The new face of health care in Ontario

Canada is experiencing a dramatic increase in the number of older people in its population. Adopting strategies that involve physician actions, a societal approach and individual participation may substantially improve the health of senior citizens. This article presents ways to improve the quality of life and reduce the risk of premature death through manoeuvres that can be initiated by physicians in the context of the periodic health examination. The authors highlight the role of evidence in choosing the most appropriate interventions, speculate on areas of future importance and emphasize a societal approach to population health.     

Acculturation process and its effects on dietary habits, nutritional behavior and body-image in adolescents

Previous studies have indicated that the acculturation process may contribute to psychosocial and health problems among immigrants through the mediation of acculturation stress. This study focuses on adolescents with immigrant background permanently settled in the Croatian region of Dalmatia and the influences of the acculturation process on their dietary habits, nutritional behavior and perceived body-image. The survey was conducted on the total sample of 510 adolescents (aged 14-19) including 52 first generation and 248 second generation immigrants. The analysis included dietary habits and questions of restrictive diet as indicators of unhealthy influence on physical health. Psychological factors (stress and self-esteem) have been found to be associated with dietary habits, diet behavior and dissatisfaction with body-image among adolescents with significant differences by immigrant status. Immigrant status is viewed as a risk factor for psychological distress and unhealthy dieting behavior. Research stresses the need to study the interaction between acculturation and health not only from an individual perspective, but also from the broader socio-ecological context of population subgroups.     

Values at stake: autonomy, responsibility, and trustworthiness in relation to genetic testing and personalized nutrition advice

Personalized nutrition has the potential to enhance individual health control. It could be seen as a means to strengthen people’s autonomy as they learn more about their personal health risks, and receive dietary advice accordingly. We examine in what sense personalized nutrition strengthens or weakens individual autonomy. The impact of personalized nutrition on autonomy is analyzed in relation to responsibility and trustworthiness. On a societal level, individualization of health promotion may be accompanied by the attribution of extended individual responsibility for one’s health. This constitutes a dilemma of individualization, caused by a conflict between the right to individual freedom and societal interests. The extent to which personalized nutrition strengthens autonomy is consequently influenced by how responsibility for health is allocated to individuals. Ethically adequate allocation of responsibility should focus on prospective responsibility and be differentiated with regard to individual differences concerning the capacity of adults to take responsibility. The impact of personalized nutrition on autonomy also depends on its methodological design. Owing to the complexity of information received, personalized nutrition through genetic testing (PNTGT) is open to misinterpretation and may not facilitate informed choices and autonomy. As new technologies, personalized nutrition and PNTGT are subject to issues of trust. To strengthen autonomy, trust should be approached in terms of trustworthiness. Trustworthiness implies that an organization that develops or introduces personalized nutrition can show that it is competent to deal with both the technical and moral dimensions at stake and that its decisions are motivated by the interests and expectations of the truster.     

Genetic variation in taste and its influence on food selection

Abstract Taste perception plays a key role in determining individual food preferences and dietary habits. Individual differences in bitter, sweet, umami, sour, or salty taste perception may influence dietary habits, affecting nutritional status and nutrition-related chronic disease risk. In addition to these traditional taste modalities there is growing evidence that "fat taste" may represent a sixth modality. Several taste receptors have been identified within taste cell membranes on the surface of the tongue, and they include the T2R family of bitter taste receptors, the T1R receptors associated with sweet and umami taste perception, the ion channels PKD1L3 and PKD2L1 linked to sour taste, and the integral membrane protein CD36, which is a putative "fat taste" receptor. Additionally, epithelial sodium channels and a vanilloid receptor, TRPV1, may account for salty taste perception. Common polymorphisms in genes involved in taste perception may account for some of the interindividual differences in food preferences and dietary habits within and between populations. This variability could affect food choices and dietary habits, which may influence nutritional and health status and the risk of chronic disease. This review will summarize the present state of knowledge of the genetic variation in taste, and how such variation might influence food intake behaviors.     

A Biosemiotic Perspective of the Resource Criterion: Toward a General Theory of Resources

Describing resources and their relationships with organisms seems to be a useful approach to a ‘unified ecology’, contributing to fill the gap between natural and human oriented processes, and opening new perspectives in dealing with biological complexity. This Resource Criterion defines the main properties of resources, describes the mechanisms that link them to individual species, and gives a particular emphasis to the biosemiotic approach that allows resources to be identified inside a heterogeneous ecological medium adopting the eco-field model. In particular, this Criterion allows to couple matter, structured energy and information composing the ecological systems to the biosemiotic and cognitive mechanisms adopted by individual species to track resources, transforming neutral surroundings into meaningful species-specific Umwelten. The expansion of the human semiotic niche that is a relevant evolutionary process of the present time, assigns the role of powerful and efficient agency to the Resources Criterion to evaluate the effect of human intrusion into the natural systems with habits of key stone species, under the challenge of a growing use of alloctonous, immaterial and symbolic resources of the actual globalized societal models. The Resource Criterion interprets the ecological dynamics contributing to complete the epistemology of the ecology, to open a bridge toward economy and other societal sciences, and to contribute to formulate a General Theory of Resources.     

Community nurse assessment of cardiovascular behavioural risk factors--a qualitative analysis within the CroHort study

The aim of our study was to identify major determinants of cardiovascular behavioural risk factors among subjects at increased risk of cardiovascular disease (CVD). The data for the qualitative analysis were obtained from the Croatian Adult Health Cohort Study (CroHort). The data analysis was based on the principles of Grounded Theory. We have generated the concept of an individual in a vicious circle of risky health behaviour, defined by the low level of motivation and unfavourable personal characteristics which in interaction with unsupportive social environment adversely influence one's health behaviour, leading to negative health outcomes that produce negative effects on one's motivation and social environment. Community nurses assessed that the respondents often weren't adequately recognising their CVD risk and were very reluctant about the change in their risky habits. Our results are supported by the quantitative analysis and are complementing other analyses of the cardiovascular risks within the CroHort study.     

Diminishing returns to aggregate level studies

The idea that the health of individuals depends on the characteristics of the society in which they live and on their own characteristics is important. The aggregate level relation between income inequality and population mortality has been examined by empirical works. However, if the individual level relation between risk of mortality and income is curvilinear, at least part of any association between population mortality and income inequality is artifactual in the sense that it could arise even if individual risk was due only to individual income and not to its distribution. Wolfson et al attempted to estimate how much of the variation in cross-sectional US state-level mortality could be due to the curvature of the relation between individual level mortality and income interacting with differences in the distribution of income within states. They concluded that the artifact is not the main reason for the frequently documented correlations between population mortality and income distribution. However, in the absence of any detailed information on the regressions, it is difficult to determine if the difference between actual and hypothetical mortality is significantly related to income equality. The individual risk of mortality is also affected by other individual characteristics, like climate or public health infrastructure. The authors suggest that investigations of the determinants of individual health test the effect of societal factors and that such testing requires both individual level and aggregate data.     

Network Approach for Analyzing and Promoting Equity in Participatory Ecohealth Research

Effective involvement and equity in participation between men and women and the various community groups are likely to influence the equity in the sharing of the development outcomes of any participatory research project. The CARUSO project, a participatory research based on the ecosystem approach to human health, showed that the inhabitants from Brasília Legal, a small village located on the river banks of the Tapajós river in the Brazilian Amazon, are exposed to mercury through fish consumption; a subsequent participatory intervention based on dietary changes was effective in reducing mercury exposure of the population. In the present study, we focus on equity in participation and analyze the discussion network about mercury and health to measure individual and group involvement in the community. Participation in the discussion network is associated with the awareness of the critical information necessary to allow the individual to change dietary habits toward the preferential consumption of the less contaminated fish species. Our network analysis shows that gender, age, religion, education, subsistence activities, and spatial distribution of the houses are key elements affecting the involvement of the population in discussions about mercury and health. Based on these results, we propose strategies for integrating the research results and the knowledge of the villagers in a new cycle of participatory research in order to address the lack of involvement of some groups and to promote equitable participation and benefit sharing.     

Recognition versus identity — the role of biometrics

The distinction between the recognition of an individual using an automated biometric system and the fundamental notion of their identity is subtle and therefore provokes much debate relating to privacy and other societal issues. This article seeks to clarify some of these issues relating to biometric recognition and identity by providing a framework, and by distinguishing between the technology and societal issues.     

Ethical models underpinning responses to threats to public health: a comparison of approaches to communicable disease control in Europe

Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring or intentionally instigated by bioterrorism. According to the World Health Organisation, global partnerships are necessary to gather the most up-to-date information and to mobilize resources to tackle GIDs when necessary. Communicable disease control also depends upon national public health laws and policies. The containment of an infectious disease typically involves detection, notification, quarantine and isolation of actual or suspected cases; the protection and monitoring of those not infected; and possibly even treatment. Some measures are clearly contentious and raise conflicts between individual and societal interests. In Europe national policies against infectious diseases are very heterogeneous. Some countries have a more communitarian approach to public health ethics, in which the interests of individual and society are more closely intertwined and interdependent, while others take a more liberal approach and give priority to individual freedoms in communicable disease control. This paper provides an overview of the different policies around communicable disease control that exist across a select number of countries across Europe. It then proposes ethical arguments to be considered in the making of public health laws, mostly concerning their effectiveness for public health protection.     

A multilevel analysis of the determinants of high-risk sexual behaviour in sub-Saharan Africa

A number of authors have identified multiple concurrent sexual partnerships by both men and women to lie at the root of the HIV/AIDS epidemic in sub-Saharan Africa. This study applies multilevel models to Demographic and Health Survey data collected during 2003-2008 in 20 sub-Saharan African countries to examine the influence of social and cultural context on involvement with multiple sexual partnerships in the region, above and beyond the effects of individual characteristics. The findings provide support for the ecological argument that health behaviours are shaped and determined by societal conditions, in addition to the effects of individual and household characteristics. Involvement with multiple sex partners is most prevalent in societies in which sexual norms are widely permissive and where polygyny is common. Individual autonomy is substantial and attitudes towards sexuality are more liberal among men and women who live in communities in which sexual norms are widely permissive. Men and women who are most likely to have multiple sex partners in the sub-Saharan region are those who initiated sexual activity earlier and those who have the individual attributes (e.g. young age, urban residence, education, media exposure and working for cash and away from home) that bring to them more rights and/or decision-making autonomy, but not necessarily more financial resources and economic security (mostly among women). On the other hand, involvement with multiple partners is determined by cultural norms (i.e. permissive sexual norms) and social change (i.e. mass education, expansion of cash employment). The findings suggest a number of opportunities for more effective policy and programmatic responses to curb the prevalence of multiple partnerships in sub-Saharan Africa.     

Collective Dynamics of Belief Evolution under Cognitive Coherence and Social Conformity

Human history has been marked by social instability and conflict, often driven by the irreconcilability of opposing sets of beliefs, ideologies, and religious dogmas. The dynamics of belief systems has been studied mainly from two distinct perspectives, namely how cognitive biases lead to individual belief rigidity and how social influence leads to social conformity. Here we propose a unifying framework that connects cognitive and social forces together in order to study the dynamics of societal belief evolution. Each individual is endowed with a network of interacting beliefs that evolves through interaction with other individuals in a social network. The adoption of beliefs is affected by both internal coherence and social conformity. Our framework may offer explanations for how social transitions can arise in otherwise homogeneous populations, how small numbers of zealots with highly coherent beliefs can overturn societal consensus, and how belief rigidity protects fringe groups and cults against invasion from mainstream beliefs, allowing them to persist and even thrive in larger societies. Our results suggest that strong consensus may be insufficient to guarantee social stability, that the cognitive coherence of belief-systems is vital in determining their ability to spread, and that coherent belief-systems may pose a serious problem for resolving social polarization, due to their ability to prevent consensus even under high levels of social exposure. We argue that the inclusion of cognitive factors into a social model could provide a more complete picture of collective human dynamics.     

Physical and Social Environment Are Associated to Leisure Time Physical Activity in Adults of a Brazilian City: A Cross-Sectional Study

The physical activity practice is highlighted as a strategy to health promotion and to avoid chronic diseases. In addition to individual factors, environmental characteristics in which people live, may offer opportunities or barriers in adopting healthy habits and this is related to the physical activity (PA) practice among individuals. The aim of this study is to investigate the associations between neighborhood environment and leisure-time physical activity in adults. This is a cross-sectional study, developed using the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL 2008/2010) of Belo Horizonte, Brazil. Individuals with the habit of practicing PA for at least 150 minutes of moderate-intensity PA or at least 75 minutes of vigorous-intensity PA throughout the week in leisure time were classified as active in leisure time. To characterize the built and social environment we used georeferenced data of public and private places for physical activity, population density, residential density, homicide rate and total income of the coverage area of the basic health units. The covered area of the basic health units was used as context unit. For data analysis, we used multilevel logistic regression. The study included 5779 adults, 58.77% female. There was variability of physical activity in leisure time between area covered by the basic health units (Median Odds ratio = 1.30). After adjusting for individual characteristics, the increase of density of private places for physical activity (Odds ratios—OR = 1.31; 95% confidence interval—95% CI: 1.15 to 1.48) and the smaller homicide rate (OR = 0.82; IC95%: 0.70 to 0.96) in the neighborhood increased physical activity in leisure time. The evidence of this study shows that neighborhood environment may influence the physical activity practice in leisure time and should be considered in future interventions and health promotion strategies.     

A pilot study of the relationship between bowel habits and sleep health by actigraphy measurement and fecal flora analysis

We have previously reported that there may be a relationship between bowel habits including functional constipation (FC) and irritable bowel syndrome and sleep health. However, our previous studies were based on only subjective parameters by self-reported questionnaire. The aim of this study is to investigate the relationship between bowel habits such as FC and sleep health using objective parameters. Sleep health was assessed by actigraphy measurement and bowel habits by fecal flora analysis. The FC and control subjects, whose bowel habits were defined at Rome II, were recruited from evaluated respondents in our previous study directed at middle-aged Japanese women, ten FC and ten control subjects participating in this study. Wake after sleep onset (WASO) and WASO (%) (WASO/total sleep time multiplied by 100) in FC subjects was significantly longer and greater than those in control subjects, respectively. Average activity during sleep in FC subjects was significantly higher than that in control subjects. FC had no effect on total sleep time. Bifidobacterium is broadly accepted to be useful intestinal bacteria for human health and one of the indices showing that the intestinal environment is in a desirable condition. Bifidobacterium counts per gram of wet feces and proportion in total bacterial cell counts in FC subjects were significantly lower than those in control subjects. In conclusion, these results suggest that corresponding to low Bifidobacterium counts and proportion, sleep in FC subjects may be worse than that in control subjects. There may be a relationship between bowel habits and sleep health. Bowel habits such as FC might be a risk factor for sleep disorders.     

The use of zootherapeutics in folk veterinary medicine in the district of Cubati, Paraíba State, Brazil

Background

Viewed through the micro focus of an interpretive lens, medical anthropology remains mystified because interpretivist explanations seriously downplay the given context in which individual health seeking-behaviours occur. This paper draws upon both the interpretivist and political economy perspectives to reflect on the ethno medical practices within the Korean-Australian community in Sydney.

Methods

We draw on research data collected between 1995 and 1997 for an earlier study of the use of biomedical and traditional medicine by Korean-Australians in Sydney. A total of 120 interviews were conducted with a range of participants, including biomedical doctors, traditional health professionals, Korean community leaders and Korean migrants representing a range of socio-economic backgrounds and migration patterns.

Results and Discussion

First, the paper highlights the extent to which the social location of migrants in a host society alters or restructures their initial cultural practices they bring with them. Second, taking hanbang medicine in the Korean-Australian community as an illustrative case, the paper explores the transformation of the dominant biomedicine in Australia as a result of the influx of ethnomedicine in the era of global capitalism and global movement.

Conclusion

In seeking to explain the popularity and supply of alternative health care, it is important to go beyond the culture of each kind of health care itself and to take into consideration the changes occurring at societal, national and global levels as well as consequential individual response to the changes. New social conditions influence the choice of health care methods, including herbal/alternative medicine, health foods and what are often called New Age therapies.     

城市人群血清营养水平指标与膳食习惯关系的分析

目的:分析血清营养状态指标与膳食习惯的关联关系与意义。方法:采用横断面调查的数据,用标准问卷询问1694人相关信息,内容包括人口学资料、自报疾病现患史、膳食习惯、健康自评、认知功能信息;同时采集被调查人群血样本;测定血红蛋白、白蛋白、叶酸和维生素B12水平。采用R 3.2.5和SPSS 20.0软件进行相关和显著性差异分析。结果:人体血红蛋白、白蛋白、叶酸和维生素B12水平与被调查个体进食水果和鸡蛋习惯有密切关联;天天进食水果、鸡蛋的个体上述指标水平明显高于不进食此类食物的个体,且血红蛋白、白蛋白水平随增龄下降程度减低;天天进食水果习惯的个体同时具有天天进食蛋、奶、菜习惯;有进食水果习惯的人群表现为受教育程度高;自评健康状态好和相对自报患病率低等特点。结论:合理膳食习惯可保持较高的血营养状态指标水平;且延缓相关指标水平随增龄下降的程度。天天进食水果习惯可被视为合理膳食的指标,为膳食评估提供简易、可行、有效的指标。     

Medical decision making and medical education: challenges and opportunities

The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include the physician's own decision skills, the ability to guide patients in shared decisions, and knowledge of health policy decisions at the societal level. Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.     

Moral distress or moral comfort

Moral distress in healthcare results from a professional's inability to provide compassionate care to patients because of individual, organizational, or societal barriers. Research suggests that moral distress is a growing concern among nurses, and may be a major reason why nurses leave one job for another or abandon the profession of nursing. Some professionals, however, have identified strategies that help them work through their moral distress toward an experience of moral comfort. These strategies may be individual, organizational, or societal. The focus of this paper is to identify examples of strategies professionals have used to alleviate distressful feelings and enhance moral comfort.     

Proposal of a data collection form to record dento-alveolar features--application to two Roman skeletal samples from Italy

Bones and teeth are an important source of information about the lifestyle, health status and dietary habits of past populations. Modifications and lesions of the periodontal tissues also provide information about the health status and behavior of an individual or of an ancient population. In this paper a method to record some dento-alveolar features of both deciduous and permanent teeth is described. The forms that we propose make it easy to record the data in a Microsoft Excel sheet. The form for adults has been applied to two Roman Imperial age skeletal samples from northern Italy - Casalecchio di Reno (II-V c. AD, Bologna) and Emilia Romagna, and central Italy - Quadrella (I-IV c. AD, Isernia, Molise).     

Population biobanks and returning individual research results: mission impossible or new directions?

Historically, large-scale longitudinal genomic research studies have not returned individual research results to their participants, as these studies are not intended to find clinically significant information for individuals, but to produce ‘generalisable’ knowledge for future research. However, this stance is now changing. Commentators now argue that there is an ethical imperative to return clinically significant results and individuals are now expressing a desire to have them. This shift reflects societal changes, such as the rise of social networking and an increased desire to participate in medical decision-making, as well as a greater awareness of genetic information and the increasing ability of clinicians to use this information in health care treatment. This paper will discuss the changes that have prompted genomic research studies to reconsider their position and presents examples of projects that are actively engaged in returning individual research results.