Toxin or medicine? Explanatory models of radon in Montana health mines

Environmental protection and public health agencies in the United States and elsewhere label radioactive radon gas a toxic environmental hazard and a major cause of lung cancer. Paradoxically, in Europe and Japan radon gas is also used as an analgesic and anti-inflammatory, as one choice in the spectrum of conventional medical care. Although it is possible to find radon therapy in the United States, it exists only as an unconventional practice in Montana "radon health mines." In this article, I examine the use of radon therapy by Americans despite intensive public health education media campaigns. Using the notion of explanatory models as an analytical framework, I argue that American health mine clients adjust or replace "toxic models" of radon with new kinds of explanatory models that allow radon to be redefined as a healing substance. The manner of this adjustment varies according to peoples' individual needs, their own preexisting cultural models and experiences, and their individual personalities; the source of authoritative knowledge accepted by each person is a strong influence. Through these altered explanatory models, mine clients are able to view their use of radon therapy as a rational course of action.     

Authoritative knowledge and single women's unintentional pregnancies,abortions, adoption,and single motherhood: social stigma and structural violence

This article explores the sources of authoritative knowledge that shaped single, white, middle-class women's unintentional pregnancies and child-bearing decisions throughout five reproductive eras. Women who terminated a pregnancy were most influenced by their own personal needs and circumstances. birth mothers' decisions were based on external sources of knowledge, such as their mothers, social workers, and social pressures. In contrast, single mothers based their decision on instincts and their religious or moral beliefs. Reproductive policies further constrained and significantly shaped women's experiences. The social stigma associated with these forms of stratified maternity suggests that categorizing pregnant women by their marital status, or births as out-of-wedlock, reproduces the structural violence implicit to normative models of female sexuality and maternity. This mixed-method study included focus groups to determine the kinds of knowledge women considered authoritative, a mailed survey to quantify these identified sources, and one-on-one interviews to explore outcomes in depth.     

Husband involvement in the treatment of child illness in Guatemala

The aim of this study is to test prevailing assumptions that Guatemalan men are authoritative or aloof husbands and, in turn, are either problematic or irrelevant to child health. Based on survey data collected in 1994-95 about 959 children, this research examines whether, how and why husbands were involved in recent episodes of young children's illness and sheds light on the potential effect of husband involvement on treatment. A relatively high percentage of women reported that they asked for advice or assistance from their husbands regarding child illness, and, contrary to popular notions, the multivariate analyses suggest that husbands' involvement was not driven by their household authority. Rather, key determinants of whether husbands gave advice or assistance included characteristics of the illness and child and the availability of sources of social support, while key determinants of what kind of support husbands gave (namely whether they gave/bought medicines, recommended a provider visit, or gave other advice or assistance) largely related to characteristics of the illness and child, as well as the availability of biomedical health care providers in the community and ethnicity.     

乳酸菌治疗乳糖不耐受症的研究进展

乳糖不耐受与人体健康尤其是婴儿期的营养密切相关,该病症主要影响人体对乳糖的消化吸收。乳酸菌作为有效的微生态制剂,已被广泛应用于医药卫生、营养保健、食品工业等领域。近年研究发现,含乳酸菌的微生态制剂在治疗乳糖不耐受症方面具有明显疗效。本文综述了乳糖不耐受症的发病机制及分型、乳酸菌治疗乳糖不耐受症的研究进展。     

"Part and Parcel of Being a Woman": Female Urinary Incontinence and Constructions of Control

This article draws on extensive interviews with middle-aged Australian women experiencing urinary incontinence. Our discussion derives from the difficulties women face in seeking advice on the management of incontinence, as a consequence of their perception that the condition is an inevitability, a "normal" part of being female. Women do not, on the whole, support a single cause for incontinence but, rather, explain its incidence in terms of personal history, which may include childbearing and parturition, menopause and aging, and early socialization. In addition, women link their own continence problems with perceived personal failings (e.g., lack of exercise, being overweight) and, hence, see the condition as a symbol of their lack of moral worth. Following this, women's understandings of the relationship of incontinence to their social membership extend far beyond the difficulties of disguising their physical problems.     

Climate change and local public health in the United States: preparedness, programs and perceptions of local public health department directors

While climate change is inherently a global problem, its public health impacts will be experienced most acutely at the local and regional level, with some jurisdictions likely to be more burdened than others. The public health infrastructure in the U.S. is organized largely as an interlocking set of public agencies at the federal, state and local level, with lead responsibility for each city or county often residing at the local level. To understand how directors of local public health departments view and are responding to climate change as a public health issue, we conducted a telephone survey with 133 randomly selected local health department directors, representing a 61% response rate. A majority of respondents perceived climate change to be a problem in their jurisdiction, a problem they viewed as likely to become more common or severe over the next 20 years. Only a small minority of respondents, however, had yet made climate change adaptation or prevention a top priority for their health department. This discrepancy between problem recognition and programmatic responses may be due, in part, to several factors: most respondents felt personnel in their health department--and other key stakeholders in their community--had a lack of knowledge about climate change; relatively few respondents felt their own health department, their state health department, or the Centers for Disease Control and Prevention had the necessary expertise to help them create an effective mitigation or adaptation plan for their jurisdiction; and most respondents felt that their health department needed additional funding, staff and staff training to respond effectively to climate change. These data make clear that climate change adaptation and prevention are not currently major activities at most health departments, and that most, if not all, local health departments will require assistance in making this transition. We conclude by making the case that, through their words and actions, local health departments and their staff can and should play a role in alerting members of their community about the prospect of public health impacts from climate change in their jurisdiction.     

Knowledge of Cervical Cancer Screening among Women across Different Socio-Economic Regions of China

Background and Objective

China has a high burden of cervical cancer (CC) and wide disparities in CC burden exist among different socio-economic regions. In order to reduce these disparities, China’s government launched the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 2009. Understanding the factors associated with underutilization of CC screening among target populations is important to improve the screening participation rate, and a high participation rate is key to achieving the goals of a screening program. However, data on the knowledge of CC among target populations in program areas is lacking in China. This study will investigate the knowledge of CC prevention and control among women in specific project counties to develop a better understanding of factors that might influence CC screening participation in order to improve the implementation of the NCCSPRA.

Materials and Methods

A cross-sectional survey was conducted and face-to-face interview questionnaires were completed by 308 women who received CC screening services in 6 project counties of NCCSPRA across different socio-economic regions of China. ANOVA and Chi-square tests were used to compare the knowledge rates and scores across the different subgroups. Logistic regression was conducted to examine factors associated with knowledge level.

Results

The overall CC knowledge rate of the target population was only 19.5%. Regional socio-economic level, advice from doctors, age, and educational status were strong predictors of knowledge level of CC screening. Significantly lower knowledge rates and scores were identified in older women (55–64 years old), less educated women (with primary school or illiterate), women in less developed regions and women who did not receive any advice about screening results from doctors.

Conclusion

The knowledge of CC screening among women in the project counties of NCCSPRA was found to be very poor. Given the importance of knowledge in encouraging women to participate in screening is key to reducing CC burden in rural women in China, it is urgent that a targeted health promotion intervention is developed and implemented in project counties, especially targeting older women, women with less education and women in less developed regions, and focus on improving their CC knowledge and encouraging them to communicate with health care providers. The health promotion intervention targeting health care providers is also important to improve their knowledge of CC and provide best advice to women.     

Medicinal Plant Knowledge Among Lay People in Five Eastern Tibet Villages

Tibetans in five villages in the Mount Khawa Karpo area of the Menri (Meili Xueshan in Chinese) range, Northwest Yunnan, People’s Republic of China, were interviewed about their knowledge of a number of medicinal plants and their uses. There was large variation in people’s knowledge with significant differences among the villages and between men and women. Most of the reported knowledge focused on a small number of commercial plants and their uses. In comparison with Tibetan doctors, villagers generally knew fewer applications and focused on general health remedies. Many people collected medicinal plants for their own use as well as for sale, but also obtained medicinal plant remedies from markets and Tibetan doctors, and often used traditional Tibetan healthcare in conjunction with biomedical treatment.     

Identification of bacteria with beta-galactosidase activity in faeces from lactase non-persistent subjects

Previous studies suggest that, besides the maldigestion of lactose in the small intestine, the colonic processing of lactose might play a role in lactose intolerance. beta-Galactosidase is the bacterial enzyme which catalyzes the first step of lactose fermentation in the colon. We propose a practical method to differentiate and identify bacteria with beta-galactosidase activity in faeces which combines a colony-lift filter assay with X-gal (5-bromo-4-chloro-3-indolyl-beta-d-galactopyranoside) as substrate for differentiation and the fluorescent in situ hybridization technique for identification. The method was applied to faeces from lactase non-persistent subjects. After 28 subjects had undergone one glucose and two lactose challenges, consistent intolerant (n=5) and tolerant (n=7) groups were defined according to their symptom scores. Of the 28 faecal samples, 80.6% (mean, SD: 12.1, range: 47.8-100%) of the total cultured bacteria were found to possess beta-galactosidase activity, which indicates that the bacterial beta-galactosidase is abundant in the colon. The tolerant and intolerant groups did not differ in the percentage or composition of the bacteria with beta-galactosidase activity or beta-galactosidase activity in faeces. Results suggest that the percentage or composition of the bacteria with beta-galactosidase activity in faeces do not play a role in lactose intolerance.     

Qualitative study of decisions about infant feeding among women in east end of London

ObjectiveTo improve understanding of how first time mothers who belong to a socioeconomic group with particularly low rates of breast feeding decide whether or not to initiate breast feeding.DesignQualitative semistructured interviews early in pregnancy and 6-10 weeks after birth.SettingWomen’s homes in east end of London.Subjects21 white, low income women expecting their first baby were interviewed mostly at home, often with their partner or a relative. Two focus groups were conducted.ResultsWomen who had regularly seen a relative or friend successfully breast feed and described this experience positively were more confident about and committed to breast feeding. They were also more likely to succeed. Exposure to breast feeding, however, could be either a positive or a negative influence on the decision to breast feed, depending on the context. Women who had seen breast feeding only by a stranger often described this as a negative influence, particularly if other people were present. All women knew that breast feeding has health benefits. Ownership of this knowledge, however, varied according to the woman’s experience of seeing breast feeding.ConclusionsThe decision to initiate breast feeding is influenced more by embodied knowledge gained from seeing breast feeding than by theoretical knowledge about its benefits. Breast feeding involves performing a practical skill, often with others present. The knowledge, confidence, and commitment necessary to breast feed may be more effectively gained through antenatal apprenticeship to a breastfeeding mother than from advice given in consultations or from books.

Key messages

• Women who have seen successful breast feeding as part of their daily lives and perceive this as a positive experience are more likely to initiate breast feeding
• Embodied knowledge gained through seeing breast feeding may be more influential than theoretical knowledge about the health benefits for women of lower social class
• Listening to pregnant women talking about breast feeding could help clinicians assess the relative importance of theoretical and embodied knowledge for each woman
• Women hoping to breast feed but with little exposure to breast feeding may benefit from an antenatal apprenticeship with a breastfeeding mother
• Ideally apprenticeship would be with a breastfeeding mother from her social network to minimise the potential barriers of embarrassment and lack of confidence with strangers

     

Mastery of Mothering Skills and Satisfaction with Associated Health Services: An Ethnocultural Comparison

In this paper, I examine the mastery of mothering skills and satisfaction with associated health services in women who had recently given birth in Montreal (n = 33). I compare experience between women of two distinct ethnocultural groups: Anglophone Euro-Canadian and Anglophone Afro-Caribbean. The overall aim is to discern differentials in the mastery of mothering skills and associated satisfaction with maternal and child health services. The study is framed by neo-Weberian social theory suggesting that modernization and bureaucratization increasingly eviscerate everyday skills and knowledge. These processes also lead to changes regarding what is considered credible ‘authoritative knowledge.’ I found that older Anglophone Euro-Canadians expressed the greatest skill deficits. They attempted to redress these deficits through consultation of professionally authored books, medical Web sites and health professionals. Older Anglophone Euro-Canadians saw these resources as sources of ‘authoritative knowledge.’ They also expressed dissatisfaction with related health services. In contrast, Anglophone Afro-Caribbeans and younger lower-income Anglophone Euro-Canadians expressed satisfaction with their skills. This derived from widespread previous experience with children and more extensive and readily available kith and kin networks. These were considered sources of ‘authoritative knowledge’ in this group. This group expressed less dissatisfaction with health services, as they did not need, or expect, these services to redress skill deficits.

Inequalities in Advice Provided by Public Health Workers to Women during Antenatal Sessions in Rural India

Objectives

Studies have widely documented the socioeconomic inequalities in maternal and child health related outcomes in developing countries including India. However, there is limited research on the inequalities in advice provided by public health workers on maternal and child health during antenatal visits. This paper investigates the inequalities in advice provided by public health workers to women during antenatal visits in rural India.

Methods and Findings

The District Level Household Survey (2007–08) was used to compute rich-poor ratios and concentration indices. Binary logistic regressions were used to investigate inequalities in advice provided by public health workers. The dependent variables comprised the advice provided on seven essential components of maternal and child health care. A significant proportion of pregnant women who attended at least four ANC sessions were not advised on these components during their antenatal sessions. Only 51%–72% of the pregnant women were advised on at least one of the components. Moreover, socioeconomic inequalities in providing advice were significant and the provision of advice concentrated disproportionately among the rich. Inequalities were highest in the case of advice on family planning methods. Advice on breastfeeding was least unequal. Public health workers working in lower level health facilities were significantly less likely than their counterparts in the higher level health facilities to provide specific advice.

Conclusion

A significant proportion of women were not advised on recommended components of maternal and child health in rural India. Moreover, there were enormous socioeconomic inequalities. The findings of this study raise questions about the capacity of the public health care system in providing equitable services in India. The Government of India must focus on training and capacity building of the public health workers in communication skills so that they can deliver appropriate and recommended advice to all clients, irrespective of their socioeconomic status.     

乳糖吸收不良、乳糖不耐受与人体健康关系探讨

由于乳糖在人体生长发育和新陈代谢中发挥着重要作用,LM或LI不仅可诱发小儿佝偻病、成人骨质疏松,而且还可造成人体腹泻、影响婴幼儿脑组织和神经系统的构建,对婴幼儿的体格发育和智力发育造成损害。本研究对乳糖不耐受的病因及发病因素、分型、流行病学、临床及实验室诊断方法等做一概述,为临床实践和科学研究提供参考。     

Contraceptives,counselling, and pregnancy in women with sickle cell disease.

Sickle cell disease is listed in the manufacturers'' data sheets in the United Kingdom as a contraindication to the use of most combined contraceptive pills; the result is confused advice on family planning to a group of women who are at substantial risk from both planned and unplanned pregnancy. A study in north London on the use of contraceptives by women with sickle cell disease indicates that the use of combined oral contraceptives is common. Although medical staff usually advised against pregnancy, such advice was almost always ignored. Over half of the women surveyed had some knowledge about antenatal diagnosis. Family planning advice should be an integral part of the care of women with sickle cell disease. In the absence of specific data to the contrary all methods of contraception may be considered, although with appropriate caution.     

Exposure of surgical/orthopedic operating room personnel to monomer vapors during the use of bone cements--review of the literature and report of experiences]

PMMA bone cements are used for the fixation of artificial joint replacements. During their application in the operating theater, a small amount of the monomer evaporates. Operating room staff and surgeons are often not adequately informed about the negative properties and the effects on health of these vapours. Basic information about monomers and their toxicity, and safety regulations have been compiled. On the basis of present knowledge, the authors do not regard the repeated use of bone cement throughout the course of a day to represent a hazard to health.     

Risks of AIDS among workers in the "sex industry": some initial results from a Scottish study.

OBJECTIVE--To determine the extent to which workers in the "sex industry" in Edinburgh engage in activities with a high risk of infection with HIV. DESIGN--Cross sectional, single phase survey in which respondents were located by a non-random method ("snowballing"). SETTING--Research project coordinated by the Alcohol Research Group, Edinburgh. SUBJECTS--205 Sex workers (102 male, 103 female) interviewed between July and December 1988. END POINT--Strategies to reduce risk of AIDS among people who buy and sell sexual services. MEASUREMENTS AND MAIN RESULTS--Data were elicited by a standardised interview which related to over 300 variables. A fifth of the study group had used drugs intravenously, and one in 12 reported that they had been found to be seropositive on HIV testing. Roughly a quarter of the study group sometimes engaged in unprotected sex with clients for more money, and a similar proportion sometimes did not seek medical advice even if they had genital or anal symptoms. CONCLUSIONS--People who buy and sell sexual services should be priority targets for health education and strategies to reduce their risk of AIDS.     

Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects

Aims: Colonic metabolism of lactose may play a role in lactose intolerance. We investigated whether a 2‐week supplementation of Bifidobacterium longum (in capsules) and a yogurt enriched with Bifidobacterium animalis could modify the composition and metabolic activities of the colonic microbiota in 11 Chinese lactose‐intolerant subjects. Methods and Results: The numbers of total cells, total bacteria and the Eubacterium rectale/Clostridium coccoides group in faeces as measured with fluorescent in situ hybridization and the faecal β‐galactosidase activity increased significantly during supplementation. The number of Bifidobacterium showed a tendency to increase during and after supplementation. With PCR‐denaturing gradient gel electrophoresis, in subjects in which B. animalis and B. longum were not detected before supplementation, both strains were present in faeces during supplementation, but disappeared after supplementation. The degree of lactose digestion in the small intestine and the oro‐caecal transit time were not different before and after supplementation, whereas symptom scores after lactose challenge decreased after supplementation. Conclusions: The results suggest that supplementation modifies the amount and metabolic activities of the colonic microbiota and alleviates symptoms in lactose‐intolerant subjects. The changes in the colonic microbiota might be among the factors modified by the supplementation which lead to the alleviation of lactose intolerance. Significance and Impact of the Study: This study provides evidence for the possibility of managing lactose intolerance with dietary lactose (yogurt) and probiotics via modulating the colonic microbiota.