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Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data Sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review Methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3,190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area. [ABSTRACT FROM AUTHOR]

The article discusses that after screening for breast or colorectal cancer, what is the time lag needed before cancer deaths are seen. According to a research paper by Sei J Lee and colleagues, cancer screening does help in preventing cancer deaths in the future, the time to benefit from is unclear. The paper adds that the screening prevents one cancer death per 1000 patients screened at 10 years, and it should be carried out on patients who have a life expectancy of more than 10 years.

The article discusses a survey on smokers that assessed if the relationship between beliefs and smoking behaviors was in consistent with Cognitive Dissonance Theory. It included adult smokers from Canada, U.S., Great Britain and Australia. The findings revealed that smokers with no intetion of quitting across the three waves, were inclined towards the highest levels of rationalizations for smoking. It suggests studies to determine if the change in beliefs has any effect on intentions to quit.

The article focuses on the issue of the regulations set out by the U.S. Office of Foreign Assets Control related to the sanctions on the publication of research from Iranian medical practitioners and academics. It states that the U.S. citizens are authorized to engage with in ordinary transactions related to written publications which are not employed by the Iranian government under the sanctions.

Objectives Based mainly on findings from clinical settings, it has been claimed that women are less likely than men to quit smoking successfully. If true, this would have important implications for tobacco control interventions. The authors aimed to test this possibility using data from general population surveys. Methods The authors used data from major national surveys conducted in 2006e2007 in the USA (Tobacco Use Supplement to the Current Population Survey), Canada (Canadian Tobacco Use Monitoring Survey) and the UK (General Household Survey) to estimate rates of smoking cessation by age in men and women. Results The authors found a pattern of gender differences in smoking cessation which was consistent across countries. Below age 50, women were more likely to have given up smoking completely than men, while among older age groups, men were more likely to have quit than women. Across all age groups, there was relatively little difference in cessation between the sexes.Conclusions:Conclusions about gender differences in smoking cessation should be based on evidence from the general population rather than from atypical clinical samples. This study has found convincing evidence that men in general are not more likely to quit smoking successfully than women. [ABSTRACT FROM AUTHOR]

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate youth exposure to smoking in movies in the UK and compare the likely effect with the USA. METHODS: We collected tobacco occurrences data for 572 top-grossing films in the UK screened from 2001 to 2006 and estimated the number of on-screen tobacco impressions delivered to British youths in this time period. RESULTS: 91% of films in our sample that contained smoking were youth-rated films (British Board of Film Classification rating ‘15’ and lower), delivering at least 1.10 billion tobacco impressions to British youths during theatrical release. British youths were exposed to 28% more smoking impressions in UK youth-rated movies than American youth-rated movies, because 79% of movies rated for adults in the USA (‘R’) are classified as suitable for youths in the UK (‘15’ or ‘12A’). CONCLUSION: Because there is a dose-response relation between the amount of on-screen exposure to smoking and the likelihood that adolescents will begin smoking, the fact that there is substantially higher exposure to smoking in youth-rated films in the UK than in the USA suggests that the fraction of all youth smoking because of films in the UK is probably larger than in the USA. Other countries with ratings systems that are less conservative (in terms of language and sexuality) than the USA will also be likely to deliver more on-screen tobacco impressions to youths. Assigning an ‘18’ classification to movies that contain smoking would substantially reduce youth exposure to on-screen smoking and, hence, smoking initiation among British youths. [ABSTRACT FROM AUTHOR]

This article presents updates related to medical ethics. It announces that the British government that it would phase in the of the Mental Capacity Act 2005 for England and Wales. The British in December 2006 published a white paper entitled "Review of the Human Fertilization and Embryology Act," to seek for the revision of legislation on human reproductive technologies. The sterilization case of Ashley, a severely mentally disable children in the U.S., has ignited medical ethics debate.

The author comments on a 2012 "Journal of the American Medical Association" article which analyzed the coding data from the 2003-2009 period and suggested that the decline in hospital mortality in patients with pneumonia was due to trends in diagnostic coding.

This section offers news briefs related to medical ethics. In October 2007, Great Britain's Abortion Act will celebrate its 40th anniversary. In May 2007, a 17-year-old Irish pregnant woman was allowed to travel to Great Britain for an abortion in her second trimester because of serious fetal abnormality. On April 25, 2007, the U.S. House of Representatives voted in favor of the Genetic Information Nondiscrimination Act.

Background Owing to the limited effectiveness of traditional health education curricula in schools, there is increasing interest in interventions aiming to promote young people's health by modifying the school environment. Existing systematic reviews cannot determine whether environmental intervention is effective because they examine interventions combining environmental modifications and traditional health education. This gap is significant because school-environment interventions are complex to implement and may be sidelined in underfunded and attainment-focused school systems without evidence to support such an approach. This systematic review examined the effectiveness of school-environment interventions without health-education components on student health and inequalities. Methods This was a systematic review of experimental/ quasi-experimental studies of school-environment interventions. Sixteen databases were searched, eliciting 62 329 references which were screened, with included studies quality assessed, data extracted and narratively synthesised. Results Sixteen reports of 10 studies were included, all from the USA and the UK. Five evaluations of interventions aiming to develop a stronger sense of community and/or improve relationships between staff and students suggested potential benefits particularly regarding violence and aggression. Two trials of interventions enabling students to advocate for changes in school catering and physical activity reported benefits for physical activity but not diet. Three evaluations of improvements to school playgrounds offered weak evidence of effects on physical activity. Conclusions School environment interventions show the potential to improve young people's health particularly regarding violence, aggression and physical activity. Further trials are required to provide a stronger and more generalisable evidence base. [ABSTRACT FROM AUTHOR]

Objectives To investigate the links between health warning labels (WLs) on cigarette packets and relapse among recently quit smokers. Design Prospective longitudinal cohort survey. Setting Australia, Canada, the UK and the USA. Participants 1936 recent ex-smokers (44.4% male) from one of the first six waves (2002-2007) of the International Tobacco Control 4-Country policy evaluation survey, who were followed up in the next wave. Main outcome measures Whether participants had relapsed at follow-up (approximately 1 year later). Results In multivariate analysis, very frequent noticing of WLs among ex-smokers was associated with greater relapse 1 year later (OR: 1.52, 95% CI 1.11 to 2.09, p<0.01), but this effect disappeared after controlling for urges to smoke and self-efficacy (OR: 1.29, 95% CI 0.92 to 1.80, p¼0.135). In contrast, reporting that WLs make staying quit ‘a lot’ more likely (compared with ‘not at all’ likely) was associated with a lower likelihood of relapse 1 year later (OR: 0.65, 95% CI 0.49 to 0.86, p<0.01) and this effect remained robust across all models tested, increasing in some. Conclusions This study provides the first longitudinal evidence that health warnings can help ex-smokers stay quit. Once the authors control for greater exposure to cigarettes, which is understandably predictive of relapse, WL effects are positive. However, it may be that ex-smokers need to actively use the health consequences that WLs highlight to remind them of their reasons for quitting, rather than it being something that happens automatically. Ex-smokers should be encouraged to use pack warnings to counter urges to resume smoking. Novel warnings may be more likely to facilitate this. [ABSTRACT FROM AUTHOR]

Background This study investigates social inequalities in self-rated health dynamics for working-aged adults in four nations, representing distinct welfare regime types. The aims are to describe average national trajectories of self-rated health over a 7-year period, identify social determinants of cross-sectional and longitudinal health and compare cross-national patterns. Methods Data are from national household panel surveys in Britain, Germany, Denmark and the USA. The self-rated health of working-age respondents is measured for the years 1995–2001. Social indicators include education, occupational class, employment status, income, age, gender, minority status and marital status. Latent growth curve models are used to estimate both individual change and average national trajectories of self-rated health, conditioned on the social indicators. Results Ageing-vector graphs reveal general declines in health as people age. They also show differential patterns of change for specific national cohorts. Older cohorts in Denmark had poorer health and young cohorts in the USA had better health in 2001 than 1995. Social covariates predicted baseline health in all four countries, in ways that were consistent with welfare regime theories. Once inequalities in baseline health were accounted for, the few determinants of mean health decline occurred mainly in the USA, again in line with theoretical expectations. Finally, trajectories of health for those in average and advantaged social circumstances were similar, but disadvantaged individuals had much poorer health trajectories than ‘average’ individuals. The differences were greatest in the countries with lower levels of public transfers. Conclusion National differences in self-rated health trajectories and their social correlates may be attributed partly to welfare policies. [ABSTRACT FROM PUBLISHER]

This article provides a framework for understanding how Muslim identity, and the current social and political contexts in which it is shaped, affects the health of Muslims in the UK and the US, and the quality of health care they receive. Key medical and public health literature that addresses health concerns related to Muslim communities in the UK and the US is reviewed. Few data exist specific to health disparities for Muslim minorities. However, the article focuses on emerging studies concerning the consequences of –Islamophobia– for the physical and mental health and health care of Muslim families and children. We argue that, despite substantive structural differences in the health care systems of the UK and the US, social structural and political forces play similar roles in the health of Muslim children in both countries. Finally, we call for significant cultural and institutional adjustments in health care settings and further research studies to provide specific data to address health disparities for these growing and diverse populations. [ABSTRACT FROM AUTHOR]

Objective: This study examined the constituents of smokeless tobacco products available in the UK and compared them with products available in India, Sweden, and the USA Methods: Seven UK brands of smokeless tobacco, including a tooth cleaning powder, and four international brands of smokeless tobacco were tested for a range of toxins and known carcinogens, such as tobacco specific N-nitrosamines (TSNA), as well as nicotine availability. Results: Ten of the 11 brands tested had detectable levels of tobacco specific nitrosamines, which are proven carcinogens, and levels varied 130-fold. All had detectable levels of benzo(a)pyrene, another proven carcinogen (with around 175-fold variation) and several toxic metals (with nearly 150-fold variation). Nicotine availability varied in the UK products from 0.1 mg/g to 63.2 mg/g. All the tobacco products tested are likely to be hazardous to users' health, but the data indicate that it should be possible to reduce key toxins to non-detectable levels. Conclusions: Smokeless tobacco products should be regulated and standards set for maximum levels of toxins and carcinogens. [ABSTRACT FROM AUTHOR]

This article describes the differing American and British approaches to child health advocacy by pediatricians and pediatric organizations. In the U.S., advocacy has a long history and is well established as an important function of the American Academy of Pediatrics, but the U.S. still has to achieve universal health care coverage for children. In contrast, Great Britain has had universal health care for children for more than 50 years and individual pediatricians have spoken out for children. However the Royal College of Paediatrics and Child Health adopted advocacy as a goal only in 1997.

The definition of diabetes mellitus (DM) was recently changed by the American Diabetes Association to a fasting plasma glucose value of at least 126 mg/dl, on the basis of increased risk of the complication of retinopathy. It has been estimated that worldwide approximately 154 million people have diabetes, with up to one third of the cases remaining undiagnosed in developed countries such as the U.S. Its human cost is considerable with morbidity from retinopathy, neuropathy, renal failure, and vascular disease, in addition to the socioeconomic burden. Additional lifetime health costs attributable to DM have been estimated at £19 649 per affected individual in Great Britain.

The article discusses about the relation between ethnicity and epidemiology of sexually transmitted infections (STI). One of the most vexing problems has been defining the relation between ethnicity and STI risk. Population based cross sectional studies in the U.S. have demonstrated increased rates of gonorrhoea, chlamydia, and genital herpes in African-Americans. The herpes studies are particularly instructive because they were based on a national sample-and the differences persist when controlled for socioeconomic status and other demographic variables. The differences are also stable over time. In the Great Britain, studies have shown that gonorrhoea rates in Leeds, Birmingham, and south London and chlamydia rates in Coventry and Birmingham were substantially higher in black residents, again after controlling for socioeconomic status, and in an environment, in contrast with the U.S. where there is universal access to free health care. Ethnic classification systems invented for one purpose, such as census monitoring, may not be adequate to explain differences in health. A researcher, N. Pfeiffer developed a trenchant critique of this essentialist view of ethnicity, where culture is presented as a fixed product and all members of a defined group are assumed to share a stereotypical "true" identity and biology: "black" versus "white."

The article presents an obituary for astrobiologist John Billingham.

The article explores hospital mortality in the U.S. and in Great Britain, in reference to a study conducted by primary health care professor Brian Jarman. Based on the research, English National Health Service (NHS) patients have 45 percent chance of dying in hospitals than patients in the U.S. It describes data collection strategies utilised by Jarman which include calculation of hospital standardised mortality ratio. The need to improve NHS services is also emphasized.

Focuses on a research study on sexual dysfunction in women with HIV. Discussion on sexual problem with HIV positive women; Survey by the National Sexual Attitudes and Lifestyles in the United States, which reveals that 54 percent of women with one or more current sexual partners had at least one sexual problem for a month; Data on sexual dysfunction in HIV positive women; Report on sexual practices and difficulties in a group of 82 women from hospital outpatient departments and the community in Great Britain.