Differences In Health Effects Research Articles

Thinking beyond general greenness: The nuanced associations between a variety of greenspaces and cardiovascular diseases across urbanicity

Cardiovascular diseases (CVDs) are the leading causes of death globally. Exposure to greenspaces has been proposed to be beneficial for CVDs. However, past studies have often overlooked how varying levels of urbanicity may differently impact the relationships between greenspaces and cardiovascular health. Moreover, different types of greenspaces uniquely affect people’s behaviors and psychological wellbeing, potentially yielding distinct effects on CVDs.This study investigates the associations between population-weighted exposure to various types of greenspaces and prevalence of coronary heart disease (CHD) and stroke in the US at tract level, and whether these associations are modified by urbanicity.We identified a contrasting difference in health effects between greenspaces inside and outside park. Neighbourhoods with more forest (CHD β = −2.99, 95 % CI: −4.25, −1.73; stroke β = −1.85, 95 % CI: −2.56, −1.13) and open space (CHD β = −4.31, 95 % CI: −5.49, −3.14; stroke β = −2.33, 95 % CI: −3.00, −1.66) inside park were associated with a lower prevalence of CVDs, whereas more forest (CHD β = 7.67, 95 % CI: 5.81, 9.54; stroke β = 3.01, 95 % CI: 1.95, 4.07) and open space (CHD β = 11.52, 95 % CI: 9.99, 13.05; stroke β = 5.77, 95 % CI:4.90, 6.64) outside park were associated with a higher prevalence of CVDs. We observed a reversal pattern across urbanicity: the significant beneficial associations only held in highly urbanized tracts but attenuated or reversed in the three less urbanized tracts.These findings highlight a need to prioritize investment in parks within walking distance to urban residents and improve the accessibility and design of rural greenspaces. We propose the Landscape Compensation Effect, which may serve as a new theoretical framework to guide future research and design practices of greenspaces to promote the cardiovascular health of both urban and rural residents.

Health-Related Quality of Life and Economic Analysis of Olanzapine Versus Aprepitant in Preventing Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy in Malaysia

ObjectivesOlanzapine has been shown to be effective in preventing chemotherapy-induced nausea and vomiting (CINV) after highly emetogenic chemotherapy (HEC); however, there is limited work on the impact of CINV on health-related quality of life (HRQoL) and the comparative cost-effectiveness of CINV prophylaxis in the Malaysian context. Therefore, this study was conducted to determine the HRQoL using EQ-5D-5L and the cost-effectiveness of olanzapine compared with aprepitant for CINV prophylaxis in Malaysia using data from a local study. MethodsFifty-nine chemo-naive patients receiving either olanzapine or aprepitant were randomly recruited and completed the EQ-5D-5L before and day 5 after HEC. HRQoL utility scores were analyzed according to the Malaysian valuation set. The economic evaluation was conducted from a healthcare payer perspective with a 5-day time horizon. Quality-adjusted life days (QALD) and the rate of successfully treated patients were used to measure health effects. The incremental cost-effectiveness ratio is assessed as the mean difference between groups’ costs per mean difference in health effects. A one-way sensitivity analysis was performed to assess variations that might affect outcomes. ResultsAprepitant and olanzapine arms’ patients had comparable baseline mean HRQoL utility scores of 0.920 (SD = 0.097) and 0.930 (SD = 0.117), respectively; however, on day 5, a significant difference (P value = .006) was observed with mean score of 0.778 (SD = 0.168) for aprepitant and 0.889 (SD = 0.133) for olanzapine. The cost per successfully treated patient in the aprepitant arm was 60 times greater than in the olanzapine arm (Malaysian Ringgit [MYR] 927 vs MYR 14.83). Likewise, the cost per QALD gain in the aprepitant arm was 36 times higher than in the olanzapine arm (MYR 57.05 vs MYR 1.57). Incremental cost-effectiveness ratio of MYR −937.00 (USD −200.98) per successfully treated patient and MYR −391.84 (USD −85.43) per QALD gained for olanzapine compared with the aprepitant-based regimen. ConclusionsAn olanzapine-based regimen is a cost-effective therapeutic substitution in patients receiving HEC in Malaysia.

Emission characteristics and health effects of PM2.5 from vehicles in typical areas.

Vehicle emissions have become an important source of urban air pollution, and the assessment of air pollution emission characteristics and health effects caused by specific pollution sources can provide scientific basis for air quality management. In this paper, vehicle PM2.5 pollution in typical urban agglomerations of China (the Beijing-Tianjin-Hebei urban agglomeration (BTHUA), the triangle of the Central China urban agglomeration (TCCUA) and the Chengdu-Chongqing urban agglomeration (CCUA)) were used as research samples to evaluate the emission characteristics, health effects and economic losses of vehicle PM2.5 pollution based on the emission inventory, air quality model and exposure-response function from 2010 to 2020. The results indicated that PM2.5 emissions from vehicles in the three urban agglomerations during 2010-2020 first showed an upward yearly trend and then showed a slow decrease in recent years. Heavy-duty trucks and buses are the main contribution vehicles of PM2.5, and the contribution rates of light-duty vehicles to PM2.5 is increasing year by year. The contribution rate of PM2.5 in Beijing decreased significantly. In addition to capital cities and municipalities directly under the central Government, the emission of pollutants in other cities cannot be ignored. The evaluation results of the impact of PM2.5 pollution from vehicles on population health show that: the number of each health endpoint caused by PM2.5 pollution from vehicles in the BTHUA and CCUA showed an overall upward trend, while the TCCUA showed a downward trend in recent years. Among them, PM2.5 pollution from vehicles in the three major urban agglomerations cause about 78,200 (95% CI: 20,500-138,800) premature deaths, 122,800 (95% CI: 25,600-220,500) inpatients, and 628,400 (95% CI: 307,400-930,400) outpatients and 1,332,400 (95% CI: 482,700-2,075,600) illness in 2020. The total health economic losses caused by PM2.5 pollution from vehicles in the three major urban agglomerations in 2010, 2015 and 2020 were 68.25 billion yuan (95% CI: 21.65-109.16), 206.33 billion yuan (95% CI: 66.20-326.20) and 300.73 billion yuan (95% CI: 96.79-473.16), accounting for 0.67% (95% CI: 0.21-1.07%), 1.19% (95% CI: 0.38%-1.88%) and 1.21% (95% CI: 0.39%-1.90%) of the total GDP of these cities. Due to the differences in vehicle population, PM2.5 concentration, population number and economic value of health terminal units, there are differences in health effects and economic losses among different cities in different regions. Among them, the problems of health risks and economic losses were relatively prominent in Beijing, Chengdu, Chongqing, Tianjin and Wuhan.

Retirement Pathways' Effect on Physical and Mental Health: Evidence from Japan.

Few studies have used rigorous causal analysis to examine the difference in health effects between abrupt and gradual transitions from full-time employment to full retirement. Data were obtained from 10,253 individuals aged 50 years and older from the 2005-2019 Longitudinal Survey of Middle-aged and Older Adults conducted in Japan. An instrumental variable approach was used to determine the causal relationship between retirement pathways and health by exploiting the public pension eligibility age as the instrument. Abruptly retired individuals were more likely to have physical limitation and less likely to have depression than those not yet retired. In contrast, those who fully retired through a gradual transition were less likely to have physical limitation and more likely to have depression than those not yet retired. Retirement pathways have different effects on physical and mental health, providing important implication for labor and health policies in aging societies.

Effects of High Doses of Sodium Metavanadate on the Thyroid Status in Rats

Introduction: The widespread use of vanadium in the metallurgical industry leads to its high content in the workplace air, which poses a threat to human health both in the workforce and the community. Vanadium accumulates in many organs and has a toxic effect; yet, studies of its effects on the thyroid gland are scarce and narrowly focused. This study is aimed at establishing the effect of vanadium on the functioning of the thyroid gland. Objective: To establish thyroid status in rats after a single intraperitoneal injection of sodium metavanadate. Materials and methods: Twenty-six male Wistar rats aged 3 months weighing more than 200 g were divided into a control group (10 animals) exposed to distilled water and two exposure groups (V11 and V18) of eight animals each intraperitoneally exposed to 11 and 18 mg of sodium metavanadate per kg of body weight, respectively. Serum levels of the thyroid-stimulating hormone, total and free thyroxine and triiodothyronine were determined by enzyme immunoassay. Results: We observed that the high single exposure dose of sodium metavanadate caused significant changes in thyroid hormone levels. Administration of sodium metavanadate at the dose of 11 mg/kg b.w. induced an increase in the levels of total and free thyroxine but a decrease in the ratio of total triiodothyronine to total thyroxine compared with the controls. Administration of a higher dose of the compound (18 mg/kg b.w.) increased the levels of free triiodothyronine, free thyroxine, the ratio of free triiodothyronine to total triiodothyronine, and the ratio of free thyroxine to total thyroxine compared with the controls. We also noted the differences in health effects between the exposure groups, such as a higher level of free triiodothyronine and higher ratios of free triiodothyronine to total triiodothyronine and of free thyroxine to total thyroxine in the V11 exposure group. Conclusions: Our findings show that a single intraperitoneal injection of sodium metavanadate at high doses of 11 and 18 mg/kg b.w. suppresses thyroid function and induces hypothyroidism, even 14 days after administration.

Associations between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Jinan: potential benefits from air quality improvements.

Evidence between air pollution and chronic obstructive pulmonary disease (COPD) is inconsistent and limited in China. In this study, we aim to examine the associations between air pollutants and hospital admissions for COPD, hoping to provide practical advice for prevention and control of COPD. Hospital admissions for COPD were collected from a Grade-A tertiary hospital in Jinan from 2014 to 2020. A generalized additive model (GAM) was used to examine the associations between air pollutants and hospital admissions for COPD. Stratified analysis was also conducted for gender, age (20-74 and ≥75 years), and season (warm and cold). The avoidable number of COPD hospital admissions was calculated when air pollutants were controlled under national and WHO standards. Over the study period, a total of 4,012 hospital admissions for COPD were recorded. The daily hospital admissions of COPD increased by 2.36% (95%CI: 0.13-4.65%) and 2.39% (95%CI: 0.19-4.65%) for per 10 μg/m3 increase of NO2 and SO2 concentrations at lag2, respectively. There was no statistically significant difference in health effects caused by increased concentrations of PM2.5, PM10, CO, and O3. The health effects of increased SO2 concentration were stronger in women, the ≥75 years old people and the cold season. About 2 (95%CI: 0-3), 64 (95%CI: 4-132) and 86 (95%CI: 6-177) COPD admissions would be avoided when the SO2 concentration was controlled below the NAAQS-II (150 μg/m3), NAAQS-I (50 μg/m3), and WHO's AQG2021 standard (40 μg/m3), respectively. These findings suggest that short-term exposure to NO2 and SO2 was associated with increased risks of daily COPD admissions, especially for females and the elderly. The control of SO2 and NO2 under the national and WHO standards could avoid more COPD admissions and obtain greater health benefits.

Predictive clustering methods to identify differential toxicity of air pollutant mixtures

BACKGROUND AND AIM: Spatial misalignment between the relatively small number of locations where air pollution mixtures are measured and the locations of cohort members poses a challenge to assessing health effects. This talk presents a clustering-based approach to defining multipollutant exposure profiles that can be well predicted at unobserved locations. METHODS: Clusters are defined by combining multipollutant measurements with spatial and spatiotemporal characteristics of the monitoring location in a Gaussian mixture model. Cluster membership for cohort locations and times are then predicted using parametric and machine learning classification algorithms. RESULTS: We demonstrate this approach using PM2.5 components on a national scale and on-road multipollutant measures (including ultrafine particles and volatile organic compounds) on a regional scale. We identify mixtures associated with differing effects of air pollution exposure on atherosclerosis, blood pressure, and cancer risk. CONCLUSIONS: Cluster-based approaches for defining pollution mixtures provide an effective approach to assessing multipollutant exposures using spatially misaligned data. Incorporating location characteristics can improve predictive accuracy and power for assessing differences in health effects of ambient air pollution exposure. KEYWORDS: ambient air pollution, fine particulate matter, k-means, multipollutant exposures, spatiotemporal statistics

The Intersection of Immigrant and Environmental Health: A Review of the Literature

BACKGROUND: Transnational immigration has grown since the 1950s. In countries such as the United States, immigrants now comprise over 15% of the population. Although differences in health between immigrants and non-immigrants are well-documented, it is unclear how environmental exposures contribute to these disparities. AIM: We systematically reviewed current knowledge on exposure to environmental pollutants for immigrants compared to non-immigrants. We also considered observational epidemiologic studies that estimated health effects associated with environmental exposures, separately for immigrants and non-immigrants. METHODS: We screened 3705 articles identified through Pubmed and selected those that fit our inclusion criteria. After abstract and full-text review, we summarized findings from 50 studies. RESULTS: We found a high degree of evidence for higher exposures to metals and fine particulate matter (PM2.5), as well as a moderate degree of evidence for higher exposures to select organic compounds and hazardous air pollutants in immigrants compared to non-immigrants. Among immigrants, there was some evidence for disparities by country of origin and time since immigration. Of the 50 studies, 43 were conducted in North America. There was a low degree of evidence for disparities in health effects from exposures in immigrants compared to non-immigrants. CONCLUSIONS: The environmental health of immigrants remains an understudied area, especially outside of North America. While most identified studies explored potential exposure disparities, few investigated subsequent differences in health effects. Future research should investigate environmental health disparities of immigrants, especially outside North America, and the role of country of origin, time since immigration, and combined effects with socioeconomic status, race/ethnicity, education, and related characteristics. KEYWORDS: Environmental Equity, Environmental Justice, Immigrant Health, Health Disparities, Systematic Review

The Intersection of Immigrant and Environmental Health: A Scoping Review of Observational Population Exposure and Epidemiologic Studies.

Background:Transnational immigration has increased since the 1950s. In countries such as the United States, immigrants now account for of the population. Although differences in health between immigrants and nonimmigrants are well documented, it is unclear how environmental exposures contribute to these disparities.Objectives:We summarized current knowledge comparing immigrants’ and nonimmigrants’ exposure to and health effects of environmental exposures.Methods:We conducted a title and abstract review on articles identified through PubMed and selected those that assessed environmental exposures or health effects separately for immigrants and nonimmigrants. After a full text review, we extracted the main findings from eligible studies and categorized each article as exposure-focused, health-focused, or both. We also noted each study’s exposure of interest, study location, exposure and statistical methods, immigrant and comparison groups, and the intersecting socioeconomic characteristics controlled for.Results:We conducted a title and abstract review on 3,705 articles, a full text review on 84, and extracted findings from 50 studies. There were 43 studies that investigated exposure (e.g., metals, organic compounds, fine particulate matter, hazardous air pollutants) disparities, but only 12 studies that assessed health disparities (e.g., mortality, select morbidities). Multiple studies reported higher exposures in immigrants compared with nonimmigrants. Among immigrants, studies sometimes observed exposure disparities by country of origin and time since immigration. Of the 50 studies, 43 were conducted in North America.Discussion:The environmental health of immigrants remains an understudied area, especially outside of North America. Although most identified studies explored potential exposure disparities, few investigated subsequent differences in health effects. Future research should investigate environmental health disparities of immigrants, especially outside North America. Additional research gaps include the role of immigrants’ country of origin and time since immigration, as well as the combined effects of immigrant status with intersecting socioeconomic characteristics, such as race/ethnicity, income, and education attainment. https://doi.org/10.1289/EHP9855

An Indicator Measuring the Influence of the Online Public Food Environment: An Analytical Framework and Case Study.

The online public food environment (OPFE) has had a considerable impact on people's lifestyles over the past decade; however, research on its exposure is sparse. The results of the existing research on the impact of the food environment on human health are inconsistent. In response to the lack of food elements in the definition of the food environment and the lack of a clear method to assess the health attributes and the impact degree of the food environment, we proposed a new analytical framework based on the latest disease burden research, combining the characteristics of China's current food environment, from the perspective of environmental science. We redefined the food environment and proposed that food and its physical space are two core elements of the food environment. Accordingly, we extracted four domains of characteristics to describe the basic components of the food environment. Using the sales records, we designed an approach by referring to the standard process of environmental health indicators, including the health attributes and the impact degree of the food environment, to measure the OPFE of takeaway food outlets. Further, we conducted a case study and extracted three domains of characteristics for more than 18,000 effective takeaway meals from 812 takeaway food outlets located in 10 administrative subdivisions in the Haidian District and Xicheng District of Beijing Municipality. The results showed that more than 60% of single meals sold by takeaway food outlets were considered as healthy, and only 15% of takeaway food outlets sold healthy meals exclusively. Additionally, there were significant differences in health effects among different types of food environments, and high-risk areas of different types of food environments can be spatially identified. Compared with the counting method in the availability of food environment, the proposed new approach can depict food environment characteristics not only in the macro-scale like the counting method but also in the meal-scale. The indicators could be useful for large-scale and long-term monitoring of food environmental changes due to their simple calculation and design depending on the food delivery platform.

What Activities in Forests Are Beneficial for Human Health? A Systematic Review.

Over the past decade, clinical trials of forest-based interventions have increased, leading to their recognition as preventive medicine. However, little is known about the differences in health effects according to the activity characteristics of interventions. This study aimed to understand the types of activities and their associated health effects to identify differences in health effects between activities. PubMed, PsycINFO, Web of Science, and Scopus databases were searched, and methodological quality was assessed using Cochrane ROB2. A total of 32 randomized controlled trials (RCTs) met the eligibility criteria. Health outcomes were collected from 6264 participants aged 6–98 years, and the sample size was 12–585. The Interventions were walking (n = 21), staying (n = 7), exercise (n = 4), indirect exposure (n = 4), and the activity time was between 10 and 240 min. Overall, walking showed consistent positive health effects, and there were differences in effects on anxiety and depression, cognitive function, stress hormone, and inflammation according to the activity. However, most of the included studies had a high risk of bias, and interventions were limited to specific activities, durations, and frequencies. Although a few limitations remain, the findings in this study are of great significance in providing the basis for the design of forest-based interventions.

Determining the Efficiency and Yield of Caffeine Extraction for Robusta and Arabica Coffee Beans

The objective of this review is to determine the difference in caffeine content in the coffee beans from different brands that are available in Costco. Two different popular coffee bean brands were bought and tested to determine which brand would have the highest caffeine content and their relative popularity among consumers. The extraction DMC method was conducted by using chemicals such as calcium carbonate, water, and DMC. The same amount of coffee beans were boiled with water until highly concentrated solutions were formed. Extraction funnel was utilized to wash out caffeine. Then, the recrystallization and vacuum filtration was utilized to obtain caffeine in solid form. The identity of the product along with the purity of the product was determined using melting temp, IR-spectroscopy, UV-vis spectrum, and TLC plating. The mass of caffeine produced from individual coffee brands were measured and compared. It was hypothesized that robusta coffee beans would yield more caffeine than arabica coffee beans. The expected results verify those claims as the data demonstrates that the amount of caffeine extracted from 10 grams of robusta coffee would be around .8021 grams, while the amount of caffeine extracted from 10 grams of arabica coffee would be around .4321 grams. The IR graph, UV-vis graph, and TLC plate were conducted to verify the identity of the product. The predicted IR graph, UV-vis graph, and TLC plate closely matched with the literature values, which indicates that the product produced is pure caffeine. One source of error that could skew the data could be the presence of impurities from the coffee beans that react in solution while we are trying to extract the caffeine. The broader impact of this review is that by understanding the caffeine content in different products, the medical and scientific field can further determine the difference in health effects between excess and optimal caffeine consumption to the human body. Additionally, scientists can research various medical usages of caffeine to help different patients with sleep disorders.

Sex and age differences in the incidence of acute myocardial infarction during the COVID-19 pandemic in a Swedish health-care region without lockdown: a retrospective cohort study

The incidence of acute myocardial infarction has decreased during the COVID-19 pandemic, but sex and age differences in this change in incidence have not been tested. Thus, we aimed to compare the incidence of acute myocardial infarction in a health-care region in Sweden during the COVID-19 pandemic with previous years and to evaluate sex and age differences. We did a retrospective, observational cohort study using data from a national registry of patients admitted to coronary care units in Sweden. All patients admitted to one of three hospitals in Region Jönköping County with a diagnosis of acute myocardial infarction during the COVID-19 pandemic (March 1 to July 31, 2020) or reference period (March 1 to July 31, 2017-19) were included. The incidence of acute myocardial infarction (ST-elevation and non-ST-elevation) was calculated for both study periods. Participants were grouped according to sex and age (<70 years vs ≥70 years). The incidence and the incidence rate ratio (IRR) between the two study periods was calculated for each group and compared between groups using the Breslow-Day test. The study included 1088 participants, 846 who were admitted for acute myocardial infarction during the reference period and 242 who were admitted during the COVID-19 pandemic period. The IRR of acute myocardial infarction for the COVID-19 period compared with the reference period was 0·85 (95% CI 0·73-0·98). The IRR for acute myocardial infarction was significantly lower among women aged 70 years or older (0·56 [0·40-0·78]) than among men aged 70 years or older (0·97 [0·77-1·23]; p=0·0074). The incidence of acute myocardial infarction decreased predominantly among women aged 70 years or older during the COVID-19 pandemic. This highlights potential sex differences in health effects of the COVID-19 pandemic, which should be further elucidated. None.

Work-Related Symptoms, Safety Concerns, and Health Service Utilization Among Korean and Chinese Nail Salon Workers in the Greater New York City Area.

The purpose of this study was to determine similarities and differences in health effects, safety concerns, and health service utilization among Korean and Chinese immigrant women working in nail salons in the Greater New York City area. In this cross-sectional study, analyses involved descriptive statistics, t tests, and χ2 tests. Koreans had longer work experience and more work-related health effects and concerns, but were less likely to use personal protective equipment than Chinese workers. Although Koreans reported better socioeconomic status than Chinese workers, they were less likely to have health care access and utilized less health services. To prevent prolonged exposure to toxic chemicals, nail salon employees need education regarding the importance of personal protective equipment use. Reducing structural barriers and increasing health care access for all nail salon workers are especially important in improving their health service utilization.

Gender difference in hepatic toxicity of titanium dioxide nanoparticles after subchronic oral exposure in Sprague-Dawley rats.

Existing literature pointed out that the liver may be the target organ of toxicity induced by titanium dioxide nanoparticles (TiO2 NPs) via oral exposure. Gender differences in health effects widely exist and relevant toxicological research is important for safety assessment. To explore the gender susceptibility of TiO2 NP-induced hepatic toxicity and the underlying mechanism, we examined female and male Sprague-Dawley rats administrated with TiO2 NPs orally at doses of 0, 2, 10 and 50mg/kg body weight per day for 90days. The serum biochemical indicators and liver pathological observation were used to assess hepatic toxicity. We found significant hepatic toxicity could be induced by subchronic oral exposure to TiO2 NPs, which was more obvious and severe in female rats. No accumulation of TiO2 NPs in the liver was observed, indicating that hepatic toxicity may not be caused through direct pathways. Oxidized glutathione, lipid peroxidation products increased significantly and reduced glutathione decreased significantly in the liver of rats in repeated TiO2 NP-exposed groups. Hematological parameters of white blood cells and inflammatory cytokines in serum including interleukin 1α, interleukin 4 and tumor necrosis factor also increased significantly. Indirect pathways through initiating oxidative stress and inflammatory responses were suggested as the possible mechanism of the hepatic toxicity in this experiment. The higher sensitivity to redox homeostasis imbalance and inflammation of female rats may be the main reason for gender differences. Our research suggested that gender should be a susceptible factor for identifying and monitoring long-term oral toxicity of TiO2 NPs.

The health effects of individual characteristics and environmental factors in China: Evidence from the hierarchical linear model

Abstract Environmental pollution and its health risks to human beings have been becoming increasingly serious in China, and the health status of the individuals is not only affected by their environment but also by their own characteristics and socio-economic status. Based on the survey data of China Family Panel Studies (2014), three hierarchical linear models at three levels of individual, family, and community were developed to investigate the influencing factors of individual health status. The results indicate that: (1) there exists significant difference among individual health status, of which 16% and 9.11% are caused by the family and community levels, respectively; (2) the average health status of men is better than that of women by 6.95%. As for the difference in health effects produced by gender, total household income can reduce this difference; (3) age has significant negative health effects, while the level of education has positive effect on individual health status; and (4) the health effects of pollution is mainly reflected by its interaction with gender; in particular, when men and women face the same level of pollution exposure, men are more susceptible.

Adequate Use of Economic Evaluations Based on the Endpoints of a Registrative Clinical Trial: Cost-Minimization Analysis and the Return of the Living Dead

Cost-effectiveness analysis (CEA) has been widely applied to compare alternative options when a difference in health effects is observed. In contrast, a cost-minimization analysis (CMA) must be performed if the health effects of the alternatives can be considered reasonably similar. However, several authors have been suggested the death of CMA and supported the use of CEA alongside registrative clinical trials, even if the clinical end points of a study fail to demonstrate a statistically significant difference. The aim of the article is to discuss the potentially misleading implications of the inadequate use of CEA in translating results into clinical recommendations. A case study based on main findings from a published CEA evaluating the use of direct acting oral anticoagulants (DOACs), vitamin K antagonists, or antiplatelet drugs for the prevention of stroke in patients with atrial fibrillation, has been considered. The CEA recommends the use of apixaban as the first choice among DOACs, since it ranks the highest on the balance of efficacy, safety, and cost. However, no clinical evidence supporting this recommendation is available. In contrast, from a therapeutic perspective, several aspects support the preferential use of the other DOACs as a better first choice. In the case-study discussion, the step in which the incremental net benefit is calculated in the absence of at least one better alternative option either in regard to QALYs or total cost is critical and may promote incorrect conclusions and misleading clinical recommendations. The article proposed synoptic framework of the adequate use of economic evaluations based on the endpoints of registrative clinical trials, considering limitations on the use of CEAs and the expansion of CMA applications. Thus, CMAs should not only be limited to comparisons of products with evidence of efficacy from studies using an equivalence hypothesis test.

The effect of employment transitions on physical health among the elderly in South Korea: A longitudinal analysis of the Korean Retirement and Income Study

This study aims to answer three research questions: First, is the positive effect of retirement on physical health replicated in Korea? Second, is there any difference in health effects of employment transition according to employment status? Third, to what extent do monetary, non-monetary and work-related factors explain the effects of employment transitions on changes in physical health? The longitudinal panel data from five waves of the Korea Retirement and Income Study was used. We conducted (a) the pooled cross-sectional analysis, which used five-wave pooled data; and (b) the fixed-effects analyses to investigate how within-individual changes in employment status correspond to changes in subjective physical health among older adults aged 55 to 84. Results show that transition into retirement leads to poor physical health in Korea, and such effect was moderately mediated by both monetary and non-monetary factors. Compared to respondents who moved to non-precarious employment, those who became employers, self-employers, precarious workers, and unpaid family workers experienced significantly greater odds of reporting subjective poor physical health. Job dissatisfaction seems to be the most important mechanism through which employment transitions were translated into increasing likelihood of poor physical health. In conclusion, the social cost of retirement should consider the negative effects of retirement on the well-being and psychological health of retired individuals and their relationships with family, friends and neighbors, as well as income loss and economic uncertainty. Improving employment quality and working conditions for older working adults may be crucial in accomplishing longer and healthier working lives.

Cytotoxic and Inflammatory Potential of Air Samples from Occupational Settings with Exposure to Organic Dust.

Organic dust and related microbial exposures are the main inducers of several respiratory symptoms. Occupational exposure to organic dust is very common and has been reported in diverse settings. In vitro tests using relevant cell cultures can be very useful for characterizing the toxicity of complex mixtures present in the air of occupational environments such as organic dust. In this study, the cell viability and the inflammatory response, as measured by the production of pro-inflammatory cytokines tumor necrosis factor-α (TNFα) and interleukin-1 β (IL-1β), were determined in human macrophages derived from THP-1 monocytic cells. These cells were exposed to air samples from five occupational settings known to possess high levels of contamination of organic dust: poultry and swine feed industries, waste sorting, poultry production and slaughterhouses. Additionally, fungi and particle contamination of those settings was studied to better characterize the organic dust composition. All air samples collected from the assessed workplaces caused both cytotoxic and pro-inflammatory effects. The highest responses were observed in the feed industry, particularly in swine feed production. This study emphasizes the importance of measuring the organic dust/mixture effects in occupational settings and suggests that differences in the organic dust content may result in differences in health effects for exposed workers.

Effect Of Fine Particulate Matter And Its Constituents On Mortality During Asian Dust Storm Events In Seoul, Korea

Although the difference in fine particulate matter (PM2.5) constituents during Asian dust storms (ADS) and non-ADS days has been reported in previous studies, the difference in health effects of PM...