We investigated the concentration of trihalomethanes （THMs） in tap water and swimming pool water in the area of the Nakhon Path- om Municipality during the period April 2005-March 2006. The concentrations of total T...We investigated the concentration of trihalomethanes （THMs） in tap water and swimming pool water in the area of the Nakhon Path- om Municipality during the period April 2005-March 2006. The concentrations of total THMs, chloroform, bromodichloromethane, dibromochloromethane and bromoform in tap water were 12.70-41.74, 6.72-29.19, 1.12-11.75, 0.63-3.55 and 0.08-3.40 μg/L, respectively, whereas those in swimming pool water were 26.15-65.09, 9.50-36.97, 8.90-18.01, 5.19-22.78 and ND-6.56 μg/L, respectively. It implied that the concentration of THMs in swimming pool water was higher than those in tap water, particularly, brominated-THMs. Both tap water and swimming pool water contained concentrations of total THMs below the standards of the World Health Organization （WHO）, European Union （EU） and the United States Environmental Protection Agency （USEPA） phase Ⅰ, but 1 out of 60 tap water samples and 60 out of 72 swimming pool water samples contained those over the Standard of the USEPA phase Ⅱ. From the two cases of cancer risk assessment including Case Ⅰ Non-Swimmer and Case Ⅱ Swimmer, assessment of cancer risk of nonswimmers from exposure to THMs at the highest and the average concentrations was 4.43×10^-5 and 2.19×10^-5, respectively, which can be classified as acceptable risk according to the Standard of USEPA. Assessment of cancer risk of swimmers from exposure to THMs at the highest and the average concentrations was 1.47×10^-3 and 7.99×10^-4, respectively, which can be classified as unacceptable risk and needs to be improved. Risk of THMs exposure from swimming was 93.9%-94.2% of the total risk. Cancer risk of THMs concluded from various routes in descending order was： skin exposure while swimming, gastro-intestinal exposure from tap water intake, and skin exposure to tap water and gastro-intestinal exposure while swimming. Cancer risk from skin exposure while swimming was 94.18% of the total cancer risk.展开更多
Health is important to economic development, and economic development has an important impact on health outcomes. Health Expenditure makes up a substantial part of the global economy. In the world, the costs of health...Health is important to economic development, and economic development has an important impact on health outcomes. Health Expenditure makes up a substantial part of the global economy. In the world, the costs of healthcare are increasing;patients are compelled to pay more for treatment, and that makes a lot of people faced to Catastrophic Health Expenditures (CHE) and in long run fall below the poverty line. One of the most urgent and vexing challenges faced by many low- and middle-income countries is how to provide health care for the more than two billion poor people who live in these areas (developing countries). As much as more than 65% (in 2014) of total private health care expenditure in low-income countries comes from out-of-pocket payment by patients. In addition, according to World Bank report (2007), in low and lower middle-income countries was speared nearly 13% of global health spending with 87% the global disease burden. The WHO considers health financing models with high risk pooled, such as health insurance and prepaid schemes, a promising means for achieving universal health-care coverage and promotion health care. A crucial concept in health financing is that of pooling. The WHO defines risk-pooling as the “accumulation and management of revenues in such a way as to ensure that the risk of having to pay for health care is borne by all members of the pool and not by each contributor individually”. The larger degree of pooling, the less people will have to bear the health financial risks. Furthermore, adopting and operating financing policies based on greeter risk pooling/sharing (prepayments) are recommended to all countries (especially in low and lower-middle income countries). It means risk sharing/pooling plays a key role in all financing systems for achieving effectiveness and efficiency health systems.展开更多
Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medi...Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medical literature. Unfortunately, when conflicting guidelines for a specific disease are published, confusion results. Purpose: This article provides a suggested guideline outcome measure that would benefit the physician and patient. Methods: A review of 19 different guidelines for cardiovascular disease treatment is one example of the lack of specific outcomes that currently exist. The basic problem with most guidelines is that they do not state the expected end result (i.e., the benefit to the patient) if that guideline is followed. When guidelines use cardiovascular disease risk factors to dictate therapy, the end benefit is never stated so that the patient can make an appropriate choice of which (if any) guideline to follow. Results: A good example is guidelines published by the American Heart Association for reducing cardiovascular disease. These guidelines are risk factor based and only indicate that cardiovascular disease would be reduced if followed. No specific percentage in the reduction of the incidence of disease is given. In contrast, when elimination of the disease is the stated goal of the guideline, the end result is clear. To date, this goal has been stated by only one organization devoted to eliminating cardiovascular disease. Conclusion: Guidelines need to be written to provide the physician and the patient with a specific end point that is expected when the guideline is followed. Patient acceptance and compliance will be much improved if the patient knows the risk/benefit of following the guideline’s recommendations.展开更多
文摘We investigated the concentration of trihalomethanes （THMs） in tap water and swimming pool water in the area of the Nakhon Path- om Municipality during the period April 2005-March 2006. The concentrations of total THMs, chloroform, bromodichloromethane, dibromochloromethane and bromoform in tap water were 12.70-41.74, 6.72-29.19, 1.12-11.75, 0.63-3.55 and 0.08-3.40 μg/L, respectively, whereas those in swimming pool water were 26.15-65.09, 9.50-36.97, 8.90-18.01, 5.19-22.78 and ND-6.56 μg/L, respectively. It implied that the concentration of THMs in swimming pool water was higher than those in tap water, particularly, brominated-THMs. Both tap water and swimming pool water contained concentrations of total THMs below the standards of the World Health Organization （WHO）, European Union （EU） and the United States Environmental Protection Agency （USEPA） phase Ⅰ, but 1 out of 60 tap water samples and 60 out of 72 swimming pool water samples contained those over the Standard of the USEPA phase Ⅱ. From the two cases of cancer risk assessment including Case Ⅰ Non-Swimmer and Case Ⅱ Swimmer, assessment of cancer risk of nonswimmers from exposure to THMs at the highest and the average concentrations was 4.43×10^-5 and 2.19×10^-5, respectively, which can be classified as acceptable risk according to the Standard of USEPA. Assessment of cancer risk of swimmers from exposure to THMs at the highest and the average concentrations was 1.47×10^-3 and 7.99×10^-4, respectively, which can be classified as unacceptable risk and needs to be improved. Risk of THMs exposure from swimming was 93.9%-94.2% of the total risk. Cancer risk of THMs concluded from various routes in descending order was： skin exposure while swimming, gastro-intestinal exposure from tap water intake, and skin exposure to tap water and gastro-intestinal exposure while swimming. Cancer risk from skin exposure while swimming was 94.18% of the total cancer risk.
文摘Health is important to economic development, and economic development has an important impact on health outcomes. Health Expenditure makes up a substantial part of the global economy. In the world, the costs of healthcare are increasing;patients are compelled to pay more for treatment, and that makes a lot of people faced to Catastrophic Health Expenditures (CHE) and in long run fall below the poverty line. One of the most urgent and vexing challenges faced by many low- and middle-income countries is how to provide health care for the more than two billion poor people who live in these areas (developing countries). As much as more than 65% (in 2014) of total private health care expenditure in low-income countries comes from out-of-pocket payment by patients. In addition, according to World Bank report (2007), in low and lower middle-income countries was speared nearly 13% of global health spending with 87% the global disease burden. The WHO considers health financing models with high risk pooled, such as health insurance and prepaid schemes, a promising means for achieving universal health-care coverage and promotion health care. A crucial concept in health financing is that of pooling. The WHO defines risk-pooling as the “accumulation and management of revenues in such a way as to ensure that the risk of having to pay for health care is borne by all members of the pool and not by each contributor individually”. The larger degree of pooling, the less people will have to bear the health financial risks. Furthermore, adopting and operating financing policies based on greeter risk pooling/sharing (prepayments) are recommended to all countries (especially in low and lower-middle income countries). It means risk sharing/pooling plays a key role in all financing systems for achieving effectiveness and efficiency health systems.
文摘Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medical literature. Unfortunately, when conflicting guidelines for a specific disease are published, confusion results. Purpose: This article provides a suggested guideline outcome measure that would benefit the physician and patient. Methods: A review of 19 different guidelines for cardiovascular disease treatment is one example of the lack of specific outcomes that currently exist. The basic problem with most guidelines is that they do not state the expected end result (i.e., the benefit to the patient) if that guideline is followed. When guidelines use cardiovascular disease risk factors to dictate therapy, the end benefit is never stated so that the patient can make an appropriate choice of which (if any) guideline to follow. Results: A good example is guidelines published by the American Heart Association for reducing cardiovascular disease. These guidelines are risk factor based and only indicate that cardiovascular disease would be reduced if followed. No specific percentage in the reduction of the incidence of disease is given. In contrast, when elimination of the disease is the stated goal of the guideline, the end result is clear. To date, this goal has been stated by only one organization devoted to eliminating cardiovascular disease. Conclusion: Guidelines need to be written to provide the physician and the patient with a specific end point that is expected when the guideline is followed. Patient acceptance and compliance will be much improved if the patient knows the risk/benefit of following the guideline’s recommendations.
