A recent paper suggests that suicidal rates remained stable in Greece during the last decade,1 despite the unprecedented economic downturn that the country has and is still facing.
The authors of the paper insist on misinterpreting the data concerning suicide mortality rates in Greece, based on two false assumptions. The first is their argument that the period 2007–2010 covers only 1 year (2010) of economic hardship for Greece, and the second is that the suicide mortality trends show no variation between age groups and sex.
As figures in table 1 show, the total suicide mortality rate in Greece increased by 11.7% between 2007 and 2010. This period coincides with the shrinking of the Greek economy (Gross Domestic Product (GDP) decreased by 6.8% between 2007 and 2010), which actually started in the fourth quarter of 2007 when GDP showed zero or close to zero growth rates for the...
In the early weeks of January 2012, a report of four cases of tuberculosis from Mumbai, India, stirred up a storm.1 India bears a giant's share of the world's multidrug-resistant tuberculosis (MDR-TB) burden, but these cases were different even though they came from a centre (Hinduja Hospital and Research Center) which has been reporting on the alarming escalation in drug-resistant TB in Mumbai over the last two decades. The four patients described in this report were resistant to all first-line (isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin) and second-line drugs (kanamycin, amikacin, capreomycin, ofloxacin, moxifloxacin, ethionamide and para-amino salicylic acid) to which they were tested. That the report came from Mumbai's most reputed mycobacterial laboratory, accredited for drug susceptibility testing (DST) by the Revised National TB Control Program (RNTCP), and serving as the de facto reference mycobacterial laboratory for the city added to the veracity of this...
The HIV/AIDS pandemic has so far caused about 35 million deaths, while 34 million individuals currently live with HIV.12 Even if this will have no impact on the course of the epidemic, understanding the factors that allowed the successful emergence of HIV-1 is important, first as a moral obligation towards the victims, but also to draw lessons that could ultimately help mankind avoid facing similar threats in the future.
Over the last 12 years, much progress has been made in unravelling the complex chain of events that led to the worst pandemic of modern times. The source of HIV-1 group M (‘M’ for main) is the Pan troglodytes troglodytes chimpanzee of central Africa34 which inhabits southern Cameroon, Gabon, Equatorial Guinea, the Congo–Brazzaville, the southwest of the Central African Republic, the Cabinda enclave of Angola and a small part of the...
Food safety incidents in China over the past two decades1 have not just threatened the health of the people in the country but have also caused international concern, as China is now a major food exporter in the international market.2 One of the most infamous food safety scandals in China in recent years, the ‘melamine milk’ incident, came to light in September 2008. This incident attracted so much international attention that within about 2 months, the United Nations system launched a paper to prompt China to improve food safety.3 In this editorial, readers will be updated with the recent and less well-known changes to the major control mechanisms for food safety in mainland China. Major weaknesses in this control regime will be discussed in order to raise awareness, as well as to pave the way for making recommendations for improvement.
Food safety is one of the most important public health issues worldwide. It has also become one of the most challenging social issues in China that needs to be addressed. Domestic issues concerning food safety occur more frequently in China than in other countries; there are loopholes in all the aspects of the food chain—from the farm to the table; public concerns over food safety are growing. A severe scandal related to food safety was recently exposed with regards to the production and extensive use of banned cooking oil which shows that China faces a grave situation in ensuring food safety. In contrast with the different major food safety issues in developed countries, China is dealing with recurrent instances of foodborne diseases, not due to micro-organisms or environmental pollutants, but due to the illegal use of pesticides and veterinary drugs as well as adulterated materials.1
According to WHO,1 health impact assessment (HIA) is
A combination of procedures, methods and tools used to evaluate the potential health effects of a policy, programme or project. Using qualitative, quantitative and participatory techniques, HIA aims to produce recommendations that will help decision makers and other stakeholders make choices about alternatives and improvements to prevent disease/injury, and to actively promote health.
The typical procedural steps in HIA include screening, scoping, assessment of health effects, recommending alternatives and mitigations, reporting and monitoring.2 Each step helps predict or foresee potential effects of policy decisions on a population's health. In specific, quantitative risk assessment, an essential component of HIA, provides estimations of the potential health risks or impacts associated with a variety of hazards.3–6
Since the beginning of HIA development, environmental risk factors have been one of the...
Previous studies have proposed that higher blood pressure (BP) in winter is an important cause of increased mortality from cardiovascular disease during the winter. Some observational and physiological studies have shown that cold exposure increases BP, but evidence from a randomised controlled study assessing the effectiveness of intensive room heating for lowering BP was lacking.
The present study aimed to determine whether intensive room heating in winter decreases ambulatory BP as compared with weak room heating resulting in a 10°C lower target room temperature when sufficient clothing and bedclothes are available.
We conducted a parallel group, assessor blinded, simple randomised controlled study with 1:1 allocation among 146 healthy participants in Japan from November 2009 to March 2010. Ambulatory BP was measured while the participants stayed in single experimental rooms from 21:00 to 8:00. During the session, participants could adjust the amount of clothing and bedclothes as required. Compared with the weak room heating group (mean temperature±SD: 13.9±3.3°C), systolic morning BP (mean BP 2 h after getting out of bed) of the intensive room heating group (24.2±1.7°C) was significantly lower by 5.8 mm Hg (95% CI 2.4 to 9.3). Sleep-trough morning BP surges (morning BP minus lowest night-time BP) in the intensive room heating group were significantly suppressed to about two thirds of the values in the weak room heating group (14.3 vs 21.9 mm Hg; p<0.01).
Intensive room heating decreased morning BP and the morning BP surge in winter.
Structural interventions focused on community mobilisation to engender an enabling social context have reduced sexual risk behaviours among sex workers. Interventions to date have increased social participation and shown an association between participation and safer sex. Social participation could modify risk for other health behaviours, particularly drug use. We assessed social participation and drug use before and after implementation of a clinical, social and structural intervention with sex workers intended to prevent sexually transmitted infections/HIV infection.
We followed 420 sex workers participating in the Encontros intervention in Corumbá, Brazil, between 2003 and 2005. We estimated the association of participation in external social groups with drug use at baseline and follow-up using logistic regression and marginal modelling. Follow-up analyses of preintervention/postintervention change in drug use employed inverse probability weighting to account for censoring and were stratified by exposure to the intervention.
Social participation showed a protective association with drug use at baseline (1 SD higher level of social participation associated with 3.8% lower prevalence of drug use, 95% CI –0.1 to 8.3). Among individuals exposed to Encontros, higher social participation was associated with an 8.6% lower level of drug use (95% CI 0.1 to 23.3). No significant association was found among the unexposed.
A structural intervention that modified sex workers’ social environment, specifically participation in external social groups, was associated with reduced drug use. These findings suggest that sexual risk prevention initiatives that enhance social integration among marginalised populations can produce broad health impacts, including reductions in drug use.
The aim of this article was to anthropologically analyse knowledge and practices about hydration and rehydration in a specific ethnographic context, where diverse therapies are combined to treat and take care of child diarrhoea as part of a wider social process that circumscribes transactions between self-care and biomedicine.
Ethnographic data from a qualitative study in the neighbourhood of Nova Constituinte (Salvador, Bahia) which was part of an interdisciplinary project aimed at epidemiologically evaluating an environmental sanitation programme. These data results from a series of in-depth interviews of 29 interviewees and field observations collected over two stages (1997/1998–2003/2004).
Knowledge about hydration and rehydration is practical knowledge that demonstrates some of the cultural limits of dehydration in terms of the normality or pathology criteria related to child diarrhoea. This knowledge belongs to local interpretations, treatment experiences and the care that mothers provide in relation to their child's diarrhoea. We observed a process of medicalisation in the discourse about hydration and self-care.
Unlike rehydration, hydration is structural to self-care processes. While the former constitutes a way of alleviating diarrhoea, the latter is a type of care centred on healing. The difference between these practices does not lie in the type of remedies used but in the meaning attributed to them and the way they are combined.
Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load.
In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation.
Parental interest in their offspring's studies during the last year of compulsory school—rather than the parent's social class or availability of practical academic support—was found to predict adult allostatic load (β=–0.12, 95% CI –0.20 to –0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load.
Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.
In March 2007, the Hong Kong Government halved its heavy excise taxes on beer and wine, and 1 year later, it eliminated all duties on these beverages. This study examines the impact of such duty reductions on cardiovascular disease (CVD)-related mortality among the elderly in Hong Kong.
Box-Jenkins autoregressive integrated moving average intervention time series analyses were applied to monthly morality data from 2001 to 2010 to quantify the impacts of duty reduction and exemption on CVD death rates among those aged 65 years or older.
The alcohol duty reduction in March 2007 was associated with an estimated 13% increase (95% CI 2% to 24%) in CVD death rates among elderly men, after controlling for the other intervention, outlier, trends and seasonal variations. This was equivalent to an extra 11 CVD deaths per 100 000 elderly men each month. Much of the observed impacts on CVD death rates were found to have contributed only by that on ischaemic heart disease mortality (18% increase in rate for men (95% CI 4% to 34%); 15% increase for women (95% CI 0.4% to 31%)), not by mortality due to stroke or hypertension. The alcohol duty exemption on March 2008 was not found to have impacted the CVD death rates.
The increase in CVD death rates among the Chinese elderly after alcohol duty reduction suggest that the purported beneficial effect of moderate alcohol use may not apply to certain Chinese populations, adding fuel to the ongoing debate on the risks and benefits of moderate alcohol consumption on mortality.
Mortality increases during heat waves have been reported worldwide. The magnitude of these increases can vary within regions according to sociodemographic and urban landscape characteristics. The objectives of this study were to explore this variation and its determinants, and to identify the most heat-vulnerable areas by mapping heat vulnerability.
We conducted a time-stratified case-crossover analysis using daily mortality in the Barcelona metropolitan area during the warm seasons of 1999–2006. Temperature data on the date of death were assigned to each individual, which were assigned to their census tract of residence. Eight census tract-level variables on socioeconomic or built environment characteristics were obtained from the census. Residence surrounding greenness was obtained from satellite data. The relative risk (RR) of mortality after three consecutive hot days (defined as those exceeding the 95th percentile of maximum temperature) was calculated via conditional logistic regression. Effect modification was examined by including interaction terms.
Analyses were based on 52 806 deaths. The effect of three consecutive hot days was a 30% increase in all-cause mortality (RR=1.30, 95% CI 1.24 to 1.38). Heterogeneity of this effect was observed across census tracts. The effect of heat on mortality was higher in the census tracts with a large percentage of old buildings (RR=1.21, 95% CI 1.00 to 1.46), manual workers (RR=1.25, 95% CI 0.96 to 1.64) and residents perceiving little surrounding greenness (RR=1.29, 95% CI 1.01 to 1.65). After three consecutive hot days, mortality doubled in the most heat-vulnerable census tracts.
Sociodemographic and urban landscape characteristics are associated to mortality risk during heat waves and are useful to build heat vulnerability maps.
Whether it is relative wealth or relative poverty that drives the HIV epidemic in sub-Saharan Africa, is a controversial aspect of HIV/AIDS epidemiology. We suggest that the social epidemiology of HIV in Africa is changing. Previously, new infections were more rapidly acquired by those of relatively higher socioeconomic position (SEP). More recently, those of relatively low SEP are at greater risk. If confirmed, we further suggest in this paper that this pattern would be compatible with Cesar Victora's ‘inverse equity hypothesis’, first articulated in relation to child morbidity and mortality. The hypothesis suggests that those of higher SEP benefit first from new health interventions.1
Reviews draw different conclusions about the association between SEP and HIV infection within sub-Saharan African countries. Some authors stress that poverty is a key driver of HIV, and that poverty alleviation is the only sustainable solution.2 Others show that...
Taking antiobesity medication can be a cost effective way to lose weight. Uptake is determined in part by a General Practitioner's decision to prescribe weight loss medication and, in part, by patient preference. It is probable that the latter may indicate a patient's readiness to lose weight.
Analysis of cross-sectional data (from February 2003 to March 2011) from a population based prescribing database (~1.75 million people) using an adjusted Poisson regression.
The number of antiobesity medications increased from 23.4 per 1000 population in 2004 to 30.7 per 1000 population in 2010 and was three times higher in female than in male subjects. Against this background, a marked seasonal variation in the number of antiobesity medications dispensed was evident (p<0.001), peaking in June/July with a trough in December/January (±8.0% peak to trough). The seasonal component was stronger in female subjects, ±11.2% peak to trough, compared with ±3.5% for male subjects.
Obese patients, particularly women, increase their uptake of weight loss medication in the months leading up to the summer holiday period. The period prior to the summer may represent a time that health professionals could promote increased participation of obese patients in weight loss programmes.
Vitamin D has been suggested to have a role in infection defence and on the immune system. We therefore investigated the effect of serum 25-hydroxyvitamin D3 (25(OH)D3) on the risk of incident hospitalised pneumonia in an ageing general population in eastern Finland.
The study population included 723 men and 698 women aged 53–73 years from the prospective population-based Kuopio Ischemic Heart Disease Risk Factor study who were free of pneumonia, other pulmonary diseases and cancer at baseline in 1998–2001. Incident pneumonia episodes leading to hospitalisation were collected by record linkage to the hospital discharge register. The serum vitamin D status was assayed as 25(OH)D3 concentration. Cox proportional hazards regression models were used to analyse the effect of serum 25(OH)D3 on the risk of incident pneumonia.
The mean (SD) serum 25(OH)D3 concentration of the study population was 43.5 (17.8) nmol/l. 73 subjects had at least one hospitalisation episode due to pneumonia during an average follow-up of 9.8 years. After multivariable adjustments, the subjects in the lowest serum 25(OH)D3 tertile had a 2.6-fold (95% CI 1.4 to 5.0, p trend across tertiles=0.005) higher risk of developing pneumonia compared with the subjects in the highest tertile. This significant result remained even after adjustment for the determinants of serum 25-hydroxyvitamin D3.
These data suggest an inverse effect of serum 25(OH)D3 concentration on the risk of incident pneumonia in the general ageing population.