Incentivizing Children's Fruit and Vegetable Consumption: Results of a United States Pilot Study of the Food Dudes Program

ObjectivePreliminary evaluation in the United States (US) of a school-based fruit and vegetable (F/V) intervention, known as the Food Dudes (FD) program, developed in the United Kingdom.MethodsOver 16 days (Phase 1), elementary-school children (n = 253) watched short videos featuring heroic peers (the FD) eating F/V and received a reward for eating F/V served at lunchtime. In the 3 months that followed (Phase 2), children received increasingly intermittent rewards for eating F/V. Consumption was measured by photo analysis and assessment of skin carotenoids.ResultsFruit and vegetable intake increased significantly after Phases 1 and 2 (P < .001 for both). This effect was most discriminable among children who consumed no fruit (n = 100) or no vegetables (n = 119) at pre-intervention baseline. Among these children, F/V intake (combined) increased by 0.49 (0.53) cups per day.Conclusions and ImplicationsThe FD program can increase F/V intake in US elementary schools.     

Hemp Seeds in Post-Arthroplasty Rehabilitation: A Pilot Clinical Study and an In Vitro Investigation

Osteoarthritis is a type of degenerative joint disease that results from the breakdown of joint cartilage and underlying bone. Due to their antioxidants and anti-inflammatory action, the phytochemical constituents of many vegetable varieties could represent a new frontier for the treatment of patients with Osteoarthritis and are still being explored. The aim of this pilot human study was to investigate the effects of pasta enriched with hemp seed flour on osteoarticular pain and bone formation markers in patients in post-arthroplasty rehabilitation. Another purpose was to evaluate the effect of hemp seed extract on bone metabolism, in vitro. A pilot, controlled, clinical study was conducted to verify the feasibility of pain symptom reduction in patients with Osteoarthritis undergoing arthroplasty surgery. We also investigated the effect of hemp seed extract on the Wnt/β-catenin and ERK1/2 pathways, alkaline phosphatase, RANKL, RUNX-2, osteocalcin, and COL1A on Saos-2. After 6 weeks, the consumption of hemp seed pasta led to greater pain relief compared to the regular pasta control group (−2.9 ± 1.3 cm vs. −1.3 ± 1.3 cm; p = 0.02). A significant reduction in serum BALP was observed in the participants consuming the hemp seed pasta compared to control group (−2.8 ± 3.2 µg/L vs. 1.1 ± 4.3 µg/L; p = 0.04). In the Saos-2 cell line, hemp seed extract also upregulated Wnt/β-catenin and Erk1/2 pathways (p = 0.02 and p = 0.03) and osteoblast differentiation markers (e.g., ALP, OC, RUNX2, and COL1A) and downregulated RANKL (p = 0.02), compared to the control. Our study demonstrated that hemp seed can improve pain symptoms in patients with osteoarthritis undergoing arthroplasty surgery and also improves bone metabolism both in humans and in vitro. However, more clinical studies are needed to confirm our preliminary findings.     

安徽省主粮中杂色曲霉素污染状况调查

报道了安徽省部分地区小麦、玉米、大米三种主要粮食中霉菌侵染状况。杂色曲霉素（ＳＴ）用化学方法提取，毒素含量测定用灵敏、快速的ＥＬＬＳＡ方法。结果表明三种粮食中霉菌侵染严重，侵染率分别为９６．２７％，８４．７９％和２６．８０％。霉菌菌相以曲霉为主。ＳＴ在粮食中污染较普遍，阳性率为６７．２％～１００％，平均含量为０．４９～２３１．５３μｇ／ｋｇ。尤其在小麦中阳性率高达１００％，平均含量达１６１．３μｇ／ｋｇ，１９９４年收获的小麦、玉米平均含毒量明显高于１９９５年收获的小麦、玉米，说明ＳＴ在粮食储藏过程中易产生     

Unemployment and Mortality: A Comparative Study of Germany and the United States

Objectives. We examined the relationship between unemployment and mortality in Germany, a coordinated market economy, and the United States, a liberal market economy.Methods. We followed 2 working-age cohorts from the German Socio-economic Panel and the US Panel Study of Income Dynamics from 1984 to 2005. We defined unemployment as unemployed at the time of survey. We used discrete-time survival analysis, adjusting for potential confounders.Results. There was an unemployment–mortality association among Americans (relative risk [RR] = 2.4; 95% confidence interval [CI] = 1.7, 3.4), but not among Germans (RR = 1.4; 95% CI = 1.0, 2.0). In education-stratified models, there was an association among minimum-skilled (RR = 2.6; 95% CI = 1.4, 4.7) and medium-skilled (RR = 2.4; 95% CI = 1.5, 3.8) Americans, but not among minimum- and medium-skilled Germans. There was no association among high-skilled Americans, but an association among high-skilled Germans (RR = 3.0; 95% CI = 1.3, 7.0), although this was limited to those educated in East Germany. Minimum- and medium-skilled unemployed Americans had the highest absolute risks of dying.Conclusions. The higher risk of dying for minimum- and medium-skilled unemployed Americans, not found among Germans, suggests that the unemployment–mortality relationship may be mediated by the institutional and economic environment.The relationship between unemployment and mortality has been a well-studied phenomenon. Unemployment has been found to be associated with all-cause mortality1–4 for both men5–7 and women,8,9 for older workers,10–14 for cause-specific outcomes,15,16 and after controls for health selection into unemployment.17–20 Some studies have found that the relationship between unemployment and mortality is smaller during times of high unemployment than in times of low unemployment21,22; studies of plant closure conducted during times of high unemployment have found a consistent relationship.23,24Unemployment has almost always been viewed as an individual-level risk factor on health within the context of a single country or economy. When context has been considered it has been to investigate whether the effect of unemployment on health is different during times or places with high unemployment compared with low unemployment.22,25,26 Unemployment may influence health through material (e.g., loss of income) and psychosocial (e.g., loss of individual and social identity) pathways. These pathways are embedded in and influenced by societal and institutional context at every point, from determining who is unemployed (and who participates in the labor market), the meaning of unemployment, the material effect of unemployment, and the future employment consequences of unemployment.Recent scholarship in health inequalities has begun to characterize the structural and contextual features of a society that lead to better or worse population health outcomes.27,28 This research has emphasized the importance of welfare-regime type as the principal independent variable in explaining variation in health inequalities among countries. Welfare-regime typologies classify countries according to how the state provides social and economic protection to its citizens. Although there are many welfare-regime typologies,29 Esping-Andersen’s30 typology that classifies countries into social democratic (universal provision), conservative (class-based provision), and liberal or residual (mean-tested provision) welfare-regime clusters is the most common.Few studies have examined whether the relationship between unemployment and health varies across welfare-regime type. Bambra and Eikemo found that the unemployed in liberal welfare regimes had the highest odds of reporting poorer self-reported health status for both unemployed men and women, but that high odds ratios were also found for unemployed men in conservative welfare regimes and women in social democratic welfare regimes.31 Cooper et al. examined the relationship between unemployment and exit into poor health in 14 European countries, but did not find any relationship across welfare regimes.32,33 Rodriguez examined whether the receipt of means-tested (i.e., welfare or social assistance) and unemployment benefits moderated the relationship between unemployment and self-assessed health in Germany (a conservative welfare regime), the United Kingdom, and the United States (2 liberal welfare regimes).34 Regular unemployment benefits moderated the relationship between unemployment and health in all 3 countries compared with the unemployed in receipt of means-tested benefits. The unemployed not in receipt of any benefits in the United States also reported poorer self-assessed health.Hall and Soskice’s Varieties of Capitalism typology35 provides a more relevant way of understanding how the institutional environment may affect the health of the unemployed because it is based, more directly than Esping-Andersen’s typology, on the conditions of employment and unemployment. Economies of high-income countries are grouped into coordinated market economies (CMEs) and liberal market economies (LMEs) that have different production specializations, similar economic growth and aggregate levels of wealth, but different economic and labor market institutions. Within CMEs and LMEs there is an interdependent relationship between the coordinating features of the market economy, the goods and services produced, the skills required by workers, and the potential future consequences of unemployment. The CMEs (e.g., Germany and Sweden) are characterized by collaboration among firms, trade unions, and other market actors and specialize in the production of goods and services that require a high degree of firm- or industry-specific skills and require workers that are technically or vocationally trained. High levels of employment protection (i.e., restrictions on terminating employees) and unemployment protection (i.e., the availability and level of unemployment benefits) safeguard the educational investment of workers, as once unemployed there may not be demand for their skills in other firms or industries.36In LMEs, by contrast, competitive market institutions predominate, including a flexible labor market with low levels of unemployment and employment protection. These economies specialize in goods and services that require general skills that are readily transferred across firms and industries. In accordance, the risk of unemployment and its effect on the health of the unemployed may vary across countries and within countries by skill level, depending on the protections provided to the unemployed and the opportunities for reemployment. Specifically, in LMEs the flexible labor market advantages those with high general skills (i.e., a university degree), whereas in CMEs the more coordinated labor market is structured to support workers with firm- and industry-specific vocational skills.37We examined whether the relationship between unemployment and mortality differs between Germany, a CME, and the United States, an LME, with 2 comparable working-age cohorts. We hypothesized that the higher levels of unemployment protection in Germany will mediate the effect of unemployment on mortality compared with the United States and that the gradient in the risk of unemployment on mortality by general educational status will be steeper in the United States compared with Germany.     

A panic foretold: Ebola in the United States

This paper reconsiders the Ebola response in the US as a panic that was both predictable and problematic. Public health professionals and policy-makers have historically drawn attention to and prepared for emerging infectious diseases by raising the specter of catastrophe, generating fears that the media and politicians are often willing to amplify. Although this approach can increase awareness of and funding for global health threats, it also sows the seeds of panic, stigmatizing people associated with the disease, and compromising an effective, evidence-based response. We offer lessons for public health leaders as they review the US Ebola response in order to prepare more responsibly for future disease scares such as that posed by the Zika virus.     

Assessment of Cooking Matters Facebook Platform to Promote Healthy Eating Behaviors among Low-Income Caregivers of Young Children in the United States: A Pilot Study

How best to deliver healthy-eating education through social media among a low-income population remains understudied. To assess the impact of the Cooking Matters (CM) Facebook page on healthy eating behaviors among low-income caregivers, we conducted a pre–post survey of new CM Facebook followers in early 2020. A convenience sample was recruited at baseline from WICShopper app users and the CM Facebook page. The recruited sample included 397 low-income caregivers of a child younger than 6 who never followed CM Facebook. Among the baseline caregivers, 184 completed the follow-up survey. Paired t-test and McNemar–Bowker tests were conducted to compare the outcomes pre- and post-following CM Facebook. A binary indicator was developed to measure whether the outcomes were improved (1 = Improved; 0 = Not improved). Multi-variable logistic regressions were applied to examine the relationship between whether the outcome was improved with reference to the baseline socio-demographics. No significant differences were detected between pre and post outcomes overall (p > 0.05), except improvement in feeding healthy meals within the budget available (p < 0.05). However, improvement in select outcomes was more significant in men and single-parent households. The CM Facebook page could be an important platform to influence low-income caregivers of young children.     

Immunizations in the United States: success, structure, and stress

Immunization is a great success of preventive medicine. In the United States, most vaccine-preventable diseases of childhood are at or near record lows while the number of diseases preventable by vaccination has increased. These successes result from a comprehensive system that includes basic research; developing and testing vaccine candidates; a manufacturing base; a regulatory authority; development of immunization policies; implementation of immunization recommendations; and a compensation system for the few people unavoidably injured by vaccines. Despite the successes, the system faces numerous challenges, including vaccine supply, cost, and safety; adult immunization; vaccine research and development; and biopreparedness.     

School Health Services in the United States: A View from the United Kingdom

Despite sharing both a common heritage and a common language, differences exist between life in the United States and the United Kingdom. During spring 1988, the author, who formerly served as editor for the Health Visitor, published by the Health Visitor's Association, completed a six-week study tour of school health services in the United States. In this article, she gives her impressions from the experience, including observations regarding salary, working conditions, professional preparation, and professional recognition. She concludes by identifying several poignant questions to clarify the school nurse's role and to set priorities for the optimal use of time and expertise.     

Expensive Cancer Drugs: A Comparison between the United States and the United Kingdom

Context: This article compares the United Kingdom''s and the United States’ experiences with expensive cancer drugs to illustrate the challenges posed by new, extremely costly, medical technologies.Methods: This article describes British and American coverage, access, and cost-sharing policies with regard to expensive cancer drugs and then compares the costs of eleven such drugs to British patients, American Medicare beneficiaries, and American patients purchasing the drugs in the retail market. Three questions posed by these comparisons are then examined: First, which system is fairer? In which system are cancer patients better off? Assuming that no system can sustainably provide to everyone at least some expensive cancer drugs for some clinical indications, what challenges does each system face in making these difficult determinations?Findings: In both the British and American health care systems, not all patients who might benefit from or desire access to expensive cancer drugs have access to them. The popular characterization of the United States, where all cancer drugs are available for all to access as and when needed, and that of the British NHS, where top-down population rationing poses insurmountable obstacles to British patients’ access, are far from the reality in both countries.Conclusions: Key elements of the British system are fairer than the American system, and the British system is better structured to deal with difficult decisions about expensive end-of-life cancer drugs. Both systems face common ethical, financial, organizational, and priority-setting challenges in making these decisions.     

Recent vaccine mandates in the United States,Europe and Australia: A comparative study

BackgroundIn response to recent outbreaks of vaccine-preventable diseases and concerns around vaccine refusal, several high-income countries have adopted or reformed vaccine mandate policies. While all make it more difficult for parents to refuse vaccines, the nature and scope of ‘mandatory vaccination’ is heterogeneous, and there has been no attempt to develop a detailed, comparative systematic account of the possible forms mandates can take.MethodsWe compare the construction, introduction/amendment, and operation of six new high profile vaccine mandates in Australia, France, Germany, Italy, California, and Washington. We rank these policies in order of their relative restrictiveness and analyze other differences between them.ResultsNew mandate instruments differ in their effects on behavior, and with regard to their structure, exemptions, target populations, consequences and enforcement. We identify diverse means by which vaccine mandates can restrict behaviors, various degrees of severity, and different gradations of intensity in enforcement.ConclusionWe suggest that politico-cultural context and vaccine policy history are centrally important factors for vaccine mandate policymakers to consider. It matters whether citizens trust their governments to limit individual freedom in the name of public health, and whether citizens have previously been subjected to vaccine mandates. Furthermore, political communities must consider the diverse mechanisms by which they may construct vaccine mandate policies; whether through emergency decrees or ordinary statutes, and how (or whether) to involve various stakeholder groups in developing and implementing new vaccine mandate policies.     

Understanding the Patient Experience of Severe,Recurrent, Bilateral Nasal Polyps: A Qualitative Interview Study in the United States and Germany

ObjectivesTo qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP).MethodsA targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192). A subset of 10 participants reported symptoms and impacts using a smartphone or tablet application (app) over a 10-day period.ResultsA paucity of qualitative evidence regarding patient experience of NP was identified from the literature or blog review. Twenty-seven participant interviews were conducted. Thirty-six symptoms were identified, including 7 primary symptoms (nasal congestion [n = 27 of 27], breathing difficulties [n = 27 of 27], postnasal drip [n = 25 of 27], runny nose [n = 24 of 27], head/facial pressure [n = 23 of 27], loss of smell [n = 23 of 27], loss of taste [n = 22 of 27]) and 29 secondary symptoms (the most common were mucus/catarrh and nose bleeds [both n = 20 of 27]). Most symptoms were reported to vary both within and between days. Sixty impacts of severe NP were reported, including impacts on sleep (n = 22 of 27), physical functioning (n = 21 of 27), activities of daily living (n = 21 of 27), emotional well-being (n = 27 of 27), treatment (n = 23 of 27), social life (n = 26 of 27), and work (n = 19 of 27). Symptoms/impacts reported using the app were consistent with interview findings, although new symptoms were identified (ear pain, throat pain, nasal scabs, and nasal burning). These results supported the development of a conceptual model outlining concepts related to symptoms, impacts, and treatment of NP.ConclusionsSevere, recurrent, bilateral NP are associated with a range of symptoms that have significant detrimental impact on HRQoL.