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Herttua K, Thapa S, Ahrenfeldt LJ, Paljarvi T. The role of modifiable risk factors in incident cancer in transport, rescue, and security industries. Ann Epidemiol 2023; 83:71-77.e1. [PMID: 37100100 DOI: 10.1016/j.annepidem.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries. METHODS This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature. RESULTS During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer. CONCLUSIONS Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes.
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Affiliation(s)
- Kimmo Herttua
- Center of Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark.
| | - Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Herttua K, Crawford M, Paljarvi T, Fazel S. Associations between antipsychotics and risk of violent crimes and suicidal behaviour in personality disorder. Evid Based Ment Health 2022; 25:e58-e64. [PMID: 36283800 PMCID: PMC9811101 DOI: 10.1136/ebmental-2022-300493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite uncertain benefits, people with personality disorder are commonly treated with antipsychotic medication. OBJECTIVE To investigate the association between antipsychotics and violent crimes and suicidal behaviour in individuals with personality disorder. METHODS We used nationwide Danish registries to identify all individuals with diagnosed personality disorder aged 18-64 years during 2007 to 2016. Antipsychotics were recorded in dispensed prescriptions, and individuals were followed up for police-recorded suspicions for violent crimes and healthcare presentations of suicidal behaviour. We applied a within-individual design where outcome rates for individuals with personality disorder during medicated periods were compared with rates during non-medicated periods. FINDINGS The cohort included 166 328 people with diagnosed personality disorder, of whom 79 253 were prescribed antipsychotics, presented at least one outcome and were thus included in the within-individual analyses. Compared with periods when individuals were not on antipsychotic medication, violent crime suspicions were 40% lower (incident rate ratio (IRR) 0.60, 95% CI 0.55 to 0.63) in men and 10% lower (IRR 0.90, 95% CI 0.79 to 1.01) in women, while rates of suicidal behaviour were 32% lower both in men (IRR 0.68, 95% CI 0.66 to 0.71) and in women (IRR 0.68, 95% CI 0.65 to 0.70). In subgroup analyses, the magnitude of the association varied across specific personality disorders for criminal outcomes but less for suicidal behaviour, with largest association in dissocial personality disorder for violent criminality (IRR 0.53, 95% CI 0.47 to 0.59). CONCLUSIONS Treatment with antipsychotics was associated with reduced risks for violent crime suspicions and suicidal behaviour among individuals with personality disorder. CLINICAL IMPLICATIONS Potential effects of antipsychotics on suicidal behaviour and violence should be taken into account when considering treatment options for people with personality disorders.
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Affiliation(s)
- Kimmo Herttua
- Public Health, University of Southern Denmark - Campus Esbjerg, Esbjerg, Denmark
| | - Mike Crawford
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Tapio Paljarvi
- Psychiatry, Oxford University, Oxford, UK
- Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Seena Fazel
- Psychiatry, University of Oxford, Oxford, UK
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Herttua K, Paljarvi T, Ahrenfeldt LJ. Modifiable risk factors and cancer mortality in transport, rescue, and security industries. Ann Epidemiol 2022; 75:32-38. [PMID: 36075496 DOI: 10.1016/j.annepidem.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We investigated the risk of mortality from cancers attributable to modifiable risk factors across representative transport, rescue, and security industries. METHODS We used nationwide Danish registries to identify all 307,605 workers from these industries from 2001 through 2015 and 2,278,363 other economically active individuals aged 18-64 years at the baseline for comparison. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for site-specific cancer deaths were calculated using Cox regression. Site-specific cancers were categorized by using population-attributable fraction (PAF) estimates derived from the previous literature. RESULTS During an average follow-up of 12.8 years, 5977 cancer deaths were registered in these industries. Cancer mortality with a high proportion of avoidable deaths (i.e., high PAF) was elevated in male seafarers (1.37; 1.16-1.62), in men of land transport (1.44; 1.35-1.52), in women of land transport (1.51; 1.29-1.77), and in women of defense forces (1.43; 1.13-1.81). In contrast, cancer mortality with a high PAF was reduced in men of police force (0.63; 0.51-0.78). The total cancer mortality was higher in seafarers (1.24; 1.12-1.37), workers in land transport (1.31; 1.27-1.36), and workers in defense forces (1.14; 1.07-1.22). CONCLUSIONS We observed considerable cancer mortality disparities associated with modifiable risk factors across transport, rescue, and security industries.
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Affiliation(s)
- Kimmo Herttua
- Center of Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark.
| | - Tapio Paljarvi
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Linda J Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Fazel S, Paljarvi T. Response to 'Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data': reply from authors. Br J Dermatol 2022; 187:450-451. [PMID: 35482467 DOI: 10.1111/bjd.21626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Seena Fazel
- Department of Psychiatry, Warneford Hospital, Oxford University, Oxford, UK
| | - Tapio Paljarvi
- Department of Psychiatry, Warneford Hospital, Oxford University, Oxford, UK
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
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Abstract
IMPORTANCE The evidence base for the association between montelukast and adverse neuropsychiatric outcomes is mixed and inconclusive. Several methodological limitations have been identified in the evidence base on the safety of montelukast in observational studies. OBJECTIVE To investigate the association between new montelukast exposure and 1-year incident neuropsychiatric diagnoses with improved precision and control for baseline confounders. DESIGN, SETTING, AND PARTICIPANTS This propensity score-matched cohort study was conducted using electronic health records from 2015 to 2019 in the TriNetX Analytics Network patient repository of more than 51 million patients from 56 health care organizations, mainly in the US. Included patients were those aged 15 to 64 years at index prescription for montelukast or for control prescription who had a history of asthma or allergic rhinitis. After propensity score matching for various baseline confounders, including comorbidities and dispensed prescription medicines, we included 154 946 patients, of whom 77 473 individuals were exposed to montelukast. Patients were followed up for 12 months. Data were analyzed from June through November 2021. EXPOSURES New dispensed prescription for leukotriene receptor antagonist montelukast or control medication. MAIN OUTCOMES AND MEASURES Incident neuropsychiatric diagnoses at 12 months identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. RESULTS There were 72 490 patients with asthma (44 726 [61.7%] women; mean [SD] age at index prescription, 35 [15] years) and 82 456 patients with allergic rhinitis (54 172 [65.7%] women; mean [SD] age at index prescription, 40 [14] years). In patients exposed to montelukast, the odds ratio [OR] for any incident neuropsychiatric outcome was 1.11 (95% CI, 1.04-1.19) in patients with asthma and 1.07 (95% CI, 1.01-1.14) in patients with allergic rhinitis compared with patients who were unexposed. The highest OR was for anxiety disorders (OR, 1.21; 95% CI, 1.05-1.20) among patients with asthma exposed to montelukast and insomnia (OR, 1.15; 95% CI, 1.05-1.27) among patients with allergic rhinitis exposed to montelukast. CONCLUSIONS AND RELEVANCE This study found that patients with asthma or allergic rhinitis had increased odds of adverse neuropsychiatric outcomes after montelukast initiation. These findings suggest that clinicians should consider monitoring potential adverse mental health symptoms during montelukast treatment, particularly in individuals with a history of mental health or sleep problems.
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Affiliation(s)
- Tapio Paljarvi
- Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, England, United Kingdom
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Julian Forton
- Children’s Hospital for Wales, Heath Park, Cardiff, Wales, United Kingdom
| | | | - Kimmo Herttua
- Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, England, United Kingdom
- Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, England, United Kingdom
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Paljarvi T, McPherson T, Luciano S, Herttua K, Fazel S. Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data. Br J Dermatol 2022; 187:64-72. [PMID: 35174880 PMCID: PMC9543533 DOI: 10.1111/bjd.21049] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Tapio Paljarvi
- Department of Psychiatry Oxford University Warneford Hospital, Headington OX3 7JX Oxford United Kingdom
- Department of Forensic Psychiatry University of Eastern Finland Niuvanniemi Hospital Kuopio Finland
| | - Tess McPherson
- Department of Dermatology Oxford University Hospitals OX3 9DU Oxford United Kingdom
| | - Sierra Luciano
- TriNetX LLC, 125 Cambridgepark Drive, Suite 500 Cambridge MA 02140 USA
| | - Kimmo Herttua
- Department of Public Health University of Southern Denmark Degnevej 14 DK‐6705 Esbjerg Denmark
| | - Seena Fazel
- Department of Psychiatry Oxford University Warneford Hospital, Headington OX3 7JX Oxford United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, OX3 7JX Oxford United Kingdom
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Paljarvi T, Strang J, Quinn PD, Luciano S, Fazel S. Abuse-deterrent extended-release oxycodone and risk of opioid-related harm. Addiction 2021; 116:3541. [PMID: 34553443 DOI: 10.1111/add.15667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - John Strang
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Patrick D Quinn
- Department of AppliedHealth Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | | | - Seena Fazel
- Department of Psychiatry, Oxford University, UK
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Paljarvi T, Strang J, Quinn PD, Luciano S, Fazel S. Abuse-deterrent extended-release oxycodone and risk of opioid-related harm. Addiction 2021; 116:2409-2415. [PMID: 33394528 PMCID: PMC8363193 DOI: 10.1111/add.15392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/05/2020] [Accepted: 12/23/2020] [Indexed: 01/05/2023]
Abstract
AIM To establish and quantify the association between abuse-deterrent formulation (ADF) oxycodone and 1-year risk of opioid-related harm. DESIGN Propensity score-matched cohort study of electronic medical records for years 2014-18, with patients followed up for 1 year after their index health-care visit. SETTING More than 70 million patients from 56 US health-care organizations. PARTICIPANTS Patients aged 18-64 years at index health-care visit with any indication for an oral opioid analgesic, with no past 12-month history of oral oxycodone use or substance use disorder, and who were alive at the end of the 1-year follow-up (new episode of prescription oral ADF oxycodone [OxyContin], n = 45 045; new episode of non-ADF oxycodone opioid preparation, n = 1 377 359). MEASUREMENTS International Classification of Diseases diagnoses of any opioid-related disorder or non-fatal opioid poisoning within 1 year of the index health-care visit. Pooled odds ratios (OR) with 95% confidence intervals (95% CI). FINDINGS After propensity score matching, 89 802 patients with a mean age of 44 [standard deviation (SD) = 11] years (62% women, 68% white) were included. During 1-year follow-up, 1445 diagnoses of opioid use disorder or opioid poisoning occurred in the ADF oxycodone cohort (34.8/1000 person-years) and 765 occurred in the non-ADF oxycodone cohort (18.2/1000 person-years). The odds of opioid-related adverse outcomes were increased in the ADF oxycodone cohort compared with the non-ADF oxycodone opioid cohort, including for opioid use disorders (OR = 2.02; 95% CI = 1.83, 2.23) and opioid poisoning (OR = 1.64 95% CI = 1.35, 1.99). CONCLUSIONS Patients with a new prescription of abuse-deterrent formulation oxycodone may be at increased risk of opioid-related harm.
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Affiliation(s)
- Tapio Paljarvi
- Department of Psychiatry, Oxford University, United Kingdom
| | - John Strang
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, USA
| | | | - Seena Fazel
- Department of Psychiatry, Oxford University, United Kingdom
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Herttua K, Ahrenfeldt LJ, Paljarvi T. Risk of major chronic diseases in transport, rescue and security industries: a longitudinal register-based study. Occup Environ Med 2021; 79:162-168. [PMID: 34462305 DOI: 10.1136/oemed-2021-107764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the risk of hospitalisation for major chronic diseases across representative transport, rescue and security industries. METHODS We performed a register-based study of 624 571 workers from six industries in Denmark between 2000 and 2005, followed up hospitalisation for chronic diseases up to 17 years, and compared with a 20% random sample of the economically active population. RESULTS HR from the Cox regression models showed that seafarers had higher risk of lung cancer (men: 1.54, 95% CI 1.31 to 1.81; women: 1.63, 95% CI 1.13 to 2.36), and male seafarers had higher risk of diabetes (1.32, 95% CI 1.21 to 1.43) and oral cancer (1.51, 95% CI 1.21 to 1.88). Men and women in land transport had increased risk of diabetes (men: 1.68, 95% CI 1.63 to 1.73; women 1.55, 95% CI 1.40 to 1.71) and chronic respiratory disease (men: 1.21, 95% CI 1.16 to 1.25; women 1.42, 95% CI 1.32 to 1.53). Among women, a higher risk of gastrointestinal cancer was observed in aviation (1.53, 95% CI 1.23 to 1.89) and police force (1.29, 95% CI 1.01 to 1.65), oral cancer in defence forces (1.83, 95% CI 1.20 to 2.79), and chronic respiratory disease in rescue service (1.47, 95% CI 1.21 to 1.77), while men in defence forces, police force and rescue service had mainly lower risk of these chronic diseases. CONCLUSIONS We observed considerable health disparities from chronic diseases across transport, rescue and security industries, with workers in seafaring and land transport generally bearing the greatest relative burden.
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Affiliation(s)
- Kimmo Herttua
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Tapio Paljarvi
- Department of Psychiatry, University of Oxford, Oxford, UK
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Herttua K, Vork J, Paljarvi T. Does seafarers' limited access to health care increase risk for community-acquired pneumonia requiring hospital care? A longitudinal register-based analysis. Am J Ind Med 2021; 64:639-645. [PMID: 33792929 DOI: 10.1002/ajim.23248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Limited access to medical care can be considered as an occupational risk of seafaring and it may predispose to developing community-acquired pneumonia (CAP) requiring hospital care. We sought to investigate the risk for CAP and other lower respiratory tract infections (LRTI) requiring hospital care among seafarers. We examined the length of hospital stay (LOS) as a proxy for severity of illness. METHODS The study population in this panel data analysis were all seafarers and a 20% random sample of economically active individuals aged 18-65 years who were residing in Denmark in 1997-2016, constituting more than 11 million person-years of follow-up. Annually-registered socio-demographic and work characteristics were linked to data on cause of hospital admissions. We used fixed-effects and zero-truncated Poisson regression to estimate the rate ratios of hospitalization for CAP and other LRTI, and compared LOS across the two populations. RESULTS The adjusted incident rate ratio (IRR) for CAP in seafarers compared to the economically active population was 1.42 (95% confidence interval [CI]: 1.15-1.77), whereas the IRR was 0.73 (95% CI: 0.38-1.42) for other LRTI. For LOS, the IRRs for CAP and other LRTI in seafarers were 1.08 (95% CI: 1.04-1.12) and 0.92 (95% CI: 0.83-1.01), respectively. CONCLUSIONS Our findings indicate that seafaring was associated with an increased risk for CAP requiring hospital care. Limited access to health care may be an important contributing factor.
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Affiliation(s)
- Kimmo Herttua
- Department of Public Health, Center of Maritime Health and Society University of Southern Denmark Esbjerg Denmark
| | - Jan Vork
- Department of Emergency, Radio Medical Denmark Hospital of South West Jutland Denmark
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Taber JM, Cribbet MR, Cadmus-Bertram L, Mays D, Smith MEB, Rana B, Paljarvi T. Associations Among Sleep and Cancer Risk Behaviors: a Scoping Review of Experimental Studies in Healthy Adult Populations. Int J Behav Med 2021; 28:162-176. [PMID: 32405919 DOI: 10.1007/s12529-020-09892-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Links among poor sleep and cancer risk behaviors have been largely overlooked in the context of cancer prevention and behavioral medicine. The goal of this scoping review was to determine the extent and nature of experimental studies conducted with healthy adult populations that tested the associations among poor sleep and cancer risk behaviors. METHOD Electronic databases and major sleep journals were searched to identify experimental studies in healthy adult samples published through January 2018. Studies examined associations among eight pairings of manipulated behaviors and outcomes ("independent variable (IV)-outcome pairs"): the impact of sleep manipulations on physical activity (PA), diet, alcohol consumption, and tobacco use outcomes; and the impact of PA, diet, alcohol consumption, and tobacco use manipulations on sleep outcomes. Studies were characterized in terms of sample characteristics; study design; IV type, dose, and duration; and outcome measurement and duration. RESULTS Abstracts of 5697 papers and 345 full texts were screened. Eighty-eight studies describing 125 comparisons met inclusion criteria. Only two studies tested the association between tobacco use and sleep; none tested whether sleep influenced alcohol consumption. Sample sizes were typically small, most studies used crossover designs, and studies tended to include younger and more male participants. Within each IV-outcome pair, there was substantial heterogeneity in how behaviors were manipulated, outcome measurement, and type of control group. Few studies assessed mechanisms. CONCLUSION There is a need for larger experimental studies with more representative samples. Overall, heterogeneity and limitations in study designs make it difficult to synthesize evidence across studies.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242-0001, USA.
| | - Matthew R Cribbet
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, 35401, USA
| | - Lisa Cadmus-Bertram
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, 20007, USA
| | - M E Beth Smith
- Department of Medicine, Oregon Health & Science University, Portland, OR, 97237-3098, USA.,Legacy Health Systems, Portland, OR, 97209, USA
| | - Brinda Rana
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Tapio Paljarvi
- Division of Population Medicine, Cardiff University, Cardiff, CF14 4YS, UK
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Hurt L, Paranjothy S, Lucas PJ, Watson D, Mann M, Griffiths LJ, Ginja S, Paljarvi T, Williams J, Bellis MA, Lingam R. Interventions that enhance health services for parents and infants to improve child development and social and emotional well-being in high-income countries: a systematic review. BMJ Open 2018; 8:e014899. [PMID: 29439064 PMCID: PMC5829600 DOI: 10.1136/bmjopen-2016-014899] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 07/14/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Experiences in the first 1000 days of life have a critical influence on child development and health. Health services that provide support for families need evidence about how best to improve their provision. METHODS We systematically reviewed the evidence for interventions in high-income countries to improve child development by enhancing health service contact with parents from the antenatal period to 24 months postpartum. We searched 15 databases and trial registers for studies published in any language between 01 January 1996 and 01 April 2016. We also searched 58 programme or organisation websites and the electronic table of contents of eight journals. RESULTS Primary outcomes were motor, cognitive and language development, and social-emotional well-being measured to 39 months of age (to allow the interventions time to produce demonstrable effects). Results were reported using narrative synthesis due to the variation in study populations, intervention design and outcome measurement. 22 of the 12 986 studies identified met eligibility criteria. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group criteria, the quality of evidence overall was moderate to low. There was limited evidence for intervention effectiveness: positive effects were seen in 1/6 studies for motor development, 4/11 for language development, 4/8 for cognitive development and 3/19 for social-emotional well-being. However, most studies showing positive effects were at high/unclear risk of bias, within-study effects were inconsistent and negative effects were also seen. Intervention content and intensity varied greatly, but this was not associated with effectiveness. CONCLUSIONS There is insufficient evidence that interventions currently available to enhance health service contacts up to 24 months postpartum are effective for improving child development. There is an urgent need for robust evaluation of existing interventions and to develop and evaluate novel interventions to enhance the offer to all families. PROSPERO REGISTRATION NUMBER CRD42015015468.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | - Debbie Watson
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Lucy J Griffiths
- Population, Policy and Practice Programme, Institute of Child Health, London, UK
| | - Samuel Ginja
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Tapio Paljarvi
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Raghu Lingam
- Institute of Health and Society, Newcastle University, Newcastle, UK
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Paljarvi T. Health smart devices and applications for prevention—a cautionary note. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tudor Car L, van-Velthoven MHMMT, Paljarvi T, Car J, Atun R. Integrating prevention of mother-to-child HIV transmission (PMTCT) programmes with other health services for preventing HIV infection and improving HIV outcomes in developing countries. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Makela P, Paljarvi T. Do consequences of a given pattern of drinking vary by socioeconomic status? A mortality and hospitalisation follow-up for alcohol-related causes of the Finnish Drinking Habits Surveys. J Epidemiol Community Health 2008; 62:728-33. [DOI: 10.1136/jech.2007.065672] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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