mais indicada (49,21%), seguida do lambedor (40,69%). Os dados encontrados revelaram que o conhecimento popular sobre as plantas medicinais é de extrema importância para o controle das afecções e contribui para a realização de estudos etnofarmacológicos.

The present study aimed to survey the native medicinal plants in the biome Caatinga in the community of Sítio Nazaré from Milagres, in Ceará, Brazil. Semi-structured interviews with 100 persons, from 25 to 85 years old, were recorded. Sixty-two species were pointed for medical information on use, used plant part, therapeutic indication and methods of preparation of home remedies. We also prepared the collection of botanical material and production of exsiccates. The most representative families reported in this study were: Fabaceae (15 spp.), Euphorbiaceae (7 spp.), Cucurbitaceae and Malvaceae (3 spp.). On the preparation of remedies, we found that all parts of the plants were used, predominantly the roots (33.77%) and the barks (29.87%). The most common way of preparation observed was tea (49.21%), followed by syrup (40.69%). These collected data revealed that popular knowledge on medicinal Caatinga plants were important for disease control in the local population and it has contributed to other ethnopharmacology studies.

Estudo das plantas medicinais, utilizadas pelos pacientes atendidos no programa "Estratégia saúde da família" em Maringá/PR/Brasil / Study of the use of medicinal plants by population served by the family health strategy in Maringá, Paraná, Brazil

RESUMO Estima-se que 80% da população mundial dependam das plantas medicinais no processo da atenção primária em saúde, e grande parte destes tem nas plantas a única fonte de medicamentos. O presente estudo teve como objetivo verificar a utilização de plantas medicinais pela comunidade, pertencente à equipe 10 da Estratégia Saúde da Família (ESF) da Unidade Básica de Saúde (UBS) Pinheiros, em Maringá, Paraná, Brasil. Os dados foram coletados no período de março de 2012 a maio de 2012. A equipe de pesquisadores aplicou 95 questionários intercalando os domicílios. Observou-se que 24,2% utilizam plantas medicinais com frequência, 40% utilizam esporadicamente e 35,8% não utilizam. Entre as pessoas que utilizam, observou-se que a forma mais citada foi o uso era pela indicação de amigos ou pelos ancestrais As plantas medicinais mais citadas foram: hortelã (Mentha sp.), boldo (Plectranthus barbatus), camomila (Matricaria recutita), erva cidreira (Melissa officinalis) e guaco (Mikania glomerata). Quando perguntados se o uso de plantas medicinais somente fazem bem à saúde, 68,5% dos participantes afirmaram que plantas medicinais não causam nenhum mal à saúde. A partir destes resultados, observou-se que a utilização de plantas medicinais é bem aceita pela população e que ainda existe uma lacuna grande a ser preenchida pelos profissionais da saúde no que diz respeito à orientação sobre o uso correto desse tipo de terapia.

ABSTRACT It is estimated that 80% of the population depends on herbal medicine regarding primary health care and most of these people use plants as their only source of drugs. The current study aimed to know the profile of the community served by the staff 10 of the Family Health Strategy (FHS) of Basic Unity of Health (BUH) Pinheiros, in Maringá, Paraná State, in regard to the use of medicinal plants. The data was collected between March of 2012 and May of the same year. Ninety-five questionnaires were applied. 24.2% of people employ medicinal plants frequently, 40% use it occasionally and 35.8% do not appeal to them at all. Most of them learnt about medicinal plants with family and friends. The most mentioned medicinal plants by population were the following: Mentha sp., Plectranthus barbatus, Matricaria recutita, Melissa officinalis and Mikania glomerata. 68.5% of the participants believe that medicinal plants do not cause any harm to health. From these results, we can notice that medicinal plants are widely accepted and there is a big gap to be filled by health professional in terms of proper orientation about the use of this kind of therapy.

Diversidade e usos de plantas medicinais nos quintais da comunidade de São João da Várzea em Mossoró RN / Diversity and uses of medicinal plants in homegardens at the community São João da Varzea, Mossoró RN

RESUMO Nos quintais do nordeste brasileiro são mantidas tradicionalmente diversas espécies vegetais para o tratamento de doenças. O objetivo do presente trabalho foi realizar um levantamento das espécies medicinais em quintais na Comunidade de São João da Várzea, Mossoró, Rio Grande do Norte, Brasil. Participaram do estudo 22 informantes e foram aplicadas para a coleta de dados técnicas de observação direta e participante, turnê guiada, lista livre e entrevistas semiestruturadas. Verificou-se a presença de 57 espécies pertencentes a 37 famílias botânicas. As espécies com maior frequência de ocorrência foram goiabeira (Psidium guajavaL.) e coqueiro (Cocos nucifera L.), presentes em 59% e 55% dos quintais, respectivamente. Para estas espécies houve maior índice de concordância de uso (CUPc de 61,5% e 92,3%). Foram citadas 67 patologias e o maior número de plantas medicinais foi indicado para o tratamento de gripe, disenteria, inflamações e como cicatrizante de ferimentos. O principal modo de administração foi por via oral, na forma de decocção (58%) e as folhas foram as partes mais usadas (32,6%). Os quintais são sistemas que atuam como uma estratégia de uso mais sustentável dos recursos medicinais por conservarem também as espécies nativas. As espécies medicinais mais frequentes nos quintais são arvores frutífero-alimentícias importantes para a renda familiar. A gripe e desinteria são os principais agravos de saúde tratados com espécies medicinais pela comunidade. Ziziphus joazeiro Mart., Citrus X limonia (L.) Osbeck, Punica granatum L., Cocos nucifera L. e Psidium guajava L. são espécies que merecem maiores estudos farmacológicos.

ABSTRACT Traditionally, at homegardens in the northeastern of Brazil, several plant species are employed for the treatment of diseases. The aim of this study was to research the species of medicinal use in homegardens of São João da Varzea, Mossoró, Rio Grande do Norte, Brazil. 22 homegardens were studied through the techniques of direct and participant observations , guided tours, free list and semi structured interviews. We verified the presence of 57 botanical species belonging to 37 families. The two species with the highest frequency of occurrence were the guava (Psidium guajava L.) and the coconut (Cocos nucifera L.), present in 59% and 55% of the homegardens, respectively. For these species there was more agreement of use (CUPc 61.5% and 92.3%). 67 diseases, including influenza and dysentery were the most common ones mentioned during the interviews. The main mode of administration was orally, in the form of decoction (58%), and the leaves were the most employed component (32.6%). Homegardens are systems that act as a more sustainable use of medicinal resources strategy since they conserve native species. The most common medicinal plants in the homegardens are the fruitful-food trees, important to the family income. The flu and the dysentery are the main health problems treated with medicinal plants by the community. The Ziziphus joazeiro Mart., Citrus X limonia (L.) Osbeck, Punica granatum L., Cocos nucifera L. and Psidium guajava L. are species that deserve further pharmacological studies.

Validity of an ecometric neighborhood physical disorder measure constructed by virtual street audit.

Neighborhood physical disorder is thought to affect mental and physical health, but it has been difficult to measure objectively and reliably across large geographical areas or multiple locales. Virtual street audits are a novel method for assessing neighborhood characteristics. We evaluated the ecometric properties of a neighborhood physical disorder measure constructed from virtual street audit data. Eleven trained auditors assessed 9 previously validated items developed to capture physical disorder (e.g., litter, graffiti, and abandoned buildings) on 1,826 block faces using Google Street View imagery (Google, Inc., Mountain View, California) dating from 2007-2011 in 4 US cities (San Jose, California; Detroit, Michigan; New York, New York; and Philadelphia, Pennsylvania). We constructed a 2-parameter item response theory scale to estimate latent levels of disorder on each block face and defined a function using kriging to estimate physical disorder levels, with confidence estimates, for any point in each city. The internal consistency reliability of the resulting scale was 0.93. The final measure of disorder was positively correlated with US Census data on unemployment and housing vacancy and negatively correlated with data on owner-occupied housing. These results suggest that neighborhood physical disorder can be measured reliably and validly using virtual audits, facilitating research on possible associations between physical disorder and health.

Bidens pilosa L. (Asteraceae): traditional use in a community of southern Brazil / Bidens pilosa Linn (Asteraceae): uso tradicional em uma comunidade do Sul do Brasil

The correct use of plants for therapeutic purposes requires selection of those showing efficacy and safety based on the popular tradition and/or scientific validation. Bidens pilosa L. is a species that widely occurs in tropical regions and is known in Brazil as "picão-preto". Four agents from the Health Pastoral Service were identified in the region of Criciuma, Santa Catarina State, for their popular knowledge of Bidens pilosa. The study was conducted by means of interview which provided data concerning the knowledge of "picão preto", handling, used plant part, plant/solvent proportion, preparation methods, administration route/dosage, indication and restrictions. The pharmaceutical form, as well as the posology, was significantly variable. Analysis of the collected data showed anti-inflammatory action as the main therapeutic indication.

O emprego correto de plantas para fins terapêuticos pela população requer o uso daquelas selecionadas por sua eficácia e segurança, com base na tradição popular e/ou cientificamente validadas como medicinais. Bidens pilosa L. é uma espécie que ocorre amplamente em regiões tropicais sendo conhecida no Brasil pelo nome popular "picão-preto". Quatro agentes da pastoral da Saúde foram identificadas na região de Criciúma/SC por possuírem maiores informações de cunho popular sobre Bidens pilosa. A pesquisa ocorreu por meio de entrevista, onde foram compiladas informações sobre o conhecimento do "picão-preto", manuseio, farmacógeno, proporção farmacógeno/ solvente, técnica de preparo, formas de uso/posologia, indicações e restrições de uso. A forma farmacêutica utilizada variou significativamente, assim como a posologia. A análise de informações coletadas mostra a ação antiinflamatória como principal indicação terapêutica.

From Kindergarten readiness to fourth-grade assessment: longitudinal analysis with linked population data.

Early child development (ECD)--the development of physical, social-emotional, and language-cognitive capacities in the early years--is a foundation of health, well-being, learning, and behaviour across the life course. Consequently, the capacity to monitor ECD is an important facet of a modern society. This capacity is achieved by having in place an ongoing flow of high-quality information on the state of early child development, its determinants, and long-term developmental outcomes. Accordingly, there remains a considerable need for research that merges community-centred, longitudinal, and linked-data approaches to monitoring child development. The current paper addresses this need by introducing one method of summarising and quantifying the developmental trajectories of British Columbian children at the neighbourhood- or district-level: computing the Community Index of Child Development (CICD) for each geographic area. A simple index that describes change in children's developmental trajectories at the aggregate level, the CICD is computable because of our capacity to conduct individual-level linkage of two population data sets: the Early Development Instrument (EDI), a holistic measure of children's readiness for school which is administered at Kindergarten, and the British Columbia Ministry of Education's Foundation Skills Assessment (FSA), a Grade 4 measure of academic skills. In this paper, we demonstrate: (a) wide variation in the CICDs according to the children's district of residence in Kindergarten; (b) an association of the CICDs with an indicator of the socioeconomic character of the neighbourhoods; and (c) contrasting patterns of neighbourhood convergence and divergence in two different school districts--such that, in some areas, children from high vulnerability neighbourhoods tend to catch up between Kindergarten and Grade 4 whereas, in other areas, they tend to fall further behind.

Perceived health is associated with visiting natural favourite places in the vicinity.

Visiting favourite natural settings may serve as a resource for regulating negative feelings and coping with perceived stress. The authors investigated the association between perceived health, the selection and experiential qualities of favourite places in four residential areas; 211 respondents (average age 40 years) responded to the questionnaire. Respondents with a certain amount of health complaints, such as headaches, chest or stomach pains, and faintness or dizziness, were more likely to select natural favourite places than those with few complaints. Respondents with health complaints benefited more in emotional terms from their visits to the favourite place although they did not visit their places more frequently than others. The change toward positive feelings was associated in particular with natural favourite places and relaxing in them. The results give impetus to research on the self-regulation of mood and neighbourhood context in health.

Disparities in complementary and alternative medical therapy recommendations for children in two different socioeconomic communities.

OBJECTIVE: To compare the content, quality, and cost of recommendations for children made by complementary and alternative medicine (CAM) retailers within 2 New York City neighborhoods of divergent socioeconomic status (SES). METHODS: Posing as consumers, researchers sought recommendations from CAM retailers for 2 clinical scenarios: 1) a febrile 6-week-old and 2) a 4-year-old with an upper respiratory infection (URI). All retailers selling CAM therapies outside the direction of a licensed provider within East Harlem (EH) and the Upper East Side (UES) were eligible and mapped. The febrile infant scenario was posed at sites in business in March (n = 23) and the URI scenario at sites that remained in business in April (n = 20) of 2004. RESULTS: In response to the febrile infant scenario, 33% of UES retailers referred to a MD, 0% to the emergency department, and 47% made other recommendations-of which 43% were not indicated. In EH, 50% referred to a MD, 5% to the emergency department, and 37% made other recommendations. The mean price of UES recommendations was Dollars 9.66, whereas EH was Dollars 2.33 (P = .04). In response to the URI scenario, 93% of UES and 83% of EH retailers made recommendations. The mean price of UES recommendations was Dollars 10.55 while EH was Dollars 4.26 (P = .002). CONCLUSIONS: Complementary and alternative medicine retailers made numerous recommendations for children, including some that were contraindicated for age. East Harlem retailers tended to refer an infant with a potentially serious condition to the emergency department or to an MD and made less expensive recommendations than their UES counterparts.

Healthy naturally occurring retirement communities: a low-cost approach to facilitating healthy aging.

Naturally occurring retirement communities (NORCs) are broadly defined as communities where individuals either remain or move when they retire. Using the determinants of health model as a base, we hypothesize that some environmental determinants have a different impact on people at different ages. Health benefits to living within NORCs have been observed and likely vary depending upon where the specific NORC exists on the NORC to healthy-NORC spectrum. Some NORC environments are healthier than others for seniors, because the NORC environment has characteristics associated with better health for seniors. Health benefits within healthy NORCs are higher where physical and social environments facilitate greater activity and promote feelings of well-being. Compared to the provision of additional medical or social services, healthy NORCs are a low-cost community-level approach to facilitating healthy aging. Municipal governments should pursue policies that stimulate and support the development of healthy NORCs.

Does socio-demographic status influence the effect of pollens and molds on hospitalization for asthma? Results from a time-series study in 10 Canadian cities.

PURPOSE: Social status influences asthma morbidity but the mechanisms are not well understood. To determine if sociodemographics influence the susceptibility to ambient aeroallergens, we determined the association between daily hospitalizations for asthma and daily concentrations of ambient pollens and molds in 10 large Canadian cities. METHODS: Daily time-series analyses were performed and results were adjusted for day of the week, temperature, barometric pressure, relative humidity, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide. Results were then stratified by age, gender, and neighborhood family education and income. RESULTS: There appeared to be age and gender interactions in the relation between aeroallergens and asthma. An increase in basidiomycetes equivalent to its mean value, about 300/m3, increased asthma admissions for younger males (under 13 years of age) by 9.3% (95% CI, 4.8%, 13.8%) vs. 4.2% (95% CI, - 0.1%, 8.5%) for older males. The reverse was true among females with increased effect in the older age group: 2.3% (95% CI, 1.2%, 5.8%) in those under 13 years vs. 7.1% (95% CI, 4.1%, 10.1%) for older females. Associations were seen between aeroallergens and asthma hospitalization in the lowest but not the highest education group. CONCLUSIONS: Our results suggest that younger males and those within less educated families may be more vulnerable to aeroallergens as reflected by hospitalization for asthma.

The influence of socio-economic and locational disadvantage on survival after a diagnosis of lung or breast cancer in Western Australia.

OBJECTIVE: The effects of demographic, locational and socio-economic disadvantage, and the influence of private health care on five-year mortality rates in patients with lung cancer or after breast cancer surgery in Western Australia were examined. METHODS: The Western Australian Record Linkage Project was used to extract all hospital morbidity, cancer and death records of all people with lung or breast cancer in Western Australia from 1982 to 1996. Mortality rate ratios after a diagnosis of lung cancer or breast cancer surgery were estimated using Cox regression. Two sets of analyses were carried out: demographically adjusted from 1982 to 1996; and demographically and disadvantage adjusted from 1992 to 1996. RESULTS: Overall, 87.7% of lung cancer and 17.8% of breast cancer patients were deceased by five years. Lung and breast cancer patients treated in rural hospitals had higher mortality rates (1992-1996: relative risk (RR) 1.24, 95% confidence interval (CI) 1.07-1.44, and RR 1.20, 95% CI 0.92-1.56, respectively; 1982-1996: RR 1.20, 95% CI 1.11-1.30, and RR 1.19, 95% CI 1.06-1.33, respectively), whereas location of residence had little effect. Lung and breast cancer patients treated in private hospitals had lower mortality (1992-1996: RR 0.85, 95% CI 0.76-0.95, and RR 0.90, 95% CI 0.77-1.05, respectively; 1982-1996: RR 0.91, 95% CI 0.84-0.97, and RR 0.92, 95% CI 0.85-0.99, respectively), although insurance status was not a factor. Women with breast cancer had significantly worse survival in the more socio-economically disadvantaged groups (1992-1996: RR 1.41 to 1.26; 1982-1996: RR 1.45 to 1.29). CONCLUSIONS: Survival was poorer in patients treated in the public hospital system, but the possession of private health insurance was not predictive of better outcomes. People treated in rural hospitals had worse survival, whereas location of residence was not an independent factor. Women in more socio-economically advantaged groups who underwent breast cancer surgery had improved survival.