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Background: In Tanzania, the distribution and coverage of insecticide-treated nets (ITNs) is inequitable. Arguments about the most effective and equitable approach to distributing ITNs centre around whether to provide ITNs free of charge or continue with existing social marketing strategies. The Government has decided to provide free ITNs to all children under five in the country. It is still uncertain whether this strategy will achieve equitable coverage and use. This study examined the equity implications of ownership and use of ITNs in households from different socioeconomic quintiles in a district with free ITNs and a district without free ITN distribution. Methods: A cross-sectional comparative household survey was conducted in two districts: Mpanda in Rukwa Region (with free ITN roll out) and Kisarawe in Coast region (without free ITNs). Heads of 314 households were interviewed in Mpanda and Kisarawe. The concentration index was estimated and regression analysis was performed to compare socioeconomic inequalities in ownership and use of ITNs. Results: Ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda, with nearly perfect equality in use (concentration index 0.009) and ownership (concentration index 0.010). In Kisarawe, ownership of ITNs increased from 48% in the 2007/08 national survey to 53%, with a marked inequality concentration index 0.132. ITN use in Kisarawe district was 42% with a pro rich concentration index of 0.027. Conclusions: The results shed some light on the possibilities of reducing inequality in ownership and use of ITNs and attaining Roll Back Malaria and Millennium Development Goals through the provision of free ITNs to all. This has the potential to decrease the burden of disease and reduce disparity in disease outcome. ; publishedVersion

Background: The implementation of decentralisation reforms in the health sector of Tanzania started in the 1980s. These reforms were intended to relinquish substantial powers and resources to districts to improve the development of the health sector. Little is known about the impact of decentralisation on recruitment and distribution of health workers at the district level. Reported difficulties in recruiting health workers to remote districts led the Government of Tanzania to partly re-instate central recruitment of health workers in 2006. The effects of this policy change are not yet documented. This study highlights the experiences and challenges associated with decentralisation and the partial re-centralisation in relation to the recruitment and distribution of health workers. Methods: An exploratory qualitative study was conducted among informants recruited from five underserved, remote districts of mainland Tanzania. Additional informants were recruited from the central government, the NGO sector, international organisations and academia. A comparison of decentralised and the reinstated centralised systems was carried out in order to draw lessons necessary for improving recruitment, distribution and retention of health workers. Results: The study has shown that recruitment of health workers under a decentralised arrangement has not only been characterised by complex bureaucratic procedures, but by severe delays and sometimes failure to get the required health workers. The study also revealed that recruitment of highly skilled health workers under decentralised arrangements may be both very difficult and expensive. Decentralised recruitment was perceived to be more effective in improving retention of the lower cadre health workers within the districts. In contrast, the centralised arrangement was perceived to be more effective both in recruiting qualified staff and balancing their distribution across districts, but poor in ensuring the retention of employees. Conclusion: A combination of centralised and decentralised recruitment represents a promising hybrid form of health sector organisation in managing human resources by bringing the benefits of two worlds together. In order to ensure that the potential benefits of the two approaches are effectively integrated, careful balancing defining the local-central relationships in the management of human resources needs to be worked out. ; publishedVersion

Background: Several countries are discussing new legislation on the ban of smoking in public places, and on the acceptable levels of traffic-related air pollutants. It is therefore useful to estimate the burden of disease associated with indoor and outdoor air pollution. Methods: We have estimated exposure to Environmental Tobacco Smoke (ETS) and to air pollution in never smokers and ex-smokers in a large prospective study in 10 European countries (European Prospective Investigation into Cancer and Nutrition)(N = 520,000). We report estimates of the proportion of lung cancers attributable to ETS and air pollution in this population. Results: The proportion of lung cancers in never- and ex-smokers attributable to ETS was estimated as between 16 and 24%, mainly due to the contribution of work-related exposure. We have also estimated that 5–7% of lung cancers in European never smokers and ex-smokers are attributable to high levels of air pollution, as expressed by NO2 or proximity to heavy traffic roads. NO2 is the expression of a mixture of combustion (traffic-related) particles and gases, and is also related to power plants and waste incinerator emissions. Discussion: We have estimated risks of lung cancer attributable to ETS and traffic-related air pollution in a large prospective study in Europe. Information bias can be ruled out due to the prospective design, and we have thoroughly controlled for potential confounders, including restriction to never smokers and long-term ex-smokers. Concerning traffic-related air pollution, the thresholds for indicators of exposure we have used are rather strict, i.e. they correspond to the high levels of exposure that characterize mainly Southern European countries (levels of NO2 in Denmark and Sweden are closer to 10–20 ug/m3, whereas levels in Italy are around 30 or 40, or higher). Therefore, further reduction in exposure levels below 30 ug/m3 would correspond to additional lung cancer cases prevented, and our estimate of 5–7% is likely to be an underestimate. Overall, our prospective study draws attention to the need for strict legislation concerning the quality of air in Europe.

This is an Accepted Manuscript of an article published by Taylor & Francis in Medical Anthropology on 12.10.2015, available online: http://dx.doi.org/10.1080/01459740.2015.1102248 ; In recent years an extensive social gradient in cancer outcome has attracted much attention, with late diagnosis proposed as one important reason for this. Whereas earlier research has investigated health care seeking among cancer patients, these social differences may be better understood by looking at health care seeking practices among people who are not diagnosed with cancer. Drawing on long-term ethnographic fieldwork among two different social classes in Denmark, our aim in this article is to explore the relevance of class to health care seeking practices and illness concerns. In the higher middle class, we predominantly encountered health care seeking resembling notions of health consumerism, practices sanctioned and encouraged by the health care system. However among people in the lower social class, health care seeking was often shaped by the inseparability of physical, political, and social dimensions of discomfort, making these practices difficult for the health care system to accommodate.

SummaryCypripedium calceolus L., the lady's slipper orchid, is described and illustrated. Details of its distribution, relationships, pollination, patterns of hybridization and its history and conservation in England are provided. Notes on propagation and cultivation are also included.

'"Social medicine", a concept notably developed in Latin America by Salvador Allende in the 1930s, links up a broader model and ethos of public health with processes of social transformation. In recent years that influence has spread to Timor Leste, through a very large Cuban health cooperation and training program. This paper considers to what extent an endogenous "social medicine" might be developing in Timor Leste. Such a development would require transition away from the existing model based on small, private clinics. The paper accepts Guzmán's observation that Latin American social medicine is a wider, more dynamic and participatory model than that presented from European epidemiology – the 'social determinants' approach – but asserts that there are different forms of social medicine, conditioned by distinct histories and cultures. If earlier Chilean social medicine was a key element of that country's radical social democracy, and Cuban social medicine expressed revolutionary solidarity and internationalism, what might be the character of an East Timorese social medicine? This paper traces the idea of 'social medicine' from Chile, through Cuban solidarity aid, to the synthesis emerging in Timor Leste. This is an interpretive history, making use of past analyses, contemporary information on the Cuba-Timor Leste health program and the East Timorese responses. It includes a number of interviews and direct observations of pedagogy and practice. It concludes that a transition to social medicine in Timor Leste has some advantages: the large scale of the new training program; a sympathetic culture; and potential leadership. Less certain is the exact form of East Timorese social medicine. However the ideas seem set to be absorbed into a domestic culture of community solidarity, inclusive Christianity, and an independent spirit.

Source at https://doi.org/10.1186/s12906-018-2179-8 . ; Intentional use of complementary and alternative medicine (CAM) has previously only been researched in small, possibly biased, samples. There seems to be a lack of scientific information regarding healthy individual's attitudes and presumed use of CAM. The aim of this study is to describe prevalence and characteristics of participants who intend to see a CAM provider compared to participants who intend to see a medical doctor (MD) only when suffering from a chronic, non- life-threatening disease and in the need of treatment. Further to describe differences between the groups regarding expected reasons for CAM use and expected skills of CAM providers. METHOD: The survey was conducted in January 2016 as part of the "TNS Gallup Health policy Barometer". In total, 1728 individuals aged 16-92 years participated in the study, constituting an overall response rate of 47%. The survey included questions regarding opinions and attitudes towards health, health services and health politics in Norway. RESULTS: The majority of the participants (90.2%) would see a MD only if they were suffering from a chronic, non- life-threatening disease and were in the need of treatment. Men over the age of 60 with a university education tended to see a MD only. Only 9.8% of all respondents would in addition visit a CAM provider. Being an intentional user of a MD + CAM provider was associated with being a woman under the age of 60. The respondents believed that CAM providers have professional competence based on formal training in CAM. They also believed that individuals seeing a CAM provider have poor health and are driven by the hope of being cured. Further, that they have heard that others have good experience with such treatment. CONCLUSION: Intentional use of CAM is associated with positive attitudes, trustworthiness, and presumed positive experiences in the CAM-patient-setting. Intentional CAM users also have the impression that CAM providers have professional competence based on formal training in alternative therapies.

Pleasure Consuming Medicine investigates the significance of the classification of drugs forconceptions of personhood in the context of consumer citizenship. It examines howdrug discourses operate politically to sustain particular notions of personhood andorganise bodies. As the normative conception of social life shifts to a discourse ofconsumer agency and active citizenship, it is argued, drugs come to describe the moralboundaries of a freedom configured around personal consumption. The thesis tracks theparallel rise of two discourses of drug mis/use from the 1970s - a discourse of 'drugabuse' and a discourse of 'patient compliance' - illustrating how these discourses bindpersonal agency to medical authority through a vocabulary of self-administration. Itdescribes how illicit drugs are constructed as a sign and instance of excessive conformity toconsumer culture, and how this excess is opportunistically scooped off andspectacularised to stage an intense but superficial battle between the amoral market andthe moral state. Pleasure Consuming Medicine uses a theoretical frame developed from queertheory, corporeal feminism, governmentality studies and cultural studies to explore thepolitical character of drug regimes, tracing some of the ramifications for sex, race, class,and citizenship. Then it turns to the field of gay men's HIV education to conceive somealternative and provisional vocabularies of safety. The thesis develops an argument onthe exercise of power in consumer society, with the aim of contributing to cultural andcritical understandings of consumption, embodiment, sex, health, and citizenship.

This item has been retyped from the original and pagination will differ from the original. ; I WAS asked to discuss the problems of Blood Grouping with reference to paternity, but I suggested a change of subject in order to avoid the impression that Forensic Medicine was the only common ground for the legal and the medical professions. There is much in common also in the problems of Social Medicine. The University has been, and is bound to remain. The intellectual leader of the country; with the restitution of Self Government its importance will increase ; many of our law givers will come out of it. It is therefore proper that students of law, as possible legislators of the future, should be acquainted with the problems of health with reference to social life. ; N/A