Pub Date : 2019-11-14DOI: 10.1136/jech-2018-211773
A. Garcia, Nurie S. Athifa, Elizabeth Hammond, A. Parrett, Anné Gebbie-Dibén
Background The immediate and sustained impacts of the Eat Better Feel Better cooking programme (EBFBCP) on food choices and eating behaviours in families and children were evaluated. Methods The EBFBCP (6 weeks, 2 hours/week) was delivered by community-based organisations in Greater Glasgow and Clyde, Scotland. Before, after and at follow-up, parents/caregivers completed short pictorial questionnaires to report family/child eating behaviours and food literacy. Results In total, 83 EBFBCPs were delivered and 516 participants enrolled, of which 432 were parents and caregivers. Questionnaire completion rates were 57% (n=250) for before and after and 13% (n=58) for follow-up. Most participants (80%) were female, 25–44 years old (51%) and considered socioeconomically deprived (80%). The immediate effects of the EBFBCP on eating behaviours and food literacy were families ate less takeaway/fast foods (10% reduction, p=0.019) and ready meals (15% reduction, p=0.003) and cooked more from scratch (20% increase, p<0.001). Children’s consumption of discretionary food/drinks was significantly reduced after the EBFBCP for sugary drinks (10% reduction, p=0.012), savoury snacks (18%, p=0.012), biscuits (17%, p=0.007), sweets/chocolates (23%, p=0.002), fried/roasted potatoes (17%, p<0.001) and savoury pastries (11%, p<0.001). The number of fruit (15%, p=0.008) and vegetable portions (10%, p<0.001) increased, while the number of biscuit portions decreased (13%, p=0.005). Parental food label reading increased (calories, 22%; fat, 23%; sugar, 22%; ingredients, 19%; and portion size, 19%). Most changes were sustained at a median of 10 months’ follow-up. Conclusion The EBFBCP improved children’s and families’ food choices and behaviours. The EBFBCP can be recommended to support families to make better food choices.
{"title":"Community-based cooking programme ‘Eat Better Feel Better’ can improve child and family eating behaviours in low socioeconomic groups","authors":"A. Garcia, Nurie S. Athifa, Elizabeth Hammond, A. Parrett, Anné Gebbie-Dibén","doi":"10.1136/jech-2018-211773","DOIUrl":"https://doi.org/10.1136/jech-2018-211773","url":null,"abstract":"Background The immediate and sustained impacts of the Eat Better Feel Better cooking programme (EBFBCP) on food choices and eating behaviours in families and children were evaluated. Methods The EBFBCP (6 weeks, 2 hours/week) was delivered by community-based organisations in Greater Glasgow and Clyde, Scotland. Before, after and at follow-up, parents/caregivers completed short pictorial questionnaires to report family/child eating behaviours and food literacy. Results In total, 83 EBFBCPs were delivered and 516 participants enrolled, of which 432 were parents and caregivers. Questionnaire completion rates were 57% (n=250) for before and after and 13% (n=58) for follow-up. Most participants (80%) were female, 25–44 years old (51%) and considered socioeconomically deprived (80%). The immediate effects of the EBFBCP on eating behaviours and food literacy were families ate less takeaway/fast foods (10% reduction, p=0.019) and ready meals (15% reduction, p=0.003) and cooked more from scratch (20% increase, p<0.001). Children’s consumption of discretionary food/drinks was significantly reduced after the EBFBCP for sugary drinks (10% reduction, p=0.012), savoury snacks (18%, p=0.012), biscuits (17%, p=0.007), sweets/chocolates (23%, p=0.002), fried/roasted potatoes (17%, p<0.001) and savoury pastries (11%, p<0.001). The number of fruit (15%, p=0.008) and vegetable portions (10%, p<0.001) increased, while the number of biscuit portions decreased (13%, p=0.005). Parental food label reading increased (calories, 22%; fat, 23%; sugar, 22%; ingredients, 19%; and portion size, 19%). Most changes were sustained at a median of 10 months’ follow-up. Conclusion The EBFBCP improved children’s and families’ food choices and behaviours. The EBFBCP can be recommended to support families to make better food choices.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"9 1","pages":"190 - 196"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86194096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-02DOI: 10.1136/jech-2019-212531
Y. Gu, X. Bao, Yanyan Wang, G. Meng, Hongmei Wu, Qing Zhang, Li Liu, K. Song, Yaogang Wang, K. Niu
Background Hypertension and diabetes frequently coexist, which results in the difficulty of hypertension control in community-dwelling elderly adults who lack effective prevention and control strategies. The aim of this study is to determine whether a combined pedometer and home blood pressure monitoring (HBPM) programme could improve blood pressure (BP) among community-dwelling elderly adults with hypertension and diabetes. Methods The trial was a 2×2 factorial randomised clinical trial that recruited 180 community-dwelling elderly people (aged ≥60) with hypertension and diabetes in Tianjin, China. Participants were randomly assigned to control, pedometer, HBPM, and pedometer+HBPM groups. Intervention period was 12 months. The coprimary outcomes of the study were systolic and diastolic BP; the secondary outcomes included the proportion of patients with controlled hypertension. BP was measured twice in the right arm using a mercurial sphygmomanometer. The mean of these two measurements was taken as the BP value. Results At 12 months, compared with the control group, the adjusted differences in least squares mean (95% CI) in systolic and diastolic BP changes for pedometer, HBPM, and pedometer+HBPM groups were −4.2 (–8.4 to 0.1), –2.7 (–6.9 to 1.5) and −8.1 (–12.3 to –3.9) mm Hg (p<0.01); −3.2 (–5.2 to –1.1), −0.1(−2.1 to 1.9) and −3.6 (–5.6 to –1.5) mm Hg (p<0.001), respectively; the adjusted difference in percentage (95% CI) in the controlled hypertension (BP <140/90 mm Hg) for pedometer, HBPM and pedometer+HBPM groups were 7.5 (–12.2 to 27.1), 9.9 (–10.4 to 30.3) and 23.1 (5.0 to 41.1) (p=0.09). Conclusion Combination pedometer and HBPM interventions can significantly decrease BP levels in elderly adults with hypertension and diabetes. Trials Registration number UMIN000021613.
{"title":"Effects of self-monitoring devices on blood pressure in older adults with hypertension and diabetes: a randomised controlled trial","authors":"Y. Gu, X. Bao, Yanyan Wang, G. Meng, Hongmei Wu, Qing Zhang, Li Liu, K. Song, Yaogang Wang, K. Niu","doi":"10.1136/jech-2019-212531","DOIUrl":"https://doi.org/10.1136/jech-2019-212531","url":null,"abstract":"Background Hypertension and diabetes frequently coexist, which results in the difficulty of hypertension control in community-dwelling elderly adults who lack effective prevention and control strategies. The aim of this study is to determine whether a combined pedometer and home blood pressure monitoring (HBPM) programme could improve blood pressure (BP) among community-dwelling elderly adults with hypertension and diabetes. Methods The trial was a 2×2 factorial randomised clinical trial that recruited 180 community-dwelling elderly people (aged ≥60) with hypertension and diabetes in Tianjin, China. Participants were randomly assigned to control, pedometer, HBPM, and pedometer+HBPM groups. Intervention period was 12 months. The coprimary outcomes of the study were systolic and diastolic BP; the secondary outcomes included the proportion of patients with controlled hypertension. BP was measured twice in the right arm using a mercurial sphygmomanometer. The mean of these two measurements was taken as the BP value. Results At 12 months, compared with the control group, the adjusted differences in least squares mean (95% CI) in systolic and diastolic BP changes for pedometer, HBPM, and pedometer+HBPM groups were −4.2 (–8.4 to 0.1), –2.7 (–6.9 to 1.5) and −8.1 (–12.3 to –3.9) mm Hg (p<0.01); −3.2 (–5.2 to –1.1), −0.1(−2.1 to 1.9) and −3.6 (–5.6 to –1.5) mm Hg (p<0.001), respectively; the adjusted difference in percentage (95% CI) in the controlled hypertension (BP <140/90 mm Hg) for pedometer, HBPM and pedometer+HBPM groups were 7.5 (–12.2 to 27.1), 9.9 (–10.4 to 30.3) and 23.1 (5.0 to 41.1) (p=0.09). Conclusion Combination pedometer and HBPM interventions can significantly decrease BP levels in elderly adults with hypertension and diabetes. Trials Registration number UMIN000021613.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"71 1","pages":"137 - 143"},"PeriodicalIF":0.0,"publicationDate":"2019-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87982576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-02DOI: 10.1136/jech-2019-212714
Maryrose Faulkner, L. Barker, S. Vigod, C. Dennis, H. Brown
Background Chronic medical conditions (CMCs) and poverty commonly co-occur and, while both have been shown to independently increase the risk of perinatal mental illness, their collective impact has not been examined. Methods This population-based study included 853 433 Ontario (Canada) women with a singleton live birth and no recent mental healthcare. CMCs were identified using validated algorithms and disease registries, and poverty was ascertained using neighbourhood income quintile. Perinatal mental illness was defined as a healthcare encounter for a mental health or substance use disorder in pregnancy or the first year postpartum. Modified Poisson regression was used to test the independent impacts of CMC and poverty on perinatal mental illness risk, adjusted for covariates, and additive interaction between the two exposures was assessed using the relative excess risk due to interaction (RERI) and synergy index (SI). Results CMC and poverty were each independently associated with increased risk of perinatal mental illness (CMC vs no CMC exposure: 19.8% vs 15.6%, adjusted relative risk (aRR) 1.21, 95% CI (CI) 1.20 to 1.23; poverty vs no poverty exposure: 16.7% vs 15.5%, aRR 1.06, 95% CI 1.05 to 1.07). However, measures of additive interaction for the collective impact of both exposures on perinatal mental illness risk were not statistically significant (RERI 0.02, 95% CI −0.01 to 0.06; SI 1.09, 95% CI 0.95 to 1.24). Conclusion CMC and poverty are independent risk factors for perinatal mental illness and should be assessed as part of a comprehensive management programme that includes prevention strategies and effective screening and treatment pathways.
背景:慢性疾病(CMCs)和贫困通常是同时发生的，虽然两者都被证明独立地增加了围产期精神疾病的风险，但它们的集体影响尚未得到研究。方法:本研究以人群为基础，纳入853 433名安大略省(加拿大)单胎活产且近期无精神保健的妇女。使用经过验证的算法和疾病登记来确定cmc，使用社区收入五分位数来确定贫困。围产期精神疾病被定义为在怀孕期间或产后第一年因精神健康或物质使用障碍而就诊。采用修正泊松回归检验CMC和贫困对围产期精神疾病风险的独立影响，对协变量进行调整，并采用相对过量相互作用风险(relative excess risk due interaction, RERI)和协同作用指数(synergy index, SI)评估两种暴露之间的加性相互作用。结果CMC和贫困分别与围产期精神疾病风险增加独立相关(CMC vs无CMC暴露:19.8% vs 15.6%，调整相对风险(aRR) 1.21, 95% CI (CI) 1.20 ~ 1.23;贫困vs无贫困:16.7% vs 15.5%， aRR 1.06, 95% CI 1.05 - 1.07)。然而，两种暴露对围产期精神疾病风险的总体影响的加性相互作用的测量结果没有统计学意义(rei 0.02, 95% CI−0.01至0.06;SI 1.09, 95% CI 0.95 ~ 1.24)。结论CMC和贫困是围产期精神疾病的独立危险因素，应纳入综合管理方案，包括预防策略和有效的筛查和治疗途径。
{"title":"Collective impact of chronic medical conditions and poverty on perinatal mental illness: population-based cohort study","authors":"Maryrose Faulkner, L. Barker, S. Vigod, C. Dennis, H. Brown","doi":"10.1136/jech-2019-212714","DOIUrl":"https://doi.org/10.1136/jech-2019-212714","url":null,"abstract":"Background Chronic medical conditions (CMCs) and poverty commonly co-occur and, while both have been shown to independently increase the risk of perinatal mental illness, their collective impact has not been examined. Methods This population-based study included 853 433 Ontario (Canada) women with a singleton live birth and no recent mental healthcare. CMCs were identified using validated algorithms and disease registries, and poverty was ascertained using neighbourhood income quintile. Perinatal mental illness was defined as a healthcare encounter for a mental health or substance use disorder in pregnancy or the first year postpartum. Modified Poisson regression was used to test the independent impacts of CMC and poverty on perinatal mental illness risk, adjusted for covariates, and additive interaction between the two exposures was assessed using the relative excess risk due to interaction (RERI) and synergy index (SI). Results CMC and poverty were each independently associated with increased risk of perinatal mental illness (CMC vs no CMC exposure: 19.8% vs 15.6%, adjusted relative risk (aRR) 1.21, 95% CI (CI) 1.20 to 1.23; poverty vs no poverty exposure: 16.7% vs 15.5%, aRR 1.06, 95% CI 1.05 to 1.07). However, measures of additive interaction for the collective impact of both exposures on perinatal mental illness risk were not statistically significant (RERI 0.02, 95% CI −0.01 to 0.06; SI 1.09, 95% CI 0.95 to 1.24). Conclusion CMC and poverty are independent risk factors for perinatal mental illness and should be assessed as part of a comprehensive management programme that includes prevention strategies and effective screening and treatment pathways.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"21 1","pages":"158 - 163"},"PeriodicalIF":0.0,"publicationDate":"2019-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87877027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1136/jech-2019-213332
S. Jivraj
Timonin et al article adds weight to a need to address geographical health inequalities in Russia.1 They show, for the first time, how inequalities between districts are much greater than the inequalities between larger regional geographical containers. The difference in life expectancy between the best-performing and worst-performing groups of districts, each accounting for 5% of the Russian population, was as large as 16 years for men and 10 years for women. The mortality inequality was 2.6 times larger between districts than it was between regions. There is hope that these geographical inequalities in health can be reduced with the appropriate political will and infrastructure. Evidence from England has shown how life expectancy …
{"title":"To Russia, with love (and back again, hopefully)","authors":"S. Jivraj","doi":"10.1136/jech-2019-213332","DOIUrl":"https://doi.org/10.1136/jech-2019-213332","url":null,"abstract":"Timonin et al article adds weight to a need to address geographical health inequalities in Russia.1 They show, for the first time, how inequalities between districts are much greater than the inequalities between larger regional geographical containers. The difference in life expectancy between the best-performing and worst-performing groups of districts, each accounting for 5% of the Russian population, was as large as 16 years for men and 10 years for women. The mortality inequality was 2.6 times larger between districts than it was between regions.\u0000\u0000There is hope that these geographical inequalities in health can be reduced with the appropriate political will and infrastructure. Evidence from England has shown how life expectancy …","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"23 1","pages":"107 - 107"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81349550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1136/jech-2019-212977
Yingqi Guo, Shu-Sen Chang, C. Chan, Qingsong Chang, Chia-Yueh Hsu, P. Yip
Background Previous studies investigating the independent effects of neighbourhood-level factors on depression are rare within the Asian context, especially in the elderly population. Methods Data for 29 099 older adults aged 65 years or above who have received health examinations at elderly health centres in Hong Kong in 2008–2011 were analysed. Using multilevel regression modelling, the cross-sectional associations of neighbourhood social attributes (neighbourhood poverty, ethnic minority, residential stability and elderly concentration) and physical (built) attributes (recreational services and walkability) with depression outcomes (depressive symptoms and depression) after adjusting for individual-level characteristics were investigated. Gender interaction effects were also examined. Results Neighbourhood poverty was associated with both depressive symptoms and depression in the elderly. Neighbourhood elderly concentration, recreational services and walkability were associated with fewer depressive symptoms. The association between neighbourhood poverty and elderly depressive symptoms was found in women only and not in men. Conclusion Policies aimed at reducing neighbourhood poverty, increasing access to recreational services and enhancing walkability might be effective strategies to prevent depression in older adults in the urban settings.
{"title":"Association of neighbourhood social and physical attributes with depression in older adults in Hong Kong: a multilevel analysis","authors":"Yingqi Guo, Shu-Sen Chang, C. Chan, Qingsong Chang, Chia-Yueh Hsu, P. Yip","doi":"10.1136/jech-2019-212977","DOIUrl":"https://doi.org/10.1136/jech-2019-212977","url":null,"abstract":"Background Previous studies investigating the independent effects of neighbourhood-level factors on depression are rare within the Asian context, especially in the elderly population. Methods Data for 29 099 older adults aged 65 years or above who have received health examinations at elderly health centres in Hong Kong in 2008–2011 were analysed. Using multilevel regression modelling, the cross-sectional associations of neighbourhood social attributes (neighbourhood poverty, ethnic minority, residential stability and elderly concentration) and physical (built) attributes (recreational services and walkability) with depression outcomes (depressive symptoms and depression) after adjusting for individual-level characteristics were investigated. Gender interaction effects were also examined. Results Neighbourhood poverty was associated with both depressive symptoms and depression in the elderly. Neighbourhood elderly concentration, recreational services and walkability were associated with fewer depressive symptoms. The association between neighbourhood poverty and elderly depressive symptoms was found in women only and not in men. Conclusion Policies aimed at reducing neighbourhood poverty, increasing access to recreational services and enhancing walkability might be effective strategies to prevent depression in older adults in the urban settings.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"7 1","pages":"120 - 129"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81482078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-29DOI: 10.1136/jech-2018-211856
S. L. Newell, Michelle L. Dion, Nancy Doubleday
Background Previous research association increased levels of cultural continuity and decreased rates of youth suicide in First Nations communities. We investigate the relationship between cultural continuity and self-rated health looking specifically at Inuit living in the Canadian Arctic. Methods The Arctic Supplements of the Aboriginal Peoples Survey from years 2001 and 2006 were appended to explore the relationship between various measures of cultural continuity and self-rated health. These measures include access to government services in an Aboriginal language, Inuit cultural variables, community involvement and governance. Literature related to Inuit social determinants of health and health-related behaviours were used to build the models. Results All measures of cultural continuity were shown to have a positive association with self-rated health for Inuit participants. Background and other control variables influenced the strength of the association but not the direction of the association. Access to services in an Aboriginal language, harvesting activities and government satisfaction were all significantly related to the odds of better health outcomes. Finally, the study contributes a baseline from a known data horizon against which future studies can assess changes and understand future impacts of changes. Conclusion The Canadian government and other agencies should address health inequalities between Inuit and non-Inuit people through programmes designed to foster cultural continuity at a community level. Providing access to services in an Aboriginal language is a superficial way of promoting cultural alignment of these services; however, more inclusion of Inuit traditional knowledge is needed to have a positive influence on health.
{"title":"Cultural continuity and Inuit health in Arctic Canada","authors":"S. L. Newell, Michelle L. Dion, Nancy Doubleday","doi":"10.1136/jech-2018-211856","DOIUrl":"https://doi.org/10.1136/jech-2018-211856","url":null,"abstract":"Background Previous research association increased levels of cultural continuity and decreased rates of youth suicide in First Nations communities. We investigate the relationship between cultural continuity and self-rated health looking specifically at Inuit living in the Canadian Arctic. Methods The Arctic Supplements of the Aboriginal Peoples Survey from years 2001 and 2006 were appended to explore the relationship between various measures of cultural continuity and self-rated health. These measures include access to government services in an Aboriginal language, Inuit cultural variables, community involvement and governance. Literature related to Inuit social determinants of health and health-related behaviours were used to build the models. Results All measures of cultural continuity were shown to have a positive association with self-rated health for Inuit participants. Background and other control variables influenced the strength of the association but not the direction of the association. Access to services in an Aboriginal language, harvesting activities and government satisfaction were all significantly related to the odds of better health outcomes. Finally, the study contributes a baseline from a known data horizon against which future studies can assess changes and understand future impacts of changes. Conclusion The Canadian government and other agencies should address health inequalities between Inuit and non-Inuit people through programmes designed to foster cultural continuity at a community level. Providing access to services in an Aboriginal language is a superficial way of promoting cultural alignment of these services; however, more inclusion of Inuit traditional knowledge is needed to have a positive influence on health.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"45 1","pages":"64 - 70"},"PeriodicalIF":0.0,"publicationDate":"2019-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80003440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-28DOI: 10.1136/jech-2019-212699
P. Hagedoorn, P. Groenewegen, Hannah Roberts, M. Helbich
Background Neighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualised neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group. Methods Using a nested case-control design, all suicides aged 18–64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600 and 1000 metre circular buffers around each subject’s residential address. Results Suicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40–64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for those aged 18–39 years and for short-term residents. In deprived neighbourhoods, suicide risk was lower for men aged 40–64 years and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes. Conclusion Our findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide.
{"title":"Is suicide mortality associated with neighbourhood social fragmentation and deprivation? A Dutch register-based case-control study using individualised neighbourhoods","authors":"P. Hagedoorn, P. Groenewegen, Hannah Roberts, M. Helbich","doi":"10.1136/jech-2019-212699","DOIUrl":"https://doi.org/10.1136/jech-2019-212699","url":null,"abstract":"Background Neighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualised neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group. Methods Using a nested case-control design, all suicides aged 18–64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600 and 1000 metre circular buffers around each subject’s residential address. Results Suicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40–64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for those aged 18–39 years and for short-term residents. In deprived neighbourhoods, suicide risk was lower for men aged 40–64 years and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes. Conclusion Our findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"225 1","pages":"197 - 202"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87678585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.1136/jech-2019-212311
L. Davis, Emma Bogner, N. Coburn, T. Hanna, P. Kurdyak, P. Groome, A. Mahar
Introduction Individuals with a pre-existing mental illness, especially those experiencing reduced social, occupational and functional capacity, are at risk for cancer care disparities. However, uncertainty surrounding the effect of a mental illness on cancer outcomes exists. Methods We conducted a systematic review and meta-analysis of observational studies using MEDLINE and PubMed from 1 January 2005 to 1 November 2018. Two reviewers evaluated citations for inclusion. Advanced stage was defined as regional, metastatic or according to a classification system. Cancer survival was defined as time survived from cancer diagnosis. Pooled ORs and HRs were presented. The Newcastle-Ottawa bias risk assessment scale was used. Random-effects models used the Mantel-Haenszel approach and the generic inverse variance method. Heterogeneity assessment was performed using I2. Results 2381 citations were identified; 28 studies were included and 24 contributed to the meta-analysis. Many demonstrated methodological flaws, limiting interpretation and contributing to significant heterogeneity. Data source selection, definitions of a mental illness, outcomes and their measurement, and overadjustment for causal pathway variables influenced effect sizes. Pooled analyses suggested individuals with a pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis and are at risk of worse cancer survival. Individuals with more severe mental illness, such as schizophrenia, are at a greater risk for cancer disparities. Discussion This review identified critical gaps in research investigating cancer stage at diagnosis and survival for individuals with pre-existing mental illness. High-quality research is necessary to support quality improvement for the care of psychiatric patients and their families during and following a cancer diagnosis.
{"title":"Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis","authors":"L. Davis, Emma Bogner, N. Coburn, T. Hanna, P. Kurdyak, P. Groome, A. Mahar","doi":"10.1136/jech-2019-212311","DOIUrl":"https://doi.org/10.1136/jech-2019-212311","url":null,"abstract":"Introduction Individuals with a pre-existing mental illness, especially those experiencing reduced social, occupational and functional capacity, are at risk for cancer care disparities. However, uncertainty surrounding the effect of a mental illness on cancer outcomes exists. Methods We conducted a systematic review and meta-analysis of observational studies using MEDLINE and PubMed from 1 January 2005 to 1 November 2018. Two reviewers evaluated citations for inclusion. Advanced stage was defined as regional, metastatic or according to a classification system. Cancer survival was defined as time survived from cancer diagnosis. Pooled ORs and HRs were presented. The Newcastle-Ottawa bias risk assessment scale was used. Random-effects models used the Mantel-Haenszel approach and the generic inverse variance method. Heterogeneity assessment was performed using I2. Results 2381 citations were identified; 28 studies were included and 24 contributed to the meta-analysis. Many demonstrated methodological flaws, limiting interpretation and contributing to significant heterogeneity. Data source selection, definitions of a mental illness, outcomes and their measurement, and overadjustment for causal pathway variables influenced effect sizes. Pooled analyses suggested individuals with a pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis and are at risk of worse cancer survival. Individuals with more severe mental illness, such as schizophrenia, are at a greater risk for cancer disparities. Discussion This review identified critical gaps in research investigating cancer stage at diagnosis and survival for individuals with pre-existing mental illness. High-quality research is necessary to support quality improvement for the care of psychiatric patients and their families during and following a cancer diagnosis.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"7 1","pages":"84 - 94"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83191132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-23DOI: 10.1136/jech-2019-212557
N. Escobar, E. Plugge
Background and objectives Imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population. Methods We systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group. Findings A total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes. Conclusion Imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended. PROSPERO registration number CRD42014009690.
{"title":"Prevalence of human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer in imprisoned women worldwide: a systematic review and meta-analysis","authors":"N. Escobar, E. Plugge","doi":"10.1136/jech-2019-212557","DOIUrl":"https://doi.org/10.1136/jech-2019-212557","url":null,"abstract":"Background and objectives Imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population. Methods We systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group. Findings A total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes. Conclusion Imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended. PROSPERO registration number CRD42014009690.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"54 1","pages":"102 - 95"},"PeriodicalIF":0.0,"publicationDate":"2019-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88753230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-19DOI: 10.1136/jech-2019-212488
Ian W Watson, S. C. Oancea
Background The influenza virus caused 48.8 million people to fall ill and 79 400 deaths during the 2017–2018 influenza season, yet less than 50% of US adults receive an annual flu vaccination (AFV). Having health insurance coverage influences whether individuals receive an AFV. The current study aims to determine if an association exists between an individual’s health plan type (HPT) and their receipt of an AFV. Methods Data from the 2017 Behavioral Risk Factor Surveillance System and the optional ‘Health Care Access’ module were used for this study. The final study sample size was 35 684. Multivariable weighted and adjusted logistic regression models were conducted to investigate the association between HPT and AFV. Results Medicare coverage was significantly associated with an increase in AFV for both men (adjusted OR (AOR) 1.62 (95% CI 1.28 to 2.06)) and women (AOR 1.28 (95% CI 1.00 to 1.53)). For men, other sources of coverage were also significantly positively associated with AFV (AOR 1.67 (95% CI 1.27 to 2.19)), while for women obtaining coverage on their own was significantly negatively associated with AFV (AOR 0.75 (95% CI 0.59 to 0.97)). Conclusion These findings are of interest to health policy makers as these show there are HPTs which are effective at improving vaccination rates. Adopting methods used by these HPTs could help the USA reach its Healthy People 2020 AFV coverage goal of 70%.
2017-2018年流感季节期间，流感病毒导致4880万人患病，79400人死亡，但只有不到50%的美国成年人每年接种流感疫苗(AFV)。是否有健康保险会影响个人是否接受AFV。目前的研究旨在确定个人的健康计划类型(HPT)和他们收到AFV之间是否存在关联。方法采用2017年行为风险因素监测系统和可选的“卫生保健获取”模块的数据进行研究。最终研究样本量为35 684。采用多变量加权和调整后的logistic回归模型来研究HPT与AFV之间的关系。结果医疗保险覆盖率与男性(调整后的OR (AOR) 1.62 (95% CI 1.28至2.06)和女性(AOR 1.28 (95% CI 1.00至1.53))的AFV增加显著相关。对于男性，其他来源的保险也与AFV显著正相关(AOR 1.67 (95% CI 1.27至2.19))，而对于女性，自行获得保险与AFV显著负相关(AOR 0.75 (95% CI 0.59至0.97))。结论这些发现引起了卫生政策制定者的兴趣，因为这些发现表明存在有效提高疫苗接种率的hpt。采用这些hpt使用的方法可以帮助美国实现其健康人2020年AFV覆盖率70%的目标。
{"title":"Does health plan type influence receipt of an annual influenza vaccination?","authors":"Ian W Watson, S. C. Oancea","doi":"10.1136/jech-2019-212488","DOIUrl":"https://doi.org/10.1136/jech-2019-212488","url":null,"abstract":"Background The influenza virus caused 48.8 million people to fall ill and 79 400 deaths during the 2017–2018 influenza season, yet less than 50% of US adults receive an annual flu vaccination (AFV). Having health insurance coverage influences whether individuals receive an AFV. The current study aims to determine if an association exists between an individual’s health plan type (HPT) and their receipt of an AFV. Methods Data from the 2017 Behavioral Risk Factor Surveillance System and the optional ‘Health Care Access’ module were used for this study. The final study sample size was 35 684. Multivariable weighted and adjusted logistic regression models were conducted to investigate the association between HPT and AFV. Results Medicare coverage was significantly associated with an increase in AFV for both men (adjusted OR (AOR) 1.62 (95% CI 1.28 to 2.06)) and women (AOR 1.28 (95% CI 1.00 to 1.53)). For men, other sources of coverage were also significantly positively associated with AFV (AOR 1.67 (95% CI 1.27 to 2.19)), while for women obtaining coverage on their own was significantly negatively associated with AFV (AOR 0.75 (95% CI 0.59 to 0.97)). Conclusion These findings are of interest to health policy makers as these show there are HPTs which are effective at improving vaccination rates. Adopting methods used by these HPTs could help the USA reach its Healthy People 2020 AFV coverage goal of 70%.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"87 1","pages":"57 - 63"},"PeriodicalIF":0.0,"publicationDate":"2019-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79713320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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