Preventive Public Health Policies Research Articles

Association of diabetes mellitus with dementia- and non-dementia-related mortality amongst women: a secondary competing risks analysis of the California Teachers Study.

The prevalence of dementia is rapidly increasing. Attempts to further understand modifiable risk factors such as diabetes mellitus (DM) are urgently needed to inform public health policies for prevention. Thus, the objective of the current study was to assess the relationship between DM and risk of dementia and non-dementia mortality amongst women in the California Teachers Study prospective cohort. Women (n = 124,509) aged 22-104 years at baseline were included. DM was ascertained from self-reported questionnaires and hospital-linked records. Dementia-related deaths were ascertained from state and national records. Competing risk regression models were used to estimate cause-specific hazard ratios and 95% confidence intervals for the association of DM with dementia- and non-dementia-related mortality. There were 10,511 total DM cases and 3625 deaths due to dementia over a mean of 21.3 years of follow-up. Fully adjusted cause-specific hazard ratios of the association with DM were 2.26 (2.01, 2.55) for dementia-related and 1.97 (1.89, 2.05) for the competing risk of non-dementia-related mortality. This association was strongest amongst participants with incident DM, younger age at baseline and higher alcohol consumption or who were overweight. In the California Teachers Study, women with DM had increased risk of mortality due to both dementia and non-dementia causes; however, the risk of mortality due to dementia was elevated compared to non-dementia causes only amongst participants with incident DM.

Prevention and management of health products shortages by the French national agency (ANSM), 10 years of experience.

Shortages of drugs and medical devices have tended to increase in France and worldwide, with consequences for patients and healthcare professionals. Preventing shortages of health products has become a priority for regulatory authorities, including the French National Agency for Medicines and Health Products Safety (ANSM). To highlight perspectives for a better prevention, we described and analyzed the management of shortages in the availability of health products in France over the last 10 years. The supply chain was mapped to identify the main causes of shortages and stakeholders involved in managing shortages throughout the supply chain. National and European initiatives and regulatory measures were reviewed. A retrospective nationwide data analysis from the French reporting system of health product shortage reports was conducted over 10 years for drugs (2013-2022) and over an 18-month period for medical devices, from 1st March 2022 to 31st August 2023. An increase in drug shortage reports was observed, rising from 404 in 2013 to 3,761 in 2022 for drugs, with a relatively constant distribution of affected therapeutic classes. In 2022, the main reported causes of drug shortage risk were insufficient production capacity (27.1%), increased sales volume (21.5%), or lack of supply (13.6%). Over half of the reports on medical devices (55.4%) were objectified as indispensable, and their causes were mainly due to a lack of supply (48.2%), discontinuation of marketing (14.9%), increased sales volume (13.2%), and regulatory reasons (9.6%). ANSM and French authorities have engaged a public health policy for prevention and management of health product shortages including financial penalties, minimum safety stocks for Major Therapeutic Interest drugs, and a shortage management plan. Based on 10 years of experience, four priority measures have been identified to anticipate the risk of heath products shortages based: the importance of a national coordination from raw materials to local market, the implementation of new prevention and management actions in the supply chain, strengthening European cooperation and regulation including the establishment of a list of critical drugs, and promoting transparency and information.

Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study

BackgroundCervical cancer (CC) is globally ranked fourth in terms of incidence and mortality among women. Vaccination against Human Papillomavirus (HPV) and screening programs can significantly reduce CC mortality rates. Hence, executing cost-effective public health policies for prevention and surveillance is crucial. However, defining policies that make the best use of the available resources is not easy, as it requires predicting the long-term costs and results of interventions on a changing population. Since the simpler task of predicting the results of public health policies is difficult, devising those that make the best usage of available resources is an arduous challenge for decision-makers.MethodsThis paper proposes a fine-grained epidemiological simulation model based on differential equations, to effectively predict the costs and effectiveness of CC public health policies that include vaccination and screening. The model represents population dynamics, HPV transmission within the population, likelihood of infection clearance, virus-induced appearance of precancerous lesions and eventually CC, as well as immunity gained with vaccination and early detection with screening.ResultsWe offer a compartmentalized modeling approach that separates population, epidemics, and intervention concerns. We instantiate models with actual data from a Colombian case study and analyze their results to show how our modeling approach can support CEA studies. Moreover, we implement models in an open-source software tool to simultaneously define and evaluate multiple policies. With the support of the tool, we analyze 54 policies within a 30-year time horizon and use as a comparator the CC policy that has been used until recently. We identify 8 dominant policies, the best one with an ICER of 6.3 million COP (Colombian Pesos) per averted DALY. We also validate the modeling approach against the available population and HPV epidemic data. The effects of uncertainty in the values of key parameters (discount rate, sensitivity of screening tests) is evaluated through one-way sensitivity analysis.ConclusionsOur modeling approach can provide valuable support for healthcare decision-makers. The implementation into an automated tool allows customizing the analysis with country-specific data, flexibly defining public health policies to be evaluated, and conducting disaggregate analyses of their cost and effectiveness.

Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015-2021.

BackgroundChildhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0–18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised.MethodsAn update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect.FindingsMeta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD –0·03, 95%CI –0·06,–0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6–12 years; 13–18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness.InterpretationThis updated synthesis of obesity prevention interventions for children aged 6–18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning.FundingThis research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).

A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America.

ABSTRACTObjective.To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean.Methods.The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle–Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported.Results.Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants).Conclusions.Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.

Impact of COVID-19 Pandemic on Nigerian Exports

Abstract The paper set out to evaluate the impact of the COVID-19 pandemic on Nigerian exports. The Coronavirus was first detected in Wuhan, China but it quickly spread around the world and was declared a global pandemic on 11th March 2020 by the World Health Organization (WHO). Various disruptive preventive public health policies were rolled out to control its spread. These policies and the severity of the negative health effects of the virus affected the global economic activities including Nigeria adversely. Using an Ordinary Least Square (OLS) regression and variation analyses, the paper found that the pandemic impacted negatively on total exports but more significantly on crude oil exports and less on non-crude oil and non-oil exports. The results reinforce the generally held view that Nigeria needs to diversify its exports away from crude oil so as to minimize the impact of negative external shocks on Nigerian exports and economy. Keywords: Exports, International trade, COVID-19 pandemic, Nigeria. JEL Classification Codes: F10, I10.

High risk internet behaviors and psychosocial well-being among Greek preadolescents

INTRODUCTION: Nowadays the Internet has become an integral part of adolescents’ lives. The purpose of this study is to investigate the relationship between compulsive Internet use of pre-adolescents in Greece and their psychosocial well-being. MATERIALS - METHODS: A cross-sectional study design was applied. The study population (N=655) consisted of a random sample of adolescents attending Years 5 and 6 in primary schools located in Athens, Greece. Self-completed questionnaires were distributed, pertaining to internet access characteristics based on the Compulsive Internet Use Scale (CIUS) Also, socio-demographic variables were applied. Furthermore, teachers completed the Strengths and Difficulties Questionnaire (SDQ) related to their students’ psychosocial well-being. RESULTS: The results presented that 6th graders, boys and adolescents, who were not born in Greece, had significantly higher CIUS scores. On the other hand, greater CIUS scores were observed in students who had started using the Internet in a younger age, were members of SNS and played games online. Overall, compulsive Internet Use was positively correlated with emotional and conduct problems of pre-adolescents, along with hyperactivity scores on the SDQ. DISCUSSION: The results have implications about an association between Compulsive Internet Use of pre-adolescents in Greece and psychosocial difficulties. The results appear to suggest the importance of formulating early preventive public health policies that concentrate on enhancing students’ communication skills, self-regulation and healthy life habits.

Role of Age and Sex on Simple and Complex Carbohydrates Rich Foods Consumption and Thyroid Cancer Risk: Hospital Based Case - Control Study

Background: The risk of thyroid cancer has already been related to diet/carbohydrates rich foods, but the association has not been investigated in terms of age and sex implications. Objective: We studied the relationship between thyroid cancer and the consumption of simply and complex carbohydrates rich foods, mainly investigating the possible predictive role of age and sex. Methods: We analyzed data from a hospital case-control study conducted in Italy from 2015 to 2018, including 106 cases of thyroid cancer and 121 controls. The consumption of simple and complex carbohydrates rich foods was investigated through the validated Lifestyles Questionnaire using a 4-level scale (never, 1 time per week, 2–3 times a week, 6 times a week). Statistical data analysis was conducted using the IBM SPSS Statistics 21.0 program. Results: We found a moderate negative correlation between simple carbohydrates rich foods consumption and age (rho= -0.364, p:0.00), particularly in females (females: rho= -0.374, p:0.00; males: rho=-0.266, p=0.036). A weak positive correlation was found between age and complex carbohydrates-rich foods only in males (rho= 0.244, p=0.054). The Two-Way Analysis of Variance confirmed that, overall, simple carbohydrates rich foods consumption decreased with age categories (Case: F=2.59, p=0.032; Control: F=3.14, p=0.011), although it remains higher for female than male cases at all age categories (≤38, 39-52, 53+years). Conversely the complex carbohydrates rich foods intake had interaction with age categories only in controls group (Control: F=1.95, p=0.09; Case: F=0.744, p=0.592), where based on sex, it remains higher for female than male at ≤38 and 39-52 age categories. It should be emphasized that in category ≤38 we had only one male cases. Conclusion: Our study adds new and relevant information to support the hypothesis that age and sex could impact the thyroid cancer risk by their involvement in simple carbohydrates rich foods consumption. Therefore, future interventions are needed for an understanding of the pathophysiological associations between only carbohydrates rich foods intake and thyroid cancer, mainly for older and female populations, and also for the improvement of preventive public health policies and “Gender Medicine”.

Prevalence and pattern of problematic internet use among engineering students from different colleges in India.

Introduction:The college students are prone to use internet in a manner that could negatively affect several aspects of their life. The present study is one of the largest studies to be undertaken in India, aimed at understanding the existing pattern of internet use and estimating the prevalence of problematic internet use (PIU) among college students.Materials and Methods:The Generalized Problematic Internet Use Scale 2 (GPIUS-2) was used to assess the PIU. Multiple linear regression analysis was conducted to ascertain the relationship between GPIUS-2 total score and demographic and internet use-related variables.Results:Of 3973 respondents from 23 engineering colleges located in the different parts of the country, about one-fourth (25.4%) had GPIUS-2 scores suggestive of PIU. Among the variables studied, older age, greater time spent online per day, and use of internet mainly for social networking were associated with greater GPIUS-2 scores, indicating higher risk for PIU. Students who used internet mainly for academic activities and during evening hours of the day were less likely to have PIU.Conclusion:This study suggests PIU among engineering college students in India is an important public health concern. There is a need to create awareness among students, emerging adults, parents, and concerned authorities about the harms associated with PIU. Furthermore, there is a need to implement preventive strategies for inculcating pattern of safe and healthy internet usage among them. In addition, there is a need to develop public health policies for prevention and treatment of PIU and conduct further research to enhance our understanding about the same.

Risk factor profile for non-communicable diseases: findings of a STEPS survey from urban settlement of Bangalore

Background: Increasing burden of non-communicable diseases (NCDs) across the globe is largely due to the rise in prevalence of various risk factors. These risk factors are measurable and largely modifiable. Quantifying the present levels of risk factors exposure in a community is helpful in predicting the future risk and driving the public health policy for prevention and control of NCDs. Keeping this in mind, present study was planned to estimate the prevalence of NCDs risk factors in an urban settlement of Bangalore.Methods: A community based cross-sectional survey was done with 600 individuals aged 15-64 years in Hegganahalli locality of Bangalore city from April to October 2017. Systematic random sampling technique was applied to obtain the desired sample size. Information on NCD risk factors was collected by using STEPS questionnaire.Results: Tobacco and alcohol consumption was observed in 27.2% and 11.8% of respondents respectively. Low level of physical activity was recorded among 14.8% and inadequate consumption of fruit and vegetable was observed among all the respondents. Prevalence of general and central obesity in the study population was found to be 30.7% and 12.8% respectively. Hypertension was prevalent among 35.5% respondents.Conclusions: High prevalence of NCD risk factors was observed among the study population that needs to be addressed through a comprehensive approach with due emphasis on preventive care in order to make ‘healthy living’ a social norm.

Epidemiology of asthma and associated factors in an urban Pakistani population: adult asthma study-Karachi

BackgroundThis study was conducted in order to determine the prevalence of asthma and associated risk factors in the adult population of Karachi, Pakistan.MethodsThis multi-stage, cross-sectional survey was conducted from May 2014–August 2015; comprising 1629 adults in 75 randomly selected clusters in Karachi, Pakistan. Definitions included: ‘self-reported asthma’, ‘reversibility in FEV1’ and ‘respiratory symptoms and reversibility in FEV1’.ResultsPrevalence of asthma was 1.8% (self-reported) (95% CI: 1.0–2.6), 11.3% (reversibility in FEV1) (95% CI: 9.4–13.3) and 6.6% (symptoms and reversibility in FEV1) (95% CI: 5.1–8.1). Asthmatics were more likely to belong to the age group ≥38 years according to ‘reversibility in FEV1’ and ‘respiratory symptoms and reversibility in FEV1’ (AOR: 1.9, 95% CI: 1.2–3.3) and (AOR: 2.1, 95% CI: 1.1–4.2), respectively. Asthmatics were more likely to report history of allergies (AOR: 1.9, 95% CI: 1.2–2.9) and (AOR: 2.8, 95% CI: 1.7–4.8); and were exposed to environmental tobacco smoke (AOR: 1.6, 95% CI: 1.1–2.5) and (AOR: 1.9, 95% CI: 1.1–3.3) according to ‘reversibility in FEV1’ and ‘respiratory symptoms and reversibility in FEV1’, respectively. Asthmatics were more likely to report pack years of smoking ≥5 (AOR: 2.3, 95% CI: 1.1–4.7) according to ‘respiratory symptoms and reversibility in FEV1’.ConclusionThis study reports a high prevalence of asthma among Pakistani adults and calls for developing appropriate public health policies for prevention and control of asthma in the country. Further studies should be conducted to determine the national prevalence as well as follow-up studies to identify preventable causes for adult asthma.

The Role of States in Controlling the Obesity Epidemic, and a Personal Autonomy to Decide

Obesity has reached pandemic proportions in the world. Who is to blame for this: the person or the State (or both?). An increase in diseases associated with excess weight is also worldwide reported, such as Diabetes, Hypertension and some types of cancers. Therefore, the economic impacts of these comorbidities are an important issue to be discussed by States and citizens. Although the World Health Organization (WHO) has set and classified obesity as a disease more than 30 years ago, the American Medical Society was until recently (2010) not so sure about this definition. This article discusses the relevance of the implementation of public health policies for prevention and control of obesity, along with the possible ethical limitations to these actions, considering the autonomy of individuals regarding their health.

Factors associated with Internet addiction: Cross-sectional study of Turkish adolescents.

The aim of this study was to investigate the prevalence of Internet addiction (IA), and the relationship between sociodemographic characteristics, depression, anxiety, attention-deficit-hyperactivity disorder (ADHD) symptoms and IA in adolescents. This was a cross-sectional school-based study with a representative sample of 468 students aged 12-17 years at the first trimester of the 2013-2014 academic year. The students were assessed using Young's Internet Addiction Scale, Children's Depression Inventory, Beck Anxiety Inventory, Conners' Parent Rating Scale, Conners' Teacher Rating Scale, Hollingshead-Redlich Scale, and the information form including characteristics of Internet use and socioeconomic status (SES). The relationship between these factors and Internet use was examined. Approximately 1.6% of students were identified as having IA, whereas 16.2% had possible IA. There were significant correlations between IA and depression, anxiety, attention disorder and hyperactivity symptoms in adolescents. Smoking was also related to IA. There was no significant relationship between IA and age, sex, body mass index, school type, and SES. Depression, anxiety, ADHD and smoking addiction are associated with PIU in adolescent students. Preventive public health policies targeting the psychological wellbeing of young people are needed.

Association between problematic internet use, socio-demographic variables and obesity among European adolescents.

Overweight of children and adolescents continues to be an important and alarming global public health problem. As the adolescent's time spent online has increased, problematic internet use (PIU) potentially leads to negative health consequences. This study aimed to examine the relation between PIU and overweight/obesity among adolescents in seven European countries and assess the effect of demographic and lifestyle factors recorded in the European Network for Adolescent Addictive Behaviour (EU NET ADB) survey (www.eunetadb.eu). A cross-sectional school-based survey of 14- to 17-year-old adolescents was conducted in seven European countries: Germany, Greece, Iceland, the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control and the Internet Addiction Test. Associations between overweight/obesity and potential risk factors were investigated by logistic regression analysis, allowing for the complex sample design. The study sample consisted of 10 287 adolescents aged 14-17 years. 12.4% were overweight/obese, and 14.1% presented with dysfunctional internet behavior. Greece had the highest percentage of overweight/obese adolescents (19.8%) and the Netherlands the lowest (6.8%). Male sex [odds ratio (OR) = 2.89, 95%CI: 2.46-3.38], heavier use of social networking sites (OR = 1.26, 95%CI: 1.09-1.46) and residence in Greece (OR = 2.32, 95%CI: 1.79-2.99) or Germany (OR = 1.48, 95%CI: 1.12-1.96) were independently associated with higher risk of overweight/obesity. A greater number of siblings (OR = 0.79, 95%CI: 0.64-0.97), higher school grades (OR = 0.74, 95%CI: 0.63-0.88), higher parental education (OR = 0.89, 95%CI: 0.82-0.97) and residence in the Netherlands (OR = 0.49, 95%CI: 0.31-0.77) independently predicted lower risk of overweight/obesity. The results indicate an association of overweight/obesity with PIU and suggest the importance of formulating preventive public health policies that target physical health, education and sedentary online lifestyle early in adolescence with special attention to boys.

Prevalence of metabolic syndrome among workers from the Company of Generation and Distribution of Energy in Rio de Janeiro, Brazil

Little is known about the prevalence of metabolic syndrome in the World’s working force. We examined the prevalence of such disease in the Company of Generation and Distribution of Energy in Rio de Janeiro city, Brazil.METHODS: A cross-sectional study was designed to analyze data from employees submitted to the annual company medical check-up in 2008. Medical charts were reviewed for collection of clinical and laboratorial information.RESULTS: The total prevalence of metabolic syndrome was 48.6% (95%CI 46.0-51.2). It increased with age and reached 58.7% (95%CI 56.1-61.3) in employees older than 60 years. The age- adjusted prevalence was 38.2% (95%CI 35.7-40.7). Increased waist circumference was the most prevalent component of the syndrome (94.2%; 95%CI 92.1-95.7), followed by high blood pressure (69.3%; 95%CI 65.7-72.7). In a multivariate analysis age, sedentary lifestyle and level of uric acid were significantly associated with the metabolic syndrome.CONCLUSION: Metabolic syndrome is highly prevalent in the studied working population in Rio de Janeiro. Our study will help delineating key risk factors for the development of metabolic syndrome in Brazil and may help the creation of new preventive public health policies.

Overweight and obesity among low-income Muslim Uyghur women in far western China: correlations of body mass index with blood lipids and implications in preventive public health.

BackgroundThe pandemic of obesity is a global public health concern. Most studies on obesity are skewed toward high-income and urban settings and few covers low-income populations. This study focused on the prevalence of overweight and obesity and their correlations with blood lipids/metabolites/enzymes (bio-indicators) in a rural community typical of low-income in remote western China.MethodsThis study was performed in a Muslim ethnic Uyghur rural community in Kashi Prefecture of Xinjiang, about 4,407 km (2,739 miles) away from Beijing. Body mass index (BMI) and major blood bio-indicators (25 total items) were measured and demographic information was collected from 1,733 eligible healthy women aged 21 to 71 yrs, of whom 1,452 had complete data for analysis. More than 92% of the women lived on US$1.00/day or less. According to the Chinese criteria, overweight and obesity were defined as BMI at 24 to <28 kg/m2 and at ≥28 kg/m2, respectively.ResultsThe average BMI among these low-income women was 24.0±4.0 (95% CI, 17.5–33.7) kg/m2. The prevalence of obesity and overweight was high at 15.1% and 28.9%, respectively. Among 25 bio-indicators, BMI correlated positively with the levels of 11 bio-indicators including triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TCHOL), glucose (GLU), and uric acid (UA); but negatively with the levels of 5 bio-indicators including high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A/B (APO A/B).ConclusionsThis is the first investigation reporting overweight and obesity being common in low-income Muslim Uyghur women, whose BMI correlates with several important blood bio-indicators which are risk factors for diabetes and cardiovascular diseases. These findings may help make preventive public health policies in Uyghur communities. To prevent diabetes and cardiovascular diseases in low-income settings, we therefore propose a cost-effective, two-step strategy first to screen for obesity and then to screen persons with obesity for diabetes and cardiovascular diseases.

The geometrical headache of French policies: Can vertical cultures be tilted horizontally?

Thomas Saïas and Cécile Delawarde Paris, France Peer Reviewed This paper is based on our work as a community psychologist, working in a French governmental agency, and as a sociologist of mental health studying the processes of political decision-making in regard to preventive public health policies. The objective is first to reflect on the distinctive aspects of governmental policymaking in our country, and second, to underline the obstacles to and facilitators of success in our social policy-related work.

Diversity in causes and characteristics of drug-induced deaths in an urban setting

Aims: To assess demographic characteristics, treatment utilization and circumstances of death among those who died from drug-induced deaths in an urban setting and to identify possible subpopulations that should be targeted specifically to further develop preventive public health policies. Methods: Subjects (N = 231) who died, from drug-induced deaths, in the Norwegian capital Oslo (2006–2008) were identified through the National Cause of Death Registry. Data on toxicology, prison release and contact with health and social services in Oslo were collected. Results: Majority of cases were men (78%) and the mean age was 37 years. Nearly all cases (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most common place of death (67%). Most cases (82%) had been in contact with health and social services in the year before death. Women were 4 years older, more often Oslo residents (82% vs. 64%) and fewer died from heroin intoxication. Non-Oslo residents were younger and more likely to have been found outdoors with heroin as the main intoxicant. Other identified subpopulations were those who died after prison release and those discharged from drug treatment. Conclusions: The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services. Yet, the heterogeneity among cases indicates that such measures need to be multifaceted. Finally, it is important for policymakers and health and social workers in various countries to consider subpopulations such as women and non-city residents when developing public health interventions to prevent overdose deaths.

A cluster-randomized controlled trial of handrubs for prevention of infectious diseases among children in Colombia

To evaluate the effectiveness of alcohol-based handrubs (ABH) in reducing acute diarrheal diseases (ADD) and acute respiratory infections (ARI) among children 1-5 years of age in childcare centers with limited tap water. This was the first cluster-randomized controlled trial in a developing country. The study took place at 42 childcare centers with sporadic and limited water availability in six towns in Colombia. Participants were randomly assigned to use ABH as a complement to handwashing (intervention arm: 21 centers/794 children); or to continue existing handwashing practices (control arm: 21 centers/933 children). ADD and ARI cases were identified through teacher-reported signs and symptoms of illness. Adverse events were monitored. Hazard ratios (HR) were obtained using Cox proportional hazards multivariate regression shared frailty models. Child-days of surveillance totaled 336 038. Loss to follow up was 14.5%. For both ADD and ARI, there were no differences in hazard ratios during the first trimester of the study. In the second and third trimesters, significant reductions in the risk of ADD were found in the intervention compared to control arm (HR = 0.55, P < 0.001 and HR = 0.44, P < 0.001, respectively). There were also significant risk reductions for ARI in the second trimester (HR = 0.80, P < 0.05) and in the third trimester (HR = 0.69, P < 0.001). No adverse events occurred. ABH effectively prevent ADD and ARI, and are safe. Colombia's national public health policies for prevention of these diseases should include use of ABH, especially in settings where handwashing with soap and water is limited by water availability.

A COUPLE OF SQUIRTS A DAY KEEPS THE DOCTOR AWAY. A CLUSTER RANDOMIZED CONTROLLED TRIAL OF ALCOHOL-BASED HANDRUBS FOR PREVENTION OF INFECTIOUS DISEASE IN CHILDREN

Background and Aims: This first cluster randomized controlled trial in a developing country setting sought to investigate if the use of alcohol-based handrub (ABH) reduced the incidence of acute diarrhoea (ADD) and respiratory infection (ARI) in children under five years. Handwashing with soap and water is known to be effective to prevent these illnesses, but alternatives are needed for settings where it is impractical. Methods: The trial was performed in childcare centres with limited tap water availability located in six Colombian towns. Participants were randomly assigned to use ABH as a complement to handwashing (intervention arm: 21 centres/794 children); or to continue previous handwashing practices (control arm: 21 centres/933 children). Cases were identified through teacher-reported signs and symptoms of illness. Adverse events were monitored. Hazard ratios were obtained using Cox proportional hazards multivariate regression shared frailty models. Results: Child-days of surveillance totalled 336,038. Attrition rate was 14%. For both diseases the hazard ratio did not differ during the first trimester of the trial. However, after this period the hazard ratios favour the intervention arm. The respective estimated risk of ADD for the second and third trimesters among children in the intervention group was 55% and 44% of the risk in the control group (p&lt;0.001). The respective estimated risk of ARI for trimesters two and three among children in the intervention group was 80% and 69% of the risk in the control group (p&lt;0.001). No adverse events occurred. Conclusions: Alcohol-based handrub gels effectively prevent acute diarrhoea and respiratory infection and are safe. These results corroborate the findings of studies done in more affluent societies. National public health policies for prevention of these diseases should consider use of gels. Further research about the cost-effectiveness of ways to facilitate long-term behaviour change and technology adoption in diverse cultural contexts is needed.