#Gambling #harm: a #global #problem requiring global solutions (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Gambling harm: a global problem requiring global solutions

Gerda Reith, Heather Wardle, Ian Gilmore

Published: August 20, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)31991-9

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Addicted to Gambling, an episode of the BBC’s Panorama programme broadcast on Aug 12, 2019, highlighted the profound harms that can be associated with gambling and the impact these have on individuals, families, and society. According to data published in England, problem gamblers are much more likely to think about taking their lives and to attempt suicide than those who do not have a gambling problem. 1 Other publications have highlighted the importance of a public health approach to gambling 2,3 and research from different jurisdictions shows a similar picture. Swedish data suggested a 15-times increase in mortality among people with gambling disorder. 4 Research from Victoria, Australia, conservatively estimated that around 2% of deaths by suicide were related to gambling. 5

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Keywords: Society; Psychiatry; Public Health.

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#Emergency #Declarations for #PublicHealth Issues: Expanding Our #Definition of Emergency (J Law Med Ethics, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Law Med Ethics. 2019 Jun;47(2_suppl):95-99. doi: 10.1177/1073110519857328.

Emergency Declarations for Public Health Issues: Expanding Our Definition of Emergency.

Sunshine G1, Barrera N1, Corcoran AJ1, Penn M1.

Author information: 1 Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona’s Office of the Attorney General, where she practices public health law. Aubrey Joy’s practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O’Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC’s Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control’s Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia.

 

Abstract

Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration.

PMID: 31298138 DOI: 10.1177/1073110519857328

Keywords: USA; Public Health.

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#Insurance #Reimbursements for Routinely Recommended #Adult #Vaccines in the #Private Sector (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Insurance Reimbursements for Routinely Recommended Adult Vaccines in the Private Sector

Yuping Tsai, PhD , Fangjun Zhou, PhD, Megan C. Lindley, MPH

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

DOI: https://doi.org/10.1016/j.amepre.2019.03.011 / Published online: June 25, 2019

 

Abstract

Introduction

Financial concerns are frequently cited by providers as a barrier to adult vaccination. This study assessed insurance reimbursements to providers for administering vaccines to adults in the private sector.

Methods

This study, conducted in 2018, used the 2016 MarketScan Commercial Claims and Encounters Database and included vaccination visits made by adults aged 19–64 years. Four routinely recommended vaccines targeted at adults were included: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); tetanus and diphtheria toxoids (Td); zoster; and influenza. The mean reimbursements for vaccine purchase and administration were reported and examined by state, metropolitan statistical area, provider type, and insurance plan type. Using the private vaccine purchase price published by the Centers for Disease Control and Prevention (CDC), the study reported the proportion of vaccination visits receiving reimbursements above the CDC-published price.

Results

The mean vaccine administration reimbursement was $25.80 for the first dose and $14.71 for additional doses in the same visit. The mean vaccine purchase reimbursement was $44.15 for Tdap, $25.78 for Td, and $216.05 for the zoster vaccine; the unweighted mean for the four examined influenza vaccines was $17.25. Reimbursements varied widely by state. Vaccine reimbursements exceeded the CDC-published price for most visits where Tdap (71.4%), zoster (87.8%), and three of four influenza (61.5%–88.5%) vaccines were administered but only for 25.8% of visits where Td was given.

Conclusions

On average, reimbursements for administering vaccines to privately insured adults were adequate for most private practices. However, providers’ financial concerns may vary across geographic locations.

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Keywords: USA; Vaccines; Public Health.

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#Mortality, #morbidity, and #risk #factors in #China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Prof Maigeng Zhou, PhD *, Haidong Wang, PhD *, Xinying Zeng, MS, Peng Yin, PhD, Prof Jun Zhu, MD, Prof Wanqing Chen, PhD, Xiaohong Li, PhD, Prof Lijun Wang, MS, Prof Limin Wang, MS, Yunning Liu, MS, Jiangmei Liu, MS, Mei Zhang, PhD, Jinlei Qi, PhD, Prof Shicheng Yu, PhD, Ashkan Afshin, MD, Prof Emmanuela Gakidou, PhD, Scott Glenn, MSc, Varsha Sarah Krish, BA, Molly Katherine Miller-Petrie, MSc, W Cliff Mountjoy-Venning, BA, Erin C Mullany, BA, Sofia Boston Redford, MPH, Hongyan Liu, PhD, Prof Mohsen Naghavi, PhD, Prof Simon I Hay, DSc, Prof Linhong Wang, MD, Prof Christopher J L Murray, DPhil, Xiaofeng Liang, MD

Open Access / Published: June 24, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30427-1

 

Summary

Background

Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.

Methods

We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).

Findings

Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (–3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer’s disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4).

Interpretation

China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system.

Funding

China National Key Research and Development Program and Bill & Melinda Gates Foundation.

Keywords: China; Public Health; Society.

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Causes of Excess #Mortality in #Veterans Treated for #PTSD (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Causes of Excess Mortality in Veterans Treated for Posttraumatic Stress Disorder

Jenna A. Forehand, MD, MPH1, Talya Peltzman, MPH1, Christine Leonard Westgate, MS1, Natalie B. Riblet, MD, MPH1,2,3, Bradley V. Watts, MD, MPH1,2,4, Brian Shiner, MD, MPH1,2,3,5

DOI: https://doi.org/10.1016/j.amepre.2019.03.014

 

Abstract

Introduction

Published research indicates that posttraumatic stress disorder (PTSD) is associated with increased mortality. However, causes of death among treatment-seeking patients with PTSD remain poorly characterized. The study objective was to describe causes of death among Veterans with PTSD to inform preventive interventions for this treatment population.

Methods

A retrospective cohort study was conducted for all Veterans who initiated PTSD treatment at any Department of Veterans Affairs Medical Center from fiscal year 2008 to 2013. The primary outcome was mortality within the first year after treatment initiation. In 2018, collected data were analyzed to determine leading causes of death. For the top ten causes, standardized mortality ratios (SMRs) were calculated from age- and sex-matched mortality tables of the U.S. general population.

Results

A total of 491,040 Veterans were identified who initiated PTSD treatment. Mean age was 48.5 (±16.0) years, 90.7% were male, and 63.5% were of white race. In the year following treatment initiation, 1.1% (5,215/491,040) died. All-cause mortality was significantly higher for Veterans with PTSD compared with the U.S. population (SMR=1.05, 95% CI=1.02, 1.08, p<0.001). Veterans with PTSD had a significant increase in mortality from suicide (SMR=2.52, 95% CI=2.24, 2.82, p<0.001), accidental injury (SMR=1.99, 95% CI=1.83, 2.16, p<0.001), and viral hepatitis (SMR=2.26, 95% CI=1.68, 2.93, p<0.001) versus the U.S. population. Of those dying from accidental injury, more than half died of poisoning (52.3%, 325/622).

Conclusions

Veterans with PTSD have an elevated risk of death from suicide, accidental injury, and viral hepatitis. Preventive interventions should target these important causes of death.

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Keywords: PTSD; Psychiatry; Society; Public Health; USA.

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Managing #tuberculosis in the #Baltic states (Lancet Resp Med., summary)

[Source: Lancet Respiratory Medicine, full page: (LINK). Summary, edited.]

Managing tuberculosis in the Baltic states

Vijay Shankar Balakrishnan

Published: June 17, 2019 / DOI: https://doi.org/10.1016/S2213-2600(19)30219-X

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In March, WHO and the European Centre for Disease Prevention and Control (ECDC) jointly released the latest tuberculosis surveillance and monitoring report. The report included a mixture of good and bad news about the management of tuberculosis in the Baltic states (Estonia, Latvia, and Lithuania), which are in fierce competition to eliminate tuberculosis by 2030.

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Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: Tuberculosis; Public Health; Estonia; Lithuania; Latvia.

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#US #sanctions in #Venezuela: #help, hindrance, or #violation of #humanrights? (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

US sanctions in Venezuela: help, hindrance, or violation of human rights?

Tanya L Zakrison, Carles Muntaner

Published: June 13, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)31397-2

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We read with interest the Review about Venezuela’s public health crisis1 and could not agree more emphatically with the authors. However, the root causes of this economic crisis, specifically, the impact of the US economic sanctions, deserve further inquiry. Since 2014, 43 unilateral, coercive measures have been applied against Venezuela by the US Administration. These have effectively paralysed the economy, blocked oil exportation globally, and frozen Venezuelan financial assets abroad while denying access to international financial systems. This loss in oil revenue and assets has amounted to a shortfall worth billions of US dollars, prohibiting the importation of essential, lifesaving products.

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We declare no competing interests.

Keywords: Public Health; Venezuela; USA; Wars; Politics; Society; Poverty.

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