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While the slow death of retail is unraveling in cities nationwide, some local shopping areas still serve an important community value. Main street retail areas are venues for commercial activity and anchor the neighborhood’s economic environment (Mehta & Bosson, 2010). The types of businesses that are found in these spaces indicate sociodemographic aspects of their nearby neighborhoods. Main streets can be homes to a variety of businesses. From a health perspective, businesses that are considered to be “health-harming” are often concentrated in underprivileged neighborhoods and are associated with higher rates of chronic disease (Cummins et al., 2007). Planning tools and policies permit such retail businesses to exist in these spaces, potentially causing adverse health impacts to the residents. Pinpointing the specific mechanisms that create health-promoting or health-harming conditions in these retail corridors s is crucial to understanding retail’s impact on communities’ health. Developing a scale for scoring business types helps us understand community-specific health outcomes for the neighborhoods near retail corridors; it could also reveal the disparate quality of life impacts that exist in different commercial corridors. With this in mind, the research that follows will examine health disparities within the broader scope of planning and policy practices. To this end, this project aims to explore the extent to which the concentration of healthy and unhealthy establishments along Los Angeles’s Main streets and retail corridors relate to the sociodemographic characteristics of their adjacent neighborhoods. Questions that frame this research are: Do high ranking businesses appear around places where people tend to be healthier because of socio-economic status? Do high ranking businesses relate to better health for the adjacent population? Methods used in this research include the mapping of Main street retail areas, deploying an index that scores the extent to which the businesses encourage health-promoting behavior, and the analysis of Main street community health outcomes. From the scoring of Main streets across the city, four sites are chosen (based on their median household income and the overall score of their retail environments) to provide a more detailed scope of the built and social environment of these streets. As seen in the research that follows, businesses in areas with higher ranking scores are tied to healthier outcomes. Deliverables of this project include the use of an instrument that measures retail’s association with health outcomes and built environment characteristics in the hopes that it can be used for future planning. This research can be used to inform policies surrounding more inclusive built environments and public spaces.

Background Defining socio-demographic factors, clinical presentations and underlying diseases associated with COVID-19 severity could be helpful in its management. This study aimed to further clarify the determinants and clinical risk factors of the disease severity in patients infected with COVID-19. Methods A multi-centre descriptive study on all patients who have been diagnosed with COVID-19 in the province of Tehran from March 2020 up to Dec 2020 was conducted. Data on socio-demographic characteristics, clinical presentations, comorbidities, and the health outcomes of 205,654 patients were examined. Characteristics of the study population were described. To assess the association of study variables with the disease severity, the Chi-Squared test and Multiple Logistic Regression model were applied. Results The mean age of the study population was 52.8 years and 93,612 (45.5%) were women. About half of the patients have presented with low levels of blood oxygen saturation. The ICU admission rate was 17.8% and the overall mortality rate was 10.0%. Older age, male sex, comorbidities including hypertension, cancer, chronic respiratory diseases other than asthma, chronic liver diseases, chronic kidney diseases, chronic neurological disorders, and HIV/AIDS infection were risk markers of poor health outcome. Clinical presentations related with worse prognosis included fever, difficulty breathing, impaired consciousness, and cutaneous manifestations. Conclusion These results might alert physicians to pay attention to determinants and risk factors associated with poor prognosis in patients with COVID-19. In addition, our findings aid decision makers to emphasise on vulnerable groups in the public health strategies that aim at preventing the spread of the disease and its mortalities.

We study the impact of the pharmacy dispensing channel (as a proxy for access to drugs) on the drug purchases, health outcomes, and health care utilization (emergency room visits or hospitalizations) of chronically ill patients in Liguria, Italy, in 2017. We use the coarsened exact matching algorithm to compare the health outcomes for a treated group of patients living in a local health authority (LHA) where drug distribution through community pharmacies was restricted. These patients were matched to a control group of patients living in other LHAs, where drugs were also dispensed through a broad network of community pharmacies. We exploit a unique administrative dataset with information on the socio-demographic characteristics and health care services utilization of Ligurian patients with chronic cardiovascular and respiratory ailments. We restrict our analysis to patients 65 years of age or older who were admitted to hospitals from 2013 to 2016 with either a principal or secondary diagnosis connected to chronic cardiovascular and respiratory diseases. Reduced access to drugs leads to lowered drug consumption, a higher probability of adverse health outcomes including mortality, and a higher consumption of medical services in terms of hospitalizations and emergency room visits. These effects increase with patients’ age. The pharmacy dispensing channel significantly affects drug consumption and acts as a proxy for adherence among chronically ill patients. Thus, health outcomes and health care utilization should be carefully evaluated when comparing the costs of alternative dispensing channels.

The objective of this study was to investigate cross-sectional and longitudinal associations between declines in sexual activity and function and health outcomes in a large population-based sample of older adults. Data were from 2577 men and 3195 women aged ≥ 50 years participating in the English Longitudinal Study of Ageing. Past-year changes in sexual desire, frequency of sexual activity, and ability to have an erection (men)/become sexually aroused (women) were assessed at baseline by self-completion questionnaire. Health outcomes (self-rated health, limiting long-standing illness, doctor-diagnosed diseases of the vascular system, and cancer) were self-reported at baseline (2012/2013) and 4-year follow-up (2016/2017). Data were analyzed using logistic regression, adjusted for sociodemographics, health behaviors, and depressive symptoms. Prospectively, men who reported a decline in sexual desire had higher odds of incident limiting long-standing illness (OR 1.41, 95% CI 1.04–1.91) and incident cancer (OR 1.63, 95% CI 1.06–2.50) than those who maintained their sexual desire. Men who reported a decline in the frequency of sexual activities had higher odds of deterioration in self-rated health (OR 1.47, 95% CI 1.04–2.08) and incident limiting long-standing illness (OR 1.69, 95% CI 1.20–2.37). In women, a decline in frequency of sexual activities was associated with deterioration of self-rated health (OR 1.64, 95% CI 1.07–2.51). Erectile dysfunction was longitudinally associated with poorer health outcomes including incident cancer (OR 1.73, 95% CI 1.11–2.70), coronary heart disease (OR 2.29, 95% CI 1.29–4.07), and fair/poor self-rated health (OR 1.66, 95% CI 1.19–2.32). Practitioners should be mindful that a decline in sexual activity, desire, or function in older age may be an important indicator of future adverse health outcomes. Electronic supplementary material The online version of this article (10.1007/s10508-019-1443-4) contains supplementary material, which is available to authorized users.

Objective: Metabolic diseases have been a clinical challenge worldwide and a major public health issue. Very few studies from China investigated the impact of metabolic multimorbidity on healthcare and health outcomes at the national level. This study aims to examine the association of metabolic multimorbidity with health service utilization, spending, functional and mental health.Materials and Methods: This is a nationally representative cross-sectional study, utilizing the data from the China Health and Retirement Longitudinal Study in 2015, including 11,377 participants aged 45 years and older. Multivariable regression models were used to assess the association of metabolic multimorbidity with healthcare, out-of-pocket expenditure (OOPE), the activities of daily living (ADL) limitation, the instrumental activities of daily living (IADL) limitation, and depression.Results: Overall, 30.50% of total participants had metabolic multimorbidity in 2015 in China. Compared with single disease, metabolic multimorbidity were associated with the number of outpatient visits [incident rate ratio (IRR) = 1.30, 95% CI = 1.05, 1.62] and days of inpatient care (IRR = 1.52, 95% CI = 1.28, 1.81). Metabolic multimorbidity was positively associated with the OOPE on outpatient care (coefficient = 82.99, 95% CI = 17.70, 148.27) and physical functional difficulties, including ADL limitation (odds ratio = 1.36, 95% CI = 1.18, 1.57).Conclusions: Metabolic multimorbidity is associated with higher levels of health-care service use, greater expenditure for outpatient care, and more difficulties in ADL among Chinese adults. China's health-care systems need to shift from single-disease models to new financing and service delivery models to effectively manage metabolic multimorbidity.

Background: Mental health literacy (MHL) promises to be an important factor for public health by enabling people to take responsibility for their own mental health. To date, there is no measurement tool that allows the assessment of a comprehensive understanding of MHL as part of health literacy (HL). Nonetheless, the widely used Health Literacy Survey European Questionnaire 47 (HLS-EU-Q47) includes items assessing at least some MHL-aspects in the context of HL. The present study aimed at investigating how these MHL-aspects are related to HL, health behavior and health outcome and how they differ between sociodemographic groups. Methods: Data from the Health Literacy Survey Zurich 2018, collected by an adapted version of the HLS-EU-Q47, served to investigate these relationships. Results: MHL-aspects were related to HL, health behavior and health outcome. Nearly half of all respondents (45%; N = 904) showed low MHL levels, particularly those with higher age and higher financial deprivation. Conclusions: Relations of MHL-aspects with HL, health behavior, and health outcome indicate their potential importance for future interventions in public health, addressing mental health and MHL. A specific MHL tool is needed to comprehensively investigate these relations, which could be developed by extending the present measurement approach., Frontiers in Public Health, 9, ISSN:2296-2565

The fast-moving coronavirus disease 2019 (COVID-19) called for a rapid response to slowing down the viral spread and reduce the fatality associated to the pandemic. Policymakers have implemented a wide range of non-pharmaceutical interventions to mitigate the spread of the pandemic and reduce burdens on healthcare systems. An efficient response of healthcare systems is crucial to handle a health crisis. Understanding how non-pharmaceutical interventions have contributed to slowing down contagions and how healthcare systems have impacted on fatality associated with health crisis is of utmost importance to learn from the COVID-19 pandemic. We investigated these dynamics in Italy at the regional level. We found that the simultaneous introduction of a variety of measures to increase social distance is associated with an important decrease in the number of new infected patients detected daily. Contagion reduces by 1% with the introduction of lockdowns in an increasing number of regions. We also found that a robust healthcare system is crucial for containing fatality associated with COVID-19. Also, proper diagnosis strategies are determinant to mitigate the severity of the health outcomes. The preparedness is the only way to successfully adopt efficient measures in response of unexpected emerging pandemics.

The term organizational health literacy (OHL) is a new concept that emerged to address the challenge of predominantly in patients with limited health literacy (HL). There is no consensus on how OHL can improve HL activities and health outcomes in healthcare organizations. In this study, a systematic review of the literature was conducted to understand the evidence for the effectiveness of OHL and its health outcome, and the facilitators and barriers that influence the implementation of OHL. A literature search was done using six databases, the gray literature method and reference hand searches. Thirteen potentially articles with data on 1254 health organizations were included. Eight self-assessment tools and ten OHL attributes have been identified. Eleven quality-improvement characteristics and 15 key barriers were reviewed. Evidence on the effectiveness of HL tools provides best practices and recommendations to enhance OHL capacities. Results indicated that shifting to a comprehensive OHL would likely be a complex process because HL is not usually integrated into the healthcare organization’s vision and strategic planning. Further development of OHL requires radical, simultaneous, and multiple changes. Thus, there is a need for the healthcare system to consider HL as an organizational priority, that is, be responsive.

Background: The Swedish Child Healthcare (CHC) system aims to provide equal and fair health care for all children and families in Sweden. Currently in Sweden, the CHC offers every family two home visits during the child's 1st year of life. During 2019, an extended home visit programme, called Grow Safely, was started in the region of Scania for first-time parents. The aim of the extended home visit programme was to provide support for first-time parents in order to improve the overall health of the child and family and contribute to better conditions for equal health. Instead of two home visits during the 1st year, a subsample of first-time parents would receive six visits during the child's first 15 months. These six visits would be conducted by CHC nurses and social workers, midwives, and dental assistants. In the present paper, we describe a research project related to the regional extended home visit programme; the project aims to illuminate the experiences of the participants and to investigate the perceived benefits of the programme in relation to improved health, social and emotional interaction between parent and child, and attitudes toward authorities and surrounding society.Method/Analysis: In order to evaluate the introduction of the intervention, three qualitative interview studies and one quantitative study with follow-up questionnaires will be conducted. Since the research project also comprises studies focusing on the implementation and expectations of politicians, civil servants, organizational managers, and professionals working within the programme, interviews within these fields will be conducted.Discussion: Sweden has a well-established CHC programme, but improvements are always possible. Previous research has shown that home visits are an effective tool to improve both the child's physical and mental health as well as the parents' well-being. However, this kind of intervention involves a significant investment from all organizations involved in the home visits; hence, it is important that the intervention is evaluated. The research project described in the present paper intends to examine the impact of the intervention, and its findings will aid decisionmakers in determining the future of the home visit programme.

Literature abounds that labor quality, in the form of human capital, clearly contributes significantly to productivity growth, but very few analysts have been interested to locate potential human capital growth outside education. Such interest will help ascertain the effectiveness of public health expenditure on health and the impact of good health to economic growth in Nigeria. This research empirically attempts to analyze health outcome and economic growth; proxied by life expectancy at birth and gross domestic product per-capita respectively using quantitative analysis. To avoid the possibility of encountering simultaneity error, we use the three stage -least -square (3SLS) regression to estimate the result. The result shows simultaneity between health outcome and economic growth. The results equally show that health expenditure is significant in determining health outcome but has no significant relationship with economic growth. As a recommendation government must increase budgetary allocation to the health sector and effectively monitor its utilization.

Background Our aim was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies and physical health outcomes associated with human immunodeficiency virus (HIV) but not acquired immunodeficiency syndrome. Methods We performed an umbrella review of observational studies. Evidence was graded as convincing, highly suggestive, suggestive, weak, or nonsignificant. Results From 3413 studies returned, 20 were included, covering 55 health outcomes. Median number of participants was 18 743 (range 403–225 000 000). Overall, 45 (81.8%) of the 55 unique outcomes reported nominally significant summary results (P < .05). Only 5 outcomes (9.0%; higher likelihood of presence of breathlessness, higher chronic obstructive pulmonary disease [COPD] prevalence, maternal sepsis, higher risk of anemia, and higher risk of all fractures among people living with HIV [PLWHIV]) showed suggestive evidence, with P values < 10–3; only 3 (5.5%; higher prevalence of cough in cross-sectional studies, higher incidence of pregnancy-related mortality, and higher incidence of ischemic heart disease among PLWHIV in cohort studies) outcomes showed stronger evidence using a stringent P value (, This umbrella review captures the complexities and variety of physical outcomes associated with human immunodeficiency virus. It reports on 55 unique outcomes: 3 (higher prevalence of cough and higher incidences of pregnancy-related mortality and ischemic heart disease) had strong evidence.

The IPD-Work (individual-participant data meta-analysis of working populations) Consortium has published several papers on job strain (the combination of low job control and high job demands) based on Karasek's demand-control model (1) and health-related outcomes including cardiovascular disease (CVD), cancer, obesity, diabetes as well as health-related behaviors, utilizing meta-analyses of a pooled database of study participants from 17 European cohorts. An IPD approach has some advantages over typical meta-analyses, eg, having access to all the data for each individual allows for additional analyses, compared to typical meta-analyses. However, such an approach, like other meta-analyses, is not free from errors and biases (2-6) when it is not conducted appropriately. In our review of the IPD-Work Consortium's (hereafter called the Consortium) publications of the last two years, we have identified and pointed out several conceptual and methodological errors, as well as unsubstantiated conclusions and inappropriate recommendations for worksite public health policies (6-15). However, the Consortium has not yet appropriately addressed many of the issues we have raised. Also several major errors and biases underlying the Consortium IPD meta-analysis publications have not been presented in a comprehensive way, nor have they been discussed widely among work stress researchers. We are concerned that the same errors and biases could be repeated in future IPD Consortium meta-analysis publications as well as by other researchers who are interested in meta-analyses on work stressors and health outcomes. It is possible that the inappropriate interpretations in the Consortium publications, which remained uncorrected to date, may have a negative impact on the international efforts of the work stress research community to improve the health of working populations. Recently, Dr. Töres Theorell, a principal investigator of the Consortium, responded in this journal (16) to some of our criticisms on the Consortium papers (17, 18). The purpose of this article is to discuss the methodological and substantive issues that remain to be resolved and how they could be addressed in future analyses. We provide recommendations for future IPD or typical meta-analyses on work stressors and health outcomes. Finally, we discuss the inappropriate conclusions and recommendations in the Consortium publications and provide alternative recommendations, including a comprehensive perspective on worksite intervention studies.

Climate-related health indicators are potentially useful for tracking and predicting the adverse public health effects of climate change, identifying vulnerable populations, and monitoring interventions. However, there is a need to understand stakeholders’ perspectives on the identification, development, and utility of such indicators. A qualitative approach was used, comprising semi-structured interviews with key informants and service providers from government and non-government stakeholder organizations in South Australia. Stakeholders saw a need for indicators that could enable the monitoring of health impacts and time trends, vulnerability to climate change, and those which could also be used as communication tools. Four key criteria for utility were identified, namely robust and credible indicators, specificity, data availability, and being able to be spatially represented. The variability of risk factors in different regions, lack of resources, and data and methodological issues were identified as the main barriers to indicator development. This study demonstrates a high level of stakeholder awareness of the health impacts of climate change, and the need for indicators that can inform policy makers regarding interventions.

Ethiopia’s remarkable socio-economic transformation over the last decade has been marked by: a reorientation of expenditure from recurrent to capital; a significant devolution of resources from Federal Government to Regions; and a clear prioritization of infrastructure spending, while protecting spending on education at four percent of GDP. The Government of Ethiopia has also leveraged external resources to boost spending in pro-poor sectors, particularly health and social protection. As a result, Ethiopia is home to the largest social safety net program in Africa, and has also achieved remarkable health outcomes using cost effective approaches. Recent investments have seen a significant build-up of capital stock, with capital spending at sector level pointing towards increased service capacity. The current public investment-led strategy requires to be complemented by increased budgetary provisions in operations and maintenance so that new investments translate into enhanced service coverage and delivery. As Ethiopia lays the foundation to become a middle income country, and the changing global environment implies declining external assistance, it is imperative that domestic taxation activity support this transition. The current tax-to-GDP ratio is low compared to peer countries, and the tax structure would benefit from increased contributions by direct tax sources. Therefore, there is an immediate need for advancing tax reforms and improve capacity and quality of tax administration. Broadening the tax bases, through review of exemptions, as well as review of tax rates might be venues to consider. Additional revenues will create the much-needed fiscal space to increase funding for operations and maintenance for service delivery, and support fiscal sustainability. As a follow-up to this Public Expenditure Review, the Government of Ethiopia has asked the World Bank to provide further analytical support, with a view to enhance domestic revenue mobilization through simpler and more efficient taxation, while retaining equity priorities in public finances.

Introduction Work-related stress is one of the major concerns for occupational safety and health. Indeed, workplace stress may affect workers’ well-being and lead to health issues, and it has been estimated that about half of all work absence is due to work-related stress disorders. The objective of this study is to investigate associations between work-related stress risk factors and a set of health outcomes, in a sample of public sector employees. Material and methods Employees (N = 779) filled in a self-report questionnaire on work-related stress, musculoskeletal pain and stressrelated disorders. Logistic regressions were conducted, with pain and disorders as outcome variables and the Health and Safety Executive Management Standards Indicator Tool (HSE-MS IT) scales as predictors. Results Excessive workload was associated with neck pain, shoulder pain and anxiety-depression symptoms. Employees exposed to risk on the role dimension reported higher neck pain and more gastrointestinal disorders. Hostile working relationships were associated with shoulder pain and gastrointestinal disorders, and lack of managers’ support turned out to be a risk factor for insomnia. Conclusions Workplace stress plays a role in the incidence of specific health outcomes. Through the use of validated work-related stress assessment instruments, such as the HSE-MS IT, management can identify the critical intervention targets in work design domains for improving workers’ health and well-being.

Background Against the achievement of nearly universal coverage for social health insurance for the elderly in China, a problem of inequity among different insurance schemes on health outcomes is still a big challenge for the health care system. Whether various health insurance schemes have divergent effects on health outcome is still a puzzle. Empirical evidence will be investigated in this study. Methods This study employs a nationally representative survey database, the National Survey of the Aged Population in Urban/Rural China, to compare the changes of health outcomes among the elderly before and after the reform. A one-way ANOVA is utilized to detect disparities in health care expenditures and health status among different health insurance schemes. Multiple Linear Regression is applied later to examine the further effects of different insurance plans on health outcomes while controlling for other social determinants. Results The one-way ANOVA result illustrates that although the gaps in insurance reimbursements between the Urban Employee Basic Medical Insurance (UEBMI) and the other schemes, the New Rural Cooperative Medical Scheme (NCMS) and Urban Residents Basic Medical Insurance (URBMI) decreased, out-of-pocket spending accounts for a larger proportion of total health care expenditures, and the disparities among different insurances enlarged. Results of the Multiple Linear Regression suggest that UEBMI participants have better self-reported health status, physical functions and psychological wellbeing than URBMI and NCMS participants, and those uninsured. URBMI participants report better self-reported health than NCMS ones and uninsured people, while having worse psychological wellbeing compared with their NCMS counterparts. Conclusions This research contributes to a transformation in health insurance studies from an emphasis on the opportunity-oriented health equity measured by coverage and healthcare accessibility to concern with outcome-based equity composed of health expenditure and health status. The results indicate that fragmented health insurance schemes generate inequitable health care utilization and health outcomes for the elderly. This study re-emphasizes the importance of reforming health insurance systems based on their health outcome rather than entitlement, which will particularly benefit the most vulnerable older groups.

Haiti has a vision to become an emerging economy by 2030. Haiti has comparative advantages, including its proximity and access to major markets; a young labor force and a dynamic diaspora; and substantial geographic, historical, and cultural assets. Areas of economic opportunity for Haiti include agribusiness, light manufacturing, and tourism. Recognizing these opportunities, the Government of Haiti issued in May 2012 a strategic development Plan (PSDH), aiming at building a new modern, diversified, resilient, competitive, and inclusive economy, respectful of its environment and in which people’s basic needs is met. This report examines more particularly how to: (i) mobilize greater fiscal revenue; (ii) enhance the growth dividend of public investment; (iii) improve the efficiency of spending in critical sectors such as health, education, and social protection; and (iv) protect the budget from a return of fuel price subsidies. This report builds on newly available data, including the 2012 household survey, the 2012 demographic and health survey (DHS), and the 2011-12 school census, to provide a better understanding of the equity and sustainability issues in the delivery of some basic services such as health and education, and engage policy makers and other actors on gaps and priorities.

Background The Ghanaian health sector has undertaken several policies to help improve the quality of care received by patients. This includes the construction of several health facilities, the increase in the training of health workers, especially nurses, and the introduction of incentive packages (such as salary increase) to motivate health workers. The important question is to what extent does the institutional arrangement between the health facilities and the government as well as between health workers and public health facility administration affect the quality of care? The objective of this study is to find the effect of institutional factors on the quality of care. The institutional factors examined were mainly the extent of decentralization between government and health facilities, as well as between health workers and facility administration, the hiring procedure, and job satisfaction. Methods The study used primary data on former patients from sixty six health facilities in three administrative regions of Ghana: the Northern, the Ashanti and the Greater Accra regions. The quality indicator used was effectiveness of treatment as determined by the patient. Ordered logit regression was run for the indicator with patient and health facility characteristics as well as institutional factors as independent variables. The sample size was 2248. Results The results showed that the patient’s level of formal education had a strong influence on the effectiveness of treatment. In addition, effectiveness of treatment differed according to the administrative region in which the facility was located, and according to the extent of decentralization between health facility and government. The quality of instruments used for treatment, the working conditions for health workers, and job satisfaction had no effect on the effectiveness of treatment. Conclusion Decentralization, the flow of information from government to health facilities and from health facility administrators to health workers are important in ensuring effectiveness. The study recommends further decentralization between health facilities as well as between health workers and administrators. In addition, the study recommends the involvement of health facilities in malaria programs to ensure the flow of information needed for effectiveness of treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0802-7) contains supplementary material, which is available to authorized users.

Madagascar’s education system exhibits severe weaknesses that leave a large number of children without the basic skills required to function in the labor market. Since the start of the political and economic crisis in 2009, progress made on key health indicators has stagnated or is being reversed with Madagascar falling off track to achieve the MDGs. The prevalence of chronic malnutrition among children under five is one of the highest in the world. Maternal mortality ratios also have remained relatively high and stagnant over the last ten years and the country.

Background The role of obesity in the prevalence and clustering of multimorbidity, the occurrence of two or more chronic conditions, is understudied. We estimated the prevalence of multimorbidity by obesity status, and the interaction of obesity with other predictors of multimorbidity. Methods Data from adult respondents (18 years and over) to the Health Quality Council of Alberta 2012 Patient Experience Survey were analyzed. Multivariable regression models were fitted to test for associations. Results The survey sample included 4803 respondents; 55.8% were female and the mean age was 47.8 years (SD, 17.1). The majority (62.0%) of respondents reported having at least one chronic condition. The prevalence of multimorbidity, including obesity, was 36.0% (95% CI, 34.8 – 37.3). The prevalence of obesity alone was 28.1% (95% CI 26.6 – 29.5). Having obesity was associated with more than double the odds of multimorbidity (odds ratio = 2.2, 95% CI 1.9 – 2.7) compared to non-obese. Conclusions The prevalence of multimorbidity in the general population is high, but even higher in obese than non-obese persons. These findings may be relevant for surveillance, prevention and management strategies for multimorbidity.

BackgroundMany countries have developed, or are developing, national strategies aimed at reducing the harms associated with hepatitis C infection. Making these strategies relevant to the vast majority of those affected by hepatitis C requires a more complete understanding of the short and longer term impacts of infection. We used a systematic approach to scope the literature to determine what is currently known about the health and psychosocial impacts of hepatitis C along the trajectory from exposure to ongoing chronic infection, and to identify what knowledge gaps remain.MethodsPubMed, Current Contents and PsychINFO databases were searched for primary studies published in the ten years from 2000–2009 inclusive. Two searches were conducted for studies on hepatitis C in adult persons focusing on: outcomes over time (primarily cohort and other prospective designs); and the personal and psychosocial impacts of chronic infection. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness and methodological coherence. Outcomes reported in 264 included studies were summarized, tabulated and synthesized.ResultsInjecting drug use (IDU) was a major risk for transmission with seroconversion occurring relatively early in injecting careers. Persistent hepatitis C viraemia, increasing age and excessive alcohol consumption independently predicted disease progression. While interferon based therapies reduced quality of life during treatment, improvements on baseline quality of life was achieved post treatment – particularly when sustained viral response was achieved. Much of the negative social impact of chronic infection was due to the association of infection with IDU and inflated assessments of transmission risks. Perceived discrimination was commonly reported in health care settings, potentially impeding health care access. Perceptions of stigma and experiences of discrimination also had direct negative impacts on wellbeing and social functioning.ConclusionsHepatitis C and its management continue to have profound and ongoing impacts on health and social well being. Biomedical studies provided prospective information on clinical aspects of infection, while the broader social and psychological studies presented comprehensive information on seminal experiences (such as diagnosis and disclosure). Increasing the focus on combined methodological approaches could enhance understanding about the health and social impacts of hepatitis C along the life course.

This paper examines the effectiveness of Taiwanese environmental health policies, whose aim is to improve environmental quality by reducing tire waste via the Tire Resource Recovery Program. The results confirm that implemented environmental health policies improve the overall health of the population (i.e. a decrease in death caused by bronchitis and other respiratory diseases). Current policy expenditures are far below the optimal level, as it is estimated that a ten percent increase in the subsidy would decrease the number of deaths caused by bronchitis and other respiratory diseases by 0.58% per county/city per year on average.

We appreciate Dr. Morfeld’s [1] interest in our recent review of the epidemiologic evidence for associations of formaldehyde with the lymphohematopoietic malignancies [2]. He notes the omission of a letter exchange [3] concerning evidence for hematotoxicity and chromosome damage among Chinese workers exposed to formaldehyde [4]. Although this exchange raised some provocative questions, it does not alter our conclusion that the proposed leukemogenesis mechanisms for formaldehyde remain unsubstantiated. As Morfeld mentions, we did neglect to cite the meta-analysis by Schwilk et al. [5], although we have critically reviewed all of the primary literature that formed the basis of this meta-analysis. We maintain that, owing to the heterogeneity of the literature in terms of health outcome definition and exposure assessment, metaanalyses of formaldehyde and risks for leukemia and lymphoma are not readily interpretable. This was a main motivation for our systematic, critical review of the evidence presented in the published epidemiologic literature. Conflict of interest The authors declare that they have no conflicts of interest.