#Drug #Decriminalization: A Matter of #Justice and #Equity, Not Just Health (Am J Prev Med., abstract)

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

Drug Decriminalization: A Matter of Justice and Equity, Not Just Health

Hakique N. Virani, MD1, Rebecca J. Haines-Saah, PhD2

DOI: https://doi.org/10.1016/j.amepre.2019.08.012

Published online: November 15, 2019

 

Abstract

Since 2016, more than 10,300 Canadians have died of an apparent opioid-related overdose, with the majority involving fentanyl or fentanyl analogs.1 This unprecedented public health crisis has decreased life expectancy at birth in the country’s most affected provinces of Alberta and British Columbia.2 Concerned by this epidemic of overdoses, Canadian advocates for drug policy reform have welcomed the recent recommendation from British Columbia’s Provincial Health Officer that drug possession for personal use be decriminalized.

© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Keywords: Opioids; Illicit drugs; Society; Canada.

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#Risk #factors, #awareness of disease and use of #medications in a deprived population: differences between #indigent natives and undocumented #migrants in #Italy (J Pub Health, abstract)

[Source: Journal of Public Health, full page: (LINK). Abstract, edited.]

Risk factors, awareness of disease and use of medications in a deprived population: differences between indigent natives and undocumented migrants in Italy

Gianfrancesco Fiorini, Cesare Cerri, Flavia Magri, Luca Chiovato, Laura Croce, Antonello E Rigamonti, Alessandro Sartorio, Silvano G Cella

Journal of Public Health, fdz123, https://doi.org/10.1093/pubmed/fdz123

Published: 08 November 2019

 

Abstract

Background

Undocumented migrants experience many health problems; a comparison with a suitable control group of natives living in the same socio-economic conditions is still lacking.

Methods

Demographic data and data on risk factors, chronic conditions and dietary habits were obtained for 6933 adults (2950 Italians and 3983 undocumented migrants) receiving medical assistance from 40 non-governmental organizations all over the country.

Results

Attributed to the fact that these were unselected groups, differences were found in their demographic features, the main ones being their marital status (singles: 50.5% among Italians and 42.8% among migrants; P < 0.001). Smokers were more frequent among Italians (45.3% versus 42.7% P = 0.03); the same happened with hypertension (40.5% versus 34.5% P < 0.001). Migrants were more often overweight (44.1% versus 40.5% P < 0.001) and reporting a chronic condition (20.2% versus 14.4% P < 0.001). Among those on medications (n = 1354), Italians were fewer (n = 425) and on different medications. Differences emerged also in dietary habits.

Conclusions

Differences in health conditions exist between native-borns and undocumented migrants, not because of a bias related to socio-economic conditions. Further studies are needed to design sustainable health policies and tailored prevention plans.

chronic diseases, dispensation of medications, poverty, undocumented migrants

Topic: hypertension – diet – adult – chronic disease – demography – habits – health policy – italy – marital status – medical assistance – single person – socioeconomic factors – poverty – overweight – prevention – nongovernmental organizations – smokers

Issue Section: Original Article

© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Public Health; Society; Poverty; Migrants; Italy.

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The #publichealth #crisis of #underimmunisation: a global plan of action (Lancet Infect Dis., summary)

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

The public health crisis of underimmunisation: a global plan of action

Prof Lawrence O Gostin, JD, Prof James G Hodge Jr, JD, Prof Barry R Bloom, MD, Ayman El-Mohandes, MD, Prof Jonathan Fielding, MD, Prof Peter Hotez, MD, Dean Ann Kurth, PhD, Prof Heidi J Larson, PhD, Prof Walter A Orenstein, Kenneth Rabin, PhD, Prof Scott C Ratzan, MD, Prof Daniel Salmon, PhD

Published: November 06, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30558-4

 

Summary

Vaccination is one of public health’s greatest achievements, responsible for saving billions of lives. Yet, 20% of children worldwide are not fully protected, leading to 1·5 million child deaths annually from vaccine-preventable diseases. Millions more people have severe disabling illnesses, cancers, and disabilities stemming from underimmunisation. Reasons for falling vaccination rates globally include low public trust in vaccines, constraints on affordability or access, and insufficient governmental vaccine investments. Consequently, an emerging crisis in vaccine hesitancy ranges from hyperlocal to national and worldwide. Outbreaks often originate in small, insular communities with low immunisation rates. Local outbreaks can spread rapidly, however, transcending borders. Following an assessment of underlying determinants of low vaccination rates, we offer an action based on scientific evidence, ethics, and human rights that spans multiple governments, organisations, disciplines, and sectors.

Keywords: Vaccines; Society; Politics; Public Health.

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Sustainable #development #levers are key in #global #response to #antimicrobial #resistance (Lancet, summary)

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

Sustainable development levers are key in global response to antimicrobial resistance

Angelina Taylor, Jasper Littmann, Anna Holzscheiter, Maike Voss, Lothar Wieler, Tim Eckmanns

Published: October 30, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32555-3

___

Antimicrobial resistance (AMR) is a borderless challenge, with drug-resistant infections estimated to cause at least 700 000 deaths per year globally. 1  To address this, member states of WHO agreed to the Global Action Plan for AMR in 2015, followed by adoption of the UN political declaration on AMR in 2016. A global governance structure is in place—namely, the Tripartite, made up of WHO, the Food and Agriculture Organization of the UN (FAO), and the World Organisation of Animal Health (OIE)—all of which are strengthening their AMR mandates. 2  The UN Interagency Coordination Group on AMR (IACG), tasked by the UN Secretary-General, has been engaging with member states and other stakeholders and has made recommendations for globally combatting AMR. 3

(…)

Keywords: Society; Poverty; Global Health; Antibiotics; Drugs Resistance.

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Long-term #survival and cause-specific #mortality of #patients newly diagnosed with #tuberculosis in São Paulo state, #Brazil, 2010–15: a population-based, longitudinal study (Lancet Infect Dis., abstract)

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

Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010–15: a population-based, longitudinal study

Otavio T Ranzani, PhD, Prof Laura C Rodrigues, PhD, Sidney Bombarda, PhD, Cátia M Minto, MSc, Prof Eliseu A Waldman, PhD, Prof Carlos R R Carvalho, PhD

Open Access / Published: October 29, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30518-3

 

Summary

Background

Long-term survival and cause-specific mortality of patients who start tuberculosis treatment is rarely described. We aimed to assess the long-term survival of these patients and evaluate the association between vulnerable conditions (social, health behaviours, and comorbidities) and cause-specific mortality in a country with a high burden of tuberculosis.

Methods

In this population-based, longitudinal study in São Paulo state, Brazil, we described the 5-year survival of patients who were newly diagnosed with tuberculosis in 2010. We included patients with newly-diagnosed tuberculosis, aged 15 years or older, and notified to the São Paulo State Tuberculosis Program in 2010. We excluded patients whose diagnosis had changed during follow-up (ie, they did not have tuberculosis) and patients who had multidrug-resistant (MDR) tuberculosis. We selected our population with tuberculosis from the dedicated electronic system TBweb. Our primary objective was to estimate the excess mortality over 5 years and within the group who survived the first year, compared with the general São Paulo state population. We also estimated the association between social vulnerability (imprisonment and homelessness), health behaviours (alcohol and drug use), and comorbidities (diabetes and mental disorders) with all-cause and cause-specific mortality. We used the competing risk analysis framework, estimating cause-specific hazard ratios (HRs) adjusted for potential confounding factors.

Findings

In 2010, there were 19 252 notifications of tuberculosis cases. We excluded 550 cases as patients were younger than 15 years, 556 cases that were not tuberculosis, 2597 retreatments, and 48 cases of MDR tuberculosis, resulting in a final cohort of 15 501 patients with tuberculosis. Over a period of 5 years from tuberculosis diagnosis, 2660 (17%) of 15 501 patients died. Compared with the source population, matched by age, sex, and calendar year, the standardised mortality ratio was 6·47 (95% CI 6·22–6·73) over 5 years and 3·93 (3·71–4·17) among those who survived the first year. 1197 (45%) of 2660 deaths were due to infection. Homelessness and alcohol and drug use were associated with death from infection (adjusted cause-specific HR 1·60, 95% CI 1·39–1·85), cardiovascular (1·43, 1·06–1·95), and external or ill-defined causes of death (1·80, 1·37–2·36). Diabetes was associated with deaths from cardiovascular causes (1·70, 1·23–2·35).

Interpretation

Patients newly diagnosed with tuberculosis were at a higher risk of death than were the source population, even after tuberculosis treatment. Post-tuberculosis sequelae and vulnerability are associated with excess mortality and must be addressed to mitigate the tuberculosis burden worldwide.

Funding

Wellcome Trust.

Keywords: Tuberculosis; Antibiotics; Drugs Resistance; Society; Poverty; Brazil.

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#Cognitive #Development of #Infants Exposed to the #Zika Virus in #PuertoRico (JAMA Netw Open, abstract)

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

JAMA Netw Open. 2019 Oct 2;2(10):e1914061. doi: 10.1001/jamanetworkopen.2019.14061.

Cognitive Development of Infants Exposed to the Zika Virus in Puerto Rico.

Valdes V1, Zorrilla CD2, Gabard-Durnam L1, Muler-Mendez N2, Rahman ZI1, Rivera D2, Nelson CA 3rd1,3.

Author information: 1 Laboratories of Cognitive Neuroscience, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts. 2 Obstetrics and Gynecology, Maternal-Infant Studies Center, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico. 3 Harvard Graduate School of Education, Cambridge, Massachusetts.

 

Abstract

IMPORTANCE:

Existing research has established a causal link between Zika virus (ZIKV) infection and severe birth defects or consequent health impairments; however, more subtle cognitive impairments have not been explored.

OBJECTIVE:

To determine whether infants of mothers with at least 1 positive ZIKV test show differences in cognitive scores at ages 3 to 6 months and ages 9 to 12 months.

DESIGN, SETTING, AND PARTICIPANTS:

This cross-sectional study recruited infants enrolled in existing ZIKV study cohorts associated with the Maternal-Infant Studies Center and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico and from the broader San Juan metropolitan area. The study took place at the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico. Participants were recruited through convenience sampling if their mothers underwent ZIKV testing prenatally and were at the target ages during the study period. Infants who were born preterm (<36 weeks’ gestational age), with low birth weight (<2500 g), or with a known genetic disorder were excluded. Infants were tested from ages 3 to 6 months or ages 9 to 12 months from May 2018 to April 2019. Data analysis was performed from March to April 2019.

EXPOSURES:

Zika virus status was measured prenatally and in the early postnatal period using real-time polymerase chain reaction or a ZIKV IgM antibody capture enzyme-linked immunosorbent assay.

MAIN OUTCOMES AND MEASURES:

The infants’ development was assessed using the Mullen Scales of Early Learning (translated to Spanish and adapted for Puerto Rico), and assessors were blinded to each infant’s ZIKV status.

RESULTS:

A total of 65 study participants were included. The mean (SD) age of the infants at the time of cognitive testing was 8.98 (3.19) months. Most of the infants were white (55 [84.6%]) and Puerto Rican (64 [98.5%]); 38 of the infants were male (58.5%). General cognitive and domain-specific scores did not differ significantly between prenatally ZIKV-positive and ZIKV-negative infants except for receptive language score (mean difference = 5.52; t = 2.10; P = .04). Exposure to ZIKV (B = -5.69; β = -0.26 [95% CI -11.01 to -0.36]; P = .04) and a measure of Hurricane Maria exposure (time without water, B = -0.05; β = -0.27 [95% CI, -0.10 to -0.01]; P = .03) were both independently and significantly associated with receptive language scores after adjusting for key confounders.

CONCLUSIONS AND RELEVANCE:

Although infants exposed to ZIKV prenatally showed unaffected motor and visually mediated cognitive development, they did show deficits in receptive language scores. Receptive language skills were also associated with the degree of exposure to Hurricane Maria, with those who spent more time without water after the hurricane having lower receptive language scores.

PMID: 31651970 DOI: 10.1001/jamanetworkopen.2019.14061

Keywords: Zika Virus; Pediatrics; Psychiatry; Extreme Weather; Hurricanes; Society; Puerto Rico.

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A comprehensive #analysis of #mortality-related #health #metrics associated with #mental #disorders: a nationwide, register-based cohort study (Lancet, abstract)

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

A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Oleguer Plana-Ripoll, PhD, Prof Carsten Bøcker Pedersen, DrMed, Prof Esben Agerbo, DrMed, Yan Holtz, MSc, Annette Erlangsen, PhD, Vladimir Canudas-Romo, PhD, Prof Per Kragh Andersen, PhD, Fiona J Charlson, PhD, Maria K Christensen, MSc, Holly E Erskine, PhD, Alize J Ferrari, PhD, Kim Moesgaard Iburg, PhD, Natalie Momen, PhD, Prof Preben Bo Mortensen, DrMed, Prof Merete Nordentoft, DrMed, Damian F Santomauro, PhD, James G Scott, PhD, Prof Harvey A Whiteford, PhD, Nanna Weye, MSc, Prof John J McGrath, MD  †, Prof Thomas M Laursen, PhD †

Published: October 24, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32316-5

 

Summary

Background

Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.

Methods

In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.

Findings

7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57–28·82] vs 12·95 deaths [12·93–12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91–1·94) for mood disorders to 3·91 (3·87–3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36–5·48) for organic disorders in females to 14·84 years (14·70–14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.

Interpretation

Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.

Funding

Danish National Research Foundation.

Keywords: Psychiatry; Society.

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