Exposure to food additive mixtures in 106,000 French adults from the NutriNet-Santé cohort

Food additives (e.g. artificial sweeteners, emulsifiers, dyes, etc.) are ingested by billions of individuals daily. Some concerning results, mainly derived from animal and/or cell-based experimental studies, have recently emerged suggesting potential detrimental effects of several widely consumed additives. Profiles of additive exposure as well as the potential long-term impact of multiple exposure on human health are poorly documented. This work aimed to estimate the usual intake of food additives among participants of the French NutriNet-Santé cohort and to identify and describe profiles of exposure (single substances and mixtures). Overall, 106,489 adults from the French NutriNet-Santé cohort study (2009-ongoing) were included. Consumption of 90 main food additives was evaluated using repeated 24 h dietary records including information on brands of commercial products. Qualitative information (as presence/absence) of each additive in food products was determined using 3 large-scale composition databases (OQALI, Open Food Facts, GNPD), accounting for the date of consumption of the product. Quantitative ingested doses were estimated using a combination of laboratory assays on food matrixes (n = 2677) and data from EFSA and JECFA. Exposure was estimated in mg per kg of body weight per day. Profiles of exposure to food additive mixtures were extracted using Non-negative Matrix Factorization (NMF) followed by k-means clustering as well as Graphical Lasso. Sociodemographic and dietary comparison of clusters of participants was performed by Chi-square tests or linear regressions. Data were weighted according to the national census. Forty-eight additives were consumed by more than 10% of the participants, with modified starches and citric acid consumed by more than 90%. The top 50 also included several food additives for which potential adverse health effects have been suggested by recent experimental studies: lecithins (86.6% consumers), mono- and diglycerides of fatty acids (78.1%), carrageenan (77.5%), sodium nitrite (73.9%), di-, tri- and polyphosphates (70.1%), potassium sorbate (65.8%), potassium metabisulphite (44.8%), acesulfame K (34.0%), cochineal (33.9%), potassium nitrate (31.6%), sulfite ammonia caramel (28.8%), bixin (19.5%), monosodium glutamate (15.1%) and sucralose (13.5%). We identified and described five clusters of participants more specifically exposed to five distinct additive mixtures and one additional cluster gathering participants with overall low additive exposure. Food additives, including several for which health concerns are currently debated, were widely consumed in this population-based study. Furthermore, main mixtures of additives were identified. Their health impact and potential cocktail effects should be explored in future epidemiological and experimental studies.

Can we rely on COVID-19 data? An assessment of data from over 200 countries worldwide

To fight COVID-19, global access to reliable data is vital. Given the rapid acceleration of new cases and the common sense of global urgency, COVID-19 is subject to thorough measurement on a country-by-country basis. The world is witnessing an increasing demand for reliable data and impactful information on the novel disease. Can we trust the data on the COVID-19 spread worldwide? This study aims to assess the reliability of COVID-19 global data as disclosed by local authorities in 202 countries. It is commonly accepted that the frequency distribution of leading digits of COVID-19 data shall comply with Benford's law. In this context, the author collected and statistically assessed 106,274 records of daily infections, deaths, and tests around the world. The analysis of worldwide data suggests good agreement between theory and reported incidents. Approximately 69% of countries worldwide show some deviations from Benford's law. The author found that records of daily infections, deaths, and tests from 28% of countries adhered well to the anticipated frequency of first digits. By contrast, six countries disclosed pandemic data that do not comply with the first-digit law. With over 82 million citizens, Germany publishes the most reliable records on the COVID-19 spread. In contrast, the Islamic Republic of Iran provides by far the most non-compliant data. The author concludes that inconsistencies with Benford's law might be a strong indicator of artificially fabricated data on the spread of SARS-CoV-2 by local authorities. Partially consistent with prior research, the United States, Germany, France, Australia, Japan, and China reveal data that satisfies Benford's law. Unification of reporting procedures and policies globally could improve the quality of data and thus the fight against the deadly virus.

Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery

BACKGROUND

The novel Coronavirus Disease 2019 (COVID-19) pandemic is having a profound impact on global healthcare. Shortages in staff, operating theatre space and intensive care beds has led to a significant reduction in the provision of surgical care. Even vascular surgery, often insulated from resource scarcity due to its status as an urgent specialty, has limited capacity due to the pandemic. Furthermore, many vascular surgical patients are elderly with multiple comorbidities putting them at increased risk of COVID-19 and its complications. There is an urgent need to investigate the impact on patients presenting to vascular surgeons during the COVID-19 pandemic.

METHODS AND ANALYSIS

The COvid-19 Vascular sERvice (COVER) study has been designed to investigate the worldwide impact of the COVID-19 pandemic on vascular surgery, at both service provision and individual patient level. COVER is running as a collaborative study through the Vascular and Endovascular Research Network (VERN), an independent, international vascular research collaborative with the support of numerous national and international organisations). The study has 3 'Tiers': Tier 1 is a survey of vascular surgeons to capture longitudinal changes to the provision of vascular services within their hospital; Tier 2 captures data on vascular and endovascular procedures performed during the pandemic; and Tier 3 will capture any deviations to patient management strategies from pre-pandemic best practice. Data submission and collection will be electronic using online survey tools (Tier 1: SurveyMonkey® for service provision data) and encrypted data capture forms (Tiers 2 and 3: REDCap® for patient level data). Tier 1 data will undergo real-time serial analysis to determine longitudinal changes in practice, with country-specific analyses also performed. The analysis of Tier 2 and Tier 3 data will occur on completion of the study as per the pre-specified statistical analysis plan.

Impacts of Public Debates on Legalizing the Same-Sex Relationships on People's Daily Lives and Their Related Factors in Taiwan

This study examined the proportion of the individuals who experienced negative impacts on daily lives resulted from public debates on the legalization of same-sex relationships and related factors in Taiwan. Data provided by 1370 participants recruited through a Facebook advertisement were analyzed. Participants completed an online questionnaire assessing negative impact of public debates on daily lives, gender, age, sexual orientation, the number of lesbian, gay and bisexual (LGB) friends, and perceived population's acceptance of homosexuality. The results showed that 39.5% of participants reported the negative impacts on their occupational or academic performance; 34.2% reported the negative impact on friendship; 37.7% reported the negative impact on family relationship; and 57.4% reported the negative impact on mood or sleep quality. Non-heterosexual participants were more likely to report negative impacts of public debates on all domains of daily lives than heterosexual ones. The number of LGB friends was positively associated with negative impacts of public debates on all domains of daily lives. Participants who were 20-29 years old were more likely to report negative impacts of public debates on the domains of family relationship and mood/sleep quality than those who were 40 or older. Participants who were 30-39 years old were more likely to report negative impacts of public debates on the domain of mood/sleep quality than those who were 40 or older. Males were less likely to report the negative impact on their mood/sleep quality than females. Perceiving population's acceptance for homosexuality were negatively associated with negative impacts of public debates on the domains of occupational/academic performance, family relationship and mood/sleep quality.

The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis

BACKGROUND

Evidence suggests that sedentary behaviour (SB) is associated with poor health outcomes. SB at any age may have significant consequences for health and well-being and interventions targeting SB are accumulating. Therefore, the need to review the effects of multicomponent, complex interventions that incorporate effective strategies to reduce SB are essential.

METHODS

A systematic review and meta-analysis were conducted investigating the impact of interventions targeting SB across the lifespan. Six databases were searched and two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies.

RESULTS

A total of 77 adult studies (n=62, RCTs) and 84 studies (n=62, RCTs) in children were included. The findings demonstrated that interventions in adults when compared to active controls resulted in non-significant reductions in SB, although when compared to inactive controls significant reductions were found in both the short (MD -56.86; 95%CI -74.10, -39.63; n=4632; I2 83%) and medium-to-long term (MD -20.14; 95%CI -34.13, -6.16; n=4537; I2 65%). The findings demonstrated that interventions in children when compared to active controls may lead to relevant reductions in daily sedentary time in the short-term (MD -59.90; 95%CI -102.16, -17.65; n=267; I2 86%), while interventions in children when compared to inactive controls may lead to relevant reductions in the short-term (MD -25.86; 95%CI -40.77, -10.96; n=9480; I2 98%) and medium-to-long term (MD -14.02; 95%CI -19.49, -8.55; n=41,138; I2 98%). The assessment of complexity suggested that interventions may need to be suitably complex to address the challenges of a complex behaviour such as SB, but demonstrated that a higher complexity score is not necessarily associated with better outcomes in terms of sustained long-term changes.

CONCLUSIONS

Interventions targeting reductions in SB have been shown to be successful, especially environmental interventions in both children and adults. More needs to be known about how best to optimise intervention effects. Future intervention studies should apply more rigorous methods to improve research quality, considering larger sample sizes, randomised controlled designs and valid and reliable measures of SB.

Association Between Greenness Surrounding Schools and Kindergartens and Attention-Deficit/Hyperactivity Disorder in Children in China

IMPORTANCE

Few studies have investigated the association between greenness and childhood attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE

To evaluate the association between greenness surrounding schools or kindergartens and symptoms of ADHD in children.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study was performed between April 2012 and January 2013 in 7 cities in northeastern China. This analysis included 59 754 children (aged 2-17 years) from 94 schools and kindergartens, who had resided in the study area for 2 years or longer. Data were analyzed from April 15, 2019, to October 10, 2019.

EXPOSURES

Greenness surrounding each child's school or kindergarten was estimated using 2 satellite image-derived vegetation indexes: the normalized difference vegetation index and the soil-adjusted vegetation index.

MAIN OUTCOMES AND MEASURES

Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) scales were used to measure ADHD symptoms (9 inattention symptoms and 9 hyperactivity-impulsivity symptoms). Parents or guardians rated the frequency of each of 18 ADHD symptoms during the preceding 6 months. Children with 6 or more symptoms of either inattention or hyperactivity-impulsivity were defined as having ADHD symptoms. Generalized linear mixed models were applied to estimate the association between greenness and ADHD symptoms.

RESULTS

The mean (SD) age of the 59 754 study participants was 10.3 (3.6) years, and 29 494 (49.4%) were girls. A total of 2566 participants (4.3%) had ADHD symptoms. Greenness levels differed substantially across schools and kindergartens. The normalized difference vegetation index within 500 m of a school or kindergarten ranged from -0.09 to 0.77. Greater greenness levels were associated with lower odds of ADHD symptoms. In covariate-adjusted models, a 0.1-unit increase in normalized difference vegetation index or soil-adjusted vegetation index within 500 m of a school or kindergarten was significantly associated with lower odds of ADHD symptoms (odds ratios, 0.87 [95% CI, 0.83-0.91] and 0.80 [95% CI, 0.74-0.86], respectively; P < .001 for both). The associations were robust in a series of sensitivity analyses.

CONCLUSIONS AND RELEVANCE

These findings suggest that there may be a beneficial association between school-based greenness and ADHD symptoms in Chinese children. Future longitudinal and mechanistic studies are needed to confirm the findings of this cross-sectional analysis and further explore potential mechanisms of this association.

The characteristics and reporting quality of research impact case studies: A systematic review

Despite the growing expectation that researchers report the impact of their research using a case study approach, systematic reviews of research impact have focused on frameworks, indicators, methods of data collection and assessment rather than impact case studies. Our aim is to provide an overview of the characteristics of published research impact case studies, including translation activities, and their reporting quality. We searched for peer-reviewed impact studies published between 2000 and 2018 using a case study approach and selected 25 suitable papers. We applied descriptive statistics to study characteristics, conducted thematic analysis of research translation activities and assessed reporting quality using the 10-point ISRIA statement. 24 papers reported intermediate impacts, such as advocacy, or the development of statements, tools, or technology. 4 reported on longer-term societal impacts, such as health outcomes and economic return on investment. 7 reported on translation activities. Papers scored well against the ISRIA statement on 5 domains of reporting quality. Weakest scores centred around identification of stakeholder needs and stakeholder involvement, and ethics and conflict of interest. We identified the need for more consistency in reporting through a case study approach, more systematic reporting of translation pathways and greater transparency concerning estimated costs and benefits of the research and its translation and impact assessment.

Estimation of daily fish intake values for use with water quality criteria for human health assessments in Korea

Daily fish intake is a key parameter of water quality criteria for protecting human health. Daily fish intake values should be representative of consumption patterns and must be practical for regulatory purposes. Thus, values must be scientifically verified and regularly updated for inclusion in water quality criteria. In Korea, four different fish intake values have been identified from food balance sheets (KREI 2000), the Korea National Health and Nutrition Examination Survey (KNHANES) II (Ministry of Health and Welfare 2002), Korean Exposure Factors Handbook (MOE 2007a), and KNHANES IV-V (CDC 2008; 2009; 2010), which have been applied to water quality standards and related national projects and regulations. This paper reviews the estimation methodologies of previous daily fish intake values from multiple sources and improvements in these values between 2000 and 2012. Finally, limitations associated with each value were examined to assist future research and regulatory management. This review provides information on changes in the daily fish intake values and their application in water quality standards in Korea.

Environmental exposure to cadmium-a risk for health of the general population in industrialized countries and preventive strategies

Cadmium (Cd) is a heavy metal belonging to the group of the main chemical pollutants of the natural and occupational environment in economically developed countries. The forecasts indicate that contamination of the environment with this toxic metal, and thus the exposure of the general population, will increase. Food (particularly plant products) is the main source of the general population exposure to this element. Moreover, an important, and often the main, source of intoxication with Cd is habitual tobacco smoking. Recent epidemiological studies have provided numerous evidence that even low-level environmental exposure to this toxic metal, nowadays occurring in numerous economically developed countries, creates a risk for health of the general population. The low-level lifetime exposure to this metal may lead to the damage to the kidneys, liver, skeletal system, and cardiovascular system, as well as to the deterioration of the sight and hearing. Moreover, it has been suggested that environmental exposure to this xenobiotic may contribute to the development of cancer of the lung, breast, prostate, pancreas, urinary bladder, and nasopharynx. Taking the above into account, the aim of this review article is to draw more attention to Cd as an environmental risk factor for the health of the general population and the need to undertake preventive actions allowing to reduce the risk of health damage due to a lifetime exposure to this toxic metal.

Finely Resolved On-Road PM2.5 and Estimated Premature Mortality in Central North Carolina

To quantify the on-road PM_2.5 -related premature mortality at a national scale, previous approaches to estimate concentrations at a 12-km × 12-km or larger grid cell resolution may not fully characterize concentration hotspots that occur near roadways and thus the areas of highest risk. Spatially resolved concentration estimates from on-road emissions to capture these hotspots may improve characterization of the associated risk, but are rarely used for estimating premature mortality. In this study, we compared the on-road PM_2.5 -related premature mortality in central North Carolina with two different concentration estimation approaches-(i) using the Community Multiscale Air Quality (CMAQ) model to model concentration at a coarser resolution of a 36-km × 36-km grid resolution, and (ii) using a hybrid of a Gaussian dispersion model, CMAQ, and a space-time interpolation technique to provide annual average PM_2.5 concentrations at a Census-block level (∼105,000 Census blocks). The hybrid modeling approach estimated 24% more on-road PM_2.5 -related premature mortality than CMAQ. The major difference is from the primary on-road PM_2.5 where the hybrid approach estimated 2.5 times more primary on-road PM_2.5 -related premature mortality than CMAQ due to predicted exposure hotspots near roadways that coincide with high population areas. The results show that 72% of primary on-road PM_2.5 premature mortality occurs within 1,000 m from roadways where 50% of the total population resides, highlighting the importance to characterize near-road primary PM_2.5 and suggesting that previous studies may have underestimated premature mortality due to PM_2.5 from traffic-related emissions.

CAPACITY BUILDING PROCESS IN ENVIRONMENTAL AND HEALTH IMPACT ASSESSMENT FOR A THAI COMMUNITY

This research aimed at exploring the development of the capacitybuilding process in environmental and health impact assessment, including the consideration of subsequent, capacity-building achievements. Data were gathered through questionnaires, participatory observations, in-depth interviews, focus group discussions, and capacity building checklist forms. These data were analyzed using content analysis, descriptive statistics, and inferential statistics. Our study used the components of the final draft for capacity-building processes consisting of ten steps that were formulated by synthesis from each respective process. Additionally, the evaluation of capacity building levels was performed using 10-item evaluation criteria for nine communities. The results indicated that the communities performed well under these criteria. Finally, exploration of the factors influencing capacity building in environmental and health impact assessment indicated that the learning of community members by knowledge exchange via activities and study visits were the most influential factors of the capacity building processes in environmental and health impact assessment. The final revised version of capacitybuilding process in environmental and health impact assessment could serve as a basis for the consideration of interventions in similar areas, so that they increased capacity in environmental and health impact assessments.

Measuring policy and related effects of a health impact assessment related to connectivity

Health Impact Assessments are an important tool to help policymakers perceive the potential positive and negative contributions of decisions to public health. While they have been increasingly used in the United States, studies have not examined intermediate effects. Using key stakeholder interviews, this manuscript examines policy outcomes and other related effects of the HIA 21months after completing a Health Impact Assessment Report around connectivity policy. Further, it reflects on the measurement of these effects as part of the monitoring and evaluation stage of the Health Impact Assessment process.

Health Impact Assessment of a Predicted Air Quality Change by Moving Traffic from an Urban Ring Road into a Tunnel. The Case of Antwerp, Belgium

Background

The Antwerp ring road has a traffic density of 300,000 vehicles per day and borders the city center. The ‘Ringland project’ aims to change the current ‘open air ring road’ into a ‘filtered tunneled ring road’, putting the entire urban ring road into a tunnel and thus filtering air pollution. We conducted a health impact assessment (HIA) to quantify the possible benefit of a ‘filtered tunneled ring road’, as compared to the ‘open air ring road’ scenario, on air quality and its long-term health effects.

Materials and Methods

We modeled the change in annual ambient PM_2.5 and NO₂ concentrations by covering 15 kilometers of the Antwerp ring road in high resolution grids using the RIO-IFDM street canyon model. The exposure-response coefficients used were derived from a literature review: all-cause mortality, life expectancy, cardiopulmonary diseases and childhood Forced Vital Capacity development (FVC).

Results

Our model predicts changes between -1.5 and +2 μg/m³ in PM_2.5 within a 1,500 meter radius around the ring road, for the ‘filtered tunneled ring road’ scenario as compared to an ‘open air ring road’. These estimated annual changes were plotted against the population exposed to these differences. The calculated change of PM_2.5 is associated with an expected annual decrease of 21 deaths (95% CI 7 to 41). This corresponds with 11.5 deaths avoided per 100,000 inhabitants (95% CI 3.9–23) in the first 500 meters around the ring road every year. Of 356 schools in a 1,500 meter perimeter around the ring road changes between -10 NO₂ and + 0.17 μg/m³ were found, corresponding to FVC improvement of between 3 and 64ml among school-age children. The predicted decline in lung cancer mortality and incidence of acute myocardial infarction were both only 0.1 per 100,000 inhabitants or less.

Conclusion

The expected change in PM_2,5 and NO₂ by covering the entire urban ring road in Antwerp is associated with considerable health gains for the approximate 352,000 inhabitants living in a 1,500 meter perimeter around the current open air ring road.

[Dengue vaccines. A reality for Argentina?]

Dengue outbreaks have occurred yearly in Argentina since 1998. A number of candidate vaccines have been tested in endemic countries. The most advanced one was licensed in three countries of Latin America for children over 9 years of age. In the present article the benefits and drawbacks of these vaccines as well as the challenges for the implementation of a vaccination strategy in Argentina are discussed. Furthermore, a risk stratification strategy with new criteria and a multidisciplinary vision is suggested as a possible path for the assessment of the pertinence of a vaccination program in areas showing the highest risk of dengue transmission and/or for people at the greatest risk of developing severe dengue. It is also suggested that the definition regarding the status of endemicity should take into account the local realities. Finally, this paper proposes a broad discussion on the evidences, the expected impact and instrumental aspects that would be involved in the incorporation of a dengue vaccine, marketed or in development, into the national immunization program, and especially which subpopulation should be targeted for the immunization strategy to be cost-effective.

Health Impacts of Active Transportation in Europe

Policies that stimulate active transportation (walking and bicycling) have been related to heath benefits. This study aims to assess the potential health risks and benefits of promoting active transportation for commuting populations (age groups 16-64) in six European cities. We conducted a health impact assessment using two scenarios: increased cycling and increased walking. The primary outcome measure was all-cause mortality related to changes in physical activity level, exposure to fine particulate matter air pollution with a diameter <2.5 μm, as well as traffic fatalities in the cities of Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. All scenarios produced health benefits in the six cities. An increase in bicycle trips to 35% of all trips (as in Copenhagen) produced the highest benefits among the different scenarios analysed in Warsaw 113 (76-163) annual deaths avoided, Prague 61 (29-104), Barcelona 37 (24-56), Paris 37 (18-64) and Basel 5 (3-9). An increase in walking trips to 50% of all trips (as in Paris) resulted in 19 (3-42) deaths avoided annually in Warsaw, 11(3-21) in Prague, 6 (4-9) in Basel, 3 (2-6) in Copenhagen and 3 (2-4) in Barcelona. The scenarios would also reduce carbon dioxide emissions in the six cities by 1,139 to 26,423 (metric tonnes per year). Policies to promote active transportation may produce health benefits, but these depend of the existing characteristics of the cities. Increased collaboration between health practitioners, transport specialists and urban planners will help to introduce the health perspective in transport policies and promote active transportation.

Applying Advanced Analytical Approaches to Characterize the Impact of Specific Clinical Gaps and Profiles on the Management of Rheumatoid Arthritis

INTRODUCTION

The goal of this study was to add a predictive modeling approach to the meta-analysis of continuing medical education curricula to determine whether this technique can be used to better understand clinical decision making. Using the education of rheumatologists on rheumatoid arthritis management as a model, this study demonstrates how the combined methodology has the ability to not only characterize learning gaps but also identify those proficiency areas that have the greatest impact on clinical behavior.

METHODS

The meta-analysis included seven curricula with 25 activities. Learners who identified as rheumatologists were evaluated across multiple learning domains, using a uniform methodology to characterize learning gains and gaps. A performance composite variable (called the treatment individualization and optimization score) was then established as a target upon which predictive analytics were conducted.

RESULTS

Significant predictors of the target included items related to the knowledge of rheumatologists and confidence concerning 1) treatment guidelines and 2) tests that measure disease activity. In addition, a striking demographic predictor related to geographic practice setting was also identified.

DISCUSSION

The results demonstrate the power of advanced analytics to identify key predictors that influence clinical behaviors. Furthermore, the ability to provide an expected magnitude of change if these predictors are addressed has the potential to substantially refine educational priorities to those drivers that, if targeted, will most effectively overcome clinical barriers and lead to the greatest success in achieving treatment goals.

Uncertainties in human health risk assessment of environmental contaminants: A review and perspective

Addressing uncertainties in human health risk assessment is a critical issue when evaluating the effects of contaminants on public health. A range of uncertainties exist through the source-to-outcome continuum, including exposure assessment, hazard and risk characterisation. While various strategies have been applied to characterising uncertainty, classical approaches largely rely on how to maximise the available resources. Expert judgement, defaults and tools for characterising quantitative uncertainty attempt to fill the gap between data and regulation requirements. The experiences of researching 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) illustrated uncertainty sources and how to maximise available information to determine uncertainties, and thereby provide an 'adequate' protection to contaminant exposure. As regulatory requirements and recurring issues increase, the assessment of complex scenarios involving a large number of chemicals requires more sophisticated tools. Recent advances in exposure and toxicology science provide a large data set for environmental contaminants and public health. In particular, biomonitoring information, in vitro data streams and computational toxicology are the crucial factors in the NexGen risk assessment, as well as uncertainties minimisation. Although in this review we cannot yet predict how the exposure science and modern toxicology will develop in the long-term, current techniques from emerging science can be integrated to improve decision-making.

A comprehensive health impact assessment and determinants of quality of life, health and psychological status in acne patients

AIM

Acne adversely affects all aspects of quality of life (QoL). Although many papers assessed acne-specific QoL impairment, there are few data on its impact on general health and psychological status. Apart from acne severity, little is known about determinants of a worse QoL. The aims of this paper were to measure acne impact on QoL, health and psychological status and to analyze the relationship between socio-demographic variables, disease severity and mental status on QoL of acne sufferers.

METHODS

Acne cases were selected from a survey conducted in 2010. The Short-Form 12-Item Health Survey and the Skindex-29 were used to assess health status and QoL. The 12-Items General Health Questionnaire was used to identify individuals at risk for non-psychotic psychiatric disorders (GHQ-positive). Physician (PhGA) and patient global assessments were obtained. We investigated the variables involved in the QoL through a logistic regression analysis.

RESULTS

One hundred ninety-five cases were analyzed. Twenty-six percent were GHQ-positive; acne's impact on health status was worse compared to other chronic diseases. A GHQ-positive status (Skindex-29 overall: OR 2.6; 95% CI 1.20-5.60, P<0.05, functioning: OR 2.5; 95% CI 1.17-5.44, P<0.05, symptoms: OR 3.0; 95% CI 1.36-6.53, P<0.01; emotions: OR 2.55; 95% CI 1.19-5.46, P<0.05) and having a severe/very severe PhGA (Skindex-29 overall: OR 3.4; 95% CI 1.20-10.38, P<0.05) were associated with a poor QoL. Age of onset >25 was linked to being GHQ-positive (OR 2.92; 95% CI 1.2-7.1, P<0.05) controlling for gender, marital status and educational level.

CONCLUSION

Acne is not a minor disease in comparison with other chronic conditions. Age of onset is capable to influence GHQ status which in turn affects QoL.

Mental health impacts of racial discrimination in Australian culturally and linguistically diverse communities: a cross-sectional survey

BACKGROUND

Racial discrimination denies those from racial and ethnic minority backgrounds access to rights such as the ability to participate equally and freely in community and public life, equitable service provision and freedom from violence. Our study was designed to examine how people from racial and ethnic minority backgrounds in four Australian localities experience and respond to racial discrimination, as well as associated health impacts.

METHODS

Data were collected from 1,139 Australians regarding types of racial discrimination experienced, settings for these incidents, response mechanisms and psychological distress as measured by the Kessler 6 (K6) Psychological Distress Scale.

RESULTS

Age, education, religion, gender, visibility and rurality were all significantly associated with differences in the frequency of experiencing racial discrimination. Experiencing racial discrimination was associated with worse mental health. Mental health impacts were not associated with the type of discriminatory experience, but experiencing racial discrimination in shops and in employment and government settings was associated with being above the threshold for high or very high psychological distress. One out of twelve response mechanisms was found to be associated with lower stress following a discriminatory incident.

CONCLUSIONS

Study results indicate that poorer mental health was associated with the volume of discrimination experienced, rather than the type of experience. However, the impact of experiencing discrimination in some settings was shown to be particularly associated with high or very high psychological distress. Our findings suggest that interventions designed to prevent the occurrence of racism have more potential to increase mental health in racial and ethnic minority communities than interventions that work with individuals in response to experiencing racism.

The impact on health outcomes and healthcare utilisation of switching to generic medicines consequent to reference pricing: the case of lamotrigine in New Zealand

BACKGROUND

Many countries have implemented generic reference pricing and substitution as methods of containing pharmaceutical expenditure. However, resistance to switching between medicines is apparent, especially in the case of anti-epileptic medicines.

OBJECTIVES

This study sought to exploit a nation-wide policy intervention on generic reference pricing in New Zealand to evaluate the health outcomes of patients switching from originator to generic lamotrigine, an anti-epileptic medicine.

METHODS

A retrospective study using the national health collections and prescription records was conducted comparing patients who switched from originator brand to generic lamotrigine with patients who remained on the originator brand. Primary outcome measures included switch behaviour, changes in utilisation of healthcare services at emergency departments, hospitalisations and use of specialist services, and mortality.

RESULTS

Approximately one-quarter of all patients using the originator brand of lamotrigine switched to generic lamotrigine, half of whom made the switch within 60 days of the policy implementation. Multiple switches (three or more) between generic and brand products were evident for around 10% of switchers. Switch-back rates of 3% were apparent within 30 days post-switch. No difference in heath outcome measures was associated with switching from originator lamotrigine to a generic equivalent and hence no increased costs could be found for switchers.

CONCLUSIONS

Switching from brand to generic lamotrigine is largely devoid of adverse health outcomes; however, creating an incentive to ensure a greater proportion of patients switch to generic lamotrigine is required to achieve maximal financial savings from a policy of generic reference pricing.

[Acceptance of illness scale and its clinical impact]

The level of chronic illness acceptance is an indicator of functioning and predictor of quality of life. The greater the acceptance of disease is, the less mental discomfort and less severe negative emotions there are. This paper presents Acceptance of Illness Scale and the main results and conclusions of the recent publications dealing with this problem in patients with chronic diseases. It has been proved that the level of acceptance of illness is significantly associated with a variety of clinical and sociodemographic factors. This justifies the rightness of its assessment, which appears to be an important element in the holistic medical and nonmedical care.

The impact of a home visiting program on children's utilization of dental services

BACKGROUND

Child Health Investment Partnership (CHIP) of Roanoke Valley is a home visiting program that promotes children's health and family self-sufficiency. CHIP's Begin With a Grin program provides preventive dental services in the home (oral health anticipatory guidance and fluoride varnish) for children aged 0 to 6 years. The purpose of this study was to compare the dental utilization of Medicaid-enrolled children in CHIP versus Medicaid-enrolled children not in CHIP.

METHODS

Using the propensity score method, control subjects were selected from the statewide Medicaid database by using a caliper-matching algorithm. A vector of chosen covariates was used to match control subjects; these covariates included risk factors, estimated propensity score, age, race, gender, and days of Medicaid eligibility. Propensity scores were developed by using a logistic regression. Differences in dental utilization outcomes were tested: ≥1 dental claim (logistic regression) and number of dental claims (Poisson regression) for each subject within the test period.

RESULTS

When CHIP children were compared with Medicaid-only children, the CHIP child was 3 times more likely to have at least 1 dental visit (odds ratio: 3.0 [95% confidence interval: 1.9-4.7]) and have a higher number of dental claims (ratio of estimated average number of dental claims [cases/control]: 8.60/3.05 = 2.82 [95% confidence interval: 2.56-3.12]).

CONCLUSIONS

A home visiting model can introduce children and their families to dental prevention, improve dental health literacy, establish a dental home, and provide application of fluoride varnish.

Violence against people with disability in England and Wales: findings from a national cross-sectional survey

Background

The recent World Report on Disability highlighted violence as a leading cause of morbidity among disabled people. However, we know little about the extent to which people with disability experience different violence types, and associated health/economic costs. The recent introduction of disability measures into the England&Wales victimization survey provided an opportunity to address this gap.

Methods and Findings

Analysis of the 2009/10 British Crime Survey (BCS), a nationally representative cross-sectional survey of 44,398 adults living in residential households in England&Wales. Using multivariate logistic regression, we estimated the relative odds of being a victim of past-year violence (physical/sexual domestic or non-domestic violence) in people with disability compared to those without, after adjusting for socio-demographics, behavioural and area confounders. 1256/44398(2.4%) participants had one or more disabilities including mental illness (‘mental illness’) and 7781(13.9%) had one or more disabilities excluding mental illness (‘non-mental disability’). Compared with the non-disabled, those with mental illness had adjusted relative odds (aOR) of 3.0(95% confidence interval (CI) 2.3–3.8) and those with non-mental disability had aOR of 1.8(95% CI: 1.5–2.2) of being a victim of past-year violence (with similar relative odds for domestic and non-domestic violence). Disabled victims were more likely to suffer mental ill health as a result of violence than non-disabled victims. The proportion of violence that could be attributed to the independent effect of disability in the general population was 7.5%(CI 5.7–9.3%), at an estimated cost of £1.51 billion. The main study limitation is the exclusion of institutionalised people with disability.

Conclusions

People with disability are at increased risk of being victims of domestic and non-domestic violence, and of suffering mental ill health when victimized. The related public health and economic burden calls for an urgent assessment of the causes of this violence, and national policies on violence prevention in this vulnerable group.

[Effects of work in childhood on health in the opinion of respondents from agricultural families]

BACKGROUND

The engagement of children in work is common in agricultural families. Work of children brings about cific benefits to both the family and the children; however, at the same time, it creates many hazards, including health risk.

MATERIALS AND METHOD

The aim of the study was to determine current and delayed health effects among individuals who were engaged in agricultural activities in childhood. The study was conducted using the method of diagnostic survey questionnaire and covered a group of 482 adults from agricultural families.

RESULTS

The majority of respondents expressed the opinion that work in childhood had no impact on their health. At the same time, 2/5 of respondents considered that work on their parents' farm exerted an effect on their health in childhood (current effects), whereas nearly 1/3 admitted that an engagement in work in childhood also affected their present state of health (delayed effects). In the respondents' opinion, overloading with work in childhood exerted an adverse effect on their health, and also resulted in health problems in adulthood.

CONCLUSION

The engagement of children in agricultural work in a small amount of working time, and adjustment of assigned jobs to their capabilities brings about many health benefits with low health risk. In turn, the engagement of children in work from their youngest years and overloading them with work exerts an adverse effect on health, especially in later life.