Mainstreaming prevention: Prescribing fruit and vegetables as a brief intervention in primary care

This is the author's PDF version of an article published in Public health© 2005.This articles discusses a project at the Castlefields Health Centre in Halton whereby primary care professionals issue a prescription for discounts on fruit and vegetables. The prescription is explicitly linked to the five-a-day message

Monitoring the impact of desert dust outbreaks for air quality for health studies

We review the major features of desert dust outbreaks that are relevant to the assessment of dust impacts upon human health. Our ultimate goal is to provide scientific guidance for the acquisition of relevant population exposure information for epidemiological studies tackling the short and long term health effects of desert dust. We first describe the source regions and the typical levels of dust particles in regions close and far away from the source areas, along with their size, composition, and bio-aerosol load. We then describe the processes by which dust may become mixed with anthropogenic particulate matter (PM) and/or alter its load in receptor areas. Short term health effects are found during desert dust episodes in different regions of the world, but in a number of cases the results differ when it comes to associate the effects to the bulk PM, the desert dust-PM, or non-desert dust-PM. These differences are likely due to the different monitoring strategies applied in the epidemiological studies, and to the differences on atmospheric and emission (natural and anthropogenic) patterns of desert dust around the world. We finally propose methods to allow the discrimination of health effects by PM fraction during dust outbreaks, and a strategy to implement desert dust alert and monitoring systems for health studies and air quality management.The systematic review was funded by WHO with as part of a Grant Agreement with Ministry of Foreign Affairs, Norway. Thanks are also given to the Spanish Ministry for the Ecological Transition for long term support in the last 2 decades to our projects on African dust effects on air quality over Spain; to the Spanish Ministry of Science, Innovation and Universities and FEDER Funds for the HOUSE project (CGL2016-78594-R), and to the Generalitat de Catalunya (AGAUR 2017 SGR41). Carlos Pérez García-Pando acknowledges long-term support from the AXA Research Fund, as well as the support received through the Ramón y Cajal program (grant RYC-2015-18690) of the Spanish Ministry of Science, Innovation and Universities.Peer ReviewedPostprint (published version

[A cohort study on mortality and morbidity in the area of Taranto, Southern Italy].

Introduction: the area of Taranto has been investigated in several environmental and epidemiological studies due to the presence of many industrial plants and shipyards. Results from many studies showed excesses of mortality and cancer incidence for the entire city of Taranto, but there are no studies for different geographical areas of the city that take into account the important confounding effect of socioeconomic position. Objective: to assess mortality and hospitalization rates of residents in Taranto, Statte and Massafra through a cohort study, with a particular focus on residents in the districts closest to the industrial complex, taking into account the socioeconomic position. Methods: a cohort of residents during the period 1998-2010 was enrolled. Individual follow-up for assessment of vital status at 31.01.2010 was performed using municipality data. The census-tract socioeconomic position level and the district of residence were assigned to each participant, on the basis of the geocoded addresses at the beginning of the follow-up. Standardized cause specific mortality/morbidity rates, adjusted for age, were calculated by gender and districts of residence. Mortality and morbidity Hazard Ratios (HR, CI95%) were calculated by districts and socioeconomic position using Cox models. All models were adjusted for age and calendar period, and were done separately for men and women. Results: 321.356 people were enrolled in the cohort (48.9% males). Mortality/morbidity risks for natural cause, cancers, cardiovascular and respiratory diseases were found to be higher in low socioeconomic position groups compared to high ones. The analyses by districts have shown several excess mortality/morbidity risks for residents in Tamburi (Tamburi, Isola, Porta Napoli and Lido Azzurro), Borgo, Paolo VI and the municipality of Statte. Conclusions: The results of this study showed a significant relationship between socioeconomic position and health status of people resident in Taranto. People living in the districts closest to the industrial zone have higher mortality/morbidity levels compared to the rest of the area also taking into account the socioeconomic position

Evaluating Spillover Effects in Network-Based Studies In the Presence of Missing Outcomes

Estimating causal effects in the presence of spillover among individuals embedded within a social network is often challenging with missing information. The spillover effect is the effect of an intervention if a participant is not exposed to the intervention themselves but is connected to intervention recipients in the network. In network-based studies, outcomes may be missing due to the administrative end of a study or participants being lost to follow-up due to study dropout, also known as censoring. We propose an inverse probability censoring weighted (IPCW) estimator, which is an extension of an IPW estimator for network-based observational studies to settings where the outcome is subject to possible censoring. We demonstrated that the proposed estimator was consistent and asymptotically normal. We also derived a closed-form estimator of the asymptotic variance estimator. We used the IPCW estimator to quantify the spillover effects in a network-based study of a nonrandomized intervention with censoring of the outcome. A simulation study was conducted to evaluate the finite-sample performance of the IPCW estimators. The simulation study demonstrated that the estimator performed well in finite samples when the sample size and number of connected subnetworks (components) were fairly large. We then employed the method to evaluate the spillover effects of community alerts on self-reported HIV risk behavior among people who inject drugs and their contacts in the Transmission Reduction Intervention Project (TRIP), 2013 to 2015, Athens, Greece. Community alerts were protective not only for the person who received the alert from the study but also among others in the network likely through information shared between participants. In this study, we found that the risk of HIV behavior was reduced by increasing the proportion of a participant's immediate contacts exposed to community alerts

Repeatability of the ISAAC video questionnaire and its accuracy against a clinical diagnosis of asthma

AbstractThe objective of the study was to evaluate the performance of the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire in terms of repeatability and accuracy against a clinical diagnosis of asthma achieved according to the National Heart, Lung and Blood Institute (NHLBI) algorithm.Two hundred and forty-one subjects, aged 13–14 years from two secondary schools in Rome, Italy, were enrolled. Video and written ISAAC questionnaires were completed twice, 3 months apart, by 194 and 190 adolescents, respectively. Two months later, 106 subjects were visited by two physicians blinded to the results of questionnaires.Sixteen subjects were classified as having clinical asthma (CA) at the clinical visit, and eight of them as having clinical active asthma (CAA) on the basis of at least one positive outcome of the NHLBI algorithm. The repeatability of video questionnaire was similar to that of the written questionnaire for items on exercise wheeze and nocturnal cough and, to a lesser degree, for items concerning any wheeze in the past. The video questionnaire showed a worse performance than the written questionnaire for items on asthma attack: K-value (95% CL)=0·59 (0·37–0·80) for video scene no. 5 and K-value (95% CL)=0·86 (0·74–0·98) for written question no. 6. The overall accuracy of the video questionnaire, estimated as a positive answer to any video scene, was lower in terms of sensitivity than that of any written question when CA was used as a gold standard (0·50 vs. 0·81, P=0·025) and increased with respect to CAA (0·75vs. 0·87, P=0·317). The specificity of any video scene was better than that of any written question, independently from the gold standard used.In conclusion, the video questionnaire showed a fairly good accuracy, although slightly lower than that of the written questionnaire and provided sufficiently reliable results. However, samples of subjects from different geographic areas and cultures should be studied in order to conclusively define the performance of the ISAAC video questionnaire

Cancer risk in oil refinery workers : a pooled mortality study in Italy

Background: Oil refinery workers are exposed to several well-established carcinogens and working in this type of industry has been classified by IARC as probable carcinogen to humans (Group 2A). Objectives: To examine the mortality experience of workers employed in four Italian oil refineries. Methods: The cohort included 5112 male workers ever employed between 1949 and 2011. The average follow-up period was 49 years. Standardized mortality ratios (SMR) and 95% Confidence Intervals (CI) were calculated using as reference age-gender-calendar specific regional rates. Analyses by duration of employment and latency were performed. Results: In the whole cohort, pleural cancer (6 deaths, SMR 1.59; 95% CI 0.71-3.53), brain cancer (14 deaths, SMR 1.47; 95% CI 0.87-2.49) and lymphatic leukemia (LL) (8 deaths, SMR 1.81; 95% CI 0.91-3.62) showed increased risks. All pleural cancers occurred after 10 years of latency and the highest risk was observed among workers with duration 6520 years; the brain cancer excess was confined in the shortest duration and latency. The LL (and chronic lymphatic leukemia in particular) excess regarded workers with latency and duration longer than 20 years. Four deaths from acute myeloid leukemia (AML) were observed and all occurred after 20 years of latency (SMR 1.55, 95% CI 0.58-4.12); a two-fold-increased risk was observed in the longest duration. No increased risk for skin cancer has been observed in our study population. Conclusion: Our findings are consistent with recent evidence of an increased mortality from pleural and hematopoietic malignancies (AML and LL) among oil refinery workers. However, the lack of individual quantitative exposure data and the small number of observed events prevent the identification of the possible causal role of individual chemicals, including benzene, especially at the current very low exposure levels

Validation of numerical methods for electromagnetic dosimetry through near-field measurements

This paper describes the arrangement of a first experimental set-up which allows the comparison between the measurement of the electromagnetic field quantities induced inside a simple cylindrical phantom and the same quantities estimated numerically through a boundary element method. The reliability of the numerical method has been tested at 64 MHz, the Larmor frequency associated to the magnetic resonance imaging devices with an isocenter magnetic field of 1.5 T. To assess its robustness, the comparison is also performed by introducing, inside the phantom, a metallic non magnetic element, which roughly simulates a medical implant

Short-term effects of air pollution on cardiovascular hospitalizations in the pisan longitudinal study

Air pollution effects on cardiovascular hospitalizations in small urban/suburban areas have been scantly investigated. Such effects were assessed among the participants in the analytical epidemiological survey carried out in Pisa and Cascina, Tuscany, Italy (2009-2011). Cardiovascular hospitalizations from 1585 subjects were followed up (2011-2015). Daily mean pollutant concentrations were estimated through random forests at 1 km (particulate matter: PM10, 2011-2015; PM2.5, 2013-2015) and 200 m (PM10, PM2.5, NO2, O3, 2013-2015) resolutions. Exposure effects were estimated using the case-crossover design and conditional logistic regression (odds ratio-OR-and 95% confidence interval-CI-for 10 μg/m3 increase; lag 0-6). During the period 2011-2015 (137 hospitalizations), a significant effect at lag 0 was observed for PM10 (OR = 1.137, CI: 1.023-1.264) at 1 km resolution. During the period 2013-2015 (69 hospitalizations), significant effects at lag 0 were observed for PM10 (OR = 1.268, CI: 1.085-1.483) and PM2.5 (OR = 1.273, CI: 1.053-1.540) at 1 km resolution, as well as for PM10 (OR = 1.365, CI: 1.103-1.690), PM2.5 (OR = 1.264, CI: 1.006-1.589) and NO2 (OR = 1.477, CI: 1.058-2.061) at 200 m resolution; significant effects were observed up to lag 2. Larger ORs were observed in males and in subjects reporting pre-existent cardiovascular/respiratory diseases. Combining analytical and routine epidemiological data with high-resolution pollutant estimates provides new insights on acute cardiovascular effects in the general population and in potentially susceptible subgroups living in small urban/suburban areas