547 research outputs found

    Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea

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    ObjectiveTo reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010.MethodsWe used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action’s effectiveness.ResultsFollowing the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (−10% per year) trend after adoption and enforcement of these laws (β2 = 0.18, p-value = 0.07; β3 = −0.10, p-value = 0.02). SHS exposure at home (β2 = 0.10, p-value = 0.09; β3 = −0.03, p-value = 0.14) and the primary cigarette smoking rate (β2 = 0.03, p-value = 0.10; β3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females.ConclusionStrengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK

    30th European Congress on Obesity (ECO 2023)

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    This is the abstract book of 30th European Congress on Obesity (ECO 2023

    International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

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    Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. Methods ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment

    IMPROVING POPULATION HEALTH BY ADDRESSING SOCIAL DETERMINANTS OF MENTAL HEALTH

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    This study examined the social determinants of mental health as influential factors on health outcomes. Three research studies comprised the dissertation. The first study was a systematic review that identified factors linking common mental disorders to the incidence of the four most prevalent non-communicable diseases (NCDs). Interventions to prevent poor health should target smokers, the elderly, women, and individuals with fewer than 12 years of schooling, according to findings. The second mixed-method study found that the pandemic and its control measures negatively impacted social determinants of mental health and health outcomes, with women, children and informal workers in Gaza being most affected. Some of the strategies deployed by the United Nations for the Relief and Works Agency in the Near East (UNRWA), such as the use of telemedicine, warrant further investigation for efficiency and acceptability. The third study assessed UNRWA's mental health and psychosocial support (MHPSS) response addressing the social determinants of mental health during the COVID-19 pandemic. During Group Model Building (GMB) workshops, participants shared their perspectives on what UNRWA did and how it addressed the vulnerabilities of Palestine refugees in Gaza during the health crisis. Findings suggested improving community wellbeing and enhancing staff support for better future pandemic preparedness. The PhD concludes that addressing social determinants of mental health is a joint responsibility between state and non-state actors and that it is necessary to reduce health inequities to lessen the global burden of disease. In addition to rigorous testing and contact tracing, addressing these determinants during crises, for example by distributing financial aid to poor families and strengthening social services, should be bolstered. This is especially important because evidence suggests that enhancing the socioeconomic status of individuals reduces health inequities and improves health outcomes

    A clinicopathological investigation of brainstem nuclei in Lewy body dementia

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    Introduction: Lewy Body Dementias (LBD) - Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD) - are clinical diagnoses based on the one-year rule and varied symptom onset. Previously, degeneration of the locus coeruleus (LC) and dorsal raphe nucleus (DRN) in LBD has been well established. However, the precise relationship between underlying neuropathology and clinical presentation remains to be determined. Methods: Immunohistochemical and image analysis techniques have been performed to examine neuronal loss and protein pathologies in the noradrenergic and serotonergic systems of 20 PD, 20 PD-MCI, 20 PDD, 20 DLB cases and 20 controls. RNAscope technology was used to decipher the role of cell-surface receptors in LBD pathophysiology. Possible associations between administration of pharmacological agents with LBD pathology and disease duration was also examined. Results: The hippocampus, thalamus and cingulate cortex - crucial components of the Papez circuit - were most affected by the proteinopathies, particularly deposition that correlated with the onset of some DLB symptomatology and non-motor symptoms. LC noradrenergic neurons were reduced in LBD compared to PD. The 5-HT2A receptor seemed to be more abundant than the α2A-adrenergic receptor (AR) and serotonin transporter (SERT) in the frontal cortex of a PD patient than a PDD or DLB patient. Conclusion: LBD phenotypes may be differentiated through their limbic involvement in the Papez circuit, where α-syn accumulation may contribute to non-motor symptoms. The behaviour of each protein type may be extremely heterogenous within each region of the noradrenergic and serotonergic systems, such that it correlates with the onset of different symptoms. There may be lower expression of receptors in LBD than PD patients, perhaps due to end-stage disease and more widespread degeneration. Hence, this study may have provided further insights into LBD pathophysiology and possibly assist clinical trials in future therapeutic interventions.Open Acces

    Patient-focused outcomes from cardiac rehabilitation: Influence of service delivery characteristics

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    Repeat acute coronary heart disease (CHD) events are common. Cardiac rehabilitation (CR) is a complex secondary prevention intervention proven to reduce repeat cardiac events. However, the delivery of CR services varies substantially between contexts, influencing important patient outcomes. In this thesis, the influence of CR service delivery characteristics on patient-focused outcomes, particularly exercise capacity, exercise self-efficacy, and health-related quality of life (HRQL), as well as patient experiences was investigated. The 29-item Patient-Reported Outcomes Measurement Information System Profile Measure version 2.0 (PROMIS-29v2) was also evaluated for use in CR settings. A series of studies were conducted to determine the effects of CR delivery on patient-focused outcomes. Patient-focused outcomes in CR were positive overall. Exercise capacity improved substantially in CR programs in the Australian cross-state audit, where more improvements were demonstrated following shorter wait times regardless of program duration/number of sessions. Multiple aspects of HRQL improved substantially from CR in the meta-analysis and in the multi-site pre-post study, regardless of delivery mode (in-person or remote). The PROMIS-29v2 demonstrated validity, reliability, and sensitivity to HRQL changes occurring in CR. A benefit evident for remote CR delivery was shorter wait times, which is balanced against lower completion rates and less improvements in exercise self-efficacy. This thesis contributes to understanding the complex influences of CR service delivery characteristics to patient-focused outcomes. Consistent improvements in important patient-focused outcomes with CR participation and the influence of CR delivery models and patient characteristics are confirmed in this thesis. A granular, multi-level evaluation of CR components, considering the wider health care and societal systems, is required in designing effective and sustainable future CR delivery models
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