The smoker’s paradox and the real risk of smoking

No satisfactory explanations have been offered for the smokers paradox, the greater short-term survival of smokers after a myocardial infarction nor for the large variations in the coronary risk rate for smoking ranging between 1 and 5.9. These discrepancies as well as the smokers paradox may be caused by different baseline characteristics of smokers and nonsmokers, whereas the usually quoted coronary risk of 2 is derived from studies based on the assumption of equal baseline characteristics. As neither this assumption nor the possibility of unequal starting conditions have been tested, we examined the main cardiovascular risk factors in smoking and nonsmoking boys as near as possible to baseline, at the age of fourteen. This age appeared to be best suited, because boys starting to smoke early are most likely to become regular and heavy smokers. Of 336 boys, 39 had smoked 8.3 ± 6.0 cigarettes/day for 15.5 ± 11.2 months. Compared to nonsmokers, boys who started to smoke early had lower LDL cholesterol and ₂-antiplasmin, greater handgrip strength, vital capacity and forced expiratory volume, better perfomance on bicycle ergometry and higher testosterone. The differences in total cholesterol, LDL cholesterol, vital capacity, handgrip strength, testosterone and ₂-antiplasmin persisted after adjustment for age, body mass, and testosterone. In addition, the differences in perfomance on bicycle ergometry and forced expiratory volume persisted after adjustment for age. These favourable baseline characteristics of those starting to smoke early can explain the smokers paradox. In addition, they suggest that the individual coronary risk in smokers is considerably higher than 2, because the assumption of equal baseline characteristics of smokers and nonsmokers cannot be upheld.This revised was published online in April 2005. In the previous version the article category was missing.     

EPA’s proposed Worker Protection Standard and the burdens of the past

Background:

An Environmental Protection Agency (EPA) recommendation for extensive changes to the Agency’s 40-year-old Worker Protection Standard is currently stalled in the “proposed rule” stage. The proposal, which was available for public comment until 18 August, would improve safety, training, and hazard communication policies for agricultural pesticides. Exposure to hazards, including high heat, heavy machinery, stoop labor, and pesticides, makes occupational illness uncommonly common among the USA’s estimated 2.5 million farm workers.

Objectives:

To consider the proposed revisions’ likelihood of addressing historical gaps in farmworker protection.Methods: The proposal was compared to the existing Worker Protection Standard, and key aspects were analyzed in relation to existing science on farm labor hazards, as well as historic occupational health, labor and immigration policy.

Results:

US law historically has left farm workers largely unprotected. These exclusions and delays have been tolerated in part thanks to the myth of the independent family farmer, but more significant is the stingy nativism that presumes to benefit from immigrant labor without assuming any responsibility to protect the humans who provide it. In the first half of the 1970s, workers lobbied for robust protections, but rule making was impeded by lack of data and by the disproportionate influence of agricultural employers who sought minimal regulation. In 1974, the EPA passed the first Worker Protection Standard for farm workers. Key aspects of the proposed revision include stronger protections against drift and re-entry exposures, better information provision and training, and increased protections for workers under 16 years.

Conclusions:

The proposed changes represent an improvement over existing legislation, but do not go far enough. The revision should be strengthened along lines suggested by farm workers themselves, and other labor laws must also be amended to give the men, women, and children who work in the fields of this country full rights and protections.     

Multiple Antioxidants in the Prevention and Treatment of Parkinson’s Disease

Parkinson’s disease (PD) is one of the major progressive neurological disorders for which no preventative or long-term effective treatment strategies are available. Epidemiologic studies have failed to identify specific environmental, dietary or lifestyle risk factors for PD except for toxic exposure to manganese, meperidine (Demerol®, the “designer drug” version of which often contains a toxic byproduct of the synthesis, 1-methyl-4-phenyl 1,2,3,6 tetrahydropyridine [MPTP]), and some herbicides and pesticides. The search for genetic risk factors such as mutation, overexpression or underexpression of nuclear genes in DA neurons in idiopathic PD has not been successful as yet. Polymorphism in certain genes appears to be a risk factor, but there is no direct evidence for the causal relationship between polymorphism and increased risk of PD. In familial PD, mutation in the α-synuclein gene is associated with the disease, but a direct role of this gene in degeneration of DA neurons remains to be established. Although mutations in the Parkin gene has been associated with autosomal recessive juvenile Parkinson’s disease, the role of this gene mutation in causing degeneration of DA neurons has not been defined. We have reported that in hereditary PD, a mutation in the α-synuclein gene may increase the sensitivity of DA neurons to neurotoxins. We hypothesize that, in idiopathic PD, epigenetic (mitochondria, membranes, protein modifications) rather than genetic events are primary targets which, when impaired, initiate degeneration in DA neurons, eventually leading to cell death. Although the nature of neurotoxins that cause degeneration in DA neurons in PD is not well understood, oxidative stress is one of the intermediary risk factors that could initiate and/or promote degeneration of DA neurons. Therefore, supplementation with antioxidants may prevent or reduce the rate of progression of this disease. Supplementation with multiple antioxidants at appropriate doses is essential because various types of free radicals are produced, antioxidants vary in their ability to quench different free radicals and cellular environments vary with respect to their lipid and aqueous phases. L-dihydroxyphenylalanine (L-dopa) is one of the agents used in the treatment of PD. Since L-dopa is known to produce free radicals during its normal metabolism, the combination of L-dopa with high levels of multiple antioxidants may improve the efficacy of L-dopa therapy.     

Women’s Quality of Life in the Premenopausal and Postmenopausal Periods

Purpose The purpose of this research was to determine the relationship between menopausal symptoms and quality of life in women in the pre and postmenopausal periods.Methods and instruments All 171 women in the climacteric period who registered at the Pamukkale University Education and Research Hospital Obstetrics and Gynecology Clinic between January and July 2001 were included in the study. A questionnaire asking for sociodemographic information, complaints related to the climacteric period, and HRT use, as well as the WHOQOL brief, were used in order to obtain data.Findings One hundred of the women who participated in the study were premenopausal and 71 were postmenopausal and the mean age was 47.39 (SD=6.65). No significant difference was found in pre and postmenopausal women in the comparison of their quality of physical life, psychological, social relationships and environment scores (p>0.05). The physical quality of life scores for those without vasomotor complaints in the pre and postmenopausal periods were significantly higher in those with a high educational level and women who had been menopausal between 1–5 years and more than 10 years (p<0.05). Age and HRT use in postmenopausal women were not found to affect quality of life scores (p>0.05).Result We did not find any significant difference in the quality of life of pre and postmenopausal women.     

The Design and Implementation of the 2016 National Survey of Children’s Health

Introduction Since 2001, the Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children’s Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016–February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child’s health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible.     

Systematic Review of the Prevalence and Incidence of Parkinson’s Disease in Asia

Background

Parkinson’s disease (PD) is a common neurodegenerative disorder in older people, and half of the world’s older population lives in Asia. However, the epidemiology of PD in Asian countries is poorly understood. This review assembles evidence on the prevalence and incidence of PD in Asian countries and identifies gaps in our present knowledge.

Methods

A systematic search of studies published from 1965 to October 2008 was conducted using MEDLINE and EMBASE. The selection criteria were defined a priori. Prevalence and incidence were standardized to the WHO World Standard Population 2000. Twenty-one original studies were selected for the review. Two studies that described the ethnic origin of participants and contained Asian populations were also included in the analysis.

Results

Excluding one study with questionably low prevalence and incidence, the remaining studies reported a standardized all-age prevalence of 51.3 to 176.9 per 100 000 in door-to-door surveys; prevalence in record-based studies ranged from 35.8 to 68.3 per 100 000. The standardized incidence rates were 8.7 per 100 000 person-years in door-to-door surveys and 6.7 to 8.3 per 100 000 person-years in record-based surveys.

Conclusions

The prevalence of PD in Asian countries was slightly lower than that in Western countries. However, comparison of incidence was difficult because of the small number of studies. Varying methodologies, diagnostic criteria, and case-finding strategies contributed to the considerable variation in the reported prevalence and incidence of PD.Key words: epidemiology, prevalence, incidence, Parkinson’s disease, Asia     

Epidemiology and etiology of Parkinson’s disease: a review of the evidence

The respective contribution of occupational and behavioural factors to social disparities in all-cause mortality has been studied very seldom. The objective of this study was to evaluate the role of occupational and behavioural factors in explaining social inequalities in premature and total mortality in the French working population. The study population consisted of a sample of 2,189 and 1,929 French working men and women, who responded to a self-administered questionnaire in mid-1996, and were followed up until the end of 2008. Mortality was derived from register-based information and linked to the baseline data. Socioeconomic status was measured using occupation. Occupational factors included biomechanical and physical exposures, temporary contract, psychological demands, and social support, and behavioural factors, smoking, alcohol abuse, and body mass index. Significant social differences were observed for premature and total mortality. Occupational factors reduced the hazard ratios of mortality for manual workers compared to managers/professionals by 72 and 41%, from 1.88 (95% CI: 1.17–3.01) to 1.25 (95% CI: 0.74–2.12) for premature mortality, and from 1.71 (95% CI: 1.18–2.47) to 1.42 (95% CI: 0.95–2.13) for total mortality. The biggest contributions were found for biomechanical and physical exposures, and job insecurity. The role of behavioural factors was very low. Occupational factors played a substantial role in explaining social disparities in mortality, especially for premature mortality and men. Improving working conditions amongst the lowest social groups may help to reduce social inequalities in mortality.     

Sexual Coercion in Intimate Relationships: A Comparative Analysis of the Effects of Women’s Infidelity and Men’s Dominance and Control

Researchers studying the proximate (or immediate) causes of sexual coercion have proposed that partner rape is motivated by a man’s attempt to dominate and control his partner and that this expression of power is the product of men’s social roles. Researchers studying the ultimate (or evolutionary) causes, in contrast, have proposed that partner rape may function as an anti-cuckoldry tactic, with its occurrence related to a man’s suspicions of his partner’s sexual infidelity. In two studies, we collected data relevant to both perspectives to explore how these variables interact with men’s sexual coercion in an intimate relationship. Regression analyses from Study 1 (self-reports from 256 men) and Study 2 (partner-reports from 290 women) indicated that men’s sexual coercion of their partners was consistently predicted by female infidelity and men’s controlling behavior, suggesting that both variables are necessary to explain men’s sexual coercion. Discussion addressed limitations of the current research and highlighted the importance of integrating multiple levels of analysis when studying men’s sexual coercion of their intimate partners.     

Agricultural activities and the incidence of Parkinson’s disease in the general French population

Most studies on pesticides and Parkinson’s disease (PD) focused on occupational exposure in farmers. Whether non-occupational exposure is associated with PD has been little explored. We investigated the association between agricultural characteristics and PD incidence in a French nationwide ecologic study. We hypothesized that persons living in regions with agricultural activities involving more intensive pesticide use would be at higher risk. We identified incident PD cases from French National Health Insurance databases (2010–2012). The proportion of land dedicated to 18 types of agricultural activities was defined at the canton of residence level. We examined the association between agricultural activities and PD age/sex-standardized incidence ratios using multivariable multilevel Poisson regression adjusted for smoking, deprivation index, density of neurologists, and rurality (proportion of agricultural land); we used a false discovery rate approach to correct for multiple comparisons and compute q-values. We also compared incidence in clusters of cantons with similar agricultural characteristics (k-means algorithm). We identified 69,010 incident PD cases. Rurality was associated with higher PD incidence (p < 0.001). Cantons with higher density of vineyards displayed the strongest association (RR_{top/bottom quartile} = 1.102, 95% CI = 1.049–1.158; q-trend = 0.040). This association was similar in men, women, and non-farmers, stronger in older than younger persons, and present in all French regions. Persons living in the cluster with greatest vineyards density had 8.5% (4.4–12.6%) higher PD incidence (p < 0.001). In France, vineyards rank among the crops that require most intense pesticide use. Regions with greater presence of vineyards are characterized by higher PD risk; non-professional pesticides exposure is a possible explanation.     

Consumption of fish and Alzheimer’s Disease

Alzheimer’s Disease (AD) has been described as ‘one of the most disabling and burdensome health conditions worldwide’ and is responsible for approximately 70% of dementia in the elderly. Based on the current prevalence of AD, an aging world population and the associated projected health care requirements, it is estimated that by 2050, the prevalence of AD will reach 104 million with around 43% requiring ongoing health care. If the onset of AD can be reduced by as little as one year, the prevalence could be reduced by 10%. There is substantial commonality in research findings to date around the positive influence of seafood consumption in reducing the risk of dementia and AD. Emerging concern about the sustainability of global fisheries supports the recommendation of selective consumption of sustainable wild caught and increased emphasis on production of farmed fish supplies to meet consumption needs.     

Prevalence of Children’s Mental Health Problems and the Effectiveness of Population-Level Family Interventions

The prevalence of mental health problems among children and adolescents is of growing importance. Intervening in children’s mental health early in life has been shown to be more effective than trying to resolve these problems when children are older. With respect to prevention activities in community settings, the prevalence of problems should be estimated, and the required level of services should be delivered. The prevalence of children’s mental health disorders has been reported for many countries. Preventive intervention has emphasized optimizing the environment. Because parents are the primary influence on their children’s development, considerable attention has been placed on the development of parent training to strengthen parenting skills. However, a public-health approach is necessary to confirm that the benefits of parent-training interventions lead to an impact at the societal level. This literature review clarifies that the prevalence of mental health problems is measured at the national level in many countries and that population-level parenting interventions can lower the prevalence of mental health problems among children in the community.Key words: child, mental health, prevalence, family intervention, evaluation     

Pediatricians’ use of the 5 A’s and nicotine replacement therapy with adolescent smokers

The purpose of this study was to examine pediatricians’ use of nicotine replacement therapy (NRT) and the 5 A’s counseling method with adolescent smokers. Using a mail survey, 203 randomly selected pediatricians (52% response rate) responded to a valid and reliable 37-item questionnaire regarding: perceptions of prescribing NRT, confidence in using NRT, perceived barriers to prescribing NRT, sources of information regarding NRT, and use of the 5 A’s counseling method. Forty-four percent of pediatricians did not feel competent in helping adolescents quit smoking cigarettes. Less than a fifth (17%) were currently prescribing NRT. A plurality (48%) perceived NRT to be safe for adolescent use but a majority (53%) rated themselves as not confident in their ability to use NRT. Those who prescribed NRT used transdermal patches (81%), nicotine gum (53%), or bupropion (44%). Pediatricians based their decisions on using NRT on whether: the adolescent showed an openness to quitting (78%), the adolescent requested NRT (72%), and if the adolescent had a health problem exacerbated by smoking (56%). The low level of perceived competence in helping adolescents quit smoking may be due to how few pediatricians identified medical school as a major source of information on helping adolescents stop smoking. Even though ample evidence suggests that NRT is safe to use with adolescents, less than half of the responding pediatricians perceived it to be safe, possibly indicating a desire for a more definitive conclusion on its safety before adopting the products or a lack of awareness of existing studies on this topic. This study was funded by the Ohio Tobacco Use Prevention and Control Foundation (Grant #04-5-015) and placed no restrictions on the published findings.     

“We’re Part of the Solution”: Evolution of the Food and Beverage Industry’s Framing of Obesity Concerns Between 2000 and 2012

We investigated how industry claim-makers countered concerns about obesity and other nutrition-related diseases in newspaper coverage from 2000, the year before the US Surgeon General’s Call to Action on obesity, through 2012. We found that the food and beverage industry evolved in its response. The defense arguments were made by trade associations, industry-funded nonprofit groups, and individual companies representing the packaged food industry, restaurants, and the nonalcoholic beverage industry. Individual companies used the news primarily to promote voluntary self-regulation, whereas trade associations and industry-supported nonprofit groups directly attacked potential government regulations. There was, however, a shift away from framing obesity as a personal issue toward an overall message that the food and beverage industry wants to be “part of the solution” to the public health crisis.Since 2001, when the US Surgeon General issued a Call to Action to address obesity,1–3 public health advocates have proposed a range of policies to improve the food and beverage environment. The food industry has strongly opposed many of these initiatives, at times using tobacco industry tactics including corporate social responsibility programs and personal responsibility rhetoric.4–7 Corporate social responsibility can take many forms, including industry adoption of self-policing strategies intended to resolve public health concerns.7–10 The food industry has launched and widely publicized a number of self-regulatory programs,11–14 but research suggests that these initiatives may have done little to mitigate unhealthful food environments.15–28 Past analyses suggest that the food industry also has used personal responsibility rhetoric to shift responsibility for health harms from the industry and its products onto individuals,4 influence how the public addresses obesity, and fight government regulation of its products and marketing practices.4–7News coverage is an important part of the public conversation about social issues such as obesity. The news helps establish which issues appear on the public agenda, and influences how the public and policymakers view these problems and craft potential solutions.29–33 Social problems such as obesity are defined by how they are framed and who is influencing the framing.34 “Framing” refers to how an issue is portrayed and understood, and involves emphasizing certain aspects of an issue to the exclusion of others.35 News coverage is a key site in which framing takes place. Frames in the news are “persistent patterns” by which the news media organize and present stories.36 Frames help readers construct meaning consciously or unconsciously,37 and shape the parameters of public policy debates by promoting “a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation for the item described.”^35(p52)Because of the importance of the news in how readers understand contemporary issues,38 news framing is a site of power struggles in which multiple groups contest to shape public perception of an issue.39,40 Different speakers or “claim-makers” quoted in the news frame the same issue in conflicting ways to serve their interests. Examining their claims offers insights into the range of perspectives represented on a particular issue.41–45Among the key claim-makers for the food and beverage industry (hereafter “food industry”) are food companies, trade associations, and industry-funded nonprofit organizations. Individual food and beverage companies include companies that sell packaged food (e.g., Kraft), restaurant meals (e.g., McDonald’s), and nonalcoholic beverages (e.g., Coca-Cola). Individual companies may comment about public policy in the news, but they also form trade associations that advocate the interests of groups of food companies.46–49 Trade associations are the public voice of an industry,50 and often lobby or otherwise influence government decision-making.51–53 Trade associations also engage in public relations to exercise political influence, including advocacy advertising and speaking with the press.51There are numerous food industry trade associations representing the interests of different sectors of the industry such as packaged food manufacturers (e.g., Grocery Manufacturer’s Association), restaurants (e.g., National Restaurant Association), beverage companies (e.g., American Beverage Association [ABA]), and food retailers (e.g., Food Marketing Institute). The food industry also funds nonprofit groups to speak on its behalf. When these groups use names that evoke grassroots consumer advocacy and do not alert the public to their connection with industry they are known as “front groups.”4 The Center for Consumer Freedom (CCF) and Americans Against Food Taxes are 2 primary examples.54To understand how the food industry has presented itself in the news in the context of obesity policy debates, we investigated how key industry claim-makers countered concerns about obesity and other nutrition-related diseases in newspaper coverage. We collected data from 2000, the year before the 2001 US Surgeon General’s Call to Action and the advent of widespread concern about obesity as a public health problem, through 2012, the last full year of data available at the time. Previous studies have tracked news coverage of obesity and childhood obesity over time,55–57 and assessed the degree to which the food industry is framed as a cause of obesity or as a potential point of intervention. These studies documented increases in obesity coverage throughout the early 2000s, and a growing trend toward addressing societal causes of and solutions to the problem of obesity, including food industry actions. However, these previous analyses have not evaluated the actual statements made by food industry claim-makers in the news.55,56For this analysis we compared the claims made by food industry trade associations, industry-funded nonprofit groups, and individual companies. We also examined the nuances among statements made by claim-makers representing the interests of the packaged food industry, restaurants, and the nonalcoholic beverage industry.     

Ricoeur’s hermeneutic arc and the “narrative turn” in the ethics of care

Medicine, Health Care and Philosophy - “Patient-centred care” is the recent response to the malaise produced in the field of health care from the point of view both of a technical...     

Environmental Health Research and the Observer’s Dilemma

Background

Environmental health researchers frequently study people in occupational, educational, recreational, or domestic settings who are exposed to hazardous agents.

Objective/discussion

Deciding whether—and how—to inform research subjects about risks they face in their environment can be a challenging task for investigators. Because legal rules and professional guidelines do not cover this topic, investigators must carefully consider their ethical obligations in light of the facts and circumstances.

Conclusion

To navigate through this dilemma, investigators should consider the evidence for the risks, the nature of the risks, the usefulness of risk information to the subjects, and the effects on the study and community of informing subjects about risks.     

Substance Use and Intimate Partner Violence: Clarifying the Relevance of Women’s Use and Partners’ Use

Research has shown that, when women and/or their partners are involved in substance use, women’s risk for intimate partner violence (IPV) is higher. Prior research has not examined whether substance use by both women and their partners contributes independently or interactively to women’s risk of victimization and has not identified factors moderating the effect of substance use by victim or partner. Mental health and social support are explored as moderators of the association between women’s victimization and substance use by victim or partner in a study of 590 impoverished women residing in the Los Angeles area. This study found that substance use by both the woman and her partner independently predicted IPV and that social support moderated the effect of women’s substance use. These findings clarify the relevance of substance use in the context of intimate relationships and that of social support as a buffer against IPV among impoverished women.     

Contrasting children and women’s health and the determinants of health in a small-sized city

Contrasts that exist in urban infrastructure and accessibility of public health and social services between suburban and urban districts of mega-cities have been well defined. There has been less research in small-sized cities (population under 500,000). This cross-sectional study was done on 1,728 ever-married reproductive-aged women living in Manisa, Turkey, in the year 2000. The probability proportion to size cluster sampling approach was used in the sample selection. Data were collected for women and 7,016 inhabitants of the interviewed households. The data were collected from the women by face to face interviews. Suburban areas (illegally occupied public land called “Gecekondu” dwellings) in Manisa differ from other urban regions (legal settlements of the city) on socioeconomic factors including household occupancy, adult literacy, social class, rates of religious marriages, unemployment, health insurance coverage, migration, cultural segregation, and social status of women. Some traditional practices were also highly prevalent in gecekondu families, where poverty is more common. Although gross fertility rate (GFR), total fertility rate (TFR), and percent decrease of the TFR were higher for gecekondu women than urban women, total wanted fertility rate (TWFR) was lower. In urban neighborhoods, prevalence of contraceptive use was higher, and the infant and child mortality rates were lower; however, when rates were adjusted for mother’s age, education and number of births, the differences turned out to be nonsignificant. Women living in urban areas receive better antenatal care, child immunization services, and professional health delivery assistance and services in a health facility; these services are very scarce in gecekondu districts. Health status of gecekondu populations can be improved by social and economic support and by making health services more available and accessible, especially maternity and child health services.