Are Cosmetic Procedures Comparable to Antidepressive Medication for Quality-of-Life Improvements? A Systematic Review and Controlled Meta-Analysis.

Cosmetic procedures, especially cosmetic minimally invasive treatments, are rising in popularity, despite societal perception that these procedures may not improve patient health. The purpose of this study was to conduct a systematic review and controlled meta-analysis to compare the effects of cosmetic procedures and antidepressant treatment on health-related quality-of-life improvement. The PubMed database was queried in two independent searches to identify peer-reviewed cosmetic and antidepressant articles published between 1996 and 2017 that prospectively assessed the impact of the treatment on quality of life. All results were screened using defined exclusion and inclusion criteria and data were extracted using a standardized protocol. The meta-analysis was performed using a random-effects model. Five of 2,788 cosmetic studies and eight of 2,312 antidepressant studies met all inclusion criteria and utilized the 36-Item Short Form Health Survey (SF-36) measure. Except for the physical functioning scale, when compared with the cosmetic studies, antidepressant studies had significantly lower median baseline and post-treatment follow-up scale scores with larger median score improvement (p < 0.05). Positive effect sizes following treatment were observed for all eight SF-36 scales (range: 0.32-1.16; p < 0.05). This meta-analysis provides evidence that cosmetic procedures objectively improve a patient's health-related quality of life. While antidepressant studies exhibited greater SF-36 score improvement except for the physical functioning scale, both treatment groups demonstrated the greatest improvement in mental health and role emotional scales. As previously suggested, a disconnect exists between score improvement and clinical improvement due to baseline severity, ceiling effect, and regression to the mean effects.

Evaluating Surveillance for Excessive Alcohol Use in New Mexico.

PURPOSE AND OBJECTIVES: Prevalence of excessive alcohol use and alcohol-attributable mortality is much higher in New Mexico than in other US states. In 2010, excessive alcohol use cost the state roughly $2.2 billion. Moreover, age-adjusted deaths from alcohol-related chronic liver disease increased 52.5% from 14.1 cases in 2010 to 21.5 cases in 2016. In 2017, the New Mexico Department of Health piloted the Recommended Council of State and Territorial Epidemiologists (CSTE) Surveillance Indicators for Substance Abuse and Mental Health, using 5 indicators to monitor alcohol use and health consequences. The purpose of this study is to evaluate the alcohol surveillance system implemented in New Mexico to ensure that the system yields useful, timely data that can help create effective public health interventions and that resources required for surveillance are adequate. INTERVENTION APPROACH: CSTE alcohol surveillance system data come from existing national and state-based surveys and vital statistics. EVALUATION METHODS: This evaluation assessed attributes defined in Evaluating Behavioral Health Surveillance Systems and Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems. Assessment was informed through data collection, systematic literature review searches, and an interview with the alcohol epidemiologist at New Mexico Department of Health. RESULTS: The CSTE alcohol surveillance system in New Mexico is a useful, stable, and accepted system with good representativeness and population coverage. Data sharing and collaboration between centers within New Mexico Department of Health are well-established, making data access easy and timely. Lastly, the resources required for data collection are accountable and adequate. IMPLICATIONS FOR PUBLIC HEALTH: The CSTE alcohol surveillance system brings together information (alcohol consumption behaviors and associated morbidity, mortality, and policy-related measures) necessary to show a clear picture of the alcohol effects in New Mexico. This information yields useable, timely data from which the state can monitor trends and develop interventions to reduce the prevalence of alcohol-attributable morbidity and mortality.

Evaluating Behavioral Health Surveillance Systems.

In 2015, more than 27 million people in the United States reported that they currently used illicit drugs or misused prescription drugs, and more than 66 million reported binge drinking during the previous month. Data from public health surveillance systems on drug and alcohol abuse are crucial for developing and evaluating interventions to prevent and control such behavior. However, public health surveillance for behavioral health in the United States has been hindered by organizational issues and other factors. For example, existing guidelines for surveillance evaluation do not distinguish between data systems that characterize behavioral health problems and those that assess other public health problems (eg, infectious diseases). To address this gap in behavioral health surveillance, we present a revised framework for evaluating behavioral health surveillance systems. This system framework builds on published frameworks and incorporates additional attributes (informatics capabilities and population coverage) that we deemed necessary for evaluating behavioral health-related surveillance. This revised surveillance evaluation framework can support ongoing improvements to behavioral health surveillance systems and ensure their continued usefulness for detecting, preventing, and managing behavioral health problems.

A Tool for Assessing a Community's Capacity for Substance Abuse Care.

Evidence-based programs for prevention and intervention in substance abuse are increasing. Community needs assessments and health rankings provide descriptions of local behavioral health needs but do not provide public health practitioners and policy makers with guidelines on the number of programs, health care practitioners, or interventions needed in the local substance abuse care system. This article presents a new framework for measuring and assessing the substance abuse care system in a community. The assessment can inform resource allocation across the continuum of care to more equitably and efficiently distribute interventions and care. We conducted 2 literature reviews and synthesized our findings to create a community assessment methodology and needs calculator, CAST (calculating for an adequate system tool). We reviewed 212 articles to produce an inventory of community and social correlates of behavioral health, components of a substance abuse care system, and numerical values for guidelines for estimating community needs. CAST produces community-specific assessments of the capacity of the components of a community substance abuse care system. CAST generates recommendations by the application of social and community determinants of health as risk coefficients to each estimate of component need. CAST can assist public health practitioners in evaluation and improvement of the capacity of community-based, substance abuse care systems. By using recommendations for component needs across the continuum of care, community leaders can use CAST to prioritize resource allocation more effectively and efficiently.

Epidemic assistance by the Centers for Disease Control and Prevention: role of the Epidemic Intelligence Service, 1946-2005.

Since 1946, the Centers for Disease Control and Prevention has responded to urgent requests from US states, federal agencies, and international organizations through epidemic-assistance investigations (Epi-Aids). The authors describe the first 60 years of Epi-Aids, breadth of problems addressed, evolution of methodologies, scope of activities, and impact of investigations on population health. They reviewed Epi-Aid reports and EIS Bulletins, contacted current and former Epidemic Intelligence Service staff, and systematically searched the PubMed and Web of Science databases. They abstracted information on dates, location, staff involved, health problems, methods, and impacts of investigations according to a preplanned protocol. They assessed the methods presented as well as the quality of reports. During 1946-2005, a total of 4,484 investigations of health events were initiated by 2,815 Epidemic Intelligence Service officers. In the early years, the majority were in response to infectious agents, although environmental problems emerged. Investigations in subsequent years focused on occupational conditions, birth defects, reproductive health, tobacco use, cancer, violence, legal debate, and terrorism. These Epi-Aids heralded expansion of the agency's mission and presented new methods in statistics and epidemiology. Recommendations from Epi-Aids led to policy implementation, evaluation, or modification. Epi-Aids provide the Centers for Disease Control and Prevention with the agility to respond rapidly to public health crises.

The association between the combined oral contraceptive pill and insulin resistance, dysglycemia and dyslipidemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of observational studies.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of young women. First-line treatment is often the oral contraceptive pill (OC), but evidence suggests that OC may worsen metabolic outcomes in this population. We undertook this meta-analysis of observational studies and cohorts from within randomized controlled studies to investigate the association between OC use and dysglycemia, dyslipidemia and insulin resistance (IR) in women with PCOS. METHODS: We searched MEDLINE (1966-April 2010), EMBASE (1980-April 2010) and All EBM Reviews. We included prospective cohorts and RCTs that treated women, aged 13-44, with PCOS with OC for at least 3 months. Blinded quality assessment and data extraction were conducted on 35 included studies by two independent reviewers. We used random effects methods to calculate weighted mean differences as the effect size. We investigated heterogeneity using sequential removal of studies, subgroup analysis and meta-regression. RESULTS: OC use was significantly associated with an increase in high-density lipoprotein cholesterol (HDL-C) (P = 0.004) and triglycerides (P = 0.004). Significant heterogeneity was found in glucose, cholesterol, HDL-C, low-density lipoprotein cholesterol triglycerides, fasting glucose to insulin ratios and homeostatic model assessments-IR. Study characteristics such as mean BMI, mean age and duration of study could explain some of the heterogeneity. CONCLUSIONS: Use of OC was not associated with clinically significant adverse metabolic consequences. Because of limitations of the underlying studies, further research including rigorously designed randomized trials would more definitively confirm our findings.

Childhood obesity: a framework for policy approaches and ethical considerations.

Although obesity rates among US children have increased during the past 3 decades, effective public policies have been limited, and the quest for workable solutions raises ethical questions. To address these concerns, in 2010, the Robert Wood Johnson Foundation convened an expert panel to consider approaches to the ethics problems related to interventions for childhood obesity. On the basis of recommendations from the expert panel, we propose frameworks for policy approaches and ethical aspects of interventions and evaluation. We present these frameworks in the context of other papers in this collection and make recommendations for public health practice.

Counting hard-to-count populations: the network scale-up method for public health.

Estimating sizes of hidden or hard-to-reach populations is an important problem in public health. For example, estimates of the sizes of populations at highest risk for HIV and AIDS are needed for designing, evaluating and allocating funding for treatment and prevention programmes. A promising approach to size estimation, relatively new to public health, is the network scale-up method (NSUM), involving two steps: estimating the personal network size of the members of a random sample of a total population and, with this information, estimating the number of members of a hidden subpopulation of the total population. We describe the method, including two approaches to estimating personal network sizes (summation and known population). We discuss the strengths and weaknesses of each approach and provide examples of international applications of the NSUM in public health. We conclude with recommendations for future research and evaluation.

Who knew? The misleading specificity of "double-blind" and what to do about it.

BACKGROUND: In randomized trials, the term "double-blind" (and its derivatives, single- and triple-blind, fully blind, and partially blind or masked) has no standard or widely accepted definition. Agreement about which groups are blinded is poor, and authors using these terms often do not identify which groups were blinded, despite specific reporting guidelines to the contrary. Nevertheless, many readers assume-incorrectly-that they know which groups are blinded. Thus, the term is ambiguous at best, misleading at worst, and, in either case, interferes with the accurate reporting, interpretation, and evaluation of randomized trials. The problems with the terms have been thoroughly documented in the literature, and many authors have recommended that they be abandoned. PROPOSAL: We and our co-signers suggest eliminating the use of adjectives that modify "blinding" in randomized trials; a trial would be described as either blinded or unblinded. We also propose that authors report in a standard table which groups or individuals were blinded, what they were blinded to, how blinding was implemented, and whether blinding was maintained. Individuals with dual responsibilities, such as caregiving and data collecting, would also be identified. If blinding was compromised, authors should describe the potential implications of the loss of blinding on interpreting the results. CONCLUSION: "Double blind" and its derivatives are terms with little to recommend their continued use. Eliminating the use of adjectives that impart a false specificity to the term would reduce misinterpretations, and recommending that authors report who was blinded to what and how in a standard table would require them to be specific about which groups and individuals were blinded.

An analysis of time trends for canine heartworm disease in Grenada and its associated risk factors based on veterinary clinical pathology laboratory data base records between 2003 and 2015.

Canine heartworm (CHW) disease is a common parasitic infection in dogs in the Caribbean islands. However, studies on temporal trends and risk factors are limited for this region. This study represents the time trends in laboratory prevalence and risk factors of canine heartworm infections between 2003 and 2015. In this case series, 662 cases of laboratory-diagnosed heartworm were compared to 662 dogs without a laboratory diagnosis of heartworm (controls). One hundred and seventy two frozen serum positive samples were later analyzed for heartworm antigens using Heska solo® Step CH, and all 172 cases of microfilariae were confirmed as Dirofilaria immitis. Annual prevalence, linear trends and odds ratios (OR) for CHW were estimated using EPIINFO version 7 at a significance level of α = 0.05. Logistic regression was used to assess the association of CHW with variables showing a statistically significant univariate relationship. Laboratory prevalence of CHW decreased from 72 cases per 1000 dogs per year in 2003 to 15 cases per 1000 dogs per year in 2015 [X2 for linear trend = 151.8, p < 0.0001], with the occurrence of an epidemic of CHW between 2008 and 2010. The odds of CHW were higher among adult dogs [(OR) = 3.9 (95% CI, 2.9-7.0)] and geriatric dogs [OR = 2.1 (95% CI, 1.1-4.3)] compared to puppies. The odds of CHW were higher [OR = 1.3 (95% CI, 1.1-1.6)] among male dogs than female dogs, but the odds for CHW were lower among neutered dogs [OR = 0.4 (95% CI, 0.2 - 0.6)] compared to intact dogs. The odds of a dog being diagnosed with CHW were elevated [OR = 4.1 (95% CI, 3.2-5.2)] during the dry season compared to the rainy season. Our findings show that canine heartworm is extensive in laboratory submissions in Grenada. However, the laboratory prevalence of CHW decreased between 2003 and 2015, with an epidemic occurring between 2008 and 2010. Age of the dog, sex, neutered status, and seasonality of diagnosis were significantly associated CHW in Grenada.

Reversing the trend of childhood obesity.

In March 2008, a group of experts in anthropology, law, epidemiology, ethics, and social networking met to share their diverse perspectives on preventing childhood obesity. In meeting their charge to identify innovative ways to lower the prevalence of childhood obesity, they asked several questions: What has succeeded and what has not? What are the barriers to success? Whose job is it to address these barriers? We provide a brief background on childhood obesity and highlight some of the ideas generated at the Symposium on Epidemiologic, Ethical, and Anthropologic Issues in Childhood Overweight and Obesity, which took place in March 2008 at Saint George's University, Saint George,

Reporting the methods used in public health research and practice.

The methods section of a scientific article often receives the most scrutiny from journal editors, peer reviewers, and skeptical readers because it allows them to judge the validity of the results. The methods section also facilitates critical interpretation of study activities, explains how the study avoided or corrected for bias, details how the data support the answer to the study question, justifies generalizing the findings to other populations, and facilitates comparison with past or future studies. In 2006, the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Programme began collecting and disseminating guidelines for reporting health research studies. In addition, guidelines for reporting public health investigations not classified as research have also been developed. However, regardless of the type of study or scientific report, the methods section should describe certain core elements: the study design; how participants were selected; the study setting; the period of interest; the variables and their definitions used for analysis; the procedures or instruments used to measure exposures, outcomes, and their association; and the analyses. Specific requirements for each study type should be consulted during the project planning phase and again when writing begins. We present requirements for reporting methods for public health activities, including outbreak investigations, public health surveillance programs, prevention and intervention program evaluations, research, surveys, systematic reviews, and meta-analyses.

Measuring the public's health.

Allocation of public health resources should be based, where feasible, on objective assessments of health status, burden of disease, injury, and disability, their preventability, and related costs. In this article, we first analyze traditional measures of the public's health that address the burden of disease and disability and associated costs. Second, we discuss activities that are essential to protecting the public's health but whose impact is difficult to measure. Third, we propose general characteristics of useful measures of the public's health. We contend that expanding the repertoire of measures of the public's health is a critical step in targeting attention and resources to improve health, stemming mounting health care costs, and slowing declining quality of life that threatens the nation's future.

Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults.

BACKGROUND: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking. METHODS: Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of U.S. adults, was used to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day. RESULTS: After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that we assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results. CONCLUSIONS: These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States.

Surveillance and the Tao of leadership: a perspective from the United States.

This paper discusses how the epidemiologists who guide the collection, analysis, and sharing of public health data are powerful and can use their influence to bring about changes that will benefit the health of people around the world. They can frame public debate and the actions of policy makers on major health issues because they have the power to determine what health indicators are measured, which questions are asked, and how the raw data are presented. To be effective leaders, these epidemiologists can learn much from the ancient Chinese philosophy of the Tao Te Ching, which advises powerful people to lead others without domination or coercion.

Homocyst(e)ine and cardiovascular disease: a systematic review of the evidence with special emphasis on case-control studies and nested case-control studies.

BACKGROUND: Elevated concentrations of homocyst(e)ine are thought to increase the risk of vascular diseases including coronary heart disease and cerebrovascular disease. METHODS: We searched MEDLINE (1966-1999), EMBASE (1974-1999), SciSearch (1974- 1999), and Dissertation Abstracts (1999) for articles and theses about homocyst(e)ine concentration and coronary heart disease and cerebrovascular disease. RESULTS: We included 57 publications (3 cohort studies, 12 nested case-control studies, 42 case-control studies) that reported results on 5518 people with coronary heart disease (11,068 control subjects) and 1817 people with cerebrovascular disease (4787 control subjects) in our analysis. For coronary heart disease, the summary odds ratios (OR) for a 5-micromol/l increase in homocyst(e)ine concentration were 1.06 (95% CI : 0.99-1.13) for 2 publications of cohort studies, 1.23 (95% CI : 1.07-1.41) for 10 publications of nested case-control studies, and 1.70 (95% CI : 1.50-1.93) for 26 publications of case-control studies. For cerebrovascular disease, the summary OR for a 5-micromol/l increase in homocyst(e)ine concentration were 1.10 (95% CI : 0.94-1.28) for 2 publications of cohort studies, 1.58 (95% CI : 1.35-1.85) for 5 publications of nested case-control studies, and 2.16 (95% CI : 1.65-2.82) for 17 publications of case-control studies. CONCLUSIONS: Prospective studies offer weaker support than case-control studies for an association between homocyst(e)ine concentration and cardiovascular disease. Although other lines of evidence support a role for homocyst(e)ine in the pathogenesis of cardiovascular disease, more information from prospective epidemiological studies or clinical trials is needed to clarify this role.

The impact of stretching on sports injury risk: a systematic review of the literature.

PURPOSE: We conducted a systematic review to assess the evidence for the effectiveness of stretching as a tool to prevent injuries in sports and to make recommendations for research and prevention. METHODS: Without language limitations, we searched electronic data bases, including MEDLINE (1966-2002), Current Contents (1997-2002), Biomedical Collection (1993-1999), the Cochrane Library, and SPORTDiscus, and then identified citations from papers retrieved and contacted experts in the field. Meta-analysis was limited to randomized trials or cohort studies for interventions that included stretching. Studies were excluded that lacked controls, in which stretching could not be assessed independently, or where studies did not include subjects in sporting or fitness activities. All articles were screened initially by one author. Six of 361 identified articles compared stretching with other methods to prevent injury. Data were abstracted by one author and then reviewed independently by three others. Data quality was assessed independently by three authors using a previously standardized instrument, and reviewers met to reconcile substantive differences in interpretation. We calculated weighted pooled odds ratios based on an intention-to-treat analysis as well as subgroup analyses by quality score and study design. RESULTS: Stretching was not significantly associated with a reduction in total injuries (OR = 0.93, CI 0.78-1.11) and similar findings were seen in the subgroup analyses. CONCLUSION: There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes. Further research, especially well-conducted randomized controlled trials, is urgently needed to determine the proper role of stretching in sports.

The prevention of shin splints in sports: a systematic review of literature.

PURPOSE: To review the published and unpublished evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and offer evidence-based recommendations to coaches, athletes, and researchers. METHODS: We searched electronic data bases without language restriction, identified citations from reference sections of research papers retrieved, contacted experts in the field, and searched the Cochrane Collaboration. Of the 199 citations identified, we emphasized results of the four reports that compared methods to prevent shin splints. We assessed the methodologic quality of these reports by using a standardized instrument. RESULTS: The use of shock-absorbent insoles, foam heel pads, heel cord stretching, alternative footwear, as well as graduated running programs among military recruits have undergone assessment in controlled trials. There is no strong support for any of these interventions, and each of the four controlled trials is limited methodologically. Median quality scores in these four studies ranged from 29 to 47, and serious flaws in study design, control of bias, and statistical methods were identified. CONCLUSION: Our review yielded little objective evidence to support widespread use of any existing interventions to prevent shin splints. The most encouraging evidence for effective prevention of shin splints involves the use of shock-absorbing insoles. However, serious flaws in study design and implementation constrain the work in this field thus far. A rigorously implemented research program is critically needed to address this common sports medicine problem.

Worsening trends in adult health-related quality of life and self-rated health-United States, 1993-2001.

OBJECTIVES: Health-related quality of life and self-rated health complement mortality and morbidity as measures used in tracking changes and disparities in population health. The objectives of this study were to determine whether and how health-related quality of life and self-rated health changed overall in U.S. adults and in specific sociodemographic and geographic groups from 1993 through 2001. METHODS: The authors analyzed data from annual cross-sectional Behavioral Risk Factor Surveillance System surveys of 1.2 million adults from randomly selected households with telephones in the 50 states and the District of Columbia. RESULTS: Mean physically and mentally unhealthy days and activity limitation days remained constant early in the study period but increased later on. Mean unhealthy days increased about 14% during the study period. The percentage with fair or poor self-rated health increased from 13.4% in 1993 to 15.5% in 2001. Health-related quality of life and self-rated health worsened in most demographic groups, especially adults 45-54 years old, high school graduates without further education, and those with annual household incomes less than $50,000. However, adults 65 years old or older and people identified as non-Hispanic Asian/Pacific Islander reported stable or improving health-related quality of life and self-rated health. In 18 of the states and the District of Columbia, mean unhealthy days increased, while only North Dakota reported a decrease. CONCLUSION: Population tracking of adult health-related quality of life and self-rated health identified worsening trends overall and for many groups, suggesting that the nation's overall health goals as identified in the Healthy People planning process are not being met.

Actual causes of death in the United States, 2000.

CONTEXT: Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities. OBJECTIVES: To identify and quantify the leading causes of mortality in the United States. DESIGN: Comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality. The search was initially restricted to articles published during or after 1990, but we later included relevant articles published in 1980 to December 31, 2002. Prevalence and relative risk were identified during the literature search. We used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data. MAIN OUTCOME MEASURES: Actual causes of death. RESULTS: The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%) [corrected], and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000). CONCLUSIONS: These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.