OBJECTIVE: To compile a global typography of commercial sex work. METHODS: A Medline search and review of 681 "prostitution" articles was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs, and their observations in more than 15 countries. Arbitrary categories were developed to compile a workable typology of sex work. RESULTS: At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of "direct" and "indirect" prostitution, with the latter group less likely to be perceived or to perceive themselves as sex workers. In general, policing sex work can change its typology and location but its prevalence is rarely affected. The public health implications of sex work vary widely. CONCLUSION: Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes. (+info)
The impact of partial smokefree legislation on health inequalities: evidence from a survey of 1150 pubs in North West England.
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BACKGROUND: The UK government claims that between 10 and 30% of pubs and bars will be exempt from proposed legislation to achieve smokefree enclosed public places across England. This arises from the contentious inclusion that pubs and bars that do not prepare and serve food and private members clubs, will be able to allow smoking. We aimed to survey pubs and bars across the North West of England to assess smoking policies and the proportion and variations by deprivation level of venues preparing and serving food. METHODS: We carried out a telephone survey of 1150 pubs and bars in 14 local authorities across the North West of England. The main data items were current smoking policy, food preparation and serving status, and intention to change food serving and smoking status in the event of implementation of the proposed English partial smokefree legislation. RESULTS: 29 pubs and bars (2.5%) were totally smoke-free, 500 (44%) had partial smoking restrictions, and 615 (54%) allowed smoking throughout. Venues situated in the most deprived quintiles (4 and 5) of deprivation were more likely to allow unrestricted smoking (62% vs 33% for venues in quintiles 1 and 2). The proportion of pubs and bars not preparing and serving food on the premises was 44% (95% CI 42 to 46%), and ranged from 21% in pubs and bars in deprivation quintile 1 to 63% in quintile 5. CONCLUSION: The proportion of pubs and bars which do not serve food was far higher than the 10-30% suggested by the UK government. The proportion of pubs allowing unrestricted smoking and of non-food venues was higher in more disadvantaged areas, suggesting that the proposed UK government policy of exempting pubs in England which do not serve food from smokefree legislation will exacerbate inequalities in smoking and health. (+info)
Environmental contamination by Toxocara sp. eggs in Ribeirao Preto, Sao Paulo State, Brazil.
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Toxocariasis is a zoonosis mainly caused by Toxocara canis, an intestinal nematode of dogs. Man acquires the infection through accidental ingestion of viable eggs, and the toxocariasis clinical manifestations may vary from an asymptomatic infection up to the Visceral Larva Migrans syndrome. Seventy eight public squares of Ribeirao Preto, Sao Paulo, Brazil, including Bonfim Paulista district were visited aiming to evaluate the soil contamination by Toxocara eggs. The squares were divided in five different areas corresponding to the Sanitary Districts of the city. From May to December 2003, soil samples weighting about 250 g each were collected from five distinct sites of each public square. The laboratory analysis was done by centrifugal-flotation techniques in magnesium sulphate solutions with 5% of potassium iodide (d = 1.33) and zinc sulphate (d = 1.20), and by the sedimentation- flotation in conic chalices with zinc sulphate (d = 1.20). Toxocara sp. eggs were found on 16 (20.5%) squares, with the lowest prevalence (12%) at the central area. From these results, it is expected that the legal authority will adopt protection measures for the city public areas, reducing thus the contamination risk by Toxocara sp. eggs. (+info)
A national programme for on-site defibrillation by lay people in selected high risk areas: initial results.
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OBJECTIVE: To report on the effectiveness of an initiative to reduce deaths from sudden cardiac arrest occurring in busy public places. SETTING: 110 such places identified from ambulance service data as high risk sites. PATIENTS: 172 members of the public who developed cardiac arrest at these sites between April 2000 and March 2004. 20,592 defibrillator months' use is reported, representing one automated external defibrillator (AED) use every 120 months. INTERVENTION: 681 AEDs were installed; staff present at the sites were trained in basic life support and to use AEDs. MAIN OUTCOME MEASURES: Initial rhythm detected by AED, restoration of spontaneous circulation, survival to hospital discharge. RESULTS: 172 cases of cardiac arrest were treated by trained lay staff working at the site before the arrival of the emergency services during the period. A shockable rhythm was detected in 135 (78%), shocks being administered in 134 an estimated 3-5 minutes after collapse; 38 (28.3%) patients subsequently survived to hospital discharge. Spontaneous circulation was restored in five additional patients who received shocks but died later in hospital. In 37 cases no shock was initially indicated; one patient survived after subsequent treatment by paramedics, cardiopulmonary resuscitation having been given soon after collapse. Overall, irrespective of the initial rhythm, 39 patients (22.7%), were discharged alive from hospital. For witnessed arrests of presumed cardiac cause in ventricular fibrillation (an international Utstein comparator) survival was 37 of 124 (29.8%). CONCLUSIONS: The use of AEDs by lay people at sites where cardiac arrest commonly occurs is an effective strategy to reduce deaths at these sites. (+info)
Introduction of monochloramine into a municipal water system: impact on colonization of buildings by Legionella spp.
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Legionnaires' disease (LD) outbreaks are often traced to colonized potable water systems. We collected water samples from potable water systems of 96 buildings in Pinellas County, Florida, between January and April 2002, during a time when chlorine was the primary residual disinfectant, and from the same buildings between June and September 2002, immediately after monochloramine was introduced into the municipal water system. Samples were cultured for legionellae and amoebae using standard methods. We determined predictors of Legionella colonization of individual buildings and of individual sampling sites. During the chlorine phase, 19 (19.8%) buildings were colonized with legionellae in at least one sampling site. During the monochloramine phase, six (6.2%) buildings were colonized. In the chlorine phase, predictors of Legionella colonization included water source (source B compared to all others, adjusted odds ratio [aOR], 6.7; 95% confidence interval [CI], 2.0 to 23) and the presence of a system with continuously circulating hot water (aOR, 9.8; 95% CI, 1.9 to 51). In the monochloramine phase, there were no predictors of individual building colonization, although we observed a trend toward greater effectiveness of monochloramine in hotels and single-family homes than in county government buildings. The presence of amoebae predicted Legionella colonization at individual sampling sites in both phases (OR ranged from 15 to 46, depending on the phase and sampling site). The routine introduction of monochloramine into a municipal drinking water system appears to have reduced colonization by Legionella spp. in buildings served by the system. Monochloramine may hold promise as community-wide intervention for the prevention of LD. (+info)
Legislation on smoking in enclosed public places in Scotland: how will we evaluate the impact?
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BACKGROUND: From 26 March 2006, smoking will be prohibited in wholly and substantially enclosed public places in Scotland, and it will be an offence to permit smoking or to smoke in no-smoking premises. We anticipate that implementation of the smoke-free legislation will result in significant health gains associated with reductions in exposure to both environmental tobacco smoke (ETS) and personal tobacco consumption as well as other social and economic impacts. METHODS: Health Scotland in conjunction with the Information Services Division (ISD) Scotland and the Scottish Executive have developed a comprehensive evaluation strategy to assess the expected short-term, intermediate and long-term outcomes. Using routine health, behavioural and economic data and commissioned research, we will assess the impact of the smoke-free legislation in eight key outcome areas--knowledge and attitudes, ETS exposure, compliance, culture, smoking prevalence and tobacco consumption, tobacco-related morbidity and mortality, economic impacts on the hospitality sector and health inequalities. CONCLUSION: The findings from this evaluation will make a significant contribution to the international understanding of the health effects of exposure to ETS and the broader social, cultural and economic impacts of smoke-free legislation. (+info)
Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction.
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AIMS: We used the hospital discharge records of Piedmont region (northern Italy) to evaluate whether a national law banning smoking in public resulted in a short-term reduction in hospital admissions for acute myocardial infarction (AMI). METHODS AND RESULTS: Rates of admission for AMI before the ban (October-December 2004) and during the ban (February-June 2005) were analysed. Each period was compared with the corresponding period 12 months before. Among persons aged under 60, the number of admissions for AMI decreased significantly after the introduction of the ban: from 922 cases in February-June 2004 to 832 cases in February-June 2005 (sex- and age-adjusted rate ratio, 0.89; 95% confidence interval, 0.81-0.98). No decrease was seen before the ban. No effect was found among persons aged at least 60. We estimated that the observed reduction in active smoking after the introduction of the ban could account for a 0.7% decrease in admissions for AMI during the study period, suggesting that most of the observed effect (11%) might be due to the reduction of passive smoking. CONCLUSION: Our study, based on a population of about 4 million inhabitants, suggests that smoke-free policies may result in a short-term reduction in admissions for AMI. (+info)
Public parks and physical activity among adolescent girls.
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OBJECTIVES: Physical activity may be constrained or facilitated by local environments. The availability of neighborhood facilities for physical activity may be particularly relevant for youth, who are unable to drive and whose activity is often limited to the immediate distance they are able to walk or bicycle. Several studies have shown that proximity to recreational facilities and parks is one of the most important predictors of physical activity. Because the United States already has an extensive infrastructure of parks, with 70% of adults indicating that they live within walking distance of a park or playground, parks may be a potential venue for increasing physical activity. This might be particularly important for adolescent girls, whose physical activity levels decline substantially as they go through puberty. The goal of this study was to examine the association between park proximity, park type, and park features and physical activity in adolescent girls. PATIENTS AND METHODS: This was a cross-sectional study using baseline data from the Trial of Activity for Adolescent Girls. It included 1556 grade 6 girls who were randomly selected from 6 middle schools in each of the following 6 field site areas: Washington, DC, and Baltimore, Maryland; Columbia, South Carolina; Minneapolis, Minnesota; New Orleans, Louisiana; Tucson, Arizona; and San Diego, California. Girls wore accelerometers for 6 days to measure metabolic equivalent-weighted moderate-to-vigorous physical activity, a measure accounting for the volume and intensity of activity. Metabolic equivalent-weighted moderate-to-vigorous physical activity was calculated for the hours outside of school time using 2 different cutpoints, activity levels > or = 3.0 metabolic equivalents and > or = 4.6 metabolic equivalents, the latter indicating activity at the intensity of a brisk walk or higher. We mapped all of the parks within 1 mile of each girl's home. Trained staff used a checklist to document the presence of facilities and amenities at each park, including passive amenities, such as drinking fountains, restrooms, and areas with shade, as well as active amenities like basketball courts, multipurpose fields, playgrounds, and tennis courts. RESULTS: Mean nonschool metabolic equivalent-weighted moderate/vigorous physical activity, using the 4.6 metabolic equivalent cutoff, was 611.1 minutes (range: 49.7-4718.6 metabolic equivalent minutes per 6 days) and 1704.8 metabolic equivalent minutes per 6 days (range: 276.2-5792.6 metabolic equivalent minutes per 6 days) when using the 3.0 metabolic equivalent cutpoint. Many girls had multiple parks within a 1-mile radius of their homes: 57% had > or = 1 type of park, the majority being neighborhood or community parks; 42% had between 1 and 3 parks, 37% had > or = 4 parks, and 14% had > or = 8 parks. The type, number, and specific parks features were associated with girls' nonschool metabolic equivalent-weighted moderate/vigorous physical activity. At the 4.6 metabolic equivalent cutpoint, higher levels of nonschool metabolic equivalent-weighted moderate/vigorous physical activity were associated with both neighborhood and community parks (22 metabolic equivalent minutes) and miniparks (40 metabolic equivalent minutes). Each park, regardless of type, in the half-mile around each girl's home was associated with an increase in nonschool metabolic equivalent-weighted moderate/vigorous physical activity by 2.8% or 17.2 nonschool minutes of metabolic equivalent-weighted moderate/vigorous physical activity per 6 days. Beyond a half-mile, each park increased nonschool metabolic equivalent-weighted moderate/vigorous physical activity by 1.1% or 6.7 metabolic equivalent minutes per 6 days. For the average girl with 3.5 parks within a 1-mile radius of home, the presence of parks accounted for 36.5 extra nonschool metabolic equivalent minutes per 6 days, approximately 6% of total nonschool metabolic equivalent-weighted moderate/vigorous physical activity. Using the 3.0 metabolic equivalent cutpoint, this sums to an additional 68 metabolic equivalent minutes of nonschool metabolic equivalent-weighted moderate/vigorous physical activity over 6 days, or 4% of the total. The most common amenities in the parks were playgrounds, multipurpose fields, and picnic areas. Slightly more than one third of girls lived within a half-mile of a park with a basketball court, and > 20% had access to walking paths and tennis courts in their local park. Higher levels of nonschool metabolic equivalent-weighted moderate/vigorous physical activity per 6 days were associated with walking paths (13 metabolic equivalent minutes), running tracks (82 metabolic equivalent minutes), playgrounds (28 metabolic equivalent minutes), and basketball courts (30 metabolic equivalent minutes). Parks with streetlights and floodlights were also associated with an increase of 18 and 22 minutes of nonschool metabolic equivalent-weighted moderate/vigorous physical activity, respectively. With the 3.0 metabolic equivalent cutoff for metabolic equivalent-weighted moderate/vigorous physical activity, additional nonschool metabolic equivalent minutes more than doubled when girls had miniparks (92 metabolic equivalent minutes), natural resource areas (36 metabolic equivalent minutes), walking paths (59 metabolic equivalent minutes), and running tracks (208 metabolic equivalent minutes) within a half-mile of their homes. Skateboard areas and special-use parks were negatively associated with nonschool metabolic equivalent-weighted moderate/vigorous physical activity in adolescent girls. CONCLUSIONS: Adolescent girls who live near more parks, particularly near those with amenities that are conducive to walking and with active features, engage in more nonschool metabolic equivalent-weighted moderate/vigorous physical activity than those with fewer parks. Whether this is because of actual use of the parks or neighborhood choice could not be determined. Although the magnitude of the association between parks and additional minutes of metabolic equivalent-weighted moderate/vigorous physical activity was small for an individual, amounting to an average of 4%-6% of a girl's total nonschool metabolic equivalent-weighted moderate/vigorous physical activity, it is likely to have a large population-level association. Because of the potential population level impact, the use of parks to promote physical activity should be further studied. (+info)