Is Bitterness Only a Taste? The Expanding Area of Health Benefits of Brassica Vegetables and Potential for Bitter Taste Receptors to Support Health Benefits

The list of known health benefits from inclusion of brassica vegetables in the diet is long and growing. Once limited to cancer prevention, a role for brassica in prevention of oxidative stress and anti-inflammation has aided in our understanding that brassica provide far broader benefits. These include prevention and treatment of chronic diseases of aging such as diabetes, neurological deterioration, and heart disease. Although animal and cell culture studies are consistent, clinical studies often show too great a variation to confirm these benefits in humans. In this review, we discuss causes of variation in clinical studies, focusing on the impact of the wide variation across humans in commensal bacterial composition, which potentially result in variations in microbial metabolism of glucosinolates. In addition, as research into host–microbiome interactions develops, a role for bitter-tasting receptors, termed T2Rs, in the gastrointestinal tract and their role in entero-endocrine hormone regulation is developing. Here, we summarize the growing literature on mechanisms of health benefits by brassica-derived isothiocyanates and the potential for extra-oral T2Rs as a novel mechanism that may in part describe the variability in response to brassica among free-living humans, not seen in research animal and cell culture studies.     

Do the Health Benefits of Cycling Outweigh the Risks?

Background

Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions, decreased greenhouse gas emissions, and increased levels of physical activity, shifts in individual adverse health effects such as higher exposure to air pollution and risk of a traffic accident may prevail.

Objective

We describe whether the health benefits from the increased physical activity of a modal shift for urban commutes outweigh the health risks.

Data sources and extraction

We have summarized the literature for air pollution, traffic accidents, and physical activity using systematic reviews supplemented with recent key studies.

Data synthesis

We quantified the impact on all-cause mortality when 500,000 people would make a transition from car to bicycle for short trips on a daily basis in the Netherlands. We have expressed mortality impacts in life-years gained or lost, using life table calculations. For individuals who shift from car to bicycle, we estimated that beneficial effects of increased physical activity are substantially larger (3–14 months gained) than the potential mortality effect of increased inhaled air pollution doses (0.8–40 days lost) and the increase in traffic accidents (5–9 days lost). Societal benefits are even larger because of a modest reduction in air pollution and greenhouse gas emissions and traffic accidents.

Conclusions

On average, the estimated health benefits of cycling were substantially larger than the risks relative to car driving for individuals shifting their mode of transport.     

Employees Sick-Listed with Mental Disorders: Who Returns to Work and When?

Purpose To investigate return to work (RTW) in employees sick-listed with mental disorders classified according to the International Classification of Diseases (ICD). Methods Sickness absences (SA) medically certified as emotional disturbance (ICD-10 R45) or mental and behavioral disorders (ICD-10 F00?CF99) were retrieved from an occupational health service register. RTW was associated with age, gender, and socioeconomic position (SEP) by parametric survival analysis. Results Emotional, neurotic, somatoform, stress-related, and mood disorders encompassed 94?% of all mental SA. Employees with emotional disturbance had the highest RTW rates: after 1?year 95?% had resumed work and after 2?years 98?% compared to 89 and 96?% of employees with neurotic, somatoform and stress-related disorders, and 70 and 86?% of employees with mood disorders. The probability of RTW decreased after 1?month of SA due to emotional disturbance, 2?months of SA with neurotic, somatoform and stress-related disorders, and 3?months of SA with mood disorders. Women resumed their work later than men. Young employees presenting with emotional disturbance, neurotic, somatoform, and stress-related disorders had earlier RTW than older employees and low-SEP employees had earlier RTW than high-SEP employees. Conclusions RTW rates and probabilities differed across categories of mental disorders. Age and SEP were associated with RTW of employees with emotional, neurotic, somatoform, and stress-related disorders, but not with RTW of employees experiencing mood disorders. To maximize the likelihood of RTW, a focus on RTW is important in the first months after reporting sick with mental disorders.     

Do Work Characteristics Predict Health Deterioration Among Employees with Chronic Diseases?

Purpose In our ageing workforce, the increasing numbers of employees with chronic diseases are encouraged to prolong their working lives. It is important to prevent health deterioration in this vulnerable group. This study aims to investigate whether work characteristics predict health deterioration over a 3-year period among employees with (1) chronic diseases, and, more specifically, (2) musculoskeletal and psychological disorders. Methods The study population consisted of 5600 employees aged 45–64 years with a chronic disease, who participated in the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM). Information on work characteristics was derived from the baseline questionnaire. Health deterioration was defined as a decrease in general health (SF-12) between baseline and follow-up (1–3 years). Crude and adjusted logistic regression analyses were performed to investigate prediction of health deterioration by work characteristics. Subgroup analyses were performed for employees with musculoskeletal and psychological disorders. Results At follow-up, 19.2% of the employees reported health deterioration (N?=?1075). Higher social support of colleagues or supervisor predicted health deterioration in the crude analyses in the total group, and the groups with either musculoskeletal or psychological disorders (ORs 1.11–1.42). This effect was not found anymore in the adjusted analyses. The other work characteristics did not predict health deterioration in any group. Conclusions This study did not support our hypothesis that work characteristics predict health deterioration among employees with chronic diseases. As our study population succeeded continuing employment to 45 years and beyond, it was probably a relatively healthy selection of employees.     

California’s Historic Effort to Reduce the Stigma of Mental Illness: The Mental Health Services Act

In a historic effort to reduce the stigma of mental illness, California voters approved the Mental Health Services Act in 2004. The law funds a comprehensive statewide prevention initiative that places stigma and discrimination reduction at its center, with 25 projects providing interventions at the institutional, societal, and individual levels.Stakeholders selected specific strategies from the research-based California Strategic Plan on Reducing Stigma and Discrimination. Strategies range from social marketing to increase public knowledge to capacity building at the local level, including training that emphasizes participation by consumers of mental health services and cultural competence. Collectively, these strategies aim to foster permanent change in the public perception of mental illness and in the individual experience of stigma.We examined the context, planning, programming, and evaluation of this effort.MORE THAN A DECADE AGO, the US surgeon general identified the stigma of mental illness as the most formidable obstacle to progress in improving mental health.1 Goffman refers to stigma as a spoiled identity.2 In the case of mental illness, stigma includes negative beliefs (e.g., people with mental health problems are dangerous), prejudicial attitudes (e.g., desire to avoid interaction), and discrimination (e.g., failure to hire or rent property to such people). The desire to avoid labeling oneself negatively or to conceal one’s problems from others appears to cause treatment avoidance, increase dropping out, and reduce adherence.3 Today, California is addressing this social injustice and improving the well-being of its communities through a comprehensive statewide initiative supported by Proposition 63, the Mental Health Services Act (MHSA).4Passed by California voters in 2004 amid calls for fundamental changes to mental health care, the MHSA begins to fulfill California’s 30-year-old promise to build a community-based mental health system as an alternative to institutionalization.4 By imposing a 1% tax on personal income in excess of $1 million, the MHSA provides funding and a framework to transform California’s traditional community mental health system to one focused on prevention and wellness, while expanding services to underserved populations and California’s diverse communities.In several ways, the MHSA resembles a blueprint for fulfilling the transformative goals identified in the New Freedom Commission’s Achieving the Promise: Transforming Mental Health Care in America in 2003.5 The MHSA provides resources to mend a fragmented service delivery system, invest in strategies that support recovery from symptoms, promote community integration rather than institutionalization, and empower clients of mental health services (consumers) and their families to direct their own care. Like the commission’s report, the MHSA makes an explicit commitment to reduce stigma and its negative consequences. Furthermore, following the surgeon general’s call to apply a public health approach to mental health,1 the MHSA requires that 20% of all funds (which average $1 billion annually) must support a wide range of prevention and early intervention strategies,6 including programs to reduce not only the stigma of mental health diagnosis and treatment but also discrimination against people with mental illness.7 Efforts supported by the MHSA aim to improve knowledge, change attitudes, increase help-seeking behaviors, reduce stigma, and challenge discriminatory policies.     

Methods to Account for Attrition in Longitudinal Data: Do They Work? A Simulation Study

Attrition threatens the internal validity of cohort studies. Epidemiologists use various imputation and weighting methods to limit bias due to attrition. However, the ability of these methods to correct for attrition bias has not been tested. We simulated a cohort of 300 subjects using 500 computer replications to determine whether regression imputation, individual weighting, or multiple imputation is useful to reduce attrition bias. We compared these results to a complete subject analysis. Our logistic regression model included a binary exposure and two confounders. We generated 10, 25, and 40% attrition through three missing data mechanisms: missing completely at random (MCAR), missing at random (MAR) and missing not at random (MNAR), and used four covariance matrices to vary attrition. We compared true and estimated mean odds ratios (ORs), standard deviations (SDs), and coverage. With data MCAR and MAR for all attrition rates, the complete subject analysis produced results at least as valid as those from the imputation and weighting methods. With data MNAR, no method provided unbiased estimates of the OR at attrition rates of 25 or 40%. When observations are not MAR or MCAR, imputation and weighting methods may not effectively reduce attrition bias.     

A Qualitative Exploration of Mothers’ Experiences Receiving Mental Health Services in a Supermarket Setting

Objectives Innovative mental health care delivery models have been proposed as a method to address disparities in access and utilization. The aim of this study is to characterize patients’ perspectives and experiences of participating in one such innovative delivery model, group cognitive behavioral therapy within a supermarket setting. Methods In this qualitative study, 16 mothers were interviewed to explore their experiences and perspectives of receiving group-based cognitive behavioral therapy in a supermarket setting, as part of their participation in an academic-community research collaborative whose mission is to address mental health needs within low-resourced communities. Data from semi-structured interviews were analyzed using inductive coding. Results Five themes related to receiving mental health services in a supermarket setting emerged from the data: (1) Participants reported a convergence of life stressors and their introduction to supermarket-based services; (2) Participants perceived the supermarket setting as convenient; (3) Participants perceived the supermarket setting as less stigmatizing; (4) Participants perceived services in the supermarket as an acceptable form of mental health treatment; and (5) Participants described the program staff as an influential component of their treatment experience. Conclusions Understanding patient experiences of various service delivery models is critical to improving access to treatment and addressing disparities in mental health service utilization and outcomes. This study supports the use of innovative delivery models to increase access to mental health services in low-resourced communities.

     

Health Benefits Offer Rates: Is There a Nonresponse Bias?

OBJECTIVE: To determine whether a nonresponse bias exists in the offer rate for health benefits in firms with fewer than 50 workers and to present a simple adjustment to correct for observed bias. DATA SOURCES: The 2003 Employer Health Benefits Survey (EHBS) conducted by the Kaiser Family Foundation and Health Research and Educational Trust, and a follow-up survey of nonrespondents to the 2003 EHBS. STUDY DESIGN: We conducted a follow-up survey to the 2003 EHBS to collect health benefits offering data from firms with fewer than 50 workers. We used McNemar's test to verify that the follow-up survey provided results comparable to the EHBS, and t-tests were used to determine nonresponse bias. We applied a simple weighting adjustment to the EHBS. DATA COLLECTION: The data for both the EHBS and the follow-up survey were collected by the same survey research firm. The EHBS interviews the person most knowledgeable about the firm's health benefits, while the follow-up survey interviews the first person who answers the telephone whether they are the most knowledgeable or not. Principal Findings. Firms with 3-9 workers were more likely to exhibit a bias than were firms with 10-24 workers and 25-49 workers. Although the calculated bias for each size category was not significant, there is sufficient evidence to warrant caution when reporting offer rates. CONCLUSIONS: Survey nonresponse in the EHBS produces an upward bias on estimates for the offer rates of small firms. Although not significant, this upward bias is because of nonresponse by small firms that do not offer health benefits. Our research is limited in that we only control for differences in the size of the firm.     

Challenges to Remaining at Work with Common Health Problems: What Helps and What Influence Do Organisational Policies Have?

Introduction: Common health problems have a significant impact on work productivity (presenteeism), and sickness absence. The aim of this study was to examine the attitudes and beliefs of employees in the public sector about common health problems and work using the Flags system as a conceptual framework to identify problems and potential solutions. Method: 63 employees took part in 14 focus groups in two public sector organisations. Discussions were audio-recorded, transcribed, and analysed thematically using NVivo. Results: The study confirmed the importance of heath-focused clinical factors (Yellow flags), perceptions of work (Blue flags), and more objective characteristics of work and organisational policies (Black flags), which emerged as major themes. The social and moral norms surrounding sickness absence and presenteeism were frequently discussed, including the impact of absence on colleagues, guilt, legitimising illness, and trust. There were interactions between the different Flags, often mediated by managers via their relationships with employees and their role in implementing organisational policy. Conclusions: The Flags system was useful as a conceptual framework in this context for identifying a number of obstacles to working with health problems, many of which were potentially modifiable on worker, workplace, or wider systems levels.     

Work and Mental Complaints: Are Response Outcome Expectancies More Important Than Work Conditions and Number of Subjective Health Complaints?

Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees’ response outcome expectancies.     

Do Health Benefits Outweigh the Costs of Mass Recreational Programs? An Economic Analysis of Four Ciclovía Programs

One promising public health intervention for promoting physical activity is the Ciclovía program. The Ciclovía is a regular multisectorial community-based program in which streets are temporarily closed for motorized transport, allowing exclusive access to individuals for recreational activities and physical activity. The objective of this study was to conduct an analysis of the cost-benefit ratios of physical activity of the Ciclovía programs of Bogotá and Medellín in Colombia, Guadalajara in México, and San Francisco in the U.S.A. The data of the four programs were obtained from program directors and local surveys. The annual cost per capita of the programs was: U.S. $6.0 for Bogotá, U.S. $23.4 for Medellín, U.S. $6.5 for Guadalajara, and U.S. $70.5 for San Francisco. The cost-benefit ratio for health benefit from physical activity was 3.23-4.26 for Bogotá, 1.83 for Medellín, 1.02-1.23 for Guadalajara, and 2.32 for San Francisco. For the program of Bogotá, the cost-benefit ratio was more sensitive to the prevalence of physically active bicyclists; for Guadalajara, the cost-benefit ratio was more sensitive to user costs; and for the programs of Medellín and San Francisco, the cost-benefit ratios were more sensitive to operational costs. From a public health perspective for promoting physical activity, these Ciclovía programs are cost beneficial.     

Do Children with Developmental Disabilities and Mental Health Conditions have Greater Difficulty Using Health Services than Children with Physical Disorders?

The objective of this study is to determine whether achievement of the Maternal and Child Health Bureau core outcome ease of use of health services differs between children with developmental disabilities, mental health conditions and physical disorders. We analyzed data from the 2005 National Survey of Children with Special Health Care Needs. Children with special health care needs were classified into 4 health condition groups: developmental disabilities (DD), mental health conditions (MH), physical disorders (PD) and multiple conditions. The outcome measure was ‘difficulty using services’. We conducted bivariate and multivariate analyses to determine the associations between the health condition groups and the outcome. Of the CSHCN included in the study, 2.6% had DD, 12.9% had MH, 49.9% had PD and 34.6% belonged to multiple conditions group. Four percent of CSHCN with PD, 17% of those with DD, 13% of those with MH and 20% of those in the multiple conditions group had difficulty using services. In multivariate analyses, CSHCN with DD had 2.3 times and MH conditions had 2.6 times the odds of having difficulty using services compared to those with PD. Existing programs for CSHCN should be evaluated for the adequacy of services provided to children with DD and MH. Future studies should evaluate how developmental disabilities and mental health policies affect navigating the health care system for this population.     

Do Children with Special Health Care Needs with Anxiety have Unmet Health Care Needs? An Analysis of a National Survey

Maternal and Child Health Journal - To describe differences in health care needs between Children with Special Health Care Needs (CSHCN) with and without anxiety and examine the association between...     

From Organizational Awareness to Organizational Competency in Health Care Social Work: The Importance of Formulating a “Profession-in-Environment” Fit

Today’s health care environments require organizational competence as well as clinical skill. Economically driven business paradigms and the principles underlying the Patient Protection and Affordable Care Act of 2010 emphasize integrated, collaborative care delivered using transdisciplinary service models. Attention must be focused on achieving patient care goals while demonstrating an appreciation for the mission, priorities and operational constraints of the provider organization. The educational challenge is to cultivate the ability to negotiate “ideology” or ideal practice with the practical realities of health care provider environments without compromising professional ethics. Competently exercising such ability promotes a sound “profession-in-environment” fit and enhances the recognition of social work as a crucial patient care component.     

The Mental Capacity Act 2005: promoting the citizenship of people with dementia?

The Mental Capacity Act 2005 came into force in England and Wales during 2007. The Act enshrines a legal right to autonomy (negative and positive) of people lacking decision-making capacity, such as people with dementia. This paper examines the extent to which the legislation promotes the social citizenship of people with dementia, focusing on its effectiveness in protecting liberty and promoting self-determination and in providing social rights to facilitate autonomy. In particular, the author considers the degree to which the Act will facilitate decision-making by people with dementia, centring on decisions relating to where to live (at home or in an institution). In addition, the historical detention (usually informal) of people with dementia in institutional care, and the role of the Act in promoting recognition of their right to liberty, is highlighted. However, the author points out that the civil rights to liberty and self-determination accorded under the Act--particularly the right to decide where to live--are restricted rights only, as the views of the person lacking capacity can be over-ridden by the decisions of others. In addition, the facilitation of these civil rights is constrained by a lack of access to social rights, particularly the availability of domiciliary and community services to avoid institutional admission. Consequently, whilst the legislation promotes the social citizenship of people with dementia, it has limited capacity to facilitate their full citizenship status.     

Preschool Teachers' Use of Time-Out: Is What They Say What They Do?

Using triangulation, this study employed two methods to compare whether the responses of early childhood teachers about their use of timeout as a discipline method in focus group discussion was congruent with their behavior from classroom videotapes. The subjects were 5 teachers, who were among a larger group that had participated in one of 6 focus groups and were later videotaped in their preschool classes. These teachers volunteered to be videotaped after they had engaged in the focus groups. In the focus groups, teachers were asked to discuss how they respond to children's misbehaviors and how they make decisions about their responses. The videotapes were subsequently taken during 2 typical mornings in each class. Detailed analyses of the teachers' use or nonuse of time-out as well as their rationale for using this method, were undertaken for both focus group responses and behaviors observed on the videotapes. Results showed that the verbal responses of the teachers were very congruent with what they carried out while teaching.