The benefits of lower ozone due to air pollution emission reductions (2002-2011) in the Eastern United States during extreme heat.

Using the Community Multiscale Air Quality (CMAQ) model and the Benefits Mapping and Analysis Program - Community Edition (BenMAP-CE) tool, we estimate the benefits of anthropogenic emission reductions between 2002 and 2011 in the Eastern United States (US) with respect to surface ozone concentrations and ozone-related health and economic impacts, during a month of extreme heat, July 2011. Based on CMAQ simulations using emissions appropriate for 2002 and 2011, we estimate that emission reductions since 2002 likely prevented 10- 15 ozone exceedance days (using the 2011 maximum 8-hr average ozone standard of 75 ppbv) throughout the Ohio River Valley and 5- 10 ozone exceedance days throughout the Washington, DC - Baltimore, MD metropolitan area during this extremely hot month. CMAQ results were fed into the BenMAP-CE tool to determine the health and health-related economic benefits of anthropogenic emission reductions between 2002 and 2011. We estimate that the concomitant health benefits from the ozone reductions were significant for this anomalous month: 160-800 mortalities (95% confidence interval (CI): 70-1,010) were avoided in July 2011 in the Eastern U.S, saving an estimated $1.3-$6.6 billion (CI: $174 million-$15.5 billion). Additionally, we estimate that emission reductions resulted in 950 (CI: 90-2,350) less hospital admissions from respiratory symptoms, 370 (CI: 180-580) less hospital admissions for pneumonia, 570 (CI: 0-1650) less Emergency Room (ER) visits from asthma symptoms, 922,020 (CI: 469,960-1,370,050) less minor restricted activity days (MRADs), and 430,240 (CI: -280,350-963,190) less symptoms of asthma exacerbation during July 2011.Implications: We estimate the benefits of air pollution emission reductions on surface ozone concentrations and ozone-related impacts on human health and the economy between 2002 and 2011 during an extremely hot month, July 2011, in the eastern United States (US) using the CMAQ and BenMAP-CE models. Results suggest that, during July 2011, emission reductions prevented 10-15 ozone exceedance days in the Ohio River Valley and 5-10 ozone exceedance days in the Mid Atlantic; saved 160-800 lives in the Eastern US, saving $1.3 - $6.5 billion; and resulted in 950 less hospital admissions for respiratory symptoms, 370 less hospital admissions for pneumonia, 570 less Emergency Room visits for asthma symptoms, 922,020 less minor restricted activity days, and 430,240 less symptoms of asthma exacerbation.

Correlates of Body Dissatisfaction in Children.

OBJECTIVE: To assess body dissatisfaction among children between 9 and 14 years of age and to examine factors (age, sex, body mass index, perceived shape, and self-esteem) associated with wanting a thinner or a larger shape. STUDY DESIGN: Through at-school questionnaires, 1515 preadolescent children (51.2% girls) were asked to fill out the Culture Free Self-Esteem Inventory and the Contour Drawing Rating Scale (body dissatisfaction). Trained assessors then weighed and measured the students individually. RESULTS: Overall, 50.5% of girls wanted a thinner shape compared with 35.9% of boys. More boys wanted a larger shape compared with girls (21.1% vs 7.2%). Most of the preadolescents who were overweight or obese were unsatisfied whereas 58.0% of girls and 41.6% of boys who were underweight were satisfied with their body. Results of a multinomial logistic regression revealed that age, sex, body mass index, perceived shape, and self-esteem were significant correlates of the 4 body dissatisfaction contrasts (wanting a slightly thinner, much thinner, slightly larger, and much larger shape) and explained 50% of the variance. An interaction between sex and perceived shape was found, revealing that girls who perceived themselves as having a larger shape were more likely to desire a thinner shape than boys. CONCLUSIONS: The high prevalence rate of body dissatisfaction among children suggests that current approaches in our society to prevent problems related to body image must be improved. The different results between girls and boys highlight the need to take into account sex differences when designing prevention programs that aim to decrease body dissatisfaction.

Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change.

BACKGROUND: Variation in effectiveness of continuous quality improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to inform effective implementation in different settings. In this paper, we explore how patterns of change in delivery of services may have been achieved in a diverse range of health centers participating in a wide-scale program to achieve improvements in quality of care for Indigenous Australians. METHODS: We elicited key informants' interpretations of factors explaining patterns of change in delivery of guideline-scheduled services over three or more years of a wide-scale CQI project, and inductively analyzed these interpretations to propose fine-grained realist hypotheses about what works for whom and in what circumstances. Data were derived from annual clinical audits from 36 health centers operating in diverse settings, quarterly project monitoring reports, and workshops with 12 key informants who had key roles in project implementation. We abstracted potential context-mechanism-outcome configurations from the data, and based on these, identified potential program-strengthening strategies. RESULTS: Several context-specific, mechanism-based explanations for effectiveness of this CQI project were identified. These were collective valuing of clinical data for improvement purposes; collective efficacy; and organizational change towards a population health orientation. Health centers with strong central management of CQI, and those in which CQI efforts were more dependent on local health center initiative and were adapted to resonate with local priorities were both favorable contexts for collective valuing of clinical data. Where health centers had prior positive experiences of collaboration, effects appeared to be achieved at least partly through the mechanism of collective efficacy. Strong community linkages, staff ability to identify with patients, and staff having the skills and support to take broad ranging action, were favorable contexts for the mechanism of increased population health orientation. CONCLUSIONS: Our study provides evidence to support strategies for program strengthening described in the literature, and extends the understanding of mechanisms through which strategies may be effective in achieving particular outcomes in different contexts.

Impact of parental emotional support and coercive control on adolescents' self-esteem and psychological distress: results of a four-year longitudinal study.

This study aims at investigating the impact of parental practices on youths' adjustment. In all, 605 adolescents completed questionnaires at ages 14, 16 and 18. Self-esteem, psychological distress as well as parental emotional support and coercive control were measured. Analyses based on individual growth models revealed that self-esteem increased with age, but psychological distress remained stable over time. Boys reported higher levels of self-esteem and lower levels of psychological distress than girls. Maternal and paternal emotional support reinforced self-esteem over time. Maternal coercive control undermined self-esteem, but only at ages 16 and 18. Psychological distress decreased with parental emotional support but increased with parental coercive control at ages 14, 16 and 18. Overall, these results indicate that positive parental practices are related to youths' well-being. These findings support the importance of establishing intervention strategies designed to promote best practices among parents of teenagers to help them develop into well-adjusted adults.