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Shanmugam H, Baum CF, Hawkins SS. Association of State Drug Laws with Nonmedical Use of Prescription Medications in Adolescents. J Addict Med 2023; 17:708-710. [PMID: 37934537 DOI: 10.1097/adm.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of the study is to examine the associations between mandatory access prescription drug monitoring programs (PDMPs), pain management clinic (PMC) laws, and doctor shopping (DS) laws with adolescent nonmedical use of prescription medications (NUPM). METHODS We linked 2011-2015 Youth Risk Behavior Survey data on 364,103 adolescents across 40 states with PDMP, PMC laws, and DS laws. We conducted a 2-way fixed effects logistic regression model to examine the associations between state drug laws and adolescent self-reported NUPM. RESULTS We found some evidence that implementation of a mandatory access PDMP was associated with a decrease in nonmedical use of prescription drugs at the P = 0.079 level (average marginal effect: -0.017, 95% confidence interval = -0.036 to 0.002), while there were no associations with the implementation of PMC and DS laws. CONCLUSIONS Our findings suggest that current state drug laws to combat NUPM are inadequate for adolescents.
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Affiliation(s)
- Hariharan Shanmugam
- From the Carroll School of Management, Boston College, Chestnut Hill, MA (HS); Department of Biology, Boston College, Chestnut Hill, MA (HS); School of Social Work, Boston College, Chestnut Hill, MA (CFB, SSH); Department of Economics, Boston College, Chestnut Hill, MA (CFB); and Department of Macroeconomics, German Institute for Economic Research (DIW Berlin), Berlin, Germany (CFB)
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Shanmugam H, Mérida-Ortega Á, Cebrián ME, Gamboa-Loira B, López-Carrillo L. Dietary fiber intake and urinary creatinine: methodological implications for epidemiological studies. Environ Sci Pollut Res Int 2021; 28:29643-29649. [PMID: 33569685 DOI: 10.1007/s11356-021-12379-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Creatinine values are used to estimate renal function and to correct for urinary dilution in exposure assessment studies. Interindividual variability in urinary creatinine (UCR) is determined positively by protein intake and negatively by age and diabetes. These factors, among others, need to be accounted for, to increase comparability throughout epidemiological studies. Recently, dietary fiber has been shown to improve renal function. This study aims to evaluate dietary fiber intake relationship with UCR and its methodological implications for studies using UCR-corrected measurements. In a cross-sectional study, we analyzed information regarding UCR, dietary fiber, age, and other UCR-related factors in 801 women residing in Northern Mexico during 2007-2009. The median fiber intake in this population was 33.14 g/day, above the adequate intake level for women > 18 years. We estimated an age-adjusted increase of 10.04 mg/dL UCR for a 10 g/day increase in dietary fiber intake. The main dietary sources of fiber in this population were corn tortillas, raw onions, flour tortillas, and beans. Our results suggest that epidemiological studies adjusting analytes by UCR should also consider controlling dietary fiber intake to improve the comparability of creatinine-corrected values and associations across different populations, such as those in Mexico and Latin America, where protein and fiber intake vary significantly.
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Affiliation(s)
- Hariharan Shanmugam
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, Santa María Ahuacatitlán, C.P, 62100, Cuernavaca, Morelos, Mexico
- Department of Biology, Boston College, MA, USA
| | - Ángel Mérida-Ortega
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, Santa María Ahuacatitlán, C.P, 62100, Cuernavaca, Morelos, Mexico
| | - Mariano E Cebrián
- Department of Toxicology, CINVESTAV-IPN, Av, Instituto Politécnico Nacional 2508, San Pedro Zacatenco, C.P, 07360, Ciudad de México, Mexico
| | - Brenda Gamboa-Loira
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, Santa María Ahuacatitlán, C.P, 62100, Cuernavaca, Morelos, Mexico
| | - Lizbeth López-Carrillo
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, Santa María Ahuacatitlán, C.P, 62100, Cuernavaca, Morelos, Mexico.
- Instituto Nacional de Salud Pública, Av Universidad 655, Santa María Ahuacatitlán C.P, 62100, Cuernavaca, Morelos, Mexico.
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Landrigan PJ, Stegeman JJ, Fleming LE, Allemand D, Anderson DM, Backer LC, Brucker-Davis F, Chevalier N, Corra L, Czerucka D, Bottein MYD, Demeneix B, Depledge M, Deheyn DD, Dorman CJ, Fénichel P, Fisher S, Gaill F, Galgani F, Gaze WH, Giuliano L, Grandjean P, Hahn ME, Hamdoun A, Hess P, Judson B, Laborde A, McGlade J, Mu J, Mustapha A, Neira M, Noble RT, Pedrotti ML, Reddy C, Rocklöv J, Scharler UM, Shanmugam H, Taghian G, van de Water JA, Vezzulli L, Weihe P, Zeka A, Raps H, Rampal P. Human Health and Ocean Pollution. Ann Glob Health 2020; 86:151. [PMID: 33354517 PMCID: PMC7731724 DOI: 10.5334/aogh.2831] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Pollution - unwanted waste released to air, water, and land by human activity - is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood. Goals (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health. Methods Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention. Environmental Findings Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources - coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths. Ecosystem Findings Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks. Human Health Findings Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children's risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals - phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste - can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South - environmental injustice on a planetary scale. Conclusions Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth's resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted.Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored.Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries. Recommendations World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health.Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress.Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries.Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas.
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Affiliation(s)
| | - John J. Stegeman
- Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | - Lora E. Fleming
- European Centre for Environment and Human Health, GB
- University of Exeter Medical School, GB
| | | | - Donald M. Anderson
- Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | | | | | - Nicolas Chevalier
- Université Côte d’Azur, FR
- Centre Hospitalier Universitaire de Nice, Inserm, C3M, FR
| | - Lilian Corra
- International Society of Doctors for the Environment (ISDE), CH
- Health and Environment of the Global Alliance on Health and Pollution (GAHP), AR
| | | | - Marie-Yasmine Dechraoui Bottein
- Intergovernmental Oceanographic Commission of UNESCO, FR
- IOC Science and Communication Centre on Harmful Algae, University of Copenhagen, DK
- Ecotoxicologie et développement durable expertise ECODD, Valbonne, FR
| | - Barbara Demeneix
- Centre National de la Recherche Scientifique, FR
- Muséum National d’Histoire Naturelle, Paris, FR
| | | | - Dimitri D. Deheyn
- Scripps Institution of Oceanography, University of California San Diego, US
| | | | - Patrick Fénichel
- Université Côte d’Azur, FR
- Centre Hospitalier Universitaire de Nice, Inserm, C3M, FR
| | | | | | | | | | | | | | - Mark E. Hahn
- Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | | | - Philipp Hess
- Institut Français de Recherche pour l’Exploitation des Mers, FR
| | | | | | - Jacqueline McGlade
- Institute for Global Prosperity, University College London, GB
- Strathmore University Business School, Nairobi, KE
| | | | - Adetoun Mustapha
- Nigerian Institute for Medical Research, Lagos, NG
- Imperial College London, GB
| | | | | | | | - Christopher Reddy
- Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, US
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, SE
| | | | | | | | | | | | - Pál Weihe
- University of the Faroe Islands and Department of Occupational Medicine and Public Health, FO
| | | | - Hervé Raps
- Centre Scientifique de Monaco, MC
- WHO Collaborating Centre for Health and Sustainable Development, MC
| | - Patrick Rampal
- Centre Scientifique de Monaco, MC
- WHO Collaborating Centre for Health and Sustainable Development, MC
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Tay Za K, Jayaranee S, Shanmugam H. Practice and performance of lupus anticoagulant tests: A single centre experience. Malays J Pathol 2020; 42:51-57. [PMID: 32342930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Lupus anticoagulant (LA) is a well-known risk factor for thrombosis. Correct diagnosis of LA is essential in patient management with anticoagulation. The objectives of this study were to document the clinical and laboratory characteristics of patients tested for LA and to evaluate existing LA testing methods in our laboratory with the aim of improving the performance of LA test interpretation and reporting. METHODS Tests for LA include dilute Russell's viper venom time (dRVVT) and Kaolin clotting time (KCT). Patients with LA ratio (dRVVT screen ratio/dRVVT confirm ratio) of ≥1.2 were considered as LA positive irrespective of KCT results. KCT was considered positive if there was a prolongation in KCT screening test which was not corrected on mixing with normal plasma. RESULTS Of 577 patients' results, 295 were normal, 178 were KCT positive with negative dRVVT and 104 were LA positive. Incidences of thrombosis, connective tissue disease (CTD) and bad obstetric events were noted in 13%, 16% and 44% of normal patients, 9%, 22% and 49% of KCT+ patients and 23%, 37% and 17% of LA+ patients respectively. On further evaluation of dRVVT screen ratios, 431 had a ratio of <1.1, 59 had a ratio between 1.1 and 1.2 and 87 had a ratio of >1.2. Positive LA results were found in 3%, 29% and 87% of patients with dRVVT screen ratios of <1.1, 1.1 - 1.2 and >1.2 respectively. CONCLUSION LA+ patients had higher incidences of thrombosis and CTD as compared to normal and KCT only positive patients. There was no significant difference in clinical characteristics between normal and KCT+ patients which suggests the presence of a high rate of false-positive KCT results. Since confirmatory testing for KCT is not widely used, the option of using another LA screening test method should be considered. In regard to dRVVT testing, confirmatory test should only be performed in patients with prolonged dRVVT screening result which was not corrected upon mixing with normal plasma as required by the International Society of Thrombosis and Haemostasis guidelines on LA testing. This practice will not only result in significant cost reduction but also avoid diagnostic confusion.
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Affiliation(s)
- K Tay Za
- University Malaya Medical Centre, Department of Pathology, Division of Laboratory Medicine, Kuala Lumpur, Malaysia.
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Niviethitha S, Bhawarlal C, Ramkumar H, Dhakshanamoorthy S, Shanmugam H. Effectiveness of an audio-visual aid on the knowledge of school teachers regarding the emergency management of dental injuries. Dent Traumatol 2018; 34:290-296. [PMID: 29676046 DOI: 10.1111/edt.12405] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Traumatic dental injuries (TDI) occur frequently in the school environment. Many studies have shown that teachers' knowledge on the emergency management of TDI is inadequate. The aim of this study was to evaluate the knowledge level among schoolteachers in Chennai, India, regarding TDI using a questionnaire and to evaluate the effectiveness of a newly developed audio-visual aid (AV) as an educational tool by reapplying the questionnaire. METHODS The questionnaire was distributed to 345 teachers in 15 randomly selected schools. A pro forma document along with the questionnaire surveyed the teachers' demographic details and their knowledge regarding the emergency management of TDI. Then, a video containing evidence-based information about the emergency management of TDI in accordance with the American Academy of Pediatric Dentistry (AAPD) guidelines was played for the participants. The questionnaire was readministered to test the teachers' knowledge after they viewed the video. RESULTS In total, 301 teachers responded to the questionnaire. Wilcoxon's signed-rank test/chi-square test showed that, after the teachers viewed the video, their knowledge had significantly improved relative to the handling of TDI (P < .0001). Their attitude towards the AV aid was positive, and all participants (100%) found the AV helpful. Almost 99.7% of the participants reported increased confidence in handling dental injuries. CONCLUSION There is a substantial lack of basic knowledge regarding the emergency TDI management among schoolteachers. The proposed AV aid is an effective tool for providing management strategies.
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Affiliation(s)
- Sabarinathan Niviethitha
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, SRM University, Chennai, Tamil Nadu, India
| | - Chanram Bhawarlal
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, SRM University, Chennai, Tamil Nadu, India
| | - Hemalatha Ramkumar
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, SRM University, Chennai, Tamil Nadu, India
| | - Senthil Dhakshanamoorthy
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, SRM University, Chennai, Tamil Nadu, India
| | - Hariharan Shanmugam
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, SRM University, Chennai, Tamil Nadu, India
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Nadarajan V, Shanmugam H, Sthaneshwar P, Jayaranee S, Sultan KS, Ang C, Arumugam S. Modification to reporting of qualitative fluorescent spot test results improves detection of glucose-6-phosphate dehydrogenase (G6PD)-deficient heterozygote female newborns. Int J Lab Hematol 2011; 33:463-70. [PMID: 21501392 DOI: 10.1111/j.1751-553x.2011.01309.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The glucose-6-phosphate dehydrogenase (G6PD) fluorescent spot test (FST) is a useful screening test for G6PD deficiency, but is unable to detect heterozygote G6PD-deficient females. We sought to identify whether reporting intermediate fluorescence in addition to absent and bright fluorescence on FST would improve identification of mildly deficient female heterozygotes. METHODS A total of 1266 cord blood samples (705 male, 561 female) were screened for G6PD deficiency using FST (in-house method) and a quantitative enzyme assay. Fluorescence intensity of the FST was graded as either absent, intermediate or normal. Samples identified as showing absent or intermediate fluorescence on FST were analysed for the presence of G6PD mutations using TaqMan@SNP genotyping assays and direct nucleotide sequencing. RESULTS Of the 1266 samples, 87 samples were found to be intermediate or deficient by FST (49 deficient, 38 intermediate). Of the 49 deficient samples, 48 had G6PD enzyme activity of ≤ 9.5 U/g Hb and one sample had normal enzyme activity. All 38 intermediate samples were from females. Of these, 21 had G6PD activity of between 20% and 60%, and 17 samples showed normal G6PD activity. Twenty-seven of the 38 samples were available for mutation analysis of which 13 had normal G6PD activity. Eleven of the 13 samples with normal G6PD activity had identifiable G6PD mutations. CONCLUSION Glucose-6-phosphate dehydrogenase heterozygote females cannot be identified by FST if fluorescence is reported as absent or present. Distinguishing samples with intermediate fluorescence from absent and bright fluorescence improves detection of heterozygote females with mild G6PD deficiency. Mutational studies confirmed that 85% of intermediate samples with normal enzyme activity had identifiable G6PD mutations.
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Affiliation(s)
- V Nadarajan
- Department of Pathology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia Division of Laboratory Medicine, Department of Pathology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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