Objectives: To examine how the public assess trust in health care in England and Wales. Design: Postal structured questionnaire in cross sectional survey. Setting: Random sample of people on the electoral register in England and Wales. Subjects: People aged 18 and over. Main outcome measures: General levels of trust and confidence in health care. Results: The response rate was 48% (n = 1187). The mean level of confidence (trust) in the healthcare system was 6.0 out of a score of 10. Levels of distrust appeared relatively high with at least 356 (30%) respondents reporting little or very little trust for 28 of 32 specific aspects of health care. The highest levels of distrust were found in relation to how the health service was run and financed, particularly waiting times and the implication of cost cutting for patients. Statistical analysis by univariable linear regression of the specific determinants of generic assessments of public trust (confidence) suggested that the key aspects were patient centred care and levels of professional expertise. Being covered by private health insurance was also a key determinant of levels of public trust. Conclusion: Public assessment of trust tends to address the views of care at the micro level. Policy makers concerned with the erosion of public trust need to target aspects associated with patient centred care and professional expertise.
Consumption of foods imported from Oaxaca was identified as a risk factor for elevated blood lead levels in Monterey County, California. Lead-contaminated imported chapulines were identified as 1 source of lead poisoning, although other sources may also contribute to the observed findings. Food transport between binational communities presents a unique risk for the importation of environmental hazards [corrected]
Summary:In California, the annual number of children under age 6 y of age with blood lead levels (BLL) ≥10μg/dL is estimated at over 1,000 cases, and up to 10,000 cases when BLL between 4.5 and 9.5μg/dL are included. State-issued health alerts for food contamination provide one strategy for tracking sources of food-related lead exposures. As well, California passed legislation in 2006 for the Food and Drug Branch (FDB) of the state health department to test and identify lead in candy. This report presents health alert data from California over a 14-y period, compares data before and after the candy testing program began, and examines country of origin, ZIP code data, and time from candy testing to release of health alerts for lead-contaminated candies for 2011–2012. After 2007, health alerts issued for lead in candy and food increased significantly. Analysis of candy-testing data indicated that multiple counties and ZIP codes were affected. Seventeen candies with high lead concentrations were identified, resulting in rapid dissemination (<2wk) of health alerts to local health departments and community clinicians and to the public. Surveillance of lead exposures from state-based food and candy testing programs provides an opportunity to identify and immediately act to remove nonpaint sources of lead affecting children. https://doi.org/10.1289/EHP2582
In Reply Dr Ji and colleagues suggest that other changes in behavior associated with smoking cessation, such as change in diet and decrease in alcohol consumption, might contribute to the decrease in cardiovascular disease we observed in our study. We agree that smokers might adopt a healthier lifestyle when they quit smoking.In the Comment section of our article, we cited this as one of the mechanisms for a decrease in cardiovascular disease associated with smoking cessation. However, the main objective of our study was not to explore potential mechanisms responsible for the decrease in cardiovascular risk when smokers quit smoking but to test the hypothesis that weight gain following smoking cessation does not attenuate the cardiovascular benefits of smoking cessation.We adjusted for potential confounding factors at baseline such as body mass index, lipid profile, blood pressure, and alcohol consumption. Except for weight change, which was one of the prespecified mediating factors explored in our analysis, we did not adjust for other potential mediating factors, such as change in alcohol consumption or diet.Ji and colleagues raise an interesting hypothesis that could be tested in a different study. In the meantime, we believe that the conclusion of our study is valid: smoking cessation is associated with a lower risk of cardiovascular events compared with continuing smoking, and the weight gain that might follow smoking cessation does not offset this benefit.
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