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Kaiser Permanente is the largest managed care organization in the country. It also happens to have the largest and most complex labor-management partnership ever created in the United States. This book tells the story of that partnership-how it started, how it grew, who made it happen, and the lessons to be learned from its successes and complications. With twenty-seven unions and an organization as complex as 8.6-million-member Kaiser Permanente, establishing the partnership was not a simple task and maintaining it has proven to be extraordinarily challenging. Thomas A. Kochan, Adrienne E. Eaton, Robert B. McKersie, and Paul S. Adler are among a team of researchers who have been tracking the evolution of the partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions ever since 2001. They review the history of health care labor relations and present a profile of Kaiser Permanente as it has developed over the years. They then delve into the partnership, discussing its achievements and struggles, including the negotiation of the most innovative collective bargaining agreements in the history of American labor relations.Healing Togetherconcludes with an assessment of the Kaiser partnership's effect on the larger health care system and its implications for labor-management relations in other industries.

Objectives: To evaluate the prevalence of perception and annoyance due to wind turbine noise among people living near the turbines, and to study relations between noise and perception/annoyance, with focus on differences between living environments. Methods: A cross-sectional study was carried out in seven areas in Sweden across dissimilar terrain and different degrees of urbanisation. A postal questionnaire regarding living conditions including response to wind turbine noise was completed by 754 subjects. Outdoor A-weighted sound pressure levels (SPLs) were calculated for each respondent. Perception and annoyance due to wind turbine noise in relation to SPLs was analysed with regard to dissimilarities between the areas. Results: The odds of perceiving wind turbine noise increased with increasing SPL (OR 1.3; 95% CI 1.25 to 1.40). The odds of being annoyed by wind turbine noise also increased with increasing SPLs (OR 1.1; 95% CI 1.01 to 1.25). Perception and annoyance were associated with terrain and urbanisation: (1) a rural area increased the risk of perception and annoyance in comparison with a suburban area; and (2) in a rural setting, complex ground (hilly or rocky terrain) increased the risk compared with flat ground. Annoyance was associated with both objective and subjective factors of wind turbine visibility, and was further associated with lowered sleep quality and negative emotions. Conclusion: There is a need to take the unique environment into account when planning a new wind farm so that adverse health effects are avoided. The influence of area-related factors should also be considered in future community noise research.

The built environment significantly affects the public’s health. This was most obvious when infectious disease was the primary public health threat during the industrial revolution; unsanitary conditions and overcrowded urban areas facilitated the spread of infection. However, even today in the age of chronic diseases there remains an important connection between population health and the built environment. Physical spaces can expose people to toxins or pollutants and influence lifestyles that contribute to diabetes, coronary vascular disease, and asthma. Public health advocates can help shape the design of cities and suburbs in ways that improve public health, but to do so effectively they need to understand the legal framework. This article reviews the connection between public health and the built environment and then describes the legal pathways for improving the design of our built environment.

Coastal settlements tend to have higher population density and economic clustering compared to inland territories. The tendency of an increasing socio-economic disbalance in favor of coastal spaces – the coastalization, has attracted the attention of the global academic community. Numerous assumptions are made on the cause of the coastalization phenomenon with the maritime activity and tourism being the primary ones. The aim of this study is to evaluate the role of the coast and tourist seaport infrastructure in the distribution of the population and tourist accommodations in cities across different sea basins of Europe. The research design implies verification of the two hypotheses: the area around the tourist seaport will have H1. The highest population density and H2. The highest density of collective accommodation facilities (CAFs) in the coastal zone of the municipality, decreasing with distance. The methodology has a two-stage structure. Firstly, the quantitative evaluation is done to allocate the tourist seaports of 28 European countries using MarineTraffic database and measure the density of population and CAFs by territorial zones using statistics. Secondly, the qualitative assessment is done presenting highlights of case studies by four sea basins (Baltic Sea, Black and Azov Sea, Northeast Atlantic Ocean, Celtic Sea, and Mediterranean Sea) and six sub-basins. 43 seaports of Europe specialize on tourism (over 90% of inbound ships). Most tourist seaports belong to the Mediterranean basin (58.1%), followed by the basin of the Northeast Atlantic Ocean (25.6%), the Azov-Black (11.6%) and Baltic (4.7%) sea basins. Cities with the tourist seaports are represented by a variety population sizes: from under 50 thousand people to over a million. Despite the differences across sea basins, the general pattern suggests a decline of population density and CAFs with the distance from the tourist seaport. Tourist seaports act as the nuclei of coastalization in Europe. The spatial proximity to the seaport has a positive influence on the density of population – the highest in the territorial zone of 2-5 km distance from the seaport, and an even higher effect on the concentration of CAFs – the highest numbers up to 1 km of the tourist seaport. We should note that population structure and tourism activity of some smaller cities are skewed towards larger adjacent cities, with the agglomeration effect outbreaking the role of the seaport.

Eight Polybrominated diphenyl ether (PBDE) congeners (BDE 28, 47, 99, 100, 153, 154, 183 and 209) were determined to examine the hair burden at low concentrations, and the relationship between PBDE concentrations in human hair and indoor dust from a college environment (Shanghai University campus). Chemical analyses showed that the total concentrations of PBDEs in hair ranged from 4.04 to 99 ng/g dw, and were found to be fourfold higher in females than in males ( p  < 0.05). The total PBDEs concentrations in indoor dust samples ranged from 170 to 1,360 ng/g dw. Significantly positive correlations were observed between human hair and indoor dust for BDE 47 (r = 0.44, p  = 0.048) and BDE 99 (r = 0.68, p  = 0.025). However, no significant association was noted between other PBDE congeners in human hair and indoor dust in the present study.

Objectives. The World Health Organization’s Regional Office for Europe has undertaken a large study to evaluate housing and health in 7 European cities. Methods. Survey tools were used to obtain information about housing and living conditions, health perception, and health status from a representative sample of the population in each city. Results. In Forli, Italy, the first city studied, preliminary findings indicate some important potential links between housing and health. Conclusions. These findings, when combined with those from the remaining European cities, will likely generate concrete recommendations for the allocation of resources to programs that can improve housing and health.

Workers in modern office buildings frequently have unexplained work-related symptoms or combinations of symptoms. We assessed whether ultraviolet germicidal irradiation (UVGI) of drip pans and cooling coils within ventilation systems of office buildings would reduce microbial contamination, and thus occupants' work-related symptoms. We undertook a double blind, multiple crossover trial of 771 participants. In office buildings in Montreal, Canada, UVGI was alternately off for 12 weeks, then turned on for 4 weeks. We did this three times with UVGI on and three times with it off, for 48 consecutive weeks. Primary outcomes of self-reported work-related symptoms, and secondary outcomes of endotoxin and viable microbial concentrations in air and on surfaces, and other environmental covariates were measured six times. Operation of UVGI resulted in 99% (95% CI 67–100) reduction of microbial and endotoxin concentrations on irradiated surfaces within the ventilation systems. 771 participants appeared to remain masked, and reported no adverse effects. On the basis of within-person estimates, use of UVGI was associated with significantly fewer work-related symptoms overall (adjusted odds ratio 0·8 [95% Cl 0·7–0·99]), as well as respiratory (0·6 [0·4–0·9]) and mucosal (0·7 [0·6–0·9]) symptoms than was non-use. Reduction of work-related mucosal symptoms was greatest among atopic workers (0·6 [0·5–0·8]), and never-smokers (0·7 [0·5–0·9]). With UVGI on, never-smokers also had large reduction of work-related respiratory (0·4 [0·2–0·9]), and musculoskeletal symptoms (0·5 [0·3–0·9]). Installation of UGVI in most North American offices could resolve work-related symptoms in about 4 million employees, caused by microbial contamination of heating, ventilation, and air-conditioning systems. The cost of UVGI installation could in the long run prove cost-effective compared with the yearly losses from absence because of building-related illness.

There is a need for a more comprehensive understanding of sanitation behaviors and determinants in the school setting to mitigate health risks, improve sanitation practices and programs, and maximize educational and health impacts. We conducted qualitative research with pupils and teachers in western Kenya to understand where pupils urinate and defecate and what factors influence location selection. Despite the availability of gender-separated latrines at all schools, pupils listed numerous locations for urination and defecation. Several physical environmental, social, and individual factors influence pupils' selection of where to urinate and defecate. Physical environment factors include condition, safety, privacy, accessibility, and availability of facilities; social factors include norms, expectations, and responsibility; and individual factors include experience, routine, risk perception, and personal needs. Students simultaneously weigh several competing factors to determine where to go. The factors that facilitate or hinder latrine use need to be taken into consideration during design, construction, operation and maintenance, if healthy habits are to be formed and sustained.

The article is aimed at studying the trends in tourism development in the regions of Ukraine. By analyzing, systematizing and generalizing statistical data and research works of many scientists, the author considers the state and trends of travel industry development in various regions of Ukraine, reveals problems in regional tourism development, substantiates areas of travel industry development in Ukraine, in general, and its regions, in particular. As a result of the study, current trends in tourism development in the regions of Ukraine are outlined, namely: the revival of tourism alternates with recessions; Ukraine’s image remains uncertain in the global market environment; the outbound tourist flow prevails over the inbound one; the private tourism share is the largest one in the structure of tourist flows both from Ukraine and to Ukraine; the neighboring countries share is the largest one in the geographical structure of tourist flows; tourism is most developed in the following regions of Ukraine: the city of Kyiv and Kyiv, Lviv, Dnipropetrovsk, Odesa and Zaporizhzhia regions; tourism is least developed in Luhansk, Kirovohrad, Zhytomyr, Ternopil, Rivne, and Sumy regions. The study reveals such problems of tourism development in the regions of Ukraine: logistics imperfection; ignoring environmental, sanitary and epidemiological issues; non-transparency of tourism business; social and political instability; global coronavirus pandemic; lack of effective demand, etc. The research in question has made it possible to determine such prospects for developing travel industry in the regions of Ukraine: the achievement of European and world standards for the ratio of service quality and prices for tourism services; adaptation of regulatory and legislative acts of the travel industry to the standards accepted in the European and world community; attracting investment in the tourism business; creation of an attractive tourist image of the regions and promotion of regional tourist products in the national and international tourist markets; development of the infrastructure of regional tourist markets, etc.

This paper comments upon three concepts that on first inspection appear to be unrelated. Social capital, segregation, and collective facilities do, in an urban setting, determine individuals’ quality of life. As such, this paper describes the link that collective equipment has as a guarantor for the construction of social capital, which is an asset that that is seriously affected in a context that tends towards segregation.