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Dragano N, Jasilionis D. Long echo of sociopolitical upheaval: life events and health in East Germany. J Epidemiol Community Health 2024; 78:343-344. [PMID: 38589222 DOI: 10.1136/jech-2024-221974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Nico Dragano
- Institute for Medical Sociology, University Hospital and Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
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Luo Y, Xu M, Liang R. Economic insecurity exposure and cognitive function in late life. J Epidemiol Community Health 2023; 77:777-781. [PMID: 37657920 DOI: 10.1136/jech-2023-220481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES This study took the State-owned Enterprises (SOE) reform from 1996 to 2002 in China as a natural experiment to explore the consequences of economic insecurity exposure during early-adulthood and mid-adulthood on cognitive function in later life. METHODS Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS), 2014 and 2015. CHARLS is a nationally representative survey covering 28 provinces in China. A total of 4536 urban dwellers born earlier than 1971 (aged 25 years old and above at the start of the SOE reform in 1996) were included in our analyses. Using province-year-level economic loss from the layoffs, we examined the impact of economic insecurity exposure on the cognitive function score by using a difference-in-differences model with 1996-2002 as the cut-off. RESULTS Individuals exposed to economic insecurity have significantly decreased cognitive function, in which a 1% point increase in expected economic loss would decrease the cognitive function score by 0.09 (95% CI: -0.17 to -0.01). Given that the average intensity of expected economic loss was 11.59% and the mean score of cognitive function was 21.26, exposure to the SOE reforms led to an average decrease in the cognitive function score by at least 4.91%. CONCLUSIONS Providing cognitive health surveillance and psychological counselling may be important for preventing cognitive decline among those experiencing economic insecurity.
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Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Ming Xu
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Richard Liang
- School of Medicine, Stanford University, Stanford, California, USA
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3
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Hernandez SM, Halpern CT, Conron KJ. Sexual orientation, gender expression and socioeconomic status in the National Longitudinal Study of Adolescent to Adult Health. J Epidemiol Community Health 2023; 78:jech-2022-220164. [PMID: 38053260 PMCID: PMC10850725 DOI: 10.1136/jech-2022-220164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 10/17/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is a fundamental contributor to health, yet it is rarely examined relative to gender expression, particularly gender non-conformity and sexual orientation. METHODS We use data from 11 242 Wave V respondents (aged 33-44) in the National Longitudinal Study of Adolescent to Adult Health (2016-2018) to examine associations between socially assigned gender expression, sexual orientation and SES, in logistic and multinomial regression models stratified by sex assigned at birth. RESULTS Among both women and men a general pattern of heightened risk for lower SES among gender non-conforming sexual minorities relative to gender conforming heterosexuals was observed. Gender non-conforming heterosexuals were also at elevated risk of lower SES compared with their conforming heterosexual peers. CONCLUSION Socioeconomic differences by sexual orientation and gender expression have important implications for understanding health disparities among gender non-conforming sexual minorities and their gender conforming heterosexual counterparts.
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Affiliation(s)
- Stephanie M Hernandez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Carolyn T Halpern
- Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kerith J Conron
- The Williams Institute, University of California School of Law, Los Angeles, California, USA
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Höhn A, Stokes J, Pollack R, Boyd J, Chueca Del Cerro C, Elsenbroich C, Heppenstall A, Hjelmskog A, Inyang E, Kopasker D, Sonthalia S, Thomson RM, Zia K, Katikireddi SV, Meier P. Systems science methods in public health: what can they contribute to our understanding of and response to the cost-of-living crisis? J Epidemiol Community Health 2023; 77:610-616. [PMID: 37328262 PMCID: PMC10423532 DOI: 10.1136/jech-2023-220435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many complex public health evidence gaps cannot be fully resolved using only conventional public health methods. We aim to familiarise public health researchers with selected systems science methods that may contribute to a better understanding of complex phenomena and lead to more impactful interventions. As a case study, we choose the current cost-of-living crisis, which affects disposable income as a key structural determinant of health. METHODS We first outline the potential role of systems science methods for public health research more generally, then provide an overview of the complexity of the cost-of-living crisis as a specific case study. We propose how four systems science methods (soft systems, microsimulation, agent-based and system dynamics models) could be applied to provide more in-depth understanding. For each method, we illustrate its unique knowledge contributions, and set out one or more options for studies that could help inform policy and practice responses. RESULTS Due to its fundamental impact on the determinants of health, while limiting resources for population-level interventions, the cost-of-living crisis presents a complex public health challenge. When confronted with complexity, non-linearity, feedback loops and adaptation processes, systems methods allow a deeper understanding and forecasting of the interactions and spill-over effects common with real-world interventions and policies. CONCLUSIONS Systems science methods provide a rich methodological toolbox that complements our traditional public health methods. This toolbox may be particularly useful in early stages of the current cost-of-living crisis: for understanding the situation, developing solutions and sandboxing potential responses to improve population health.
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Affiliation(s)
- Andreas Höhn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Roxana Pollack
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jennifer Boyd
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Corinna Elsenbroich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alison Heppenstall
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Annika Hjelmskog
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Elizabeth Inyang
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shreya Sonthalia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachel M Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kashif Zia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Lian X, Lin Y, Peng X, Wang Y, He T, He Z, Gu W, Wang H, He F, Huang Y. Causal links between socioeconomic status, leisure sedentary behaviours and gastro-oesophageal reflux disease: a multivariable two-sample Mendelian randomisation study. J Epidemiol Community Health 2023; 77:460-467. [PMID: 37185224 DOI: 10.1136/jech-2023-220311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION We implemented a two-sample multivariable Mendelian randomisation (MR) analyses to estimate the causal effect of socioeconomic status and leisure sedentary behaviours on gastro-oesophageal reflux disease (GERD). METHODS Independent single-nucleotide polymorphisms associated with socioeconomic status and leisure sedentary behaviours at the genome-wide significance level from the Medical Research Council Integrative Epidemiology Unit (MRC-IEU) UK Biobank were selected as instrumental variables. Summary-level data for GERD were obtained from a recent publicly available genome-wide association involving 78 707 GERD cases and 288 734 controls of European descent. Univariable and multivariable two-sample MR analyses, using inverse variance weighted method for primary analyses, were performed to jointly evaluate the effect of socioeconomic status and leisure sedentary behaviours on GERD risk. RESULTS Three socioeconomic status, including educational attainment (OR 0.46; 95% CI 0.30 to 0.69; p<0.001), average total household income before tax (OR 0.65; 95% CI 0.47 to 0.90; p=0.009) and Townsend Deprivation Index at recruitment (OR 1.60; 95% CI 1.06 to 2.41; p=0.026), were independently and predominately responsible for the genetic causal effect on GERD. In addition, one leisure sedentary behaviour, such as time spent watching television, was independently and predominately responsible for genetic causal effect on GERD (OR 3.74; 95% CI 2.89 to 4.84; p<0.001). No causal effects of social activities and driving on GERD were observed. CONCLUSIONS Genetically predicted Townsend Deprivation Index at recruitment and leisure watching television were causally associated with increased risk of GERD, and age at completion of full-time education and average total household income before tax were causally associated with decreased risk of GERD.
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Affiliation(s)
- Xingji Lian
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yifen Lin
- Department of Cardiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaohui Peng
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yanhui Wang
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Ting He
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Ziyong He
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Wenlong Gu
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Hongwu Wang
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Feng He
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Nephrology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
| | - Yuyu Huang
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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Sigglekow F, Wilson N, Blakely T. Income and economic productivity loss associated with comorbidity: longitudinal analysis of linked individual-level data for a whole country. J Epidemiol Community Health 2023; 77:97-100. [PMID: 36442993 DOI: 10.1136/jech-2021-218255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the income loss from having two or more diseases, over and above the independent and separate effects of having a single disease. METHODS We used linked health income data from 2006-2007 to 2015-2016 for 25-64 years, for the entire New Zealand population. Fixed effects OLS regression was used to estimate within-individual income loss for diseases separately, and to estimate if having two or more diseases together resulted in reduced (subadditive) or additional (superadditive) income impacts (relative to adding together the income impacts for each disease when experienced singly). RESULTS Of the 169 comorbidity pairs for both sexes, 28 (17%) had a statistically significant superadditive (n=14) or subadditive (n=14) effect of having two diseases. The combined total income gain from deleting all diseases and comorbidities was US$2.269 billion (95% CI US$$2.125 to US$2.389 billion), or a 3.61% (95% CI 3.38% to 3.80%) increase in income. Of this, 8.8% or US$200 million (95% CI US$193 to US$207 million) was attributable to a tendency for comorbidity interactions to increase income loss more than expected for common disease pairings. CONCLUSIONS This national longitudinal study found that disease is associated with income loss, but most of this impact is due to the distinct and independent impact of separate diseases. Nevertheless, there was a tendency for two or more diseases to disproportionately increase income loss more than the summed impacts of each of these diseases if experienced singly.
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Affiliation(s)
- Finn Sigglekow
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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Sund ER, van Lenthe FJ, Avendano M, Raina P, Krokstad S. Does urbanicity modify the relationship between a polygenic risk score for depression and mental health symptoms? Cross-sectional evidence from the observational HUNT Study in Norway. J Epidemiol Community Health 2021; 75:420-425. [PMID: 32581065 PMCID: PMC8053322 DOI: 10.1136/jech-2020-214256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research suggests that genetic predisposition for common mental disorders may be moderated by the environment. This study examines whether a polygenic risk score (PRS) for depression is moderated by the level of residential area urbanicity using five symptoms of poor mental health as outcomes. METHODS The study sample consisted of 41 198 participants from the 2006-2008 wave of the Norwegian HUNT study. We created a weighted PRS for depression based on 99 variants identified in a recent genome -wide association study. Participants were classified into urban or rural place of residence based on wards that correspond to neighbourhoods. Mixed effects logistic regression models with participants nested in 477 neighbourhoods were specified. RESULTS A SD increase in PRS for depression was associated with a small but statistically significant increase in the odds of anxiety, comorbid anxiety and depression and mental distress. Associations for depression were weaker and not statistically significant. Compared with urban residents, rural resident had higher odds for reporting poor mental health. Genetic propensity for depression was higher for residents of urban than rural areas, suggesting gene-environment correlation. There was no sign of effect modification between genetic propensity and urbanicity for depression, anxiety, comorbid anxiety and depression, or mental distress. CONCLUSION The PRS predicted small but significant odds of anxiety, comorbid anxiety and depression and mental distress, but we found no support for a differential effect of genetic propensity in urban and rural neighbourhoods for any of the outcomes.
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Affiliation(s)
- Erik Reidar Sund
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands
| | - Mauricio Avendano
- Department of GLobal Health and Social Medicine, King's College London School of Social Science and Public Policy, London, UK
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017; 71:827-834. [PMID: 28356325 PMCID: PMC5537512 DOI: 10.1136/jech-2016-208141] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. METHODS We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. RESULTS We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. CONCLUSIONS This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
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Affiliation(s)
- Rebecca Masters
- North Wales Local Public Health Team, Public Health Wales, Mold, Flintshire, UK
- Department of Public Health and Policy, University of Liverpool, UK
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Halton Borough Council, Cheshire, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
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Oddo VM, Nicholas LH, Bleich SN, Jones-Smith JC. The impact of changing economic conditions on overweight risk among children in California from 2008 to 2012. J Epidemiol Community Health 2016; 70:874-80. [PMID: 27251405 PMCID: PMC5870869 DOI: 10.1136/jech-2015-207117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/14/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The recent economic recession represents an opportunity to test whether decreases in economic resources may have deleterious consequences on childhood overweight/obesity risk. METHODS We investigated the association between indicators of changing macroeconomic conditions from 2008 to 2012 and overweight/obesity risk among school-aged children in California (n=1 741 712) using longitudinal anthropometric measurements. Multivariate regression, with individual and county fixed effects, was used to examine the effects of annual county-level unemployment and foreclosure rates on risk of child overweight/obesity, overall and among subgroups (race/ethnicity, sex, county-level median household income and county-level urban/rural status). RESULTS From 2008 to 2012, ∼38% of children were overweight/obese and unemployment and foreclosure rates averaged 11% and 6.9%, respectively. A 1-percentage point (pp) increase in unemployment was associated with a 1.4 pp (95% CI 1.3 to 1.5) increase in overweight/obesity risk. Therefore, a child of average weight could expect a 14% increase in their body mass index z-score in association with a 1 pp increase in unemployment during the study period. We found some differences in the magnitude of the effects for unemployment among demographic subgroups, with the largest effects observed for unemployment among American Indians and Pacific Islanders. CONCLUSIONS Comparing children to themselves over time, we provide evidence that increases in county-level unemployment are associated with increased overweight/obesity risk. Given that overweight among children with lower economic resources remains a challenge for public health, these findings highlight the importance of policy-level approaches, which aim to mitigate the impact of decreased resources as economic conditions change.
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Affiliation(s)
- Vanessa M. Oddo
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD USA
| | - Lauren Hersch Nicholas
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD USA
- Johns Hopkins School of Medicine, Department of Surgery, Baltimore, MD USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Sara N. Bleich
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD USA
| | - Jessica C. Jones-Smith
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD USA
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Dadgar I, Norström T. Short-term and long-term effects of GDP on traffic deaths in 18 OECD countries, 1960-2011. J Epidemiol Community Health 2016; 71:146-153. [PMID: 27531843 DOI: 10.1136/jech-2015-207138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/20/2016] [Accepted: 07/19/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Research suggests that increases in gross domestic product (GDP) lead to increases in traffic deaths plausibly due to the increased road traffic induced by an expanding economy. However, there also seems to exist a long-term effect of economic growth that is manifested in improved traffic safety and reduced rates of traffic deaths. Previous studies focus on either the short-term, procyclical effect, or the long-term, protective effect. The aim of the present study is to estimate the short-term and long-term effects jointly in order to assess the net impact of GDP on traffic mortality. METHODS We extracted traffic death rates for the period 1960-2011 from the WHO Mortality Database for 18 OECD countries. Data on GDP/capita were obtained from the Maddison Project. We performed error correction modelling to estimate the short-term and long-term effects of GDP on the traffic death rates. RESULTS The estimates from the error correction modelling for the entire study period suggested that a one-unit increase (US$1000) in GDP/capita yields an instantaneous short-term increase in the traffic death rate by 0.58 (p<0.001), and a long-term decrease equal to -1.59 (p<0.001). However, period-specific analyses revealed a structural break implying that the procyclical effect outweighs the protective effect in the period prior to 1976, whereas the reverse is true for the period 1976-2011. CONCLUSIONS An increase in GDP leads to an immediate increase in traffic deaths. However, after the mid-1970s this short-term effect is more than outweighed by a markedly stronger protective long-term effect, whereas the reverse is true for the period before the mid-1970s.
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Affiliation(s)
- Iman Dadgar
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
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Asaria M, Doran T, Cookson R. The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation. J Epidemiol Community Health 2016; 70:990-6. [PMID: 27189975 PMCID: PMC5036206 DOI: 10.1136/jech-2016-207447] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/19/2016] [Indexed: 12/03/2022]
Abstract
Background There are substantial socioeconomic inequalities in both life expectancy and healthcare use in England. In this study, we describe how these two sets of inequalities interact by estimating the social gradient in hospital costs across the life course. Methods Hospital episode statistics, population and index of multiple deprivation data were combined at lower-layer super output area level to estimate inpatient hospital costs for 2011/2012 by age, sex and deprivation quintile. Survival curves were estimated for each of the deprivation groups and used to estimate expected annual costs and cumulative lifetime costs. Results A steep social gradient was observed in overall inpatient hospital admissions, with rates ranging from 31 298/100 000 population in the most affluent fifth of areas to 43 385 in the most deprived fifth. This gradient was steeper for emergency than for elective admissions. The total cost associated with this inequality in 2011/2012 was £4.8 billion. A social gradient was also observed in the modelled lifetime costs where the lower life expectancy was not sufficient to outweigh the higher average costs in the more deprived populations. Lifetime costs for women were 14% greater than for men, due to higher costs in the reproductive years and greater life expectancy. Conclusions Socioeconomic inequalities result in increased morbidity and decreased life expectancy. Interventions to reduce inequality and improve health in more deprived neighbourhoods have the potential to save money for health systems not only within years but across peoples’ entire lifetimes, despite increased costs due to longer life expectancies.
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Affiliation(s)
- Miqdad Asaria
- Centre for Health Economics, University of York, York, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
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Abstract
Background The 2014 Ebola virus disease (EVD) outbreak in the neighbouring West African countries of Guinea, Liberia and Sierra Leone represents the most significant setback to the region's development in over a decade. This study provides evidence on the extent to which economic activity declined and jobs disappeared in Liberia during the outbreak. Methods To estimate how the level of activity and number of jobs in a given set of firms changed during the outbreak, we use a unique panel data set of registered firms surveyed by the business-development non-profit organisation, Building Markets. We also compare the change in economic activity during the outbreak, across regions of the country that had more versus fewer Ebola cases in a difference-in-differences approach. Findings We find a large decrease in economic activity and jobs in all of Liberia during the Ebola outbreak, and an especially large decline in Monrovia. Outside of Monrovia, the restaurants, and food and beverages sectors have suffered the most among the surveyed sectors, and in Monrovia, the construction and restaurant sectors have shed the most employees, while the food and beverages sectors experienced the largest drop in new contracts. We find little association between the incidence of Ebola cases and declines in economic activity outside of Monrovia. Conclusions If the large decline in economic activity that occurred during the Ebola outbreak persists, a focus on economic recovery may need to be added to the efforts to rebuild and support the healthcare system in order for Liberia to regain its footing.
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Affiliation(s)
- Jeremy Bowles
- Department of Government, Harvard University, Cambridge, Massachusetts, USA
| | - Jonas Hjort
- Columbia University, New York, New York, USA
| | | | - Eric Werker
- Beedie School of Business, Simon Fraser University, Vancouver, Canada
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Abstract
BACKGROUND As mortality is more and more concentrated at old age, it becomes critical to identify the determinants of old age mortality. It has counter-intuitively been found that mortality rates at all ages are higher during short-term increases in economic growth. Work-stress is found to be a contributing factor to this association, but cannot explain the association for the older, retired population. METHODS Historical figures of gross domestic product (Angus Maddison) were compared with mortality rates (Human Mortality Database) of middle aged (40-44 years) and older people (70-74 years) in 19 developed countries for the period 1950-2008. Regressions were performed on the de-trended data, accounting for autocorrelation and aggregated using random effects models. RESULTS Most countries show pro-cyclical associations between the economy and mortality, especially with regard to male mortality rates. On average, for every 1% increase in gross domestic product, mortality increases with 0.36% for 70-year-old to 74-year-old men (p<0.001) and 0.38% for 40-year-old to 44-year-old men (p<0.001). The effect for women is 0.18% for 70-year-olds to 74-year-olds (p=0.012) and 0.15% for 40-year-olds to 44-year-olds (p=0.118). CONCLUSIONS In developed countries, mortality rates increase during upward cycles in the economy, and decrease during downward cycles. This effect is similar for the older and middle-aged population. Traditional explanations as work-stress and traffic accidents cannot explain our findings. Lower levels of social support and informal care by the working population during good economic times can play an important role, but this remains to be formally investigated.
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Affiliation(s)
- George Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, , Athens, Attiki, Greece
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Abstract
BACKGROUND Low socioeconomic position (SEP) has been associated with increased risks of morbidity and mortality from many diseases. We investigated the associations between gastric cancer incidence and education, occupation and income as indicators for SEP. METHODS We searched the PubMed and EMBASE databases for studies on SEP and gastric cancer incidence published from 1966 through February 2013. We used a random-effect model to pool the risk estimates from the individual studies. The relative indexes of inequality (RIIs) with their 95% CIs were used as summary estimates. We stratified the analysis by SEP indicators, sex, country's income group, geographical area, level of adjustment for an established risk factor, publication year, study design, type of control and length of follow-up. RESULTS Of 1549 citations, 36 studies met our inclusion criteria. We observed an increased risk of gastric cancer among the lowest SEP categories in education (RII=2.97; 95% CI 1.923 to 4.58), occupation (RII=4.33; 95% CI 2.57 to 7.29) and combined SEP (RII=2.64; 95% CI 1.05 to 6.63) compared with the highest SEP categories. Although the association between the incidence of gastric cancer and the level of income is evident, it did not reach a statistically significant level (RII=1.25; 95% CI 0.93 to 1.68). CONCLUSIONS We found that the risk of gastric cancer incidence is higher among low SEP groups.
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Affiliation(s)
- Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, United Kingdom
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MEADOW SR. NO, THANKS; I'D RATHER STAY AT HOME. MOTHERS WHO DO NOT WANT TO ACCOMPANY THEIR CHILDREN INTO HOSPITAL--THEIR CLASS, THEIR FAMILIES, AND THEIR READING HABITS. Br Med J 1996; 2:813-4. [PMID: 14173858 PMCID: PMC1816495 DOI: 10.1136/bmj.2.5412.813] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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FURMAN SS, SWEAT LG, CROCETTI GM. SOCIAL CLASS FACTORS IN THE FLOW OF CHILDREN TO OUTPATIENT PSYCHIATRIC FACILITIES. Am J Public Health Nations Health 1996; 55:385-92. [PMID: 14263071 PMCID: PMC1256216 DOI: 10.2105/ajph.55.3.385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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JOHNSON DG. HOW MEDICAL STUDENTS FINANCE THEIR EDUCATION. J Med Educ 1965; 40:868-869. [PMID: 14339091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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RAO MN, SAHA PN. THE INDIAN AGRICULTURIST. J Occup Med 1965; 7:447-51. [PMID: 14340460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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STREIMER I, GETZKIN AJ, WENDROW B. SYSTEM DESIGN COSTS AND CONSIDERATIONS AS A FUNCTION OF MAINTAINING SPACE CREW PHYSICAL FITNESS. Aerosp Med 1965; 36:830-3. [PMID: 14332331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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GIBSON RW. MEDICARE AND THE PSYCHIATRIST'S RESPONSIBILITY. Psychiatr Serv 1965; 16:16-7. [PMID: 14329568 DOI: 10.1176/ps.16.9.16a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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HERRMANN WE. CANCER EDUCATION AND DETECTION PROGRAMS AT THE PLANT LEVEL. J Occup Med 1965; 7:431-3. [PMID: 14340456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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PIERSON RE. THE ECONOMIC LOSS ASSOCIATED WITH INFECTIOUS BOVINE RHINOTRACHEITIS IN A DAIRY HERD. J Am Vet Med Assoc 1965; 147:350-2. [PMID: 14341039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SUSSMAN MB, HAUG MR, LAMPORT MR. REHABILITATION PROBLEMS AMONG SPECIAL TYPES OF TUBERCULOUS PATIENTS. Am Rev Respir Dis 1965; 92:261-8. [PMID: 14340867 DOI: 10.1164/arrd.1965.92.2.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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BLACK BJ. THE WORKSHOP IN A CHANGING WORLD. THE THREE FACES OF THE SHELTERED WORKSHOP. Rehabil Lit 1965; 26:230-5. [PMID: 14320620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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KIDD CV. THE HEALTH SCIENCES AND THE FEDERAL GOVERNMENT. J Med Educ 1965; 40:667-674. [PMID: 14341401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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MILLER RM. NON-PROFESSIONAL SERVICES--THEY'RE HOLDING US BACK. Vet Med Small Anim Clin 1965; 60:763-6. [PMID: 14301304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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KREINDLER LS. SOME LEGAL RAMIFICATIONS OF AIRCRAFT ACCIDENTS. Aerosp Med 1965; 36:629-31. [PMID: 14338872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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GUERRIN RF, BORGATTA EF. SOCIO-ECONOMIC AND DEMOGRAPHIC CORRELATES OF TUBERCULOSIS INCIDENCE. Milbank Mem Fund Q 1965; 43:269-90. [PMID: 14346216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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MARKSTEIN DL. TRY THE PSYCHOLOGY OF WALL STREET SUCCESS. Oral Hyg 1965; 55:33-7. [PMID: 14318849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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Patterson RA. SOME ECONOMIC ASPECTS OF THE DEVELOPMENT OF THE CATTLE INDUSTRY IN NORTHERN AUSTRALIA. Aust Vet J 1965; 41:201-5. [PMID: 14338018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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GITHENS JH, ELLIOT FE, SAUNDERS LH. THE RELATION OF SOCIOECONOMIC FACTORS TO INCIDENCE OF CHILDHOOD LEUKEMIA. Public Health Rep (1896) 1965; 80:573-8. [PMID: 14310581 PMCID: PMC1919610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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COOLEY WJ, KIEL FW. SOME ASPECTS OF GOVERNMENT LIABILITY IN MILITARY AIRCRAFT ACCIDENTS. Aerosp Med 1965; 36:635-6. [PMID: 14338874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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BURNIGHT RG. CHRONIC MORBIDITY AND THE SOCIO-ECONOMIC CHARACTERISTICS OF OLDER URBAN MALES. Milbank Mem Fund Q 1965; 43:311-22. [PMID: 14348378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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ISLAM MA, SREEDHARAN T. AN ANACHRONISM: FREE CARE FOR MERCHANT SEAMEN. JAMA 1965; 192:1102-3. [PMID: 14293513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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BROWN JC. A LOOK AT PRIVATE NURSING. Can Nurse 1965; 61:465-6. [PMID: 14324271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SCHROEDER OC. MALPRACTICE AND THE PHYSICIAN. 2. DAMAGE AWARDS. Postgrad Med 1965; 37:A62-8 CONTD. [PMID: 14299899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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WOLF GA. THE SITE OF A MEDICAL SCHOOL. J Med Educ 1965; 40:506-509. [PMID: 14304327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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MENLOVE FL. AGGRESSIVE SYMPTOMS IN EMOTIONALLY DISTURBED ADOPTED CHILDREN. Child Dev 1965; 36:519-32. [PMID: 14300871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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