Self-reported health problems and obesity predict sickness absence during a 12-month follow-up : a prospective cohort study in 21 608 employees from different industries

Objectives To study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries. Methods The results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as ' work disability (WD) risk factors' in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA. Results The HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those with ' WD risk factors' and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% CI was at the lowest 2.0. In the Hurdle model, ' WD risk factors', SA days prior to the HRA and obesity were additive predictors for SA and/or the accumulated SA days in all occupational groups. Conclusion Self-reported health problems and obesity predict a higher total count of SA days in an additive fashion. These findings have implications for both management and the healthcare system in the prevention of WD. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Peer reviewe

Novel tools and best practices for education about invasive alien species

Increasing public awareness is a prerequisite for successful management of invasive alien species (IAS). Environmental education can play an important role in this process by providing relevant learning outcomes and experiences for youth and students, as well as professionals in different sectors associated with introduction pathways or who are involved in mitigation and eradication of IAS. This paper responds to the urgent call for the inclusion of the IAS topic in education through the development, implementation and evaluation of novel and user-friendly educational materials. The aim of this paper is to describe best practices in IAS education and to share the lessons learned from eight educational projects from seven different countries. We discuss four challenges for IAS education, related to (1) inconsistent and ambiguous terminology, (2) communicating risk, (3) implementation of education materials, and (4) evaluation of learning effects. Examples of best practices are the use of smartphone applications and gaming elements, place-based education and exhibitions. We also note the importance of open access publishing of education materials to make them easily available. We intend this discussion to serve as a source of inspiration to researchers, science communicators and teachers and to spur the development of new teaching materials worldwide.Peer reviewe

Sixth Åland Island Conference on von Willebrand disease

Introduction The sixth angstrom land Islands Conference on von Willebrand disease (VWD) on the angstrom land Islands, Finland, was held from 20 to 22 September 2018. Aim The meeting brought together experts in the field of VWD from around the world to share the latest advances and knowledge in VWD. Results and discussion The topics covered both clinical aspects of disease management, and biochemical and laboratory insights into the disease. The clinical topics discussed included epidemiology, diagnosis and treatment of VWD in different countries, management of children with VWD, bleeding control during surgery, specific considerations for the management of type 3 VWD and bleeding control in women with VWD. Current approaches to the management of acquired von Willebrand syndrome were also discussed. Despite significant advances in the understanding and therapeutic options for VWD, there remain many challenges to be overcome in order to optimise patient care. In comparison with haemophilia A, there are very few registries of VWD patients, which would be a valuable source of data on the condition and its management. VWD is still underdiagnosed, and many patients suffer recurrent or severe bleeding that could be prevented. Awareness of VWD among healthcare practitioners, including non-haematologists, should be improved to allow timely diagnosis and intervention. Diagnosis remains challenging, and the development of fast, simple assays may help to facilitate accurate and rapid diagnosis of VWD.Peer reviewe

Sustainable management of migratory European ducks: finding model species

Eurasian migratory duck species represent a natural resource shared between European countries. As is evident throughout human harvest history, lack of coordinated management and monitoring at appropriate levels often leads to 'the tragedy of the commons', where shared populations suffer overexploitation. Effective management can also be hampered by poor understanding of the factors that limit and regulate migratory populations throughout their flyways, and over time. Following decades of population increase, some European duck populations now show signs of levelling off or even decline, underlining the need for more active and effective management. In Europe, the existing mechanisms for delivering effective management of duck populations are limited, despite the need and enthusiasm for establishing adaptive management (AM) schemes for wildlife populations. Existing international legal agreements already oblige European countries to sustainably manage migratory waterbirds. Although the lack of coordinated demographic and hunting data remains a challenge to sustainable management planning, AM provides a robust decision-making framework even in the presence of uncertainty regarding demographic and other information. In this paper we investigate the research and monitoring needs in Europe to successfully apply AM to ducks, and search for possible model species, focusing on freshwater species (in contrast to sea duck species) in the East Atlantic flyway. Based on current knowledge, we suggest that common teal Anas crecca, Eurasian wigeon Mareca penelope and common goldeneye Bucephala clangula represent the best species for testing the application of an AM muddling approach to duck populations in Europe. Applying AM to huntable species with relatively good population data as models for broader implementation represents a cost effective way of starting to develop AM on a European flyway scale for ducks, and potentially other waterbirds in the future

Clinical practice selectively follows acute appendicitis guidelines

Peer reviewe

Regression spline bivariate probit models: A practical approach to testing for exogeneity

Bivariate probit models can deal with a problem usually known as endogeneity. This issue is likely to arise in observational studies when confounders are unobserved. We are concerned with testing the hypothesis of exogeneity (or absence of endogeneity) when using regression spline recursive and sample selection bivariate probit models. Likelihood ratio and gradient tests are discussed in this context and their empirical properties investigated and compared with those of the Lagrange multiplier and Wald tests through a Monte Carlo study. The tests are illustrated using two datasets in which the hypothesis of exogeneity needs to be tested

Global Retinoblastoma Treatment Outcomes Association with National Income Level

Purpose: To compare metastasis-related mortality, local treatment failure, and globe salvage after retinoblastoma in countries with different national income levels. Design: International, multicenter, registry-based retrospective case series. Participants: Two thousand one hundred ninety patients, 18 ophthalmic oncology centers, and 13 countries on 6 continents. Methods: Multicenter registry-based data were pooled from retinoblastoma patients enrolled between January 2001 and December 2013. Adequate data to allow American Joint Committee on Cancer staging, eighth edition, and analysis for the level, as defined by the 2017 United Nations World Population Prospects, and included high-income countries (HICs), upper middle-income countries (UMICs), and lower middle-income countries (LMICs). Patient survival was estimated with the Kaplan-Meier method. Logistic and Cox proportional hazards regression models were used to determine associations between national income and treatment outcomes. Main Outcome Measures: Metastasis-related mortality and local treatment failure (defined as use of secondary enucleation or external beam radiation therapy). Results: Most (60%) study patients resided in UMICs and LMICs. The global median age at diagnosis was 17.0 months and higher in UMICs (20.0 months) and LMICs (20.0 months) than HICs (14.0 months; P < 0.001). Patients in UMICs and LMICs reported higher rates of disease-specific metastasis-related mortality and local treatment failure. As compared with HICs, metastasis-related mortality was 10.3-fold higher for UMICs and 9.3-fold higher for LMICs, and the risk for local treatment failure was 2.2-fold and 1.6-fold higher, respectively (all P < 0.001). Conclusions: This international, multicenter, registry-based analysis of retinoblastoma management revealed that lower national income levels were associated with significantly higher rates of metastasis-related mortality, local treatment failure, and lower globe salvage. (C) 2020 by the American Academy of Ophthalmology.Peer reviewe

Expression of ABC Efflux Transporters in Placenta from Women with Insulin-Managed Diabetes

Drug efflux transporters in the placenta can significantly influence the materno-fetal transfer of a diverse array of drugs and other xenobiotics. To determine if clinically important drug efflux transporter expression is altered in pregnancies complicated by gestational diabetes mellitus (GDM-I) or type 1 diabetes mellitus (T1DM-I), we compared the expression of multidrug resistance protein 1 (MDR1), multidrug resistance-associated protein 2 (MRP2) and the breast cancer resistance protein (BCRP) via western blotting and quantitative real-time polymerase chain reaction in samples obtained from insulin-managed diabetic pregnancies to healthy term-matched controls. At the level of mRNA, we found significantly increased expression of MDR1 in the GDM-I group compared to both the T1DM-I (p<0.01) and control groups (p<0.05). Significant changes in the placental protein expression of MDR1, MRP2, and BCRP were not detected (p>0.05). Interestingly, there was a significant, positive correlation observed between plasma hemoglobin A1c levels (a retrospective marker of glycemic control) and both BCRP protein expression (r = 0.45, p<0.05) and BCRP mRNA expression (r = 0.58, p<0.01) in the insulin-managed DM groups. Collectively, the data suggest that the expression of placental efflux transporters is not altered in pregnancies complicated by diabetes when hyperglycemia is managed; however, given the relationship between BCRP expression and plasma hemoglobin A1c levels it is plausible that their expression could change in poorly managed diabetes