Public Health Database Research Articles

PREVALENCE RATES AND DISEASE SEVERITY OF NON-TB MYCOBACTERIUM IN ST. JOHN'S, NEWFOUNDLAND, CANADA

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: The identification and study of nontuberculous mycobacteria (NTM) has become increasingly more relevant and important in recent years. It is important to determine emerging epidemiological trends with respect to the burden of disease in our province, as the therapeutic goal is to treat NTM infection before it can cause irreversible lung damage. The objective of this study is to describe the epidemiology of NTM disease in Newfoundland and Labrador and to compare it to that of other, previously studied, regions of Canada and the developed world. This will help us to assess the need for increased vigilance in the surveillance of this condition in our own diseased and at-risk populations. METHODS: Ethical approval was obtained from the Newfoundland and Labrador Health Research Ethics Board (Reference # 2017.110). A retrospective chart review was conducted as follows. Nontuberculous mycobacterium positive patients were identified from the provincial public health database from the period of 2006 to 2017 in Newfoundland and Labrador. Information such as date of diagnosis, causative agent and demographic information were collected from the database as available. Subsequently a chart review was performed on each NTM positive patient identified by the database in order to determine the clinical and pathological presentation, presence of pre- and co-morbid medical conditions, and to apply ATS diagnostic criteria. RESULTS: There were 25 NTM positive culture patients in the Eastern Health Authority of the province between the years of 2012 and 2017. Duplicates and non-NTM patients were removed (n=3), leaving a total of 22 charts. The most commonly encountered species in our cohort was Mycobacterium avium, with a combined total of 10 patients or 45.5% of isolates. With respect to pathological subtype of NTM disease, the overwhelming majority (81.8% n=18) of patients had pulmonary disease, with the remaining 4 patients presenting with lymphadenitis, tissue, or non-pulmonary disease. A small portion of patients, 7 (31.8%) received treatment, while 12 of 22 or 54.5% did not. Antibiotic susceptibility testing reveals that 16 isolates (70.0%) were sensitive to clarithromycin. The median duration of length of antibiotic course was 365 days, with a minimum of 30 days and a maximum of 5475 days. CONCLUSIONS: The study of NTM disease is an important and has clinical relevance. Additionally, as the incidence of NTM pulmonary disease is increasing, and since NTM is not currently a reportable disease in Canada, further research focusing on these organisms is important to understand their impact on the health of the population. CLINICAL IMPLICATIONS: Study of the trends associated with NTM disease will help us to understand the burden of disease. In addition, as these organisms are ubiquitous in our environment, our research should then be directed to prevention of disease and improved treatment for those colonized. DISCLOSURES: No relevant relationships by Preyanka Abhyankar, source=Web Response No relevant relationships by Tanweer Azher, source=Web Response No relevant relationships by Lei JIAO, source=Web Response

The Public Health Concerns of Marijuana Legalization: An Overview of Current Trends.

The objective of this study was to conduct a review of the benefits and adverse effects of cannabis (or marijuana) legalization in various states across the US. The current study offers a preliminary evaluation of the problems concerning marijuana legalization in several states, with the primary goal being the assessment of the impact of laws and policies governing the legalization and use of marijuana for medical purposes. A comprehensive search on cannabis and its derivatives was performed using multiple resource databases: PubMed, MEDLINE, Embase, PsycINFO, CENTRAL (Cochrane Controlled Register of Trials), government web sources, and the Department of Public Health databases. A total of 47 reports that evaluated the effects of cannabis legalization were included in this review. All review stages were conducted independently by two reviewers. Data were extracted in standardized tables by one reviewer and adjusted by a second, which were verified by the third author. We examined the use of cannabis before and after the changes in policy and the impact of marijuana legalization on traffic safety, behavior and educational achievement in adolescents, public health, tax revenues, criminal justice expenditures, and financial outcomes. We analyzed the effects and consequences of marijuana use in states that have or have not legalized marijuana. This report also includes the responsiveness of the people in states where marijuana is legalized and its value in the healthcare system. Our study highlights the existing limitations of reviews that probe the effect of decriminalizing marijuana in some states of the country. Our analysis shows that detailed and precise evaluation of policy dynamics must be conducted, taking into account the heterogeneity in population sub-groups and policies. Accordingly, in states where marijuana is used for its medicinal value and recreational purposes, people have different views on the legalization of marijuana. The complete effect of legalizing and commercializing marijuana on consumers' mental health and their educational outcomes is expected to take a longer duration prior to its achievement; unfortunately, fewer merits are anticipated. Most of the reports evaluated in this article proved to be marred with inconsistencies. Many of the stated claims did not pass a methodical evaluation. Going forward, additional data from available sources will lead to stronger conclusions. We weighed the pros and cons of marijuana legalization. However, we are certain that consumers can make better decisions by weighing each opinion by its reliability and safety.

Social isolation and loneliness among immigrant and refugee seniors in Canada: a scoping review

PurposeSocial isolation and loneliness are global issues experienced by many seniors, especially immigrant and refugee seniors. Guided by the five-stage methodological framework proposed by Arksey and O’Malley and more recently Levac, Colquhoun and O’Brien, the purpose of this paper is to explore the existing literature on social isolation and loneliness among immigrant and refugee seniors in Canada.Design/methodology/approachThe authors conducted a literature search of several databases including: PubMed; MEDLINE; CINAHL; Web of Science; HealthStar Ovid; PschyInfo Ovid; Social Services s; AgeLine; Public Health Database, Google Scholar and Cochrane Library. In total, 17 articles met the inclusion criteria.FindingsBased on the current literature five themes related to social isolation and loneliness emerged: loss; living arrangements; dependency; barriers and challenges; and family conflict.Research limitations/implicationsGiven the increasing demographic of aging immigrants in Canada, it is useful to highlight existing knowledge on social isolation and loneliness to facilitate research, policy and programs to support this growing population.Practical implicationsThe population is aging around the world and it is also becoming increasingly diverse particularly in the high-income country context. Understanding and addressing social isolation is important for immigrant and refugee seniors, given the sociocultural and other differences.Social implicationsSocial isolation is a waste of human resource and value created by seniors in the communities.Originality/valueThe paper makes a unique contribution by focusing on immigrant and refugee seniors.

Explainable statistical learning in public health for policy development: the case of real-world suicide data

BackgroundIn recent years, the availability of publicly available data related to public health has significantly increased. These data have substantial potential to develop public health policy; however, this requires meaningful and insightful analysis. Our aim is to demonstrate how data analysis techniques can be used to address the issues of data reduction, prediction and explanation using online available public health data, in order to provide a sound basis for informing public health policy.MethodsObservational suicide prevention data were analysed from an existing online United Kingdom national public health database. Multi-collinearity analysis and principal-component analysis were used to reduce correlated data, followed by regression analyses for prediction and explanation of suicide.ResultsMulti-collinearity analysis was effective in reducing the indicator set of predictors by 30% and principal component analysis further reduced the set by 86%. Regression for prediction identified four significant indicator predictors of suicide behaviour (emergency hospital admissions for intentional self-harm, children leaving care, statutory homelessness and self-reported well-being/low happiness) and two main component predictors (relatedness dysfunction, and behavioural problems and mental illness). Regression for explanation identified significant moderation of a well-being predictor (low happiness) of suicide behaviour by a social factor (living alone), thereby supporting existing theory and providing insight beyond the results of regression for prediction. Two independent predictors capturing relatedness needs in social care service delivery were also identified.ConclusionsWe demonstrate the effectiveness of regression techniques in the analysis of online public health data. Regression analysis for prediction and explanation can both be appropriate for public health data analysis for a better understanding of public health outcomes. It is therefore essential to clarify the aim of the analysis (prediction accuracy or theory development) as a basis for choosing the most appropriate model. We apply these techniques to the analysis of suicide data; however, we argue that the analysis presented in this study should be applied to datasets across public health in order to improve the quality of health policy recommendations.

Diabetes Increases Risk of Gastric Cancer After Helicobacter pylori Eradication: A Territory-Wide Study With Propensity Score Analysis.

Whether diabetes mellitus (DM) increases risk of gastric cancer (GC) remains controversial because of inadequate adjustments for important risk factors, including Helicobacter pylori (HP) infection status, concomitant medication use, and cancer site. We investigated whether type 2 DM increased risk of GC in patients after they received treatment for HP infection. This was a territory-wide cohort study of patients aged ≥45 years who had received clarithromycin-based triple therapy for HP infection between 2003 and 2012 in Hong Kong. Data were retrieved from a public electronic health database. Observation started from receipt of therapy for HP infection to GC diagnosis, death, or the end of the study (December 2015). Exclusion criteria included type 1 DM, GC diagnosed within the 1st year of HP therapy, prior GC or gastrectomy, and retreatment for HP infection. The adjusted hazard ratio (aHR) of GC with type 2 DM was calculated by using a Cox model that adjusted for 20 covariates (age, sex, comorbidities, and medications) through propensity score regression. During a median follow-up of 7.1 years (interquartile range 4.8-9.3 years), 153 of 46,460 patients (0.33%) developed GC at a median age of 72.4 years. Type 2 DM was associated with an increased risk of GC (aHR 1.73 [95% CI 1.08-2.79]). Stratified analysis showed an increase in risk for cardia cancer only (aHR 3.40 [95% CI 1.45-7.97]) and in those with suboptimal DM control (time-weighted mean HbA1c ≥6.0% [42 mmol/mol]; aHR 1.68 [95% CI 1.07-2.63]). Type 2 DM is associated with an increased risk of GC among patients in whom HP was eradicated, in particular gastric cardia cancer and in those with suboptimal DM control.

CHRONIC KIDNEY DISEASE AND MORTALITY – DATA FROM THE CROATIAN COHORT OF THE ESH STROKE SURVEY

Objective: The aim of this study was to assess the association of chronic kidney disease (CKD) with all-cause and cardiovascular (CV) mortality in patients surviving their first ischemic stroke and enrolled in the Croatian part of the ESH Stroke Survey. Design and method: The cohort consisted of 292 consecutive patients (171 m, mean age 64 y) admitted to UHC Zagreb and diagnosed with ischemic stroke between 2011–2014. The mean follow-up period was 6.3 years. Data were collected from medical records. CKD was defined as eGFR < 60 ml/min/1,73m2 (CKD-Epi). Mortality data were obtained from the Croatian National Public Health database. Results: Hypertension, smoking, diabetes, dyslipidemia and atrial fibrillation were diagnosed in 75%, 27.3%, 24.5%, 17.4%, 11.7%, respectively. CKD was detected in 51.7% (men vs women 41% vs 67%; p = 0.000001). CKD stages 1, 2, 3a, 3b, 4 and 5 were diagnosed in 6.8%, 41%, 31.8%, 14.7%, 3.4% and 1.7%, respectively. During the follow-up period, 91 patients (31.1%) died. The major cause of death was stroke (60.4%), followed by other causes (15.3%), cancer (14.2%) and CV diseases (9.8%). All-cause mortality was significantly higher in the CKD than in the non-CKD group (37.1% vs 21.2%: p = 0.0000) as were stroke mortality (24.6% vs. 15.1%; p = 0.0049) and composite CV mortality (stroke, coronary heart disease, heart failure) (42.7% vs 16.2%; p = 0.0015). In a linear multivariate regression model, age was the most important determinant of death (B −0.011 SE 0.202; Beta −0.27; p < 0.000000) followed by CKD (B −0.101 SE 0.058 Beta −0.109; p = 0.085). In a model including age, gender, systolic BP at the time of stroke and CKD (R2 = 0.323), the impact of CKD on mortality risk was 9%. Conclusions: CKD is highly prevalent in patients with ischemic stroke. It is associated with higher all-cause and CV mortality. CKD should be considered a risk and a prognostic factor in patients with ischemic stroke.

Competencies acquired in epidemiology doctoral programs

PurposeThe purpose of the study was to compile and describe the range of competencies imparted by doctoral programs in epidemiology using publicly available information. MethodsThrough the Council on Education for Public Health database, institutions conferring doctoral (PhD, ScD, DrPH) degrees in epidemiology were identified. The competencies listed on the corresponding institutions' websites were extracted and summarized. ResultsForty-eight PhD and thirteen DrPH institutions indicate that their graduates will gain 11 common competencies. The most frequently noted competency for both PhD (93.7%) and DrPH (100%) degrees is related to the communication domain, reflecting the need for graduates to be able to effectively communicate epidemiologic information to others (epidemiology peers, other scientists, policy makers, students). ConclusionsAlthough variations in the listed competencies exist among doctoral programs in epidemiology, there are common competencies across programs. Further examination of these programs is required to capture information beyond that conveyed on the websites. This preliminary report, along with those findings presented in previous reports on doctoral education, may stimulate further discussion with a group of faculty teaching at the doctoral level, employers of doctoral graduates, and/or the Association of Schools and Programs of Public Health representatives.

The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review

BackgroundResidential treatment is a standard treatment for individuals with severe and complex substance use problems. However, there is limited evidence on best practice approaches to treatment in these settings. This review provides a comprehensive update on the evidence base for residential treatment, and directions for future research and clinical practice. MethodA systematic review of all studies published between January 2013 and December 2018 was conducted. Public health and psychology databases (Medline, CINAHL, PsycARTICLES and PsycINFO) were systematically searched, and forward and backward snowballing were used to identify additional studies. Studies were included if they were quantitative, assessed the effectiveness of residential substance treatment programs for adults, were published in the English language and in peer-reviewed journals. The Effective Public Health Practice Project’s Quality Assessment Tool for Quantitative Studies was used to assess methodological quality. ResultsOur search identified 23 studies. Eight were rated as methodologically strong, five as moderate and ten rated as weak. Quality ratings were impacted by attrition at follow-up and research design. Despite limitations, results provide moderate quality evidence for the effectiveness of residential treatment in improving outcomes across a number of substance use and life domains. ConclusionWith caution, results suggest that best practice rehabilitation treatment integrates mental health treatment and provides continuity of care post-discharge. Future research and practice should focus on better collection of outcome data and conducting data linkage of key health, welfare and justice agency administrative data to enhance understanding of risk and recovery trajectories.

Spatially varying age-period-cohort analysis with application to US mortality, 2002-2016.

Many public health databases index disease counts by age groups and calendar periods within geographic regions (e.g., states, districts, or counties). Issues around relative risk estimation in small areas are well-studied; however, estimating trend parameters that vary across geographic regions has received less attention. Additionally, small counts (e.g., $<10$) in most publicly accessible databases are censored, further complicating age-period-cohort (APC) analysis in small areas. Here, we present a novel APC model with left-censoring and spatially varying intercept and trends, estimated with correlations among contiguous geographic regions. Like traditional models, our model captures population-scale trends, but it can also be used to characterize geographic disparities in relative risk and age-adjusted trends over time. To specify the joint distribution of our three spatially varying parameters, we adapt the generalized multivariate conditional autoregressive prior, previously used for multivariate disease mapping. Specified in this manner, region-specific parameters are correlated spatially, and also to one another. Estimation is performed using the No-U-Turn Hamiltonian Monte Carlo sampler in Stan. We conduct a simulation study to assess the performance of the proposed model relative to the standard model, and conclude with an application to US state-level opioid overdose mortality in men and women aged 15-64 years.

Abstract P409: Mortality in Subarachnoid Hemorrhage Varies by Day and Month Within the USA

Introduction: High mortality is associated with aneurysmal subarachnoid hemorrhage (SAH). Despite years of studies and translational research, only a few health and lifestyle factors have been found to definitively associate with an increased risk of SAH incidence and mortality. Prior studies have provided some evidence that environmental factors play a role in the incidence of SAH, but the available data is not often consistent or applicable to the United States of America (USA). Here we provide support that there is a temporal differences in SAH mortality by month of the year and day of the week. Methods: The Centers for Disease Control (CDC) and Prevention public health database (wonder.cdc.gov) was accessed. Mortality events for the years 1999-2016 were obtained for deaths attributed to SAH from a named vessel distribution with accounting for day of week and month of year as well as gender from year to year. ANOVA was used to test for differences by week or month. Results: Mortality for week day variations found no significant differences (p = 0.13) in women, while men demonstrated a significant difference (p = 0.003) with the most common day of death being Monday. Mortality for monthly variation found a significant difference (p = 0.01) in total with January being the most common month of SAH mortality. However, divided by gender women (p = 0.06) and men (p = 0.10) did not meet predefined statistical significance. Conclusion: Mortality from SAH appears to have a variation in time of day of week in men and by month for both genders but this has unclear significance at this time.

Physical Activity Communication: A Scoping Review of the Literature.

Engaging in regular physical activity can help prevent chronic disease and enhance quality of life. Unfortunately, less than 20% of American adults meet the recommended physical activity guidelines, perhaps indicating ineffective communication efforts around physical activity. In preparation for the release of the second edition of the Physical Activity Guidelines for Americans, and using the physical activity guidelines as a cornerstone of our approach, we conducted a scoping review of physical activity communication research to understand the scholarly efforts related to communicating about physical activity. Using a social-ecological perspective, we identified studies using the keywords physical activity* OR exercise* AND health communication* in three public health and communication databases and retained studies conducted in the United States and published in English from 1995 through 2015. Sixty-seven articles included a mention of physical activity guidelines, a health communication focus, and media channels used in promoting physical activity. Half of the studies were published in health/science communication journals. One third of the studies mentioned physical activity guidelines. Only 19% of the studies featured mental health benefits of physical activity while more than 64% emphasized physical health benefits. Nearly all the studies (96%) mentioned the use of persuasion to encourage engagement in physical activity. More effort is needed to study the influence of communicating physical activity guidelines to the public. Best practices for future physical activity communication are discussed for both researchers and practitioners.

Paediatric tuberculosis among the foreign-born: utility of the Canadian TB immigration medical surveillance programme.

There are few data on the utility of screening paediatric immigrants for tuberculosis (TB) in low TB burden countries. To evaluate the utility of the Canadian immigration medical examination and TB Medical Surveillance (TBMS) for detecting paediatric TB disease. A 10-year population-based retrospective cohort study of foreign-born children (ages 0-10 years) and adolescents (ages 11-17 years) immigrating to Ontario, Canada, using linked immigration and public health databases. Among 232 169 individuals (median follow-up of 5.7 years), active TB was diagnosed at or after immigration in 125 cases (20 children and 105 adolescents), at an overall rate of 54/100 000 (14/100 000 children, 116/100 000 adolescents). All cases originated from 34 countries. Active TB was diagnosed in 0/419 children and 10/418 adolescents referred for medical surveillance, representing only 8.0% of all cases. TBMS referrals were correlated with a previous diagnosis of TB (κ = 0.8) and were driven by country of origin (e.g., hazard ratio 31.2 for the Philippines). Rates of pre-immigration TB diagnosis varied considerably among high TB burden countries. The current Canadian system detects little TB disease, and reveals very different rates of pre-immigration paediatric TB diagnosis in different high TB burden countries. These data provide a basis for improving TB screening strategies for immigrants to low TB burden countries.

The impact of user charges on health outcomes in low-income and middle-income countries: a systematic review

BackgroundUser charges are widely used health financing mechanisms in many health systems in low-income and middle-income countries (LMICs) due to insufficient public health spending on health. This study systematically reviews...

STI Health Disparities: A Systematic Review and Meta-Analysis of the Effectiveness of Preventive Interventions in Educational Settings.

The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17–1.39) and psychosocial (OR, 1.92; 95% CI, 1.36–2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13–4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04–2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13–1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings.

Rehabilitation and Reintegration Programming Following Female Genital Fistula Surgery: A Scoping Review

Aims: To examine the range of rehabilitation and reintegration services provided as adjunct to genital fistula surgery, map the existing programming and outcomes, and identify areas where additional research is necessary.&#x0D; Methods: Our scoping review is informed by existing methodological frameworks and conducted in accordance with PRISMA guidelines.The search strategy was designed in collaboration with a medical librarian and is applied to nine biomedical, public health, and social science databases. Grey literature is identified through targeted searches and relevant organizational websites. Two primary reviewers independently screened titles and abstracts of all articles, followed by full-text screening and standardized data extraction. Eligible articles will discuss research or programmatic efforts around service provision in adjunct to surgery.&#x0D; Results: The literature review is currently underway and preliminary results including summary tables and narrative will be available to share at the ISOFS conference.&#x0D; Conclusions: The results of this scoping review will help in understanding and describing what is known and unknown about rehabilitation and social reintegration of women following genital fistula surgery in sub-Saharan Africa and may be useful in developing and evaluating social reintegration projects.

Factors influencing the quality of life of pregnant women: a systematic review

BackgroundPregnancy is a period of transition with important physical and emotional changes. Even in uncomplicated pregnancies, these changes can affect the quality of life (QOL) of pregnant women, affecting both maternal and infant health. The objectives of this study were to describe the quality of life during uncomplicated pregnancy and to assess its associated socio-demographic, physical and psychological factors in developed countries.MethodsA systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and BDSP (Public Health Database). Two independent reviewers extracted the data. Countries with a human development index over 0.7 were selected. The quality of the articles was evaluated on the basis of the STROBE criteria.ResultsIn total, thirty-seven articles were included. While the physical component of QOL decreased throughout pregnancy, the mental component was stable and even showed an improvement during pregnancy. Main factors associated with better QOL were mean maternal age, primiparity, early gestational age, the absence of social and economic problems, having family and friends, doing physical exercise, feeling happiness at being pregnant and being optimistic. Main factors associated with poorer QOL were medically assisted reproduction, complications before or during pregnancy, obesity, nausea and vomiting, epigastralgia, back pain, smoking during the months prior to conception, a history of alcohol dependence, sleep difficulties, stress, anxiety, depression during pregnancy and sexual or domestic violence.ConclusionsHealth-related quality of life refers to the subjective assessment of patients regarding the physical, mental and social dimensions of well-being. Improving the quality of life of pregnant women requires better identification of their difficulties and guidance which offers assistance whenever possible.

Identifying the evidence relevant to the proposed prohibition of the physical punishment of children and young people in Scotland: a systematic approach

BackgroundLegislation permitting the physical punishment of children and young people is incompatible with the UN Convention on the Rights of the Child. In 2017, the Scottish Government consulted on a Bill to safeguard the wellbeing of children and young people ensuring that they were as equally protected from assault as adults by ending the legal position that physical punishment could be justified. NHS Health Scotland submitted a response to this consultation that was informed by robust evidence, which we report here. MethodsWe adopted a systematic approach to identify evidence in response to nine consultation questions. Questions included consideration of: the advantages, disadvantages, and sustainability of giving children and young people equal protection by prohibiting all physical punishment; and costs and benefits to children and professionals and the impact on individuals protected by the 2010 Equality Act. To augment the evidence presented in a 2015 systematic review by the National Society for the Prevention of Cruelty to Children, we searched Medline, Web of Science, Cochrane Library, IBSS, ASSIA, Sociological Abstracts, Social Service Abstracts, and Proquest Public Health databases to identify studies conducted in developed countries that were published in English between Jan 1, 2015, and June 1, 2017. Keywords used were child, young person, smack, slap, hit, spank, corporal punishment, and physical discipline. Two authors independently reviewed abstracts. Findings880 articles were identified, of which 33 were considered. 19 of them were of sufficient quality to provide impartial evidence about the impact of physical punishment on children and young people. The 2015 systematic review showed that a parent's right to physically punish their child was outdated, potentially harmful, and an ineffective parenting strategy. A 2016 meta-analysis found no evidence that parental spanking was associated with improved child behaviour but was associated with an increased risk of negative health outcomes (eg, aggression, antisocial behaviour, externalising and internalising behaviour problems, mental health problems, negative parent–child relationships, impaired cognitive ability, low self-esteem, and risk of physical abuse). There was no evidence that spanking was only associated with negative outcomes when it was combined with physical abuse nor that spanking was only associated with negative outcomes in studies appraised as being methodologically weak. InterpretationProtecting children and young people from physical punishment is an important public health issue that is supported by robust evidence. FundingNone.

Regulatory initiatives to reduce sugar-sweetened beverages (SSBs) in Latin America.

Background and objectivesLatin American (LA) countries have begun to adopt a variety of regulations targeting sugar-sweetened beverages (SSBs) for public health reasons. Our objective was to characterize the regulatory strategies designed to reduce SSB consumption over the last decade, and assess the available evidence on their enforcement and impact.MethodsWe searched legal and public health databases for public and private SSBs regulations in 14 LA countries and then conducted a systematic review of the available literature. We tracked comparative variations in the type of body issuing the regulations, their scope, and binding status. We present data following a 5-category framework we named NUTRE that classifies SSBs regulations as: (1) restrictions to SSB availability in schools (N), (2) taxes and other economic incentives to discourage consumption (U), (3) restrictions on advertising and marketing (T), (4) regulations on government procurement and subsidies (R), and (5) product labeling rules (E).ResultsSince 2006, 14 LA countries have adopted at least 39 public and private SSB regulatory initiatives across the NUTRE framework. Comprehensive efforts have only been approved by Chile, México and Ecuador, while the rest have comparatively few initiatives. 28 out of the 39 regulatory initiatives were passed by legislative and executive bodies; 11 initiatives represent self-regulatory undertakings by the beverage industries. An 86% (24/28) of public sector regulations are binding; 56% (22/39) contain explicit monitoring or evaluation methods; and 62% (24/39) provide for sanctions. Moreover, 23 regulations specify the body in charge of monitoring the new rules and standards.ConclusionsLA countries are targeting SSB consumption through a variety of mechanisms, particularly via restrictions to availability in schools and through taxes. Interdisciplinary evidence comparing alternative regulatory strategies is scarce, and few studies offer data on impact and implementation challenges. More evidence and further comparative assessments are needed to support future decision-making.

The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review

BackgroundExercise referral schemes within clinical populations may offer benefits for inactive and sedentary individuals, and improve and aid treatment of specific health disorders. This systematic review aims to provide an overview, and examine the impact, of exercise referral schemes in patients with cardiovascular, mental health, and musculoskeletal disorders. This review focuses on populations within the United Kingdom (UK) only, with an aim to inform national exercise referral policies and guidelines.MethodData was collected from specific sources using validated methodology through PRISMA. Systematic searches were performed using Locate, PubMed, Scopus and Pro Quest: Public Health databases. Thirteen studies met inclusion criteria set for each sub group. This included that all studies aimed to prevent, observe, or decrease ill-health relating to the disorder, participants over the age of sixteen, and health disorders and outcomes were reviewed. All studies were conducted in the UK only.ResultsIn the 13 articles, a variety of modes and types of exercise were utilised. One-to-one supervised exercise sessions based in a gym environment were most frequently employed. Results showed that longer length schemes (20+ weeks) produced better health outcomes, and had higher adherence to physical activity prescribed, than those of shorter length (8–12 weeks). In patients referred with cardiovascular disorders, cardiovascular-related measures showed significant decreases including blood pressure. Schemes increased physical activity levels over the length of scheme for all disorders.ConclusionLonger length schemes (20+ weeks) improved adherence to physical activity prescribed over the course of the scheme, and could support longer term exercise adherence upon completion, however additional research on larger samples should examine this further. An implication is that schemes currently recommended in guidelines do not tailor programmes to support long term adherence to exercise, which must be addressed. There is currently a lack of research examining programmes tailored to suit the individual’s health conditions thus further research might allow providers to tailor delivery and build upon policy recommendations in the UK.

The Use of Fluoroquinolones for Tuberculosis in Victoria between 2011 and 2016.

Setting. Tuberculosis treatment requires long regimens with multiple antibiotics and is complicated by antibiotic resistance and intolerance. Fluoroquinolones were introduced for the treatment of multidrug resistant TB and have become a vital part of therapy. Objective. Reviewing the indications for fluoroquinolones use in the treatment of active TB in Victoria, Australia. Design. This was a retrospective case-control study of Victorian patients prescribed fluoroquinolones for active tuberculosis, from January 2011 to December 2016. Indications for fluoroquinolone use were extracted from an existing public health database. Results. There were 2268 patients notified to have tuberculosis in Victoria between 2011 and 2016, 276 (12.2%) of whom received a fluoroquinolone. The indications were substitution when intolerance was present (33.3%) or anticipated (21.0%), proven drug resistance (22.5%), suspected drug resistance (13.0%), and site of disease (10.1%). Where fluoroquinolones were prescribed for suspected drug resistance, only a minority of isolates (13%) had resistance confirmed. Conclusion. Fluoroquinolones were most commonly used as replacement for first-line therapy related to adverse effects, when either present or anticipated. Where fluoroquinolones were prescribed for suspected drug resistance, only a minority of isolates ultimately had resistance confirmed. These findings reinforce the importance of fluoroquinolones in TB therapy and the need for ongoing pharmacovigilance to ensure appropriate use.