Association between tobacco control policies and current smoking across different occupational groups in the EU between 2009 and 2017

Background This study investigated the cross-national and longitudinal associations between national tobacco control policies and current smoking in 28 European Union (EU) member states between 2009 and 2017. It also examined the interaction between tobacco control policies and occupational status. Methods We used data from four waves of Eurobarometer (2009, 2012, 2014 and 2017). The total sample size was 105,231 individuals aged ≥15 years. Tobacco Control Scale scores (range 0 to 100) for years 2005, 2007, 2012 and 2014 measured the strength of country-level tobacco control policies. Logistic multilevel regression analyses with three levels (the individual, the country-year and the country) were performed with current smoker as the dependent variable. Results Across the EU, average smoking prevalence fell from 29.4% (95% CI: 28.5% to 30.2%) in 2009 to 26.3% (95% CI: 25.4% to 27.1%) in 2017. We confirmed that cross-nationally, strong national tobacco control policies are significantly associated with low probability of smoking. A one-point increase in TCS score was associated with lower odds of smoking (OR = 0.990; 95% CI = 0.963 to 0.998), but longitudinally (within-country) increases in TCS were not associated with current smoking (OR = 0.999; 95% CI = 0.994 to 1.005). Compared to those in manual occupations, the cross-national association was stronger in the upper occupational group (Conditional OR for the interaction = 0.985; 95% CI = 0.978 to 0.992) and weaker in the economically inactive group (Conditional OR for the interaction 1.009; 95% CI: 1.005 to 1.013). Conclusion Differences in tobacco control policies between countries were associated with probability of smoking but changes in TCS within countries over time were not. Differences between countries in tobacco control policies were found to be most strongly associated with likelihood of smoking in the highest occupational groups and were found to have only a weak association with smoking among the economically inactive in this sample

Impacts of chronic kidney disease and albuminuria on associations between coronary heart disease and its traditional risk factors in type 2 diabetic patients – the Hong Kong diabetes registry

<p>Abstract</p> <p>Background</p> <p>Glycated haemoglobin (HbA_1c), blood pressure and body mass index (BMI) are risk factors for albuminuria, the latter in turn can lead to hyperlipidaemia. We used novel statistical analyses to examine how albuminuria and chronic kidney disease (CKD) may influence the effects of other risk factors on coronary heart disease (CHD).</p> <p>Methods</p> <p>A prospective cohort of 7067 Chinese type 2 diabetic patients without history of CHD enrolled since 1995 were censored on July 30^th, 2005. Cox proportional hazard regression with restricted cubic spline was used to auto-select predictors. Hazard ratio plots were used to examine the risk of CHD. Based on these plots, non-linear risk factors were categorised and the categorised variables were refitted into various Cox models in a stepwise manner to confirm the findings.</p> <p>Results</p> <p>Age, male gender, duration of diabetes, spot urinary albumin: creatinine ratio, estimated glomerular filtration rate, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and current smoking status were risk factors of CHD. Linear association between TC and CHD was observed only in patients with albuminuria. Although in general, increased HDL-C was associated with decreased risk of CHD, full-range HDL-C was associated with CHD in an A-shaped manner with a zenith at 1.1 mmol/L. Albuminuria and CKD were the main contributors for the paradoxically positive association between HDL-C and CHD for HDL-C values less than 1.1 mmol/L.</p> <p>Conclusion</p> <p>In type 2 diabetes, albuminuria plays a linking role between conventional risk factors and CHD. The onset of CKD changes risk associations between lipids and CHD.</p

Intended and unintended consequences of the implementation of minimum unit pricing of alcohol in Scotland: a natural experiment

Background: Scotland was the first country to implement minimum unit pricing for alcohol nationally. Minimum unit pricing aims to reduce alcohol-related harms and to narrow health inequalities. Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. This study comprised three components. Objectives: This study comprised three components assessing alcohol consumption and alcohol-related attendances in emergency departments, investigating potential unintended effects of minimum unit pricing on alcohol source and drug use, and exploring changes in public attitudes, experiences and norms towards minimum unit pricing and alcohol use. Design: We conducted a natural experiment study using repeated cross-sectional surveys comparing Scotland (intervention) and North England (control) areas. This involved comparing changes in Scotland following the introduction of minimum unit pricing with changes seen in the north of England over the same period. Difference-in-difference analyses compared intervention and control areas. Focus groups with young people and heavy drinkers, and interviews with professional stakeholders before and after minimum unit pricing implementation in Scotland allowed exploration of attitudes, experiences and behaviours, stakeholder perceptions and potential mechanisms of effect. Setting: Four emergency departments in Scotland and North England (component 1), six sexual health clinics in Scotland and North England (component 2), and focus groups and interviews in Scotland (component 3). Participants: Research nurses interviewed 23,455 adults in emergency departments, and 15,218 participants self-completed questionnaires in sexual health clinics. We interviewed 30 stakeholders and 105 individuals participated in focus groups. Intervention: Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. Results: The odds ratio for an alcohol-related emergency department attendance following minimum unit pricing was 1.14 (95% confidence interval 0.90 to 1.44; p = 0.272). In absolute terms, we estimated that minimum unit pricing was associated with 258 more alcohol-related emergency department visits (95% confidence interval –191 to 707) across Scotland than would have been the case had minimum unit pricing not been implemented. The odds ratio for illicit drug consumption following minimum unit pricing was 1.04 (95% confidence interval 0.88 to 1.24; p = 0.612). Concerns about harms, including crime and the use of other sources of alcohol, were generally not realised. Stakeholders and the public generally did not perceive price increases or changed consumption. A lack of understanding of the policy may have caused concerns about harms to dependent drinkers among participants from more deprived areas. Limitations: The short interval between policy announcement and implementation left limited time for pre-intervention data collection. Conclusions: Within the emergency departments, there was no evidence of a beneficial impact of minimum unit pricing. Implementation appeared to have been successful and there was no evidence of substitution from alcohol consumption to other drugs. Drinkers and stakeholders largely reported not noticing any change in price or consumption. The lack of effect observed in these settings in the short term, and the problem-free implementation, suggests that the price per unit set (£0.50) was acceptable, but may be too low. Our evaluation, which itself contains multiple components, is part of a wider programme co-ordinated by Public Health Scotland and the results should be understood in this wider context. Future work: Repeated evaluation of similar policies in different contexts with varying prices would enable a fuller picture of the relationship between price and impacts.Additional co-authors: Oarabile Molaodi, Michele Open, Chris Patterson, Samantha Perry, Thomas Phillips, Gabriel Schembri, Janet Wilson, Chris Yap, Lyndal Bond, and Alastair H Leylan

Mutations of PIK3CA in gastric adenocarcinoma

BACKGROUND: Activation of the phosphatidylinositol 3-kinase (PI3K) through mutational inactivation of PTEN tumour suppressor gene is common in diverse cancer types, but rarely reported in gastric cancer. Recently, mutations in PIK3CA, which encodes the p110α catalytic subunit of PI3K, have been identified in various human cancers, including 3 of 12 gastric cancers. Eighty percent of these reported mutations clustered within 2 regions involving the helical and kinase domains. In vitro study on one of the "hot-spot" mutants has demonstrated it as an activating mutation. METHODS: Based on these data, we initiated PIK3CA mutation screening in 94 human gastric cancers by direct sequencing of the gene regions in which 80% of all the known PIK3CA mutations were found. We also examined PIK3CA expression level by extracting data from the previous large-scale gene expression profiling study. Using Significance Analysis of Microarrays (SAM), we further searched for genes that show correlating expression with PIK3CA. RESULTS: We have identified PIK3CA mutations in 4 cases (4.3%), all involving the previously reported hotspots. Among these 4 cases, 3 tumours demonstrated microsatellite instability and 2 tumours harboured concurrent KRAS mutation. Data extracted from microarray studies showed an increased expression of PIK3CA in gastric cancers when compared with the non-neoplastic gastric mucosae (p < 0.001). SAM further identified 2910 genes whose expression levels were positively associated with that of PIK3CA. CONCLUSION: Our data suggested that activation of the PI3K signalling pathway in gastric cancer may be achieved through up-regulation or mutation of PIK3CA, in which the latter may be a consequence of mismatch repair deficiency

REVIEW The social, economic, and environmental importance of inland fish and fisheries

Abstract: Though reported capture fisheries are dominated by marine production, inland fish and fisheries make substantial contributions to meeting the challenges faced by individuals, society, and the environment in a changing global landscape. Inland capture fisheries and aquaculture contribute over 40% to the world&apos;s reported finfish production from less than 0.01% of the total volume of water on earth. These fisheries provide food for billions and livelihoods for millions of people worldwide. Herein, using supporting evidence from the literature, we review 10 reasons why inland fish and fisheries are important to the individual (food security, economic security, empowerment), to society (cultural services, recreational services, human health and well-being, knowledge transfer and capacity building), and to the environment (ecosystem function and biodiversity, as aquatic &quot;canaries&quot;, the &quot;green food&quot; movement). However, the current limitations to valuing the services provided by inland fish and fisheries make comparison with other water resource users extremely difficult. This list can serve to demonstrate the importance of inland fish and fisheries, a necessary first step to better incorporating them into agriculture, land-use, and water resource planning, where they are currently often underappreciated or ignored. Key words: food security, freshwater ecosystems, importance of fish, inland fisheries. Résumé : Bien que la capture de poissons rapportée par les pêcheries soit dominée par la production marine, les poissons et les pêcheries de l&apos;intérieur des terres apportent des contributions substantielles pour rencontrer les défis rencontrés par les individus, les sociétés et l&apos;environnement dans un paysage en changement global. Les captures des pêcheries de l&apos;intérieur et l&apos;aquaculture contribuent à la hauteur de 40 % à la production mondiale rapportée pour les poissons à nageoires, à partir de moins de 0,01 % du volume total de l&apos;eau sur terre. Ces pêcheries fournissent de la nourriture pour des milliards et un moyen de subsistance pour des millions de gens, partout au monde. Dans cette revue, en utilisant des preuves venant de la littérature, les auteurs examinent 10 raisons pour lesquelles, les pêcheries et les poissons de l&apos;intérieur sont importants pour les individus (sécurité alimentaire, sécurité économique, l&apos;autonomisation), pour la société (services culturels, services récréatifs, santé humaine et bien-être, transfert de connaissances et capacité à construire) et pour l&apos;environnement (fonction écosystémique et biodiversité, comme « canaris » aquatiques, pour le mouvement « aliments verts »). Cependant, les limitations actuelles pour évaluer les services fournis par les poissons et les pêcheries intérieures rendent les comparaisons avec les autres utilisateurs de la ressource en eau extrêmement difficile. Cette liste peut servir à démontrer l&apos;importance des poissons et des pêcheries de l&apos;intérieur, une première étape essentielle pour mieux les incorporer avec l&apos;agriculture, l&apos;utilisation du territoire et la planification des ressources en eau, où elles sont actuellement sous-estimées, voire totalement ignorées. [Traduit par la Rédaction] Mots-clés : sécurité alimentaire, écosystèmes d&apos;eau douce, importance des poissons, pêcheries de l&apos;intérieur

Prevalence and correlates of subjective cognitive impairment in Chinese psychiatric patients during the fifth wave of COVID-19 in Hong Kong

IntroductionThe extent of cognitive impairment and its association with psychological distress among people with pre-existing mental illness during COVID-19 is understudied. This study aimed to investigate prevalence and correlates of subjective cognitive impairment (SCI) in Chinese psychiatric patients during fifth-wave of COVID-19 in Hong Kong (HK).MethodsFour-hundred-eight psychiatric outpatients aged 18–64 years were assessed with questionnaires between 28 March and 8 April 2022, encompassing illness profile, psychopathological symptoms, coping-styles, resilience, and COVID-19 related factors. Participants were categorized into moderate-to-severe and intact/mild cognitive impairment (CI+ vs. CI-) groups based on severity of self-reported cognitive complaints. Univariate and multivariate regression analyses were conducted to determine variables associated with CI+ status.ResultsOne-hundred-ninety-nine participants (48.8%) experienced CI+. A multivariate model on psychopathological symptoms found that depressive and post-traumatic-stress-disorder (PTSD)-like symptoms were related to CI+, while a multivariate model on coping, resilience and COVID-19 related factors revealed that avoidant coping, low resilience and more stressors were associated with CI+. Final combined model demonstrated the best model performance and showed that more severe depressive and PTSD-like symptoms, and adoption of avoidant coping were significantly associated with CI+.ConclusionAlmost half of the sample of psychiatric patients reported cognitive complaints during fifth-wave of COVID-19 in HK. Greater depressive and PTSD-like symptom severity, and maladaptive (avoidant) coping were found as correlates of SCI. COVID-19 related factors were not independently associated with SCI in psychiatric patients. Early detection with targeted psychological interventions may therefore reduce psychological distress, and hence self-perceived cognitive difficulties in this vulnerable population