Are mass-media campaigns effective in preventing drug use? A Cochrane systematic review and meta-analysis.

OBJECTIVE: To determine whether there is evidence that mass-media campaigns can be effective in reducing illicit drug consumption and the intent to consume. DESIGN: Systematic review of randomised and non-randomised studies. METHODS: We searched four electronic databases (MEDLINE, EMBASE, ProQuest Dissertations & Theses A&I and CENTRAL) and further explored seven additional resources to obtain both published and unpublished materials. We appraised the quality of included studies using standardised tools. We carried out meta-analyses of randomised controlled trials and a pooled analysis of interrupted time-series and controlled before-and-after studies. RESULTS: We identified 19 studies comprising 184,811 participants. Pooled analyses and narrative synthesis provided mixed evidence of effectiveness. Eight interventions evaluated with randomised controlled trials leaned towards no evidence of an effect, both on drug use (standardised mean difference (SMD) -0.02; 95% CI -0.15 to 0.12) and the intention to use drugs (SMD -0.07; 95% CI -0.19 to 0.04). Four campaigns provided some evidence of beneficial effects in preventing drug use and two interventions provided evidence of iatrogenic effects. CONCLUSIONS: Studies were considerably heterogeneous in type of mass-media intervention, outcome measures, underlying theory, comparison groups and design. Such factors can contribute to explaining the observed variability in results. Owing to the risk of adverse effects, caution is needed in disseminating mass-media campaigns tackling drug use. Large studies conducted with appropriate methodology are warranted to consolidate the evidence base

Thyroid Function and Dysfunction in Relation to 16 Cardiovascular Diseases.

BACKGROUND: Subclinical thyroid dysfunction, defined as thyroid-stimulating hormone levels outside the reference range with normal free thyroxine levels in asymptomatic patients, is associated with alterations in cardiac hemodynamics. We used Mendelian randomization to assess the role of thyroid dysfunction for cardiovascular disease (CVD). METHODS: Single-nucleotide polymorphisms associated with thyroid function were identified from a genome-wide association meta-analysis in up to 72 167 individuals. Data for genetic associations with CVD were obtained from meta-analyses of genome-wide association studies of atrial fibrillation (n=537 409 individuals), coronary artery disease (n=184 305 individuals), and ischemic stroke (n=438 847) as well as from the UK Biobank (n=367 703 individuals). RESULTS: Genetically predicted thyroid-stimulating hormone levels and hyperthyroidism were statistically significantly associated with atrial fibrillation but no other CVDs at the Bonferroni-corrected level of significance ( P<7.8×10-4). The odds ratios of atrial fibrillation were 1.15 (95% CI, 1.11-1.19; P=2.4×10-14) per genetically predicted 1 SD decrease in thyroid-stimulating hormone levels and 1.05 (95% CI, 1.03-1.08; P=5.4×10-5) for genetic predisposition to hyperthyroidism. Genetically predicted free thyroxin levels were not statistically significantly associated with any CVD. CONCLUSIONS: This Mendelian randomization study supports evidence for a causal association of decreased thyroid-stimulating hormone levels in the direction of a mild form of hyperthyroidism with an increased risk of atrial fibrillation but no other CVDs

Alcohol and the young: how does the press face the problem?

Background: alcohol is an important component of the Mediterranean diet and its moderate use is protective against cardiovascular risk. Binge drinking, i.e. the heavy consumption of alcohol over a short period of time, is the main consumption pattern of young people in Western countries and may lead to severe toxic effects in many organs. Mass media often address the issue by suggesting prevention measures; however, they may also have the unintended effect of encouraging alcohol misuse. This study aims to assess how the Italian press faces excessive alcohol consumption in young people, comparing the messages given by the press with scientific recommendations. Methods: articles published by the 6 best-selling Italian newspapers and the 4 best-selling Italian magazines were collected from October 15th to November 14th 2009. Medline database, governmental and non-governmental sources were searched for scientific recommendations regarding primary prevention of alcohol misuse. Press articles were described and analysed by filling out a predefined form. Results: fourteen newspaper articles regarding alcohol were found, 79% belonging to the news section. Six quotations of scientific recommendations were found: two about drink-driving, two about raising public awareness, one about Monitoring and Evaluation, and one about community and workplace action. Conclusions: scientific recommendations were often inadequately reported by the Italian press. The most covered recommendations, designed driver and public educational intervention, are also the least effective according to international literature. Therefore, a further effort is needed to tackle this issue in a more scientifically sound way

The use of Complementary and Alternative Medicine (CAM) among Italian children: A cross-sectional survey.

OBJECTIVE: To examine prevalence and modalities of CAM use in children living in Novara, a northern Italian city, and to estimate the prescription rate from paediatricians. METHOD: We administered a phone questionnaire to the parents of a sample of 147 children, asking questions about CAM use, children's health profile, parental socio-economic status, use modalities, effectiveness perceptions, and motivations. A parallel survey was conducted by e-mail by investigating family paediatricians attitudes about CAM. RESULTS: Among 147 children whose families responded to our survey 48.3% was treated with CAM at least once in life and 38,1% during the previous year. Children treated with CAM were on average younger than those who were not. The types of CAM used were herbal medicine and homeopathy. Parents who choose CAM for their children were more skeptical about vaccinations. CAM were most frequently used to treat pathologies of ear, nose and throat. 85.9% of parents was willing to use CAM in future, 78.9% would pass to conventional medicine if CAM failed. Among paediatricians 81.5% prescribed CAM at least once, but only 13.6% received specific CAM training. CONCLUSION: The prevalence of children using CAM in Novara is high, in line with investigations conducted in Northern European countries. The distribution of pathologies treated with CAM, parental socio-economic status and general scepticism towards vaccination are consistent with the literature. Physicians should keep themselves up-to-date also about evidence-based CAM therapies and, most importantly, should have an open dialogue about CAM with their patients

Media campaigns for the prevention of illicit drug use in young people.

BACKGROUND: Substance-specific mass media campaigns which address young people are widely used to prevent illicit drug use. They aim to reduce use and raise awareness of the problem. OBJECTIVES: To assess the effectiveness of mass media campaigns in preventing or reducing the use of or intention to use illicit drugs amongst young people. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2013, Issue 1), including the Cochrane Drugs and Alcohol Group's Specialised Register; MEDLINE through PubMed (from 1966 to 29 January 2013); EMBASE (from 1974 to 30 January 2013) and ProQuest Dissertations & Theses A&I (from 1861 to 3 February 2013). SELECTION CRITERIA: Cluster-randomised controlled trials, prospective and retrospective cohort studies, interrupted time series and controlled before and after studies evaluating the effectiveness of mass media campaigns in influencing drug use, intention to use or the attitude of young people under the age of 26 towards illicit drugs. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures of The Cochrane Collaboration. MAIN RESULTS: We included 23 studies involving 188,934 young people, conducted in the USA, Canada and Australia between 1991 and 2012. Twelve studies were randomised controlled trials (RCT), two were prospective cohort studies (PCS), one study was both a RCT and a PCS, six were interrupted time series and two were controlled before and after (CBA) studies. The RCTs had an overall low risk of bias, along with the ITS (apart from the dimension 'formal test of trend'), and the PCS had overall good quality, apart from the description of loss to follow-up by exposure.Self reported or biomarker-assessed illicit drug use was measured with an array of published and unpublished scales making comparisons difficult. Pooled results of five RCTs (N = 5470) show no effect of media campaign intervention (standardised mean difference (SMD) -0.02; 95% confidence interval (CI) -0.15 to 0.12).We also pooled five ITS studies (N = 26,405) focusing specifically on methamphetamine use. Out of four pooled estimates (two endpoints measured in two age groups), there was evidence of a reduction only in past-year prevalence of methamphetamine use among 12 to 17 years old.A further five studies (designs = one RCT with PCS, two PCS, two ITS, one CBA, N = 151,508), which could not be included in meta-analyses, reported a drug use outcome with varied results including a clear iatrogenic effect in one case and reduction of use in another. AUTHORS' CONCLUSIONS: Overall the available evidence does not allow conclusions about the effect of media campaigns on illicit drug use among young people. We conclude that further studies are needed.Research for and preparation of this article were supported by the National Institute on Drug Abuse (grants 3-N01-DA085063- 002 and 1-R03-DA-020893-01). The evaluation of the National Youth Anti-Drug Media Campaign was funded by Congress as part of the original appropriation for the campaign. The White House Office of National Drug Control Policy directly supervised the campaign. The National Institute on Drug Abuse supervised the evaluation; Westat, with the Annenberg School for Communication at the University of Pennsylvania as a subcontractor, received the contract. All authors were funded for this evaluation and other projects by the National Institute on Drug Abuse

Medium- and long-term health effects of earthquakes in high-income countries: a systematic review and meta-analysis.

BACKGROUND: Accurate monitoring of population health is essential to ensure proper recovery after earthquakes. We aimed to summarize the findings and features of post-earthquake epidemiological studies conducted in high-income countries and to prompt the development of future surveillance plans. METHODS: Medline, Scopus and six sources of grey literature were systematically searched. Inclusion criteria were: observational study conducted in high-income countries with at least one comparison group of unexposed participants, and measurement of health outcomes at least 1 month after the earthquake. RESULTS: A total of 52 articles were included, assessing the effects of 13 earthquakes that occurred in eight countries. Most studies: had a time-series (33%) or cross-sectional (29%) design; included temporal comparison groups (63%); used routine data (58%); and focused on patient subgroups rather than the whole population (65%). Individuals exposed to earthquakes had: 2% higher all-cause mortality rates [95% confidence interval (CI), 1% to 3%]; 36% (95% CI, 19% to 57%) and 37% (95% CI, 29% to 46%) greater mortality rates from myocardial infarction and stroke, respectively; and 0.16 higher mean percent points of glycated haemoglobin (95% CI, 0.07% to 0.25% points). There was no evidence of earthquake effects for blood pressure, body mass index or lipid biomarkers. CONCLUSIONS: A more regular and coordinated use of large and routinely collected datasets would benefit post-earthquake epidemiological surveillance. Whenever possible, a cohort design with geographical and temporal comparison groups should be used, and both communicable and non-communicable diseases should be assessed. Post-earthquake epidemiological surveillance should also capture the impact of seismic events on the access to and use of health care services

Optimising data curation pipelines for population-level analytics in secure data environments: Findings from a phenome-wide analysis in the NHS England Secure Data Environment

Objective Secure data environments (SDE) ensure safe access to large population-level sensitive data. However, computational capacity is limited in these environments, which leads to challenges in the analysis of large population data within the constraints of a complex cloud architecture leveraging multiple software ecosystems. Here we present an efficient pipeline to conduct phenome-wide analyses using electronic health records (EHR) in the NHS England SDE. Methods We accessed deidentified linked EHR from NHS SDE for around 50 million people in England. The exposure is SARS-CoV-2 infection, with outcomes being a phenome-wide atlas of all diseases recorded in EHR data. For computational efficiency, we created three cohorts tables using PySpark within the Databricks environment and a sampling algorithm with inverse probability weights which adds a flag to the dataset to mark the inclusion of a row in the sample of a specific outcome. We will conduct survival analysis using Cox models in RStudio on the samples while adjusting for potential confounders in the main datasets and 15 subgroups. Results Sampling with inverse probability weighting produced datasets that are statistically equivalent to the original population data. In terms of computational efficiency, the time needed to sample and read the data for modeling one outcome is 2.3 min compared to ~45 min when trying to read the entire dataset, which could fail due to the 4GB memory limits of in Rstudio within the SDE. This is particularly important in our study since we will be running at least 13,296 models for main and subgroup analysis in the three cohorts. By adding a flag to each data row to indicate its inclusion in a sample, the sampling strategy significantly reduced the storage space required for the outcome table of each sample. Conclusion Preparing datasets in Databricks and applying sampling can increase the efficiency of big data analysis pipelines within SDE, save storage space, and help in avoiding memory overload caused by using complete datasets for statistical analysis

[Long-term health effects of earthquakes: outlining the features of an epidemiological surveillance system in Italy.].

The major earthquakes occurred in Italy in the past 10 years (L'Aquila, Emilia and Amatrice) have resulted in 679 death, displacement of more than 120,000 people and economic losses for more than 20 billion euros. In a recent review, we found that earthquakes are associated to multiple health conditions in the long term. Because of Italy's high seismic risk, it is likely that establishing a post-earthquake surveillance system would enable early detection of many deleterious effects and mitigation of damages. In this editorial, we outline the possible features of such a surveillance system. Firstly, it should be cost-effective, capitalising on routinely collected health data. Secondly, it should be coordinated centrally by a compact multidisciplinary team, to enable harmonised procedures and analysis. Thirdly, based on current evidence, it should be able to follow-up populations for least 7 years and capture both physical and mental health diseases. Finally, it should gather sufficient information to enable stratified analysis and identify at-risk subgroups that may need specific interventions

Effects of a prevention program on multiple health-compromising behaviours in adolescence: A cluster randomized controlled trial.

We aimed to assess the effectiveness of 'Paesaggi di Prevenzione', a school-based prevention program delivered by trained teachers and designed to tackle smoking, alcohol misuse, dietary risks, and physical inactivity in adolescence. We evaluated the program between 2010 and 2013 with a two-arm, parallel-group, multicentre cluster randomized controlled trial in which schools were the units of randomization. We collected data on health-compromising behaviours using self-reported measurements of behaviour frequency administered before and after program implementation. We used multivariable mixed-effects logistic regression models to estimate program effects on health-compromising behaviours. The analysis sample included 3410 middle school students and 1651 high school students. Among middle school students, mean age at baseline was 12 years (standard deviation [SD] 0.5 years), 51% were boys, and 41% had high socioeconomic status [SES] (defined as having at least one parent/guardian with university level education). In high school students, mean age at baseline was 14 years (SD 0.7 years), 56% were boys, and 31% had high SES. The program did not have effects on smoking, alcohol misuse, and physical activity. The program had iatrogenic effects in regard to some eating behaviours, resulting in (i) lower odds of fruit consumption among middle-school students (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.68-0.99) and (ii) lower odds of having breakfast every day in high-school students at the post-intervention measurement (OR 0.76; 95%CI 0.58-0.99) but not at one-year follow-up (OR 0.94; 95%CI 0.69-1.28). Due to the possibility of unintended effects, we advise against disseminating 'Paesaggi di Prevenzione' in its present form. TRIAL REGISTRATION: ISRCTN00953701

Adherence to guidelines for hospitalized community-acquired pneumonia over time and its impact on health outcomes and mortality.

Compliance with validated guidelines is crucial to guide management of patients hospitalized with community-acquired pneumonia (CAP). Data describing real-life management and treatment of CAP are limited. We aimed to evaluate the compliance with guidelines over time, and to assess its impact on all-cause mortality and clinical outcomes. We retrospectively compared two cohorts of patients admitted to the hospital, throughout 2005, just after the implementation of a local clinical pathway based on CAP international guidelines, and 7 years later over 2012. We included all patients with a diagnosis of pneumonia and/or related complications. 564 patients were included. The Pneumonia Severity Index calculation was better documented in 2012 (25.23 %) compared to 2005 (17.70 %; p = 0.032), but compliance with guideline empirical antibiotic therapy was lower in 2012 (56.70 %) than in 2005 (68.75 %; p = 0.004). Performance of guideline recommended urinary antigen tests was higher in 2012, and associated with 57.3 % lower odds of in-hospital mortality (95 % CI 15.0-78.5 %) and with 65.9 % lower odds of 30-day mortality (95 % CI 31.5-83.0 %). Compliance with empirical antibiotic therapy was associated with 2.9 days lower mean length of hospital stay (95 % CI -4.2 to -1.6 days) and with 2.0 days lower mean duration of antibiotic therapy (95 % CI -3.3 to -0.7 days). Compliance with guidelines changed over time, with some effects on mortality and with an apparent reduction in the length of hospital stay and the duration of antibiotic therapy. Specific clinical training and hospital control policies could achieve greater compliance with guidelines, and thus reduce a burden on hospital services