Selected Health Outcomes Research Articles

Systematic Review on the Health Effects of Long-term Exposure to Nontailpipe Traffic Emissions

With reductions in tailpipe emissions of particulate matter, there is an increasing interest in public health impacts of non-tailpipe emissions, specifically tire and brake wear and road dust. Following its well-cited 2010 critical review, a new Health Effects Institute (HEI) expert panel is conducting a systematic review of the epidemiological literature on the health effects of long-term exposure to TRAP, including non-tailpipe emissions. The Panel is using a systematic approach to search the literature, assess study quality, summarize results, and reach conclusions about the body of evidence. They developed a review protocol and registered it in Prospero. An extensive search was conducted of literature published between January 1980 and July 2019. Selected health outcomes include all-cause and cause-specific mortality, respiratory effects, cardiovascular effects, diabetes, and birth outcomes. In addition, the Panel has developed an exposure framework to guide the selection and evaluation of epidemiological studies on TRAP. The review is now well underway, and preliminary results will be presented. After a broad search identifying 1100 studies potentially relevant to the broader review, the panel included 14 studies reporting both relevant health outcomes and epidemiological results for non-tailpipe pollutants. Effect estimates were reported for all-cause mortality (3 papers), circulatory mortality (1 paper), cardiovascular effects (2 papers), respiratory effects (3 papers), and neurodevelopment in children (2 papers). Ten of the papers evaluated effects of copper (Cu) and iron (Fe); others evaluated only Cu (2 papers) or non-exhaust PM2.5 mass (2 papers). Further evaluation of these papers will inform future research questions related to health effects of non-tailpipe emissions from motor vehicles.

Selected characteristics and injury patterns by age group among pedestrians treated in North Carolina emergency departments

Objective The objective of this study was to describe pedestrian demographic characteristics, crash characteristics, selected health outcomes, and injury patterns by age using linked North Carolina (NC) crash–emergency department (ED) visit data for the period October 1, 2010, to September 30, 2015. Methods This was a descriptive epidemiologic study. To examine both crash and health outcomes, NC pedestrian crash records were linked to statewide NC ED visit records using hierarchical deterministic methods. Pearson chi-square tests were used to compare the frequencies of pedestrians treated in NC EDs by sex, race/ethnicity, crash location, rurality, estimated driver speed at impact, ambient light, hospitalization/death, location of injury, and nature of injury, stratified by the following age groups: 0–14, 15–24, 25–64, and ≥65 years. Results Most pedestrians treated in NC EDs were male (57.5%), except among adults ≥65 years old (47.5%). Over half of all injured pedestrians aged 0–14 (52.6%) and 15–24 (50.5%) years were Black/African American, and 70.8% of injured pedestrians ≥65 years were white. Among pedestrians aged 25–64 years, no single racial/ethnic group was the majority. Though most pedestrians were injured on trafficways (71.7%) and at speeds ≤35 mph (80.1%), adults ≥65 years were less likely to be involved in on-trafficway crashes (51.0%) and pedestrians aged 15–24 years were more likely to be involved in >35 mph crashes (22.9%) compared to other age groups. Most pedestrians were injured under daylight conditions (56.9%). Regarding selected health outcomes, the highest frequency of hospitalization/death was for pedestrians aged ≥65 years (26.3%), compared to those aged 0–14 years (18.8%) and 15–64 years (12.4%). In terms of location of injury, 0- to 14-year-olds had the highest proportion of head injuries (39.5%), and adults ≥65 years of age had the highest proportion of spinal column/vertebral column (12.6%) and upper extremity injuries (33.2%). For nature of injury, 0- to 14-year-olds had the highest proportion of traumatic brain injuries (11.4%) and superficial wounds and contusions (62.8%). Adults aged ≥65 years had the highest proportion of open wounds/amputations and fractures (16.1%). Adults aged 25–64 years had the highest proportion of strains/sprains/dislocations (18.7%). Conclusions There were considerable differences in demographic characteristics, crash characteristics, frequency of hospitalization/death, and injury patterns by age group. It is important to design streets and implement transportation policies and programs that improve safety for all pedestrians.

Sedentary behaviour and health in adults: an overview of systematic reviews.

The purpose of this overview of systematic reviews was to determine the relationship between different types and patterns of sedentary behaviour and selected health outcomes in adults and older adults. Five electronic databases were last searched in May, 2019, with a 10-year search limit. Included reviews met the a priori population (community-dwelling adults aged 18 years and older), intervention/exposure/comparator (various types and/or patterns of sedentary behaviour), and outcomes criteria. Eighteen systematic reviews were included in the evidence synthesis. High levels of sedentary behaviour are unfavourably associated with cognitive function, depression, function and disability, physical activity levels, and physical health-related quality of life in adults. Reducing or breaking up sedentary behaviour may benefit body composition and markers of cardiometabolic risk. Total sedentary behaviour and TV viewing were most consistently associated with unfavourable health outcomes, while computer and Internet use may be favourably associated with cognitive function for older adults. The quality of evidence within individual reviews (as assessed by review authors) varied from low to high, while the certainty of evidence was low to very low. These findings have important public health implications, suggesting that adults should avoid high levels of sedentary behaviour and break-up periods of prolonged sitting. (PROSPERO registration nos.: CRD42019123121 and CRD42019127157.) Novelty High levels of sedentary behaviour are unfavourably associated with important health outcomes in adults. Reducing or breaking up sedentary behaviour may benefit body composition and markers of cardiometabolic risk. Computer and Internet use may be favourably associated with cognitive function in older adults.

The additive impact of multiple psychosocial protective factors on selected health outcomes among older adults

Our objective was to investigate the additive properties of five psychosocial protective factors: purpose-in-life, resilience, optimism, internal locus of control and social connections. Self-reported psychological (depression, stress) and physical (health status, functionality) health outcomes and measured healthcare utilization and expenditures were included. The study sample was identified from adults age ≥65 who completed a health survey during May-June 2019 (N = 3,577). Each of the five protective factors was dichotomized as high/low (1/0) and counted with equal weighting. The protective factors were additive such that significant improvements in psychological and physical health outcomes were evident across factor subgroups: as the number of factors increased, health outcomes improved. The magnitude of the improvements was greatest between 0 and 1 factor. In addition, a significant linear trend for reduced healthcare expenditures ($1,356 reduction per factor added) was evident. Interventions promoting at least one protective factor would be beneficial for older adult populations.

Vitamin A Requirements in Pregnancy and Lactation.

ABSTRACTPregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.

Racial disparities in peripartum cardiomyopathy: eighteen years of observations

Background Black women have greater than a three-fold risk of pregnancy-associated death compared to White women; cardiomyopathy is a leading cause of maternal mortality. Objectives This study examined racial disparities in health outcomes among women with peripartum cardiomyopathy. Study design Retrospective cohort of women with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 from a single referral center. Selected health outcomes among Black and White women were compared; primary outcome was ejection fraction at diagnosis. Secondary outcomes included cardiovascular outcomes, markers of maternal morbidity, resource utilization, and subsequent pregnancy outcomes. Results Ninety-five women met inclusion criteria: 48% Black, 52% White. Nearly all peripartum cardiomyopathy diagnoses were postpartum (95.4% Black, 93% White, p=.11). Ejection fraction at diagnosis was not different between Black and White women (26.8 ± 12.5 vs. 28.7 ± 9.9, p=.41). Though non-significant, fewer Black women had myocardial recovery to EF ≥55% (35 vs. 53%, p=.07); however, 11 (24%) of Black women vs. 1 (2%) White woman had an ejection fraction ≤35% at 6–12 months postpartum (p<.01). More Black women underwent implantable cardioverter defibrillator placement: n = 15 (33%) vs. n = 7 (14%), p=.03. Eight women (8.4%) died in the study period, not different by race (p=.48). Black women had higher rates of healthcare utilization. In the subsequent pregnancy, Black women had a lower initial ejection fraction (40 vs. 55%, p=.007) and were less likely to recover postpartum (37.5 vs. 55%, p=.02). Conclusions Black and White women have similar mean ejection fraction at diagnosis of peripartum cardiomyopathy, but Black women have more severe left ventricular systolic dysfunction leading to worse outcomes, increased resource use, and lower ejection fraction entering the subsequent pregnancy.

Review of policies, data, and interventions to improve maternal nutrition in Afghanistan.

Malnutrition contributes to direct and indirect causes of maternal mortality, which is particularly high in Afghanistan. Women's nutritional status before, during, and after pregnancy affects their own well‐being and mortality risk and their children's health outcomes. Though maternal nutrition interventions have documented positive impact on select child health outcomes, there are limited data regarding the effects of maternal nutrition interventions on maternal health outcomes globally. This scoping review maps policies, data, and interventions aiming to address poor maternal nutrition outcomes in Afghanistan. We used broad search categories and approaches including database and website searches, hand searches of reference lists from relevant articles, policy and programme document requests, and key informant interviews. Inclusion and exclusion criteria were developed by type of source document, such as studies with measures related to maternal nutrition, relevant policies and strategies, and programmatic research or evaluation by a third party with explicit interventions targeting maternal nutrition. We abstracted documents systematically, summarized content, and synthesized data. We included 20 policies and strategies, 29 data reports, and nine intervention evaluations. The availability of maternal nutrition intervention data and the inclusion of nutrition indicators, such as minimum dietary diversity, have increased substantially since 2013, yet few nutrition evaluations and population surveys include maternal outcomes as primary or even secondary outcomes. There is little evidence on the effectiveness of interventions that target maternal nutrition in Afghanistan. Policies and strategies more recently have shifted towards multisectoral efforts and specifically target nutrition needs of adolescent girls and women of reproductive age. This scoping review presents evidence from more than 10 years of efforts to improve the maternal nutrition status of Afghan women. We recommend a combination of investments in measuring maternal nutrition indicators and improving maternal nutrition knowledge and behaviours.

Feasibility of smartphone application- and social media-based intervention on college students’ health outcomes: A pilot randomized trial

Objective We evaluated the feasibility of a 10-week program combining a smartphone application and theoretically-based, social media-delivered health education intervention to improve college students’ health behaviors and outcomes. Participants: Forty-four college students (32 female; X̅age=21.6 years) in 2015-2016. Methods: Participants were randomized into one of two groups: (1) experimental: used MapMyFitness smartphone application to log and track physical activity (PA) and participated in a Social Cognitive Theory-based, Facebook-delivered health education intervention; (2) comparison: only included in a separate, but content-identical, Facebook intervention. Our primary outcomes pertained to intervention feasibility while our secondary outcomes reflected health behaviors and outcomes. Results: Intervention interest was high, with retention 95.5%. Experimental participants used MapMyFitness 1.71x/week, with both groups implementing the Facebook-delivered health education tips 1-3x/week. We observed a modest sedentary behavior reduction in the experimental group (−29.2-minutes/day). Additionally, both groups demonstrated slight reductions in weight (experimental:−1.2 kg/comparison:−0.6 kg) and body fat percentage (both groups:−0.8%-decrease). Increased PA-related social support and decreased barriers were observed. Conclusions: A low-burden and well-integrated social media-based intervention is feasible and of interest to college students, possibly improving select health behaviors and outcomes. PA-oriented smartphone application offered limited additional benefit.

Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers.

Primary surgical prevention in the form of risk-reducing salpingo-oophorectomy (RRSO) is the most effective option and the gold standard for ovarian cancer (OC) risk-reduction, particularly given the absence of an effective national OC screening programme. However, premenopausal RRSO leads to premature surgical menopause with detrimental long-term health sequelae particularly in women who do not/are unable to take hormone replacement therapy (HRT). HRT uptake in women undergoing pre-menopausal oophorectomy appears low and is dependent on informed counselling, the safety of HRT and efficacy in mitigating the health sequelae of premature menopause. Acceptance of a central role for the fallopian tube in OC etiopathogenesis, coupled with the detrimental consequences of premature menopause, has led to the attractive proposal of early-salpingectomy with delayed oophorectomy as an alternative OC surgical prevention strategy in premenopausal women who have completed childbearing but decline or wish to delay RRSO. The successful implementation of risk reducing surgery for OC prevention depends on the acceptability of surgery to both, recipients (e.g. BRCA1/BRCA2 carriers) and intervention deliverers (healthcare professionals/researchers). Acceptability is also informed by an understanding of health outcomes following risk reducing surgery and the safety of HRT. It is therefore vital to understand the effects of surgery on important health outcomes such as cardiovascular health, neurological function and bone health. We present a comprehensive review of acceptability, the selected health outcomes mentioned above and HRT safety following risk reducing surgery.

Evaluating Race and Ethnicity Reported in Hospital Discharge Data and Its Impact on the Assessment of Health Disparities.

Improving the collection and quality of race and ethnicity reported in hospital data is a key step in identifying disparities in health service utilization and outcomes and opportunities for quality improvement. The objective of this study was to assess the quality of race/ethnicity reported in hospital discharge data and examine the impact on the identification of disparities in select health outcomes in New York City. Using the birth certificate as a gold standard, we examined the quality of hospital discharge race/ethnicity and estimated the impact of misclassification on racial/ethnic disparities in severe maternal morbidity and preventable hospitalizations. Delivery hospitalizations from the New York State hospital discharge data (Statewide Planning and Research Cooperative System) linked with 2015 New York City birth certificates. Sensitivity and positive predictive value (PPV). The non-Hispanic white and black race had relatively high sensitivity and PPV. Hispanic ethnicity and Asian race had moderate sensitivity and high PPV, but were often misclassified as "Other." As a result, health disparities may be underestimated for those of Hispanic ethnicity and Asian race, particularly for indicators that use population denominators drawn from another source. The quality of hospital discharge data varies by race/ethnicity and may underestimate disparities in some groups. Future research should validate findings with other data sources, identify driving factors, and evaluate progress over time.

Effects of Evidence-Based Continuing Care Bundle on Health Outcomes in Rectal Cancer Patients With Temporary Stomas: A Multicenter Randomized Controlled Trial.

The patients with temporary stomas after anterior resection for rectal cancer may experience significant impact on their health outcomes, and hence continuing care is necessary and important for these patients. However, the effects of some single continuing care interventions remain unclear. Continuing care bundle may be an effective approach to address this uncertainty. The aim of this study was to investigate the effects of an evidence-based continuing care bundle on selected health outcomes in patients with temporary stomas after anterior resection for rectal cancer. This was a multicenter randomized controlled trial. A total of 124 patients with temporary stomas after anterior resection for rectal cancer were recruited from 4 general tertiary hospitals in Guangzhou, China, and were randomly assigned to a control group or an intervention group. Both groups received usual care, whereas the intervention group additionally received evidence-based continuing care bundle. Self-efficacy, quality of life, and stoma-related complications were collected at baseline and 4 and 12 weeks after surgery. Satisfaction and outcomes of stoma reversal were collected at the end of the observation. The intervention group had significantly improved the self-efficacy (F = 11.88, P = .001), quality of life (F = 17.99, P < .001) over time, satisfaction (t = 4.08, P < .001), and outcomes of stoma reversal (χ2 = 5.93, P = .015) and reduced the incidence of complications (P < .05). Evidence-based continuing care bundle can be an effective method to improve the health outcomes among these patients. By using the evidence-based continuing care bundle, nurses can help these patients improve their health outcomes in stoma-specific nursing.

Water insecurity and urban poverty in the Global South: Implications for health and human biology.

Over half of the world's population (4 billion people) experience severe water scarcity at least one month per year, while half a billion people experience severe water scarcity throughout the year. Despite progress from national and global interventions, a staggering proportion of the Global South remains water insecure. Rapid urban growth and associated demographic changes, climate change, and governance failure have also fostered the growth and expansion of urban informal settlements and slums where widespread poverty and environmental hazards exacerbate the impact of water insecurity on health. This article reflects on the interactions between water insecurity and urban poverty in the Global South across four categories of health outcomes: gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness. These examples highlight the mechanisms through which urban poverty exacerbates the adverse health effects of water insecurity. The four selected health outcomes were chosen a priori to represent two communicable conditions with well-developed literatures, and two noncommunicable conditions with newer literatures that have emerged over the last decade. We conducted a narrative literature review of scholarly and gray literature appearing between January 2000 and April 2019 using several online scholarly databases. Gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness all exemplified the relationship between water insecurity and urban poverty through human biological pathways. For each of the four health categories, we identified frontiers for human biology research contributions to the water-poverty-health nexus. We discuss our findings in the context of three crosscutting themes that merit innovative research approaches: stressor interactions and trade-offs, exposure thresholds, and intervention efficacy. We reiterate that the global burden of disease associated with water insecurity cannot be addressed in isolation from efforts to alleviate extreme poverty.

Burden of disease due to nitrogen dioxide exposure in Germany

Abstract Background Numerous studies identified adverse effects of air pollution on health. According to the recent Global Burden of Disease Study about 2.9 million people died prematurely due to the effects of ambient particulate matter (PM) pollution in 2016, which resulted in about 70 million years of life lost (YLL). In addition to PM, a growing body of evidence shows convincing associations between nitrogen dioxide (NO2) with several health outcomes. The case study provides a health risk assessment for NO2 in Germany. Methods A systematic review was performed to select health outcomes with strong evidence for an association with NO2 and to derive an updated exposure-response function (ERF). The exposure assessment was performed on a 1x1 km2 grid by combining measured and modelled data (annual means of NO2 background concentration) with population density. Exposure data and the ERF were combined by the population attributable fraction formula. The main analysis was performed using a counterfactual of 10 µg/m3. Results Only for cardiovascular mortality the evidence for the association with long-term NO2-exposure was rated as “strong”. Thus, the main analysis merely included this outcome. For the year 2014, 5,966 (95% CI: 2,031-9,893) attributable deaths and 49,726 (95% CI: 16,929-82,456) YLL were estimated. Looking at time trends a decrease of disease burden was observed compared to the year 2007 where 7,832 (95% CI: 2,669-12,973) attributable deaths and 69.244 (95% CI: 23.601-114.690) YLL due to NO2 were calculated. Conclusions Our results show a considerable burden due to NO2 in Germany. Compared to previous estimates for PM (ca. 41,100 attributable deaths in 2014) the burden due to NO2 is much lower. However, due to methodological constraints we could not incorporate higher concentrations from traffic hotspots. This, and the fact that we only considered one health outcome in our main analysis, suggests that our results might be an underestimation.

The Effect of Healthcare Expenditure on the Health Outcomes in Sub-Saharan African Countries

Health is a major component for a fulfilled life that everyone in the world desires to acquire. Governments are expected to play a vital role in providing quality health service to their people. Even though an increased health care expenditure is mostly considered as a primary contributor for an improved health outcome, empirical studies however indicate controversial results. The primary objective of this paper is to examine the effect of health expenditure on the selected health outcomes (Life Expectancy, Infant Mortality, Under-Five Mortality and Crude death) in Sub Saharan Africa. The linear dynamic generalized method of moments instrumental variable (GMM-IV) was used on a panel of 39 Sub-Saharan African Countries for the years 1995-2014. Results of this study showed that health expenditure significantly improves life expectancy and lowers infant mortality, under-five mortality &amp; crude death in Sub Saharan Africa. The separate effects of Public and private health expenditures have also shown a significant positive relationship on life expectancy and negative on infant mortality, under-five mortality &amp; crude death. The one period lag of health expenditure was estimated and the regression results indicated statistically significant relationship with health outcomes. In addition to health expenditure, other determinants like Gross Domestic Product (GDP) per capita, urbanization, immunization and basic drinking water brought improvement on life expectancy, infant mortality, under-five mortality &amp; crude death. In contrast, HIV prevalence and unemployment are factors that reduce life expectancy and increase infant mortality, under-five mortality &amp; crude death. This study indicated that health expenditure is an important element in attaining improved health outcome in Sub-Saharan African Countries. Therefore, increasing the amount of health expenditure allocated to the health sector yields a better health status. More on, revising policies to improve GDP per capita, immunization, urbanization and basic drinking water service, and strategies intended to reduce HIV prevalence and unemployment assure a better health outcome.

Long-term effects of rent supplements and mental health support services on housing and health outcomes of homeless adults with mental illness: extension study of the At Home/Chez Soi randomised controlled trial

Housing First is increasingly implemented for homeless adults with mental illness in large urban centres, but little is known about its long-term effectiveness. The At Home/Chez Soi randomised controlled trial done in five cities in Canada showed that Housing First improved housing stability and other select health outcomes. We extended the At Home/Chez Soi trial at the Toronto site to evaluate the long-term effects of the Housing First intervention on housing and health outcomes of homeless adults with mental illness over 6 years. The At Home/Chez Soi Toronto study was a randomised, controlled trial done in Toronto (ON, Canada). Here, we present the results of an extension study done at the same site. Participants were homeless adults (aged ≥18 years) with a serious mental disorder with or without co-occurring substance use disorder. In phase 1, participants were stratified by level of need for mental health support services (high vs moderate), and randomly assigned (1:1) using adaptive randomisation procedures to Housing First with assertive community treatment (HF-ACT), Housing First with intensive case management (HF-ICM), or to treatment as usual (TAU). Participants with moderate support needs were further stratified by ethnoracial status. Considering the nature of the Housing First intervention, study participants and study personnel were not masked to group assignment. Phase 1 participants could choose to enrol in the extension study (phase 2). The primary outcome was the rate of days stably housed per year analysed in the modified intention-to-treat population, which included all randomly assigned participants who had at least one assessment for the primary outcome. Participants contributed data to the study up to the point of their last interview. Multilevel multiple imputation was used to handle missing data. The trial was registered with ISRCTN, ISRCTN42520374. Between Oct 1, 2009, and March 31, 2013, 575 individuals participated in phase 1 of the Toronto Site At Home/Chez Soi study (197 [34%] participants with high support needs and 378 [66%] with moderate support needs). Of the 378 participants with moderate support needs, 204 were randomly assigned to receive the HF intervention with ICM or with ethnoracial-specific ICM services (HF-ER-ICM; HF-ICM or HF-ER-ICM groups) and 174 were randomly assigned to TAU. Of the 197 participants with high support needs, 97 were randomly assigned to receive the HF intervention with ACT (HF-ACT treatment group) and 100 were randomly assigned to TAU group. Between Jan 1, 2014, and March 31, 2017, 414 (81%) of 575 phase 1 participants participated in the extended phase 2 study. The median duration of follow-up was 5·4 years (IQR 2·1-5·9). Among phase 2 participants, 141 had high support needs (79 participants in the HF-ACT group; 62 participants in the TAU group), and 273 had moderate support needs (160 participants in the HF-ICM or HF-ER-ICM group; 113 participants in the TAU group). 187 high support needs participants (93 participants in the HF-ACT group, 94 participants in the TAU group), and 361 moderate support needs participants (201 participants in the HF-ICM or HF-ER-ICM group, 160 participants in the TAU group) were included in the modified intention-to-treat analysis for the primary outcome. The number of days spent stably housed was significantly higher among participants in the HF-ACT and HR-ICM or HF-ER-ICM groups than participants in the TAU groups at all timepoints. For participants with moderate support needs, the rate ratio (RR) of days stably housed in the Housing First group, compared with TAU, was 2·40 (95% CI 2·03-2·83) in year 1, which decreased to 1·13 (1·01-1·26) in year 6. The RR of days stably housed for participants with high support needs, compared with TAU, was 3·02 (2·43-3·75) in year 1 and 1·42 (1·19-1·69) in year 6. In year 6, high support needs participants in the Housing First group spent 85·51% of days stably housed compared with 60·33% for the TAU group, and moderate needs participants in the Housing First group spent 88·16% of days stably housed compared with 78·22% for the TAU group. Rent supplements and mental health support services had an enduring positive effect on housing stability for homeless adults with mental illness in a large, resource-rich urban centre, with a larger impact on individuals with high support needs than moderate support needs. Mental Health Commission of Canada, Ontario Ministry of Health and Long-Term Care, and the Canadian Institute of Health Research.

Testing the Impact of a Cancer Survivorship Patient Engagement Toolkit on Selected Health Outcomes.

To evaluate an interactive electronic Cancer Survivorship Patient Engagement Toolkit (CaS-PET) using a single-group pre-/post-test design. 30 cancer survivors with a mean age of 56.5 years (SD = 13.6) were recruited from the University of Maryland Medical Center in Baltimore. CaS-PET was designed to deliver survivorship care plans (SCPs) with multifactorial support and comprised of SCPs, biweekly follow-up using patient portal e-messages, and online resources. Outcomes included health-related quality of life, symptom burden, impact of cancer, fear of recurrence, physical activities, dietary behavior, patient-provider communication, adherence to treatment, and e-health literacy. At three months, there was a significant improvement in quality of life, physical symptom burden, and total symptom burden. Findings suggest an excellent potential for using CaS-PET for survivors who are in transition from treatment to survivorship.

Mortality and hospitalization associated to emissions of a coal power plant: A population-based cohort study

BackgroundCoal-fired thermal power plants represent a significant source of air pollutants, especially sulfur dioxide (SO2) that has been associated with an increased risk of mortality and morbidity for respiratory and cardiovascular disease. A coal power plant in Vado Ligure (Italy) (CPPVL) started in 1970 was stopped in 2014 by the Prosecutor's Office on the grounds of environmental and health culpable disaster. ObjectiveTo investigate the association between the exposure of residents to atmospheric pollutants emitted by CPPVL and the risk of mortality and hospitalization, considering both cancer and non-cancer causes in a population-based cohort study. MethodsSO2 and nitrogen oxides (NOx), estimated using the ABLE-MOLOCH-ADMS-Urban dispersion model, were selected as representative surrogates of exposure to CPPVL emissions (SO2-CPPVL) and cumulative emissions from other sources of pollution (NOx-MS), respectively. The relationship between each health outcome and categories of exposure to SO2-CPPVL was estimated by the Hazard Ratio (HR) using multiple sex-specific Cox regression models, adjusted for age, exposure to NOx-MS, and socio-economic deprivation index using SO2-CPPVL first quartile as a reference. Results144,019 individuals were recruited (follow-up 2001–2013). An excess of mortality was found for all natural causes (men: 1.49; 95% CI 1.38–1.60; women: 1.49; 95% CI 1.39–1.59), diseases of the circulatory system (men: 1.41; 95% CI 1.24–1.56; women: 1.59; 95% CI 1.44–1.77), of the respiratory system (men: 1.90; 95% CI 1.47–2.45; women: 1.62; 95% CI 1.25–2.09), and of the nervous system and sense organs (men: 1.34; 95% CI 0.97–1.86; women: 1.38; 95% CI 1.03–1.83), and in men for trachea, bronchus, and lung cancers (1.59; 95% CI 1.26–2.00). Results of hospitalization analysis were consistent with those of mortality. ConclusionResults obtained, also when considering multiple sources of exposure, indicate that exposure to CPP emissions represents a risk factor for selected health outcomes as well as the urgently adoption of primary prevention measures and of a specific surveillance programme.

A Novel Adaptation of the HOME Inventory for Elders: The Importance of the Home Environment Across the Life Course.

The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.

Physical Activity and Health in Children Younger than 6 Years: A Systematic Review.

Physical activity is known to provide important health benefits in school-age youth. However, until recently, few studies have examined associations between physical activity and health in young children. The purpose of this study was to conduct a systematic review of the relationship between physical activity and selected health outcomes in children younger than 6 yr. A systematic search identified randomized controlled trials and prospective cohort studies examining the associations between physical activity and adiposity/weight status, bone health, cardiometabolic health, and cognition in children younger than 6 yr. Twenty-seven studies met inclusion criteria and served as the basis for this systematic review. For weight status/adiposity, 12 of 15 studies found negative associations between physical activity and one or more measures of the outcome. For bone health, 10 articles based on four studies were identified, and nine studies showed stronger bone in more active children. For cardiometabolic health, three studies were identified and findings were limited and inconsistent. For cognition, two systematic reviews were identified and findings were limited. For all four health outcomes, evidence of dose-response relationships and effect modification by demographic factors was very limited. There is strong evidence indicating that higher amounts of physical activity are associated with better indicators of bone health and with reduced risk for excessive increases in weight and adiposity in children 3 to 6 yr. Evidence was too limited to support conclusions regarding the effects of physical activity on cardiometabolic health and cognition.

Health outcomes and services in children with sickle cell trait, sickle cell anemia, and normal hemoglobin

AbstractThe health effects of sickle cell trait among children are unknown. We compared select health outcomes and health services utilization among children with sickle cell trait, sickle cell anemia (SCA), and normal hemoglobin. Newborn screening records were used to identify children with sickle cell trait and SCA born in Michigan (1997-2014) who were enrolled in Michigan Medicaid for ≥1 year from 2012 to 2014. Each select health outcome (acute otitis media, acute respiratory infections, fever, invasive pneumococcal disease, pneumonia and influenza, renal complications, spleen problems, stroke) was defined as ≥1 claim with a diagnosis code for the respective outcome within a study year. Health services utilization was summarized as counts of emergency department, inpatient, and outpatient encounters. The relationship between hemoglobin status and each health outcome or utilization was assessed by logistic or negative binomial regression with generalized estimating equations. The study population consisted of 18 257 children with sickle cell trait, 368 with SCA, and 74 523 with normal hemoglobin (227 188 total person-years). Compared with those with normal hemoglobin, children with sickle cell trait had lower odds of acute otitis media (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.84-0.91), acute respiratory infections (OR, 0.94; 95% CI, 0.92-0.97), pneumonia and influenza (OR, 0.93; 95% CI, 0.87-0.99), and outpatient visits (incidence rate ratio, 0.95; 95% CI, 0.93-0.97). Children with SCA had higher or nonsignificant odds of all outcomes and types of health services utilization. These results indicate that children with sickle cell trait may not be at additional health risk for these outcomes. However, additional case-control studies may be necessary to identify rare events.