BACKGROUND & AIMS: OBJECTIVE:To investigate the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from the Medicaid program. DATA SOURCE:Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995. STUDY DESIGN:The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer-sponsored insurance, and fixed year and county effects. PRINCIPAL FINDINGS:Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer-sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer-sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county-level fixed effects and time effects. CONCLUSIONS:Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer-based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Since 2003, Iraq has struggled to build a single national health system administered by the Iraqi Ministry of Health, but politics, lack of leadership, and a cultural bias against treating soldiers in civilian hospitals have hindered access to care for members of Iraq's armed forces who are wounded in combat. METHODS:U.S. surgeons are providing trauma care for Iraqi soldiers in American field hospitals, with more than 80% of hospital bed days occupied by Iraqis. At the same time, Iraqi hospitals have been treating the many civilian casualties of violence, and the Ministry of Health has greatly improved its emergency response and management capabilities over the past year. RESULTS:Ministry of Health hospitals have adequate surgical capabilities and bed capacity to care for both civilian and security forces casualties. Faltering attempts to develop a national health policy that provides comprehensive care for Iraqi Security Forces will jeopardize Iraq's ability to assume responsibilities for the country's national defense, and could delay the withdrawal of Coalition military forces from Iraq. CONCLUSIONS:It is imperative that leadership of the new government of Iraq and the international surgical community strongly endorse the implementation of a single health care system for all Iraqis.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The aim of the present investigation was to characterize the effects of supraphysiological doses of the anabolic androgenic steroid nandrolone decanoate (ND) on the fertility of female rats, as well as on the morphology of their uterus. STUDY DESIGN:Female Wistar rats (n=15) received a subcutaneous injection of ND (15 mg/kg) once daily during a 2-week period, while the control animals (n=10) were administered vehicle alone (arachidis oleum) in the same manner. Estrus behavior was evaluated 4 weeks after termination of this treatment and in cases where signs of receptivity were present, the female rat was given the opportunity to copulate with a male. After breeding, the female animals were sacrificed and their uteri examined histomorphologically. RESULTS:All ND-treated animals exhibited abnormal vaginal smears, whereas all of the control smears were normal. Most (73%) of the treated females demonstrated normal estrus behavior (i.e., willingness) on the day of mating, but none got pregnant; whereas all of the control rats became pregnant. The female rats receiving the ND showed an enhanced rate of weight gain and the myometrium thickness of their uteri was significantly increased, while the endometrium was significantly thinner. Furthermore, ND caused a significant proportion of the treated animals to display tortuous and irregularly branching endometrial glands, as well as a lack of the physiologically normal infiltration of eosinophilic leukocytes into the endometrium (endometrial eosinophilic homing), a finding that has not been reported previously. CONCLUSION:The present findings indicate that high doses of ND cause morphological and physiological alterations in the uterus of female rats that are associated with a suppression of their reproductive capacity.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Surveys of the population are commonly used to obtain information on health status. Increasingly, researchers are linking self-reported health status information to primary care consultation data. However, it is not known how participating in a health-related survey affects consultation behaviour. The objective of this study was to assess whether completion of a health-related questionnaire changes primary care consultation behaviour. METHODS:Participants were 3402 adults aged 50 and over from the general population in North Staffordshire, UK, who completed a health-related postal survey received in April 2003. The survey was predominantly about occurrence and severity of knee pain in the last year. Primary care attendance for the three months following response was compared to three control periods: i) the three months prior to the survey, ii) the same time period in the previous year and iii) the same time period in the following year. Comparisons were made on consultations for any problem, consultations for musculoskeletal disorders and consultations for knee problems. RESULTS:The percentage of subjects consulting for any condition was marginally higher for the three months directly after receipt of the questionnaire but the difference was only statistically significant in comparison to the three months before the survey (64% v. 62%, p = 0.05). There was little difference in consultation prevalence for musculoskeletal problems immediately after the survey compared to the three control periods. There was an increase of 37% in knee disorder consultations for the three months after the survey compared to the three months directly before the survey (p = 0.02). However, consultation prevalence for knee problems was identical for the three months after the survey to the same time periods in the years prior to and following the survey (both p = 0.94). CONCLUSION:The results from this study suggests that questionnaires related to physical health do not affect the standard consulting behaviour of patients, even for the symptom under investigation. This should reassure researchers who wish to link self-reported health status and medical care utilisation and clinicians whose patients are involved in such research.

背景与目标：

BACKGROUND & AIMS: :The loss and fragmentation of natural habitats by human activities are pervasive phenomena in terrestrial ecosystems across the Earth and the main driving forces behind current biodiversity loss. Animal-mediated pollination is a key process for the sexual reproduction of most extant flowering plants, and the one most consistently studied in the context of habitat fragmentation. By means of a meta-analysis we quantitatively reviewed the results from independent fragmentation studies throughout the last two decades, with the aim of testing whether pollination and reproduction of plant species may be differentially susceptible to habitat fragmentation depending on certain reproductive traits that typify the relationship with and the degree of dependence on their pollinators. We found an overall large and negative effect of fragmentation on pollination and on plant reproduction. The compatibility system of plants, which reflects the degree of dependence on pollinator mutualism, was the only reproductive trait that explained the differences among the species' effect sizes. Furthermore, a highly significant correlation between the effect sizes of fragmentation on pollination and reproductive success suggests that the most proximate cause of reproductive impairment in fragmented habitats may be pollination limitation. We discuss the conservation implications of these findings and give some suggestions for future research into this area.

背景与目标： : 人类活动造成的自然栖息地的丧失和破碎是地球上陆地生态系统中普遍存在的现象，也是当前生物多样性丧失的主要驱动力。动物介导的授粉是大多数现存开花植物有性繁殖的关键过程，也是在栖息地破碎化的背景下研究最一致的过程。通过荟萃分析，我们定量回顾了过去二十年来独立破碎化研究的结果，目的是测试植物物种的授粉和繁殖是否可能对栖息地破碎化有不同的敏感性，这取决于某些生殖特征，这些特征代表了与传粉者的关系和对传粉者的依赖程度。我们发现碎片化对授粉和植物繁殖的总体影响很大。植物的相容性系统反映了对传粉媒介互惠关系的依赖程度，是解释物种效应大小差异的唯一繁殖性状。此外，碎片化对授粉的影响大小与生殖成功之间的高度显着相关性表明，碎片化生境中生殖障碍的最直接原因可能是授粉限制。我们讨论了这些发现的保护意义，并为该领域的未来研究提供了一些建议。

BACKGROUND & AIMS: :The causes of racial and ethnic inequalities in health and the most appropriate categories to use to address health inequality have been the subject of heated debate in recent years. At the same time, genetic explanations for racial disparities have figured prominently in the scientific and popular press since the announcement of the sequencing of the human genome. To understand how such explanations assumed prominence, this essay analyzes the circulation of ideas about race and genetics and the rhetorical strategies used by authors of key texts to shape the debate. The authority of genetic accounts for racial and ethnic difference in disease, the author argues, is rooted in a broad cultural faith in the promise of genetics to solve problems of human disease and the inner truth of human beings that is intertwined with historical meanings attached to race. Such accounts are problematic for a variety of reasons. Importantly, they produce, reify, and naturalize notions of racial difference, provide a scientific rationale for racially targeted medical care, and distract attention from research that probes the complex ways in which political, economic, social, and biological factors, especially those of inequality and racism, cause health disparities.

背景与目标： : 健康方面种族和族裔不平等的原因以及用于解决健康不平等的最适当类别是近年来激烈辩论的主题。同时，自从宣布人类基因组测序以来，对种族差异的遗传解释在科学和大众媒体中占有重要地位。为了理解这种解释是如何突出的，本文分析了关于种族和遗传学的思想的流传，以及关键文本作者用来塑造辩论的修辞策略。作者认为，遗传的权威解释了疾病的种族和种族差异，其根源在于广泛的文化信仰，即遗传学有望解决人类疾病和人类内在真理的问题，而内在真理与历史意义交织在一起。种族。由于各种原因，此类帐户存在问题。重要的是，它们产生，重塑和自然化了种族差异的概念，为种族针对性的医疗提供了科学依据，并分散了研究的注意力，这些研究探讨了政治，经济，社会和生物因素 (尤其是不平等) 的复杂方式和种族主义造成健康差异。

BACKGROUND & AIMS: :The Management Academy for Public Health is a team-based training program jointly offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. This 9-month program teaches public health managers how to better manage people, information, and finances. Participants learn how to work in teams with community partners, and how to think and behave as social entrepreneurs. To practice and blend their new skills, teams develop a business plan that addresses a local public health issue. This article describes the program and explains the findings of the process evaluation, which has examined how best to structure and deploy a team-based method to create more effective, more entrepreneurial public health managers. Findings indicate that recruitment and retention are strong, program elements are relevant to learners' needs, and learners are satisfied with and value the program. Several specific benefits of the program model are identified, as well as several elements that support business plan success and skills' application on the job. On the basis of these findings, four success factors critical for developing similar programs are identified.

背景与目标： : 公共卫生管理学院是由公共卫生学院和北卡罗来纳大学教堂山分校的Kenan-Flagler商学院联合提供的基于团队的培训计划。这个为期9个月的计划教公共卫生经理如何更好地管理人员，信息和财务。参与者将学习如何与社区合作伙伴一起团队合作，以及如何作为社会企业家进行思考和行为。为了实践和融合他们的新技能，团队制定了解决当地公共卫生问题的商业计划。本文介绍了该计划并解释了过程评估的结果，该评估研究了如何最好地构建和部署基于团队的方法，以创建更有效，更具企业家精神的公共卫生经理。研究结果表明，招聘和保留能力很强，课程要素与学习者的需求相关，并且学习者对课程感到满意并重视。确定了计划模型的几个特定好处，以及支持业务计划成功和技能在工作中的应用的几个要素。根据这些发现，确定了开发类似计划的四个成功因素。

BACKGROUND & AIMS: BACKGROUND:Telephone surveys have been used widely in public health research internationally and are being increasingly used in Ireland and the U.K. METHODS:This study compared three telephone surveys conducted on the island of Ireland from 2000 to 2004, examining study methodology, outcome measures and the per unit cost of each completed survey. We critically examined these population-based surveys which all explored health related attitudes and behaviours. RESULTS:Over the period from 2000 to 2005 the percentage of calls which succeeded in contacting an eligible member of the public fell, from 52.9% to 31.8%. There was a drop in response rates to the surveys (once contact was established) from 58.6% to 17.7%. Costs per completed interview rose from 4.48 euro to 15.65 euro. Respondents were prepared to spend 10-15 minutes being surveyed, but longer surveys yielded poorer completion rates. Respondents were willing to discuss issues of a sensitive nature. Interviews after 9 pm were less successful, with complaints about the lateness of the call. Randomisation from electronic residential telephone directory databases excluded all ex-directory numbers and thus was not as representative of the general population as number generation by the hundred-bank method. However the directory database was more efficient in excluding business and fax numbers. CONCLUSION:Researchers should take cognisance of under-representativeness of land-line telephone surveys, of the increasing difficulties in contacting the public and of mounting personnel costs. We conclude that telephone surveying now requires additional strategies such as a multimode approach, or incentivisation, to be a useful, cost-effective means of acquiring data on public health matters in Ireland and the U.K.

背景与目标：

BACKGROUND & AIMS: The European Conference, Health, Society and Alcohol held in Paris, 12-14 December 1995, was a meeting point between science and policy. Science informed the policy process. As a tool for policy implementation, the Conference adopted the European Charter on Alcohol, a set of ethical principles and strategies for action. Of a number of important issues that frame policy, three deserve mention. First, market forces, as opposed to health and social policy decisions are increasingly influencing the policy debate. Second, existing policy options to reduce alcohol-related harm are unlikely to lead to an increased risk of coronary heart disease among older age groups. And third, policy developments and changes in drinking patterns in countries of southern Europe are an important driving force in European policy on alcohol.

背景与目标： 1995年12月14日12日在巴黎举行的欧洲会议，健康，社会和酒精是科学与政策之间的交汇点。科学为政策进程提供了信息。作为执行政策的工具，会议通过了《欧洲酒精宪章》，这是一套道德原则和行动战略。在构成政策框架的许多重要问题中，值得一提的是三个。首先，与健康和社会政策决策相反的市场力量正在日益影响政策辩论。其次，减少与酒精有关的危害的现有政策选择不太可能导致老年群体患冠心病的风险增加。第三，南欧国家的政策发展和饮酒方式的变化是欧洲酒精政策的重要推动力。

BACKGROUND & AIMS: :Parents play an important role in the sexual health of their adolescent children. Based on previous research, formative research, and theories of behavioral change, we developed Talking Parents, Healthy Teens, an intervention designed to help parents improve communication with their adolescent children, promote healthy adolescent sexual development, and reduce adolescent sexual risk behaviors. We conduct the parenting program at worksites to facilitate recruitment and retention of participants. The program consists of 8 weekly 1-hour sessions during the lunch hour. In this article, we review the literature that identifies parental influences on adolescent sexual behavior, summarize our formative research, present the theoretical framework we used to develop Talking Parents, Healthy Teens, describe the program's components and intervention strategies, and offer recommendations based on our experiences developing the program. By targeting parents at their worksites, this program represents an innovative approach to promoting adolescent sexual health. This article is intended to be helpful to health educators and clinicians designing programs for parents, employers implementing health-related programs, and researchers who may consider designing and evaluating such worksite-based programs.

背景与目标： : 父母在青春期孩子的性健康中起着重要作用。基于先前的研究，形成性研究和行为改变理论，我们开发了会说话的父母，健康的青少年，这种干预措施旨在帮助父母改善与青春期孩子的沟通，促进健康的青春期性发展，并减少青春期的性风险行为。我们在工作场所开展育儿计划，以促进招募和留住参与者。该计划包括午餐时间每周8个1小时的课程。在本文中，我们回顾了确定父母对青少年性行为的影响的文献，总结了我们的形成性研究，提出了我们用来培养会说话的父母，健康的青少年的理论框架，描述了该计划的组成部分和干预策略，并根据我们的经验提供了建议开发该计划。通过针对工作场所的父母，该计划代表了一种促进青少年性健康的创新方法。本文旨在帮助健康教育者和临床医生为父母，实施健康相关计划的雇主以及可能考虑设计和评估此类基于工作现场的计划的研究人员设计计划。

BACKGROUND & AIMS: BACKGROUND:In a recently published article, it was suggested that governance was the significant structural factor affecting the epidemiology of HIV. This suggestion was made notwithstanding the observed weak correlation between governance and HIV prevalence (r = .2). Unfortunately, the paper raised but left unexamined the potentially more important questions about the relationship between the broader health of populations and structural factors such as the national economy and physical infrastructure. METHODS:Utilizing substantially the same data sources as the original article, the relationship between population health (healthy life expectancy) and three structural factors (access to improved water, GDP per capita, and governance) were examined in each of 176 countries. RESULTS:Governance was found to be significantly correlated with population health, as were GDP per capita, and access to improved water. They were also found to be significantly correlated with each other. CONCLUSION:The findings are discussed with reference to the growing interest in structural factors as an explanation for population health outcomes, and the relatively weak relationship between governance and HIV prevalence.

背景与目标：

BACKGROUND & AIMS: :Before the 2017 election of the Director-General of WHO, and given the importance of human rights to global health governance through WHO, Health and Human Rights asked the three final candidates for their views on human rights, WHO's human rights mandate, and the role of human rights in WHO programming. These questions were developed by the author in collaboration with Audrey Chapman, Lisa Forman, Paul Hunt, Dainius Pūras, Javier Vasquez and Carmel Williams. Based on responses to these questions from each of the three candidates, this Perspective was originally published online on April 26, 2017. On May 23, 2017, Dr Tedros Adhanom Ghebreyesus was elected Director-General and will begin his five-year term on July 1, 2017.

背景与目标： : 在2017选举世卫组织总干事之前，鉴于人权对通过世卫组织进行全球卫生治理的重要性，卫生与人权要求三位最终候选人就人权，世卫组织的人权任务以及人权在世卫组织方案编制中的作用发表意见。这些问题是作者与奥黛丽·查普曼，丽莎·福尔曼，保罗·亨特，戴尼乌斯·普拉斯，哈维尔·巴斯克斯和卡梅尔·威廉姆斯合作提出的。根据三位候选人对这些问题的回答，该观点最初是在2017年4月26日在线发布的。2017年5月23日，Tedros Adhanom Ghebreyesus博士当选为总干事，并将在2017年7月1日开始他的五年任期。

BACKGROUND & AIMS: INTRODUCTION:The aim of this article is to report, from their own perspective, the attitudes and believes towards vaccination, with special emphasis on the influence of sources of information to make the decision to get vaccinated, of health care workers (HCWs), considered as a specific risk group for immunization strategy against A (H1N1) influenza. METHODS:Cross-sectional observational study focused on active health workers in the province of Alicante. Made by face to face questionnaires to a stratified random sample based on occupational categories in hospitals and health care centres. RESULTS:The sources of information differ between subgroups; physicians used journals and/or conferences, nurses obtained information through the Ministry of Health and other nurses, and the remaining workers opted for television and/or the family physician. Of the three studied groups, physicians felt minor concern about the influenza A (H1N1) pandemic (59.4%), had the most confidence in the vaccine (42.3%), were the ones who recommended the vaccine the most (44.4%), who best followed the recommendations to avoid infection (93%), and were the most vaccinated (18.3%). Around three-quarters (75.5%) of the HCWs assessed the provided information as fair, poor or very poor. All HCWs admitted that a social alarm was created. DISCUSSION:The success of future immunization campaigns against influenza in HCWs could increase if information activities were designed to focus on each subgroup of HCWs, by adapting the strategy and improving the quality of information.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:This study assessed social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed. METHODS:A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed. RESULTS:Adolescent FSWs had a mean age of 18.2 years and reported numerous non-paying sexual partners with very low rate of consistent condom use (22.2%). Half (50.3%) the respondents had sex while feeling drunk at least once in the past week, of whom 56.4% did not use condom protection. STI prevalence was high overall (30.4%) among this group. Younger age, early sexual debut, being isolated from schools and family, short duration in sex work, and use of illicit drugs were found to be strong predictors for unprotected sex and presence of an STI. Conversely, having access to condom promotion, free HIV counselling and testing, and peer education were associated with less unprotected sex. The majority reported a need for health knowledge, free condoms and low-cost STI diagnosis and treatment. CONCLUSIONS:There is an urgent need to improve coverage, accessibility and efficiency of existing interventions targeting adolescent FSWs.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To describe the prevalence of oral diseases and their impact on oral-health-related quality of life in people with severe mental illness undertaking community-based psychiatric care. METHODS:A survey was conducted at eight outpatient psychiatric care clinics in Tower Hamlets, London, UK. One hundred and twelve consecutive patients with mental illness were invited to participate in this study. They were clinically examined and asked to complete the oral health impact profile (OHIP) questionnaire. RESULTS:The response rate was 79% (n = 89); 57 (64%) males and 58 persons over 45 years of age (65%) participated in this survey. Overall OHIP score was 25.4 (95% CI 23.3, 27.4), 70 (78%) were smokers and 45 (51%) had been to the dentist in the last two years. Forty-seven (53%) respondents had caries in at least one tooth, 60 (67%) had 21 teeth and more, and 14 (16%) used dentures. Advanced periodontal treatment was indicated in 42 (55%) of patients and 52.8% (n = 47) patients reported current pain. CONCLUSION:Overall, this survey found that oral health has a great impact on patients with severe mental illness being treated in the community setting and their oral health is poorer than the national adult general population. Future research should consider the causes that relate to the poorer oral health in this population and potential health promotion mechanisms in this population to encourage an upstream approach to health.

背景与目标：