The economic burden of cancers attributable to tobacco smoking, excess weight, alcohol use, and physical inactivity in Canada.

OBJECTIVES: The purpose of the present study was to calculate the proportion of cancers in Canada attributable to tobacco smoking (ts), alcohol use (au), excess weight (ew), and physical inactivity (pia); to explore variation in the proportions of those risk factors (rfs) over time by sex and province; to estimate the economic burden of cancer attributable to the 4 rfs; and to calculate the potential reduction in cancers and economic burden if all provinces achieved rf prevalence rates equivalent to the best in Canada. METHODS: We used a previously developed approach based on population-attributable fractions (pafs) to estimate the cancer-related economic burden associated with the four rfs. Sex-specific relative risk and age- and sex-specific prevalence data were used in the modelling. The economic burden was adjusted for potential double counting of cases and costs. RESULTS: In Canada, 27.7% of incident cancer cases [95% confidence interval (ci): 22.6% to 32.9%] in 2013 [47,000 of 170,000 (95% ci: 38,400-55,900)] were attributable to the four rfs: ts, 15.2% (95% ci: 13.7% to 16.9%); ew, 5.1% (95% ci: 3.8% to 6.4%); au, 3.9% (95% ci: 2.4% to 5.3%); and pia, 3.5% (95% ci: 2.7% to 4.3%). The annual economic burden attributable to the 47,000 total cancers was $9.6 billion (95% ci: $7.8 billion to $11.3 billion): consisting of $1.7 billion in direct and $8.0 billion in indirect costs. Applying the lowest rf rates to each province would result in an annual reduction of 6204 cancers (13.2% of the potentially avoidable cancers) and a reduction in economic burden of $1.2 billion. CONCLUSIONS: Despite substantial reductions in the prevalence and intensity of ts, ts remains the dominant risk factor from the perspective of cancer prevention in Canada, although ew and au are becoming increasingly important rfs.

Stakeholder approach in strengthening the patients' rights in the Slovak Republic.

OBJECTIVES: The described project aimed to promote patients' rights in the Slovak Republic that are stipulated by law but in practice not observed fully. BACKGROUND: The project was based on a bi-lateral agreement between The Netherlands and the Slovak Republic in the framework of European Union pre-accession program and implemented in the period from January 2002 to June 2003. METHODS: Successful Dutch models of patients' rights promotion were used. They were applied under Slovak conditions and focused on the areas in the greatest need of attention, such as information campaigning and public awareness of patients' rights issues. The initiation of a cooperation of various stakeholders active in healthcare and national patients' right forums was among the most positive aspects of the project. RESULTS: The information campaign was constructed in order to educate citizens about their entitlements and rights within healthcare. Healthcare professionals were trained on respecting the rights of their clients. Pilots were started in several hospitals and in Healthy City projects, and patients' rights modules were made available at educational centers and various private and health organizations. Some of the cooperating healthcare professionals expressed their fear that the public might misuse the gained advocacy skills. This idea has originated from the current situation in Slovak healthcare, where inadequate financing, education, and management is a barrier in the physician's ability to serve the patient's best interest. CONCLUSIONS: The implemented project started wide public discussion on patients' rights and stimulated a cooperation of a large number of stakeholders in the promotion of patients' rights (Tab. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Don't Change Much.

Few studies have assessed differences in the prevalence of and economic burden attributable to tobacco smoking, excess weight, physical inactivity, and alcohol use by gender. This article examines these gender differences in Canadians between the ages of 30 and 64 years. It also estimates the potential cost avoidance if the prevalence of the four risk factors (RFs) were reduced modestly in males. Data on the prevalence of the RFs and the relative risk of disease associated with each of the RFs were combined to calculate population-attributable fractions. A prevalence-based cost-of-illness approach was used to estimate the economic burden associated with the four RFs. Middle-aged Canadian males are more likely to smoke tobacco (26.4% vs. 20.2%), consume hazardous or harmful levels of alcohol (14.6% vs. 8.2%), and have excess weight (65.6% vs. 47.1%) than middle-aged Canadian females, resulting in an annual economic burden that is 27% higher in males than females. No significant differences were observed in the proportion of males who are physically inactive (48.4% vs. 49.4%). Modelling only a 1% annual relative reduction each year through to 2036 would result in a cumulative cost avoidance between 2013 and 2036 of $50.7 billion. The differences in RF prevalence between middle-aged males and females have an important effect on the population's economic burden. A modest annual reduction in the four RFs in males can significantly affect population health and the economy over time.

Regional variations in the economic burden attributable to excess weight, physical inactivity and tobacco smoking across British Columbia.

INTRODUCTION: Prevalence rates of excess weight, tobacco smoking and physical inactivity vary substantially by geographical region within British Columbia (B.C.). The purpose of this study is to determine the potential reduction in economic burden in B.C. if all regions in the province achieved prevalence rates of these three risk factors equivalent to those of the region with the lowest rates. METHODS: We used a previously developed approach based on population-attributable fractions to estimate the economic burden associated with the various risk factors. Sex-specific relative risk and age/sex-specific prevalence data was used in the modelling. RESULTS: The annual economic burden attributable to the three risk factors in B.C. was about $5.6 billion in 2013, with a higher proportion of this total attributable to excess weight ($2.6 billion) than to tobacco smoking ($2.0 billion). While B.C. has lower prevalence rates of the risk factors than any other Canadian province, there is significant variation within the province. If each region in the province were to achieve the best prevalence rates for the three risk factors, then $1.4 billion (24% of the $5.6 billion) in economic burden could be avoided annually. CONCLUSION: There are notable disparities in the prevalence of each risk factor across health regions within B.C., which were mirrored in each region's attributable economic burden. A variety of social, environmental and economic factors likely drive some of this geographical variation and these underlying factors should be considered when developing prevention programs.

TITRE: Écarts régionaux dans le fardeau économique attribuable au surplus de poids, à la sédentarité et à l'usage du tabac en Colombie-Britannique. INTRODUCTION: Les taux de prévalence du surplus de poids, de l'usage du tabac et de la sédentarité varient sensiblement d'une région à l'autre en Colombie-Britannique (C.-B.). La présente étude vise à déterminer la portée d'une éventuelle réduction du fardeau économique en C.-B. si toutes les régions de la province atteignaient des taux de prévalence équivalents à ceux de la région dont les taux sont les plus bas pour ces trois facteurs de risque. MÉTHODOLOGIE: Nous avons utilisé une approche élaborée précédemment fondée sur la fraction étiologique du risque pour estimer le fardeau économique associé aux divers facteurs de risque. Le risque relatif selon le sexe et les données de prévalence selon l'âge et le sexe ont été utilisés dans la modélisation. RÉSULTATS: Le fardeau économique annuel attribuable à ces trois facteurs de risque en C.-B. s'élevait à environ 5,6 milliards de dollars en 2013, la proportion la plus élevée de ce total étant attribuable au surplus de poids (2,6 milliards), suivie de celle de l'usage du tabac (2 milliards). Même si la C.-B. possède des taux de prévalence de ces facteurs de risque plus bas que toute autre province canadienne, il existe d'importants écarts en son sein. Si chaque région de la province devait atteindre les taux de prévalence les plus bas pour les trois facteurs de risque, un fardeau économique de 1,4 milliard (24 % du total de 5,6 milliards) pourrait être supprimé annuellement. CONCLUSION : Il existe des disparités notables dans la prévalence de chacun des facteurs de risque au sein des régions sanitaires de la C.-B., qui se reflètent dans le fardeau économique attribuable à chaque région. Un éventail de facteurs sociaux, environnementaux et économiques expliquent probablement une partie de ces écarts géographiques, et ces facteurs sous-jacents devraient être pris en compte lors de la mise en place de programmes de prévention.

The distribution of Salmonella enterica serovars and subtypes in surface water from five agricultural regions across Canada.

Serovar prevalence of the zoonotic pathogen, Salmonella enterica, was compared among 1624 surface water samples collected previously from five different Canadian agricultural watersheds over multiple years. Phagetyping, pulsed field gel electrophoresis (PFGE), and antimicrobial resistance subtyping assays were performed on serovars Enteritidis, Typhimurium, and Heidelberg. Serovars and subtypes from surface water were compared with those from animal feces, human sewage, and serovars reported to cause salmonellosis in Canadians. Sixty-five different serovars were identified in surface water; only 32% of these were isolated from multiple watersheds. Eleven of the 13 serovars most commonly reported to cause salmonellosis in Canadians were identified in surface water; isolates of these serovars constituted >40% of the total isolates. Common phagetypes and PFGE subtypes of serovars associated with illness in humans such as S. Enteritidis and S. Typhimurium were also isolated from surface water and animal feces. Antimicrobial resistance was generally low, but was highest among S. Typhimurium. Monitoring of these rivers helps to identify vulnerable areas of a watershed and, despite a relatively low prevalence of S. enterica overall, serovars observed in surface water are an indication of the levels of specific S. enterica serovars present in humans and animals.

Anti-filarial and total IgG4 and IgE antibody levels are correlated in mothers and their offspring.

In mothers who suffer from helminth infections or allergic diseases, prenatal sensitization with antigens/allergens is suspected to bias the immune system of the offspring towards a Th2-type response. To investigate this at the antibody level, we collected 113 blood samples on filter paper from a paediatric population aged 3 months to 10 years and their mothers, who resided in an area endemic for brugian filariasis in Indonesia. The results showed that antibody levels in children were strongly correlated with maternal antibody levels. However, for anti-filarial IgG4 and IgE this relationship was manifested directly after birth, whereas for total antibody levels a positive correlation could be detected only with children aged > or = 2 years. To investigate the influence of paternal antibody on progeny, specific IgG4 was determined in a different set of samples from 229 children and both of their parents. Interestingly, the influence of paternal IgG4 became apparent only after the age of 4 years. In contrast, maternal antibody levels were already correlated to levels produced by their offspring at a young age (3 months onwards). Taken together, it appears that children can become sensitized to parasite antigens in utero, allowing them to produce Th2-dependent specific IgG4 and IgE antibodies at a young age, whereas with increasing age, the influence of environmental factors, shared in households, such as filarial transmission and other helminth infections, becomes dominant.

The Distribution of Free Amino Acids, Especially of Proline, in the Organs of Field Bean Plants, Vicia faba L., during Development in the Field.

Concentrations of free and bound proline and total free amino acidswere measured in the organs of field bean (cv. Minica), grown under field conditions. The very young seeds of 95-day-old plants had a very high content of more than 1mg free proline per gram fresh weight. The free proline content of leaves and pod walls did not exceed 0.1 mg per g fresh weight. The ratios of free proline and total free amino acid concentrations in the different organs were not constant during the development of the plants. The ratio of the free and bound proline concentrations was very high by the time the youngest seeds and pod walls were sampled and decreased rapidly during the further process of ripening to a value which was comparable to the ratios of the other organs. This very high ratio was not a consequence of a water shortage. It is therefore suggested that free proline has a characteristic function in the development of the generative organs.

The development of specific IgG4 and IgE in a paediatric population is influenced by filarial endemicity and gender.

We set out to study how anti-filarial IgG4 and IgE, which have been studied extensively in adult populations, are influenced by gender and by the degree of filarial endemicity during childhood. Development of specific IgG4 and IgE was examined in 502 children aged 3 months to 12 years, who were resident in 3 villages in South-Sulawesi with microfilaria prevalences of 6, 23 and 42 %. Specific IgG4 and IgE could be detected as early as 18 months after birth, in low amounts, and increased to levels comparable to those produced by adults at the age of 3 years. A higher prevalence of anti-filarial IgG4 in boys, indicating higher filarial infection compared to girls, became apparent after the age of 7. The specific IgG4 response was strongly influenced by the degree of filarial endemicity and production of this antibody was considerably delayed in the low transmission village. With respect to IgE, it was noted that specific IgE was consistently higher in boys from infancy onwards indicating a predisposition for high IgE production in males. The influence of filarial endemicity was less profound on IgE thaon on IgG4. In conclusion, reactivity to filarial antigens begins early in life and is differentially influenced by gender and transmission intensity.

Assessing adolescents and young girls for plastic surgical intervention: pre-surgical appearance ratings and appearance-related burdens as reported by adolescents and young adults, parents and surgeons.

Currently available research on psychological aspects of plastic surgery offers little basis for clinical decision making in the plastic surgeon's assessment of adolescents and young adults applying for surgery. Therefore, the research aims were to study: first, how these adolescents and young adults estimate their appearance as compared to their parents and plastic surgeons to determine the reality of their own appearance perception; second, what appearance-related burdens they experience to determine the urgency of their request for surgery; and third, the surgeons' considerations for the operation. Data were obtained from 184 plastic surgical patients aged 12-22 years (71.2% girls), 172 of their parents and 37 surgeons from 16 hospitals in The Netherlands, using appearance rating scales and to surgeons and parents, and reported substantial appearance-related suffering. There was a moderate to large overlap between the adolescent- and parent-reported burdens. In their assessment, surgeons took psychological and social impediments into consideration. In conclusion, plastic surgeons may rightfully assume that adolescents and young adults have a realistic view of their appearance and that they suffer from significant appearance-related burdens. Parents prove to be an important additional source of information.