Associations between near work, outdoor activity, and myopia among adolescent students in rural China: the Xichang Pediatric Refractive Error Study report no. 2.

OBJECTIVE:

To study the associations between near work, outdoor activity, and myopia among children attending secondary school in rural China.

METHODS:

Among a random cluster sample of 1892 children in Xichang, China, subjects with an uncorrected acuity of 6/12 or less in either eye (n = 984) and a 25% sample of children with normal vision (n = 248) underwent measurement of refractive error. Subjects were administered a questionnaire on parental education, time spent outdoors, and weekly time spent engaged in and preferred working distance for a variety of near-work activities.

RESULTS:

Among 1232 children with refraction data, 998 (81.0%) completed the near-work survey. Their mean age was 14.6 years (SD, 0.8 years), 55.6% were girls, and 83.1% had myopia of -0.5 diopters or less (more myopia) in both eyes. Time and diopter-hours spent on near activities did not differ between children with and without myopia. In regression models, time spent on near activities and time outdoors were unassociated with myopia, adjusting for age, sex, and parental education.

CONCLUSIONS:

These and other recent results raise some doubts about the association between near work and myopia. Additional efforts to identify other environmental factors associated with myopia risk and that may be amenable to intervention are warranted.

Asthma control and exacerbations: two different sides of the same coin.

Purpose of review: Optimal asthma management includes both the control of asthma symptoms and reducing the risk of future asthma exacerbations. Traditionally, treatment has been adjusted largely on the basis of symptoms and lung function and for many patients, this approach delivers both excellent symptom control and reduced risk. However, the relationship between these two key components of the disease may vary between different asthmatic phenotypes and disease severities and there is increasing recognition of the need for more individualized treatment approaches.

Recent findings: A number of factors which predict exacerbation risk have been identified including demographic and behavioural features and specific inflammatory biomarkers. Type-2 cytokine-driven eosinophilic airways inflammation predisposes to frequent exacerbations and predicts response to corticosteroids, and the usefulness of sputum eosinophilia as both a marker of exacerbation risk and biomarker for adjustment of corticosteroid treatment has been established for some time. However, attempts to develop surrogate markers, which would be more straightforward to deliver in the clinic, have been challenging.

Summary: Some patients with asthma have persistent symptoms in the absence of type-2 cytokine driven-eosinophilic airways inflammation due to noncorticosteroid responsive mechanisms (T2-low disease). Composite biomarker strategies using easily measured surrogate indicators of type-2 inflammation (such as fractional exhaled nitric oxide, blood eosinophil count and serum periostin levels) may predict exacerbation risk better but it is unclear if they can be used to adjust corticosteroid treatment. Biomarkers will be used to target novel biologic treatments but additionally may be used to optimize corticosteroid treatment dose and act as prognostics for exacerbation risk and potentially other important longer term asthma outcomes.

A Reappraisal of the Safety and Cost-Effectiveness of Statin Therapy in Primary Prevention

Statins are among the most investigated drugs of all time. There is now a wealth of evidence supporting their use in the primary and secondary prevention arenas. The reduction in event recurrence has since been demonstrated across all levels of risk and in elderly patients. As a result, it is now accepted practice for statins to be prescribed universally in secondary prevention unless contraindicated. The extension of this policy into the primary prevention setting is more problematic, with moral and financial issues arising from the long-term treatment of many young apparently healthy individuals. For these reasons it is necessary to prove not only the financial sustainability of such a strategy but also the long-term safety of statins and the degree of benefit that might be expected.

Aflatoxin Exposure and Associated Human Health Effects, a Review of Epidemiological Studies

flatoxins are fungal toxins that possess acute life threatening toxicity, carcinogenic properties and other potential chronic adverse effects. Dietary exposure to aflatoxins is considered a major public health concern, especially for subsistence farming communities in sub-Saharan Africa and South Asia, where dietary staple food crops such as groundnuts and maize are often highly contaminated with aflatoxin due to hot and humid climates and poor storage, together with low awareness of risk and lack of enforcement of regulatory limits. Biomarkers have been developed and applied in many epidemiological studies assessing aflatoxin exposure and the associated health effects in these high-risk population groups. This review discusses the recent epidemiological evidence for aflatoxin exposure, co-exposure with other mycotoxins and associated health effects in order to provide evidence on risk assessment, and highlight areas where further research is necessary. Aflatoxin exposure can occur at any stage of life and is a major risk factor for hepatocellular carcinoma, especially when hepatitis B infection is present. Recent evidence suggests that aflatoxin may be an underlying determinant of stunted child growth, and may lower cell-mediated immunity, thereby increasing disease susceptibility. However, a causal relationship between aflatoxin exposure and these latter adverse health outcomes has not been established, and the biological mechanisms for these have not been elucidated, prompting further research. Furthermore, there is a dearth of information regarding the health effects of co-exposure to aflatoxin with other mycotoxins. Recent developments of biomarkers provide opportunities for important future research in this area.

The Valuation Implications of Enterprise Risk Management Maturity

Enterprise Risk Management (ERM) is the discipline by which enterprises monitor, analyze, and control risks from across the enterprise, with the goal of identifying underlying correlations and thus optimizing the risk-taking behavior in a portfolio context. This study analyzes the valuation implications of ERM Maturity. We use data from the industry leading Risk and Insurance Management Society Risk Maturity Model over the period from 2006 to 2011, which scores firms on a five-point maturity scale. Our results suggest that firms that have reached mature levels of ERM are exhibiting a higher firm value, as measured by Tobin's Q. We find a statistically significant positive relation to the magnitude of 25 percent. Upon decomposition of the maturity score, we find that the most important aspects of ERM from a valuation perspective relate to the level of top–down executive engagement and the resultant cascade of ERM culture throughout the firm. Firms that have successfully integrated the ERM process into both their strategic activities and everyday practices display superior ability in uncovering risk dependencies and correlations across the entire enterprise and as a consequence enhanced value when undertaking the ERM maturity journey ceteris paribus.

Growing Up On an Interface: Findings and Implications for the Social Needs, Mental Health and Lifetime Opportunities of Belfast Youth

In this research we aimed to find out what types of risk (if any) affected young people and children growing up in places of high religious segregation or what we normally call interface communities. This is important as we know that risk and experiences of harm and violence can have negative impacts upon development, emotional well-being and future prospects. It is important to understand what types of risk affect young people and children so as we can respond to these in terms of aiding better personal and community development with regard to health, work, education and wider opportunities.

Substance Use and Misuse : Adolescent Substance Use in the context of the family ; a qualitative study of young people's views on parent child attachments , parenting style and parental substance use

Introduction and Aims. While the role of the family in adolescent substance use has been well documented, few studies have attempted to explore in-depth youth perceptions of how these familial processes/dynamics influence teenage substance use. This paper reports the findings from a study exploring risk and protective factors for teenage substance use within the context of the family as perceived by young people with a view to informing current and future family based prevention and education interventions.
Design and Methods. Data collection took place in nine post-primary schools across Northern Ireland. Nine focus groups using participatory techniques were facilitated with a purposive sample of sixty-two young people (age 13-17 years). Data were transcribed verbatim and analysed using a content/thematic analysis.
Results. Three broad themes/aspects of the family emerged from the data, which may serve to protect or attenuate the risk of substance use among young people. Parent-child attachment was a major theme identified in protecting adolescents from substance use in addition to effective parenting particularly an authoritative style of parenting supplemented by parental monitoring and good parent-child communication to encourage child disclosure. Family substance use was deemed to impact on children’s substance use if exposed at an early age and the harms associated with PSM were discussed in detail.
Discussion and Conclusions. The qualitative approach provides insight into current understanding of youth perceptions of substance use in the context of family dynamics. A number of recommendations are outlined. Family based (preventive) interventions/parenting programmes may benefit from components on effective parenting including authoritative styles, parental monitoring, effective communication, spending time together (building attachments), parent-child conflict, adolescent development and factors which impact on parenting. Parenting programmes tailored to mothers and fathers may be beneficial. School based interventions targeting children/adolescents may be best placed to target children living with parental substance misuse.
Keywords: substance/substance related disorders, focus groups, young people/adolescent,

Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium

BACKGROUND: Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality.

METHODS: This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs.

RESULTS: Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking.

CONCLUSIONS: This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.

Indoor air quality in elementary schools of Lisbon and Aveiro

Tem havido uma preocupação crescente com a qualidade do ar interior (QAI) nas escolas em muitos países. Muitos estudos epidemiológicos têm encontrado diferenças regionais entre ambientes interiores. Apesar da elevada incidência de asma e rinite na população infantil, praticamente nada se sabia sobre a QAI em escolas portuguesas. A percepção dos problemas de QAI é crucial para avaliar os riscos para a saúde e rendimento dos estudantes, e para sugerir meios de reduzir a exposição a poluentes indesejáveis. Neste estudo procurou-se obter as concentrações de poluentes de interesse em estabelecimentos de ensino do 1º ciclo de Lisboa e Aveiro, estimar o estado atual de casos de asma e rinite em escolas primárias da capital, avaliar a influência de diferentes materiais das salas de aula/construção e hábitos escolares na QAI, identificar potenciais fontes de poluentes nos interiores e exteriores das salas de aula e propor medidas mitigadoras. Catorze escolas de Lisboa foram visitadas para obter a caracterização física das construções em termos de estrutura, ventilação, materiais de acabamento, produtos de limpeza, densidade de ocupação e potenciais fontes interiores de poluição. Os estudantes foram questionados sobre os seus hábitos e sintomas respiratórios através de inquéritos do modelo ISAAC (International Study of Asthma and Allergies in Childhood). Durante a primavera, outono e inverno (2008-2010), nas salas de aula e pátios, foram monitorizados, por amostragem passiva, compostos orgânicos voláteis (COVs), carbonilos e dióxido de azoto (NO2). Foram também medidos parâmetros de conforto e níveis de microrganismos. Duas escolas localizadas, uma no centro da cidade e outra na região suburbana, em Aveiro foram estudadas em 2010. Parâmetros de conforto, microrganismos, COVs, NO2, material particulado (PM10) foram medidos no interior e no exterior de ambas escolas. Os iões solúveis, carbono orgânico e elementar (OC e EC), e compostos orgânicos presentes no material particulado foram subsequentemente analisados em laboratório. Uma medida mitigadora - fitoremediação - foi avaliada na escola do centro da cidade de Aveiro em 2011. Os resultados do estudo mostraram que a QAI é pior do que a do ar exterior. Em geral, os níveis de CO2 e dos bioaerosóis excederam os níveis máximos aceitáveis para o conforto dos ocupantes estipulado pelas regulamentações portuguesas. Quase todos os COVs e carbonilos identificados mostraram razões interior/exterior (I/E) maiores que uma unidade, o que demonstra a importante contribuição de fontes interiores em todas as escolas. As razões I/E das concentrações de NO2 nunca excederam a unidade. Os níveis interiores diários de PM10 foram sempre maiores que os exteriores, exceto nos fins de semana. Após a colocação de plantas numa das salas de aula, observou-se uma redução estatisticamente significativa nos níveis de CO2, COVs, carbonilos, PM10, OC, e dos iões nitrato, sulfato, amónia, cálcio e carbonato. A possível redução dos níveis de poluentes no interior após a colocação de plantas pode representar uma solução de baixo custo para reduzir a exposição a muitos compostos, melhorar o rendimento e aumentar o bem estar dos alunos e professores em sala de aula.

Human biomonitoring : biomarkers, individual susceptibility, and nutrigenetics

Tese de doutoramento, Biologia (Genética), Universidade de Lisboa, Faculdade de Ciências, 2015

Exploring Variations in Teachers' Work, Lives and Their Effects on Pupils: Key Findings and Implications from a Longitudinal Mixed Methods Study

This article outlines the research design of a large‐scale, longitudinal research study in England intended to describe and explore variations in teachers' work, lives and their effects on pupils' educational outcomes. The study, funded by the Department for Education and Skills (DfES) and incorporated into the Teaching and Learning Research Programme (TLRP) as an ‘Associate Project’, used an innovative mixed‐methods research design to create case studies of 300 teachers in Years 2, 6 and 9. The research was conducted over three consecutive academic years and collected a wide range of data through interviews, questionnaire surveys of teachers' and pupils' views and assessment data on pupils' attainments in English and mathematics. The text summarises the main findings from the research in relation to four interconnected themes of the study: Professional Life Phases; Professional Identity; Relative Effectiveness; and Resilience and Commitment. The influence of school context, in terms of level of social disadvantage of pupil intake, is also investigated. Key findings and their implications for policy and practice are highlighted.

Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

A Benefit-Risk Assessment Framework for Development of Clinical Guidelines in Diagnostic Radiology

Thesis (Ph.D.)--University of Washington, 2015-12

Chancen und herausforderungen der rückversicherung in der gesetzlichen krankenversicherung (Chances and challenges of reinsurance in the social health scheme)

In 2009 a so-called morbidity orientated risk structure equalization scheme was installed for the German statutory health insurance in order to minimize structural differences between different providers with respect to revenue and expenditures. Even with this mechanism some risks to the individual health insurance providers remain. Reinsurance could be a way to mitigate these risks, but so far only very few contracts have been signed. Moreover the existing reinsurance contracts only focus on the periphery of the statutory health insurance system such as travel health insurance. In this article we therefore analyse existing risks for individual health insurance providers and evaluate their (re-)insurability. Hereafter the potential for reinsurance solutions in the German statutory health insurance itself as well as in newer forms of healthcare provision (e.g. integrated health care and managed care) is discussed. We find that reinsurance may be a reasonable solution for many of the risks in the statutory health insurance scheme. But as research in this area is very young further analysis of the nature of risks is necessary.

Rethinking gossip and scandal in healthcare organizations

Purpose – The purpose of this viewpoint paper is to argue that gossip is a neglected aspect of organizational communication and knowledge, and an under-used management resource. Design/methodology/approach – The paper challenges mainstream managerial assumptions that gossip is trivial or tainted talk which should be discouraged in the workplace. Instead, gossip is re-framed at an organizational level of analysis, which provides the opportunity for relational knowledge about systemic failure and poor practice in healthcare to surface. Findings – Rather than simply viewing gossip as an individual behaviour and interpersonal process, it is claimed that organizational gossip is also a valuable early warning indicator of risk and failure in healthcare systems. There is potentially significant value in re-framing gossip as an aspect of organizational communication and knowledge. If attended to (rather than neglected or silenced) gossip can provide fresh insights into professional practice, decision-making and relational leadership. Originality/value – This paper offers a provocative challenge to mainstream health organization and management thinking about gossip in the workplace. It offers new ways of thinking to promote patient safety, and prevent the scandals that have plagued healthcare organizations in recent years.