Sequential Cross-sectional Studies Research Articles

Othering and Marginalizing the “Queer” in Rwanda: Findings from Public Perceptions and Lived Experiences of LGBT People

Abstract Introduction The multidimensionality of stigma that LGBT people experience globally necessitates research to explore the processes at work. The study aimed to quantify the level of othering and explore the process of LGBT othering in Rwanda. Methods We conducted a sequential cross-sectional mixed-methods study of LGBT lived experiences in Rwanda. We recruited 499 participants to complete the LGBT-specific survey and 1254 for the non-LGBT survey. We conducted 16 in-depth interviews (IDIs) with non-LGBT participants. For LGBT participants, we completed six focus groups with 59 participants, six in-depth interviews, and three digital storytelling interviews. For the quantitative surveys, we conducted multivariable linear regressions and reported beta coefficients and 95% confidence interval estimates examining LGBT discrimination (LGBT survey) and attitudes toward LGBT (non-LGBT survey). We used deductive and inductive thematic and narrative analysis to analyze the qualitative data. Results In adjusted analyses of the non-LGBT survey, as compared to those who knew zero LGBT persons, persons who knew more than five had lower negative attitude scores (β = − 1.3, 95% CI − 2.2, − 0.5), while the score was lower for those that knew one to five (− 0.2), it was not significant (95% CI − 0.8, 0.5). In the LGBT survey, adjusted analyses indicated that there was no significant difference found in discrimination between bisexual, gay, or lesbian participants. However, as compared to cisgender participants, transgender participants had discrimination scores that were 2.1 points higher (95% CI 1.1, 3.0), and gender non-confirming individuals had scores that were one point higher (95% CI 0.2, 1.9). The qualitative findings showcased how societal “othering” occurs in the everyday life of LGBT Rwandans, with large ramifications in creating feelings of isolation and hampering one’s capacity to live authentically and with dignity. Conclusion The findings from our study indicate a high level of othering of the LGBT community across multiple domains, including housing, employment, healthcare, education, religion, and family within Rwanda. Policy Implications The findings highlight the importance of social education campaigns about LGBT people, particularly among vital societal role-holders, including healthcare providers and educators. Integrating the rich historical and indigenous culture related to LGBT could be successful in combating anti-West rhetoric.

Prognostic nomogram for uncontrolled type 2 diabetes using Thailand nation-wide cross-sectional studies.

Uncontrolled type 2 diabetes (T2DM) and limited hemoglobin A1c (HbA1c) levels examination are a burden in community hospitals in Thailand. The nomogram from the patients' information might be a practical solution to identify a high-risk group of diabetic complications. Thus, this study aimed to establish an effective prognostic nomogram for patients with uncontrolled T2DM. Sequential nationwide cross-sectional studies of T2DM patients in 2018 and 2015 were utilized for development and validation groups, respectively, with this chronological order aiming to capture recent trends during development and assess the nomogram's robustness across diverse timeframes. The predictive outcome was uncontrolled T2DM, defined as HbA1c ≥9%. The model was determined by multivariable regression analysis and established an effective prognostic nomogram. The receiver operating characteristic curve, Hosmer-Lemeshow goodness of fit test, and decision curve analysis (DCA) was applied to evaluate the performance of the nomogram. In 2018, 24% of the 38,568 participants in the development group had uncontrolled T2DM (defined as Hba1c ≥9%). The predictive nomogram of uncontrolled diabetes consisted of demographic characteristics, prescription medications, history of diabetic complications, and laboratory results (C-statistic of 0.77). The goodness of fit test and DCA showed good agreement between the result and clinical application for T2DM. The predictive nomogram demonstrates simplicity, accuracy, and valuable prediction to enhance diabetic care in resource-limited countries, including Thailand.

Association between periodontal diseases and chronic obstructive pulmonary disease: Evidence from sequential cross-sectional and prospective cohort studies based on UK Biobank.

To investigate the association between periodontal diseases, airflow limitation and incident chronic obstructive pulmonary disease (COPD) in a large-scale prospective UK Biobank cohort. Our approach comprised a cross-sectional study and a prospective cohort. Periodontal diseases were determined based on the participants' self-reported dental symptoms, including painful gums, bleeding gums and loose teeth. Logistic regression and Cox proportional hazards models were used to evaluate the association of periodontal diseases with airflow limitation and incident COPD in the cross-sectional study and the prospective cohort, respectively. The cross-sectional study involved 495,610 participants. Multivariable analysis found that periodontal diseases were significantly associated with airflow limitation (odds ratio = 1.036, 95% confidence interval [CI]: 1.015-1.059). The cohort study included 379,266 participants with a median follow-up period of 12.68 years. An elevated risk of incident COPD was associated with the presence of periodontal diseases (hazard ratio: 1.248, 95% CI: 1.174-1.326). The effect was consistent among subgroups, including baseline age (≤65 or >65 years), sex, smoking status and diabetes mellitus. Periodontal diseases are associated with airflow limitation and elevated COPD incidence. Maintaining good periodontal health in patients with chronic bronchitis and emphysema may help prevent the onset of COPD.

A Sequential Cross-Sectional Analysis Producing Robust Weekly COVID-19 Rates for South East Asian Countries.

The COVID-19 pandemic has expanded fast over the world, affecting millions of people and generating serious health, social, and economic consequences. All South East Asian countries have experienced the pandemic, with various degrees of intensity and response. As the pandemic progresses, it is important to track and analyse disease trends and patterns to guide public health policy and treatments. In this paper, we carry out a sequential cross-sectional study to produce reliable weekly COVID-19 death (out of cases) rates for South East Asian countries for the calendar years 2020, 2021, and 2022. The main objectives of this study are to characterise the trends and patterns of COVID-19 death rates in South East Asian countries through time, as well as compare COVID-19 rates among countries and regions in South East Asia. Our raw data are (daily) case and death counts acquired from "Our World in Data", which, however, for some countries and time periods, suffer from sparsity (zero or small counts), and therefore require a modelling approach where information is adaptively borrowed from the overall dataset where required. Therefore, a sequential cross-sectional design will be utilised, that will involve examining the data week by week, across all countries. Methodologically, this is achieved through a two-stage random effect shrinkage approach, with estimation facilitated by nonparametric maximum likelihood.

Effect of Herbal Perfumes and Synthetic Perfumes on Attention and Cognitive Functions in Young Adults: A Sequential Cross-sectional Study

Introduction: Focused and sustained attention, executive function, working memory and task switching are important cognitive abilities. Efforts to enhance cognitive abilities, have engaged the scientific community since ages. Human beings are exposed to several fragrances and the perception of the sense of smell, plays an important role in the physiological effects of mood, stress, and working capacity. Perception of olfactory stimuli involves complex brain processing, which can be directly associated with cognition and emotion. Several Electroencephalogram (EEG) studies have revealed that, fragrances significantly modulate the activities of different brain waves and are responsible for various states of the brain. Aim: To objectively demonstrate the effect of olfactory stimulation with herbal (rose) perfume on attention and executive functions. Materials and Methods: This sequential cross-sectional study was conducted in the Department of Physiology at Osmania Medical College, Hyderabad, Telangana, India. The duration of the study was one month, from 16th August 2021 to 16th September 2021. Study included 40 healthy participants (15 males and 25 females), aged between 18-30 years to olfactory stimulation by herbal (rose) extract perfume and synthetic (rose) perfume, and the effects are assessed, using the psychophysiological tests viz., Rapid Serial Visual Presentation task (RSVP), Trail Making Tests (TMT) A&B, Ruff Figural Fluency Test (RFT), and compared with the baseline scores, which are then analysed using Paired t-test. The data was analysed by using Statistical Package for Social Sciences (SPSS) version 16.0. Results: Olfactory stimulation with herbal rose perfume enhances the attention and speed of processing, as shown by the nearly significant improvement in the performance of the TMT-A (p-value=0.05433), with decreased time taken to perform the test, whereas, the synthetic rose perfume enhanced the attention, speed, switching between tasks, cognitive fluency, and flexibility. This is evident by the significant improvement in the performance of the TMT-A (p-value=0.00326) and TMT-B (p-value=0.0001693), with decreased time taken to perform the tests. The derived index TMT (B-A), which removes the speed component and is a purer index of executive functions, also showed significant results (p-value=0.002092). Conclusion: The effects of herbal and synthetic rose olfactory stimulation have shown positive influence on the attention and cognitive functions and this finding can be applied to create student friendly learning environments, by providing pleasant stimuli through means of aromatic sprays delivering the odorant in a pulsatile manner at a frequency to overcome the ensuing olfactory adaptation.

Risk of cardiovascular outcomes among women with endometriosis in the United Kingdom: a retrospective matched cohort study

To describe the prevalence and incidence of endometriosis and to estimate the risk of cardiovascular outcomes in women with endometriosis. Population-based cohort study using The Health Improvement Network database. UK primary care. Women aged 16-50years were followed from 1995 to 2018. Adjusted hazard ratios (aHR) for cardiovascular outcomes comparing women with endometriosis with those without endometriosis were estimated using multivariable Cox regression models. Prevalence and incidence of endometriosis were estimated using annual (1998-2017) sequential cross-sectional and cohort studies, respectively. The primary outcome was composite cardiovascular disease (CVD) including, ischaemic heart disease (IHD), heart failure (HF) and cerebrovascular disease. Secondary outcomes were arrhythmia, hypertension and all-cause mortality. In all, 56090 women with endometriosis and 223669 matched controls without endometriosis were included in the analysis of cardiovascular risk. Compared with women without endometriosis, the aHR for cardiovascular outcomes among women with endometriosis were: composite CVD 1.24 (95% CI 1.13-1.37); IHD 1.40 (95% CI 1.22-1.61); cerebrovascular disease 1.19 (95% CI 1.04-1.36); HF 0.76 (95% CI 0.54-1.07); arrhythmia 1.26 (95% CI 1.11-1.43); hypertension 1.12 (95% CI 1.07-1.17) and all-cause mortality 0.66 (95% CI 0.59-0.74). The incidence of endometriosis was 12.3 per 10000 person-years in 1998 and 11.5 per 10000 person-years in 2017. The prevalence of endometriosis increased from 119.7 per 10000 population in 1998 to 201.3 per 10000 population in 2017. Endometriosis is associated with an increased risk of cardiovascular outcomes. Young women with endometriosis are a potential target for CVD risk assessment and prevention. Endometriosis is associated with increased risk of cardiovascular outcomes: a UK retrospective matched cohort study.

Trends in Optic Neuritis Incidence and Prevalence in the UK and Association With Systemic and Neurologic Disease

Epidemiologic data on optic neuritis (ON) incidence and associations with immune-mediated inflammatory diseases (IMIDs) are sparse. To estimate 22-year trends in ON prevalence and incidence and association with IMIDs in the United Kingdom. This cohort study analyzed data from The Health Improvement Network from January 1, 1995, to September 1, 2019. The study included 10 937 511 patients 1 year or older with 75.2 million person-years' follow-up. Annual ON incidence rates were estimated yearly (January 1, 1997, to December 31, 2018), and annual ON prevalence was estimated by performing sequential cross-sectional studies on data collected on January 1 each year for the same period. Data for 1995, 1996, and 2019 were excluded as incomplete. Risk factors for ON were explored in a cohort analysis from January 1, 1997, to December 31, 2018. Matched case-control and retrospective cohort studies were performed using data from January 1, 1995, to September 1, 2019, to explore the odds of antecedent diagnosis and hazard of incident diagnosis of 66 IMIDs in patients compared with controls. Optic neuritis. Annual point prevalence and incidence rates of ON, adjusted incident rate ratios (IRRs) for risk factors, and adjusted odds ratios (ORs) and adjusted hazard ratios (HRs) for 66 IMIDs. A total of 10 937 511 patients (median [IQR] age at cohort entry, 32.6 [18.0-50.4] years; 5 571 282 [50.9%] female) were studied. A total of 1962 of 2826 patients (69.4%) with incident ON were female and 1192 of 1290 92.4%) were White, with a mean (SD) age of 35.6 (15.6) years. Overall incidence across 22 years was stable at 3.7 (95% CI, 3.6-3.9) per 100 000 person-years. Annual point prevalence (per 100 000 population) increased with database maturity, from 69.3 (95% CI, 57.2-81.3) in 1997 to 114.8 (95% CI, 111.0-118.6) in 2018. The highest risk of incident ON was associated with female sex, obesity, reproductive age, smoking, and residence at higher latitude, with significantly lower risk in South Asian or mixed race/ethnicity compared with White people. Patients with ON had significantly higher odds of prior multiple sclerosis (MS) (OR, 98.22; 95% CI, 65.40-147.52), syphilis (OR, 5.76; 95% CI, 1.39-23.96), Mycoplasma (OR, 3.90; 95% CI, 1.09-13.93), vasculitis (OR, 3.70; 95% CI, 1.68-8.15), sarcoidosis (OR, 2.50; 95% CI, 1.21-5.18), Epstein-Barr virus (OR, 2.29; 95% CI, 1.80-2.92), Crohn disease (OR, 1.97; 95% CI, 1.13-3.43), and psoriasis (OR, 1.28; 95% CI, 1.03-1.58). Patients with ON had a significantly higher hazard of incident MS (HR, 284.97; 95% CI, 167.85-483.81), Behçet disease (HR, 17.39; 95% CI, 1.55-195.53), sarcoidosis (HR, 14.80; 95% CI, 4.86-45.08), vasculitis (HR, 4.89; 95% CI, 1.82-13.10), Sjögren syndrome (HR, 3.48; 95% CI, 1.38-8.76), and herpetic infection (HR, 1.68; 95% CI, 1.24-2.28). The UK incidence of ON is stable. Even though predominantly associated with MS, ON has numerous other associations with IMIDs. Although individually rare, together these associations outnumber MS-associated ON and typically require urgent management to preserve sight.

Pneumococcal and meningococcal vaccines - A significant reduction of pediatric admissions and deaths

Abstract Background Mortality rates associated with paediatric inpatient stays in mainland Portuguese Hospitals have decreased approximately 50%, between 2000 and 2016, despite the majority of deaths occurring in hospitals. During this timeframe meningococcal and pneumococcal vaccines were introduced in the National Vaccination Programme (NVP). In this study, the authors analyzed admission and mortality rates associated with vaccine preventable diseases such as pneumococcal and meningococcal disease. Methods A sequential cross-sectional retrospective study was performed, from 2000 and 2016, to assess the hospitalizations for meningitis, sepsis and pneumonia of children and adolescents at the SNS (National Health Service) hospitals in mainland Portugal. An administrative Portuguese database that contains all the public hospital admissions to mainland Portugal hospitals was utilized and diagnoses were coded per ICD9. National Institute Of Statistics (INE) data was accessed as reference. All admissions of individuals 17 years old and younger were analysed. Results A 10-fold reduction of admissions and deaths for pneumococcal pneumonia and a 3-fold reduction of meningococcal sepsis were observed after the introduction of the antipneumococcal and antimeningococcal vaccine in the NVP, respectively. Conclusions These results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children and can provide evidence to educate the public towards vaccination. Key messages The results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children. The results show a 10x reduction in pneumococcal pneumonia hospital admission and deaths and a 3x in meningococcal meningitis.

Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study.

ABSTRACTOBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment.METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons.RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently.CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

Palliative care for non-cancer conditions in primary care: a time trend analysis in the UK (2009–2014)

ObjectivesWhile guidelines recommend palliative care in non-cancer conditions, this has not been widely implemented. We examined whether the recording of a palliative care approach and the numbers of hospital deaths...

343-OR: Trends in A1C and Lipid Testing, Antilipid Therapy, and Target Attainment following First-Time Glucose-Lowering Drug Treatment in Type 2 Diabetes, Denmark, 2000-2017

Objective: To examine 18-year trends in early A1C and lipid control among patients initiating first-time glucose-lowering drug therapy (GLD) for type 2 diabetes. Materials and Methods: Population-based sequential cross-sectional study using healthcare databases covering Northern Denmark (∼1.8 million persons). For all 94,175 GLD initiators during 2000-2017, we examined likelihood of A1C and lipid testing, antilipid therapy, and 1-year glycemic and LDL cholesterol target achievement. Results: The proportion of patients with at least one A1C test increased from 53% in 2000 to 95% in 2017 (Figure, Panel A). Lipid testing increased from 82% to 98% and lipid lowering therapy initiation quintupled from 12% to 61%. Mean pre-treatment A1C declined substantially, from 9.2% (77 mmol/mol) to 7.3% (56 mmol/mol) in 2011, then rose to 7.9% (63 mmol/mol) in 2017 (Panel B). Post-treatment A1C decreased less; pre- and post-treatment LDL cholesterol declined similarly. The proportion of patients achieving glycemic and cholesterol targets increased substantially over time (Panel C). Conclusion: Monitoring and treatment of A1C and cholesterol in early type 2 diabetes have improved considerably over the past 18 years, while quality improvement was somewhat flat after the 2011 change in diagnostic criteria. Disclosure J.S. Knudsen: None. D.R. Witte: None. A. Hulman: None. P.F. Rønn: Research Support; Self; Amgen AB. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. T. Lauritzen: Advisory Panel; Self; AstraZeneca. Board Member; Self; Novo Nordisk A/S. H.T. Sôrensen: None. R.W. Thomsen: None. Funding Aarhus University

Changes in Older Adults' Oral Health and Disparities: 1999 to 2004 and 2011 to 2016.

To examine changes in tooth loss and untreated tooth decay among older low-income and higher-income US adults and whether disparities have persisted. Sequential cross-sectional study using nationally representative data. The 1999 to 2004 and 2011 to 2016 National Health and Nutrition Examination Survey. Noninstitutionalized US adults, aged 65 years and older (N = 3539 for 1999-2004, and N = 3514 for 2011-2016). Differences in prevalence of tooth loss (having 19 teeth or fewer, 8 teeth or fewer, and no teeth) and untreated decay and mean number of decayed and missing teeth (DMT) between low- and high-income adults 65 years and older in each survey and changes between surveys. Adjusted prevalence and count outcomes were estimated with logistic and negative binomial regression models, respectively. Models controlled for sociodemographic characteristics and smoking status. Reported findings are significant at P < .05. In 2011 to 2016, unadjusted prevalence of having 19 teeth or fewer, 8 teeth or fewer, no teeth, and untreated decay among low-income adults 65 years and older was 50.6%, 42.0%, 28.6%, and 28.6%, respectively. Multivariate analyses indicated that although most tooth loss measures improved between surveys for both income groups, tooth loss among low-income adults remained at almost twice that among higher-income adults. The disparity in untreated decay prevalence in 2011 to 2016, 15.2 percentage points (26.1% vs 10.9% for low vs high income) was twice that in 1999 to 2004, 8.5 percentage points (22.9% vs 14.4% for low vs high income). DMT decreased for both groups, with lower-income adults having about five more affected teeth in both surveys. Tooth loss is decreasing, but differential access to restorative care by income appears to have increased.

Validation of a measurement instrument for parental child feeding in a low and middle-income country

BackgroundParental child feeding practices (PCFP) are a key factor influencing children’s dietary intake, especially in the preschool years when eating behavior is being established. Instruments to measure PCFP have been developed and validated in high-income countries with a high prevalence of childhood obesity. The aim of this study was to test the appropriateness, content, and construct validity of selected measures of PCFP in a low and middle-income country (LMIC) in which there is both undernutrition and obesity in children.MethodsAn expert panel selected subscales and items from measures of PCFP that have been well-tested in high-income countries to measure both “coercive” and “structural” behaviors. Two sequential cross-sectional studies (Study 1, n = 154; Study 2, n = 238) were conducted in two provinces in Indonesia. Findings of the first study were used to refine subscales used in Study 2. An additional qualitative study tested content validity from the perspective of mothers (the intended respondents). Factorial validation and reliability were also tested. Convergent validity was tested with child nutritional status.ResultsIn Study 1, a confirmatory factor analysis (CFA) model with 11 factors provided good fit (RMSEA = 0.045; CFI = 0.95 and TLI = 0.95) after two subscales were removed. Reliability was good among seven of the subscales. Following a decision to take out an additional subscale, the instrument was tested for factorial validity (Study 2). A CFA model with 10 subscales provided good fit (RMSEA = 0.03; CFI = 0.92 and TLI = 0.90). The reliability of subscales was lower than in Study 1. Convergent validity with nutrition status was found with two subscales.ConclusionsThe two studies provide evidence of acceptable psychometric properties for 10 subscales from tested instruments to measure PCFP in Indonesia. This provides the first evidence of the validity of these measures in a LMIC setting. Some shortcomings, such in the reliability of some subscales and further tests of predictive validity, require further investigation.

Impact of London's low emission zone on air quality and children's respiratory health: a sequential annual cross-sectional study

SummaryBackgroundLow emission zones (LEZ) are an increasingly common, but unevaluated, intervention aimed at improving urban air quality and public health. We investigated the impact of London's LEZ on air quality and children's respiratory health.MethodsWe did a sequential annual cross-sectional study of 2164 children aged 8–9 years attending primary schools between 2009–10 and 2013–14 in central London, UK, following the introduction of London's LEZ in February, 2008. We examined the association between modelled pollutant exposures of nitrogen oxides (including nitrogen dioxide [NO2]) and particulate matter with a diameter of less than 2·5 μm (PM2·5) and less than 10 μm (PM10) and lung function: postbronchodilator forced expiratory volume in 1 s (FEV1, primary outcome), forced vital capacity (FVC), and respiratory or allergic symptoms. We assigned annual exposures by each child's home and school address, as well as spatially resolved estimates for the 3 h (0600–0900 h), 24 h, and 7 days before each child's assessment, to isolate long-term from short-term effects.FindingsThe percentage of children living at addresses exceeding the EU limit value for annual NO2 (40 μg/m3) fell from 99% (444/450) in 2009 to 34% (150/441) in 2013. Over this period, we identified a reduction in NO2 at both roadside (median −1·35 μg/m3 per year; 95% CI −2·09 to −0·61; p=0·0004) and background locations (−0·97; −1·56 to −0·38; p=0·0013), but not for PM10. The effect on PM2·5 was equivocal. We found no association between postbronchodilator FEV1 and annual residential pollutant attributions. By contrast, FVC was inversely correlated with annual NO2 (−0·0023 L/μg per m3; −0·0044 to −0·0002; p=0·033) and PM10 (−0·0090 L/μg per m3; −0·0175 to −0·0005; p=0·038).InterpretationWithin London's LEZ, a smaller lung volume in children was associated with higher annual air pollutant exposures. We found no evidence of a reduction in the proportion of children with small lungs over this period, despite small improvements in air quality in highly polluted urban areas during the implementation of London's LEZ. Interventions that deliver larger reductions in emissions might yield improvements in children's health.FundingNational Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London, NHS Hackney, Lee Him donation, and Felicity Wilde Charitable Trust.

Inequalities in hip fracture incidence are greatest in the North of England: regional analysis of the effects of social deprivation on hip fracture incidence across England.

Hip fracture risk varies by geography and by levels of deprivation. We examined the effect of local area-level deprivation on hip fracture incidence across nine regions in England, using 14 years of hospital data, to determine whether inequalities in hip fracture incidence rates vary across geographic regions in England. Sequential annual cross-sectional studies over 14 years. We used English Hospital Episodes Statistics (2001/02-2014/15) to identify hip fractures in adults aged 50+years and mid-year population estimates (2001-2014) from the Office for National Statistics. The Index of Multiple Deprivation was used to measure local area deprivation. We calculated age-standardised hip fracture incidence rates per 100,000 population, stratified by gender, geographic region, deprivation quintiles and time-period, using the 2001 English population as the reference population. Using Poisson regression, we calculated age-adjusted incidence rate ratios (IRRs) for hip fracture, stratified as above. Over 14 years, we identified 747,369 hospital admissions with an index hip fracture. Age-standardised hip fracture incidence was highest in the North East for both men and women. In North England (North East, North West and Yorkshire and the Humber), hip fracture incidence was relatively higher in more deprived areas, particularly among men: IRR most vs least deprived quintile 2.06 (95% confidence interval [CI] = 2.00-2.12) in men, 1.62 (95% CI 1.60-1.65) in women. A relationship, albeit less marked, between deprivation and hip fracture incidence was observed among men in the Midlands and South, but with no clear pattern among women. Regional variation in hip fracture incidence exists across England, with the greatest absolute burden of incident hip fractures observed in the North East for both men and women. Across local areas in North England, absolute and relative inequalities in hip fracture incidence were greater than in other regions. Our findings highlight the need for improved fracture prevention programmes that aim to reduce regional and social inequalities in hip fracture incidence.

Although the Magnitude Varied, Income-Related Inequalities in Untreated Dental Caries were Consistently Found among Young Children in 3 US Surveys

Trends in income-related inequality in untreated caries among children in the United States: findings from NHANES I, NHANES III, and NHANES 1999-2004. Capurro DA, Iafolla T, Kingman A, Chattopadhyay A, Garcia J. Community Dent Oral Epidemiol 2015;43(6):500-10 SOURCE OF FUNDING: Information not available (Sequential) cross-sectional study.

Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study.

Fibrinolytic therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention. Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of fibrinolytic therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention. We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for fibrinolytic therapy. The weighted proportion of ideal candidates receiving fibrinolytic therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 ( Ptrend=0.0042). There were no regional differences in fibrinolytic therapy use. Almost all ideal patients (95.1%) were treated after admission to the hospital rather than in the emergency department. Median admission to needle time was 35 minutes (interquartile range 10-82) in 2011, which did not improve from 2006. Underdosing was common. Urokinase, with little evidence of efficacy, was used in 90.2% of patients. Over the past decade in China, the potential benefits of fibrinolytic therapy were compromised by underuse, patient and hospital delays, underdosing and the predominant use of urokinase, an agent for which there is little clinical evidence. There are ample opportunities for improvement.

Effects of Air Pollution and the Introduction of the London Low Emission Zone on the Prevalence of Respiratory and Allergic Symptoms in Schoolchildren in East London: A Sequential Cross-Sectional Study.

The adverse effects of traffic-related air pollution on children’s respiratory health have been widely reported, but few studies have evaluated the impact of traffic-control policies designed to reduce urban air pollution. We assessed associations between traffic-related air pollutants and respiratory/allergic symptoms amongst 8–9 year-old schoolchildren living within the London Low Emission Zone (LEZ). Information on respiratory/allergic symptoms was obtained using a parent-completed questionnaire and linked to modelled annual air pollutant concentrations based on the residential address of each child, using a multivariable mixed effects logistic regression analysis. Exposure to traffic-related air pollutants was associated with current rhinitis: NOx (OR 1.01, 95% CI 1.00–1.02), NO2 (1.03, 1.00–1.06), PM10 (1.16, 1.04–1.28) and PM2.5 (1.38, 1.08–1.78), all per μg/m3 of pollutant, but not with other respiratory/allergic symptoms. The LEZ did not reduce ambient air pollution levels, or affect the prevalence of respiratory/allergic symptoms over the period studied. These data confirm the previous association between traffic-related air pollutant exposures and symptoms of current rhinitis. Importantly, the London LEZ has not significantly improved air quality within the city, or the respiratory health of the resident population in its first three years of operation. This highlights the need for more robust measures to reduce traffic emissions.

Shifting Values and Life Satisfaction: A Sequential Cross-Sectional Study of the Influence of Values on Subjective Wellbeing in Singapore

This paper compares the findings of two sequential cross-sectional studies of Singaporeans conducted in 2001 and 2011 with regard to the stability of values and their influence on life satisfaction. Using supporting literature, we propose several hypotheses on the relationships between values and Singaporeans’ life satisfaction. We first report the means, importance ranks and changes in percentages for the values in the List of Values and the movements over the years. While values like security and sense of belonging have become more important, being well-respected has become less important over the decade. We then discuss the levels of life satisfaction, satisfaction with specific life domains and overall life satisfaction for Singaporeans, and the changes over 10 years. Using regression analyses and ANOVA, we examine the impact of shifting values and certain demographic variables on the life satisfaction of Singaporeans over the decade. Excitement and warm relationships with others were found to have a significant and positive influence on life satisfaction for both 2001 and 2011. The positive impact of self respect on life satisfaction was only significant in 2001, while security and sense of belonging had a significant negative and positive impact respectively on life satisfaction only in 2011. The effects of these values on life satisfaction were felt differently across age, gender, marital status, education, and income levels in 2001 and 2011. We conclude the paper with limitations and implications for policy making and future research.

Changes in use, knowledge, beliefs and attitudes relating to tobacco among nursing and physiotherapy students: a 10-year analysis.

To analyse changes in prevalence, knowledge, beliefs and attitudes relating to smoking among undergraduate nursing and physiotherapy students over a 10-year period. Few studies have been performed to describe changes in the use of tobacco and associated characteristics. This study was a sequential cross-sectional study. A self-administered survey was performed during three academic years among nursing and physiotherapy students in a Spanish Faculty of Health Sciences. The proportion of smokers among nursing and physiotherapy students in 2003, 2008 and 2013 was 29·3%, 24·7% and 18·2% respectively. The ages when participants first smoked did not vary over the years. The Fagerström test showed low nicotine dependence. A significantly high percentage of students stated they were unaware of the link between smoking and bladder cancer and oral leukoplakia. Students declared they were unaware of the association between under-weight new-borns and second-hand smoke. The majority of students recognized that healthcare professionals were role models in society, there being little variation over the years studied. In relation to education and training, the study showed a need to inform students about methods and strategies to help people quit smoking. The prevalence of smoking among nursing and physiotherapy students decreased over the ten years. Active programmes should be implemented to encourage those university students who smoke to break this habit. The decline over the years in knowledge about smoking provided evidence of a significant deficit in undergraduate training.