What motivates students to decrease or cease substance use?: A scoping review.

OBJECTIVE: The association between illicit substance use by third-level education students and their mental and physical health is well documented. The aim of this scoping review was to determine factors that contribute to student motivations to reduce or stop their use of illicit substances, and to elaborate on factors that may be pertinent for student-focused behaviour change interventions for substance use. METHOD: We searched eight databases in March 2021 using search terms based on 'students', 'illicit substance use', and 'motivations'. We identified 86 research articles that reported on third-level education students' illicit substance use and included reasons or motives for their use. RESULTS: After full-text screening, three studies were eligible for inclusion in the qualitative synthesis. The majority of studies described motives for abstention but did not describe motivation for reducing or stopping current patterns of use of illicit substances. CONCLUSION: Few studies have examined motivations of third-level education students to decrease or cease substance use. Promising avenues for research on motivations to change substance use behaviour include the social contextual factors, perceived effects on social relationships, and actions of friends and family to prompt contemplations of change.

Investing in prospective cohorts for etiologic study of occupational exposures.

Prospective cohorts have played a major role in understanding the contribution of diet, physical activity, medical conditions, and genes to the development of many diseases, but have not been widely used for occupational exposures. Studies in agriculture are an exception. We draw upon our experience using this design to study agricultural workers to identify conditions that might foster use of prospective cohorts to study other occupational settings. Prospective cohort studies are perceived by many as the strongest epidemiologic design. It allows updating of information on exposure and other factors, collection of biologic samples before disease diagnosis for biomarker studies, assessment of effect modification by genes, lifestyle, and other occupational exposures, and evaluation of a wide range of health outcomes. Increased use of prospective cohorts would be beneficial in identifying hazardous exposures in the workplace. Occupational epidemiologists should seek opportunities to initiate prospective cohorts to investigate high priority, occupational exposures.

Being old in Ireland: a fit state?

This is a cross-sectional, interview-based study profiling the health-status, functional ability and patterns of service use of an age-stratified random sample of 766 people over 70. Of 495 respondents (response rate 64.4%), 65% (n=324) rated their health as good/very good/excellent, 36% (n=180) reported long-term illness, 17% (n=82) had a moderate/severe disability. Of those living alone, 68.7% (n=125/182) were female, 39.6% (n=72/182) were over-80, 28.7% (n=51/178) had no fire alarm, 58.9 % (n=102/173) had no panic alarm. Of those who do not have a car, 66.3% (n=174/262) rely mainly on friends/family for transport. 40.7% (n=24/59) of respondents with moderate/severe disability reported no state-provided home-help. Despite much good news, a substantial vulnerable minority of older people would benefit from additional support: rural transport schemes and smoke alarm schemes should be extended; a formal needs assessment of homecare needs of older people should be considered; numbers of community therapists and access to home-help should be increased.

Increased frequency of chromosome translocations in airline pilots with long-term flying experience.

BACKGROUND: Chromosome translocations are an established biomarker of cumulative exposure to external ionising radiation. Airline pilots are exposed to cosmic ionising radiation, but few flight crew studies have examined translocations in relation to flight experience. METHODS: We determined the frequency of translocations in the peripheral blood lymphocytes of 83 airline pilots and 50 comparison subjects (mean age 47 and 46 years, respectively). Translocations were scored in an average of 1039 cell equivalents (CE) per subject using fluorescence in situ hybridisation (FISH) whole chromosome painting and expressed per 100 CE. Negative binomial regression models were used to assess the relationship between translocation frequency and exposure status and flight years, adjusting for age, diagnostic x ray procedures, and military flying. RESULTS: There was no significant difference in the adjusted mean translocation frequency of pilots and comparison subjects (0.37 (SE 0.04) vs 0.38 (SE 0.06) translocations/100 CE, respectively). However, among pilots, the adjusted translocation frequency was significantly associated with flight years (p = 0.01) with rate ratios of 1.06 (95% CI 1.01 to 1.11) and 1.81 (95% CI 1.16 to 2.82) for a 1- and 10-year incremental increase in flight years, respectively. The adjusted rate ratio for pilots in the highest compared to the lowest quartile of flight years was 2.59 (95% CI 1.26 to 5.33). CONCLUSIONS: Our data suggests that pilots with long-term flying experience may be exposed to biologically significant doses of ionising radiation. Epidemiological studies with longer follow-up of larger cohorts of pilots with a wide range of radiation exposure levels are needed to clarify the relationship between cosmic radiation exposure and cancer risk.

Recurrent localised cutaneous parapoxvirus infection in three cats.

CASE HISTORY: Three cats were presented with single proliferative lesions affecting one foot, which failed to heal after medical treatment, and recurred despite surgical resection. PATHOLOGICAL FINDINGS: Histologically, the lesions were proliferative and papillary. There was marked acanthosis, rete peg formation, and compact orthokeratosis, with large numbers of bacteria in the orthokeratotic scale. Some biopsies had multifocal keratinocyte swelling of the stratum granulosum, and amphophilic intracytoplasmic inclusions were present in some of the swollen cells. The dermis consisted of a light fibrous stroma with marked capillary proliferation. Parapoxviruses were detected in the lesions of all cats by electron microscopic examination. PCR analysis detected orf virus (contagious ecthyma virus) in two cats, and orf virus was cultured from one cat. DIAGNOSIS: Parapoxvirus infection in cats. CLINICAL RELEVANCE: Parapoxvirus infection should be considered as a differential diagnosis when dealing with proliferative, non-healing lesions on the feet of cats, especially cats in rural areas. The recovery of orf virus from a cat with typical poxvirus lesions extends the range of species affected by this virus.

Prevalence of respiratory symptoms among female flight attendants and teachers.

BACKGROUND: Potential health effects of the indoor environment in office buildings and aircraft have generated considerable concern in recent years. AIMS: To analyse the prevalence of self reported respiratory symptoms and illnesses in flight attendants (FAs) and schoolteachers. METHODS: Data were collected as part of a study of reproductive health among female FAs. The prevalences of work related eye, nose, and throat symptoms, wheezing, physician diagnosed asthma, chest illness, and cold or flu were calculated and stratified by smoking status in 1824 FAs and 331 schoolteachers. RESULTS: FAs and teachers were significantly more likely to report work related eye (12.4% and 7.4 %, respectively), nose (15.7% and 8.1%), and throat symptoms (7.5% and 5.7%) than were other working women (2.9% eye, 2.7% nose, and 1.3% throat symptoms). FAs were significantly more likely than teachers and referent working women to report chest illness during the prior three years (32.9%, 19.3%, 7.2%, respectively). Both study groups were more likely to report five or more episodes of cold or flu in the past year than were other working women (10.2% of FAs, 8.2% of teachers, 2.3% of referents), and both groups were more likely to report wheezing than other working women (22.8% of FAs, 28.4% of teachers, 16.4% of referents). FAs were significantly less likely than teachers and other working women to report ever having been diagnosed with asthma (8.2%, 13.3%, 11.8%, respectively). CONCLUSIONS: Overall, FAs and schoolteachers report a higher prevalence of work related upper respiratory symptoms, chest illness, and cold or flu than the general working population.

Spontaneous abortion, sex ratio, and paternal occupational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

There is conflicting research regarding an association between fetal death and paternal exposure to Agent Orange, a phenoxy herbicide widely used in Vietnam that was contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Men who worked in the U.S. factories that produced Agent Orange were exposed to TCDD at levels hundreds of times higher than TCDD levels in the general population. Wives of TCDD-exposed chemical workers and wives of nonexposed neighborhood referents were interviewed to determine reproductive history. Paternal serum TCDD level at time of conception was estimated for each pregnancy using serum samples taken in 1987. Estimated TCDD levels of workers during or after exposure were high (median, 254 ppt; range, 3-16,340 ppt) compared to referent levels (median, 6 ppt; range, 2-19 ppt). No association between paternal TCDD level at the time of conception and spontaneous abortion was observed among pregnancies fathered by workers with TCDD levels of < 20 ppt [odds ratio (OR) = 0.77; 95% confidence interval (CI), 0.48-1.22], 20 to < 255 ppt (OR = 0.81; 95% CI, 0.40-1.63), 255 to < 1,120, (OR = 0.69; 95% CI, 0.30-1.58), and >or= 1,120 ppt (OR = 0.95; 95% CI, 0.42-2.17) compared to pregnancies fathered by referents. The sex ratio [males/(males + females)] of offspring also did not differ by TCDD exposure (0.53 and 0.54 among workers and referents, respectively). We did not find an association between paternal serum TCDD level and spontaneous abortion or sex ratio of offspring in this population. The estimated TCDD levels in this exposed worker population were much higher than in other studies, providing additional evidence that paternal TCDD exposure does not increase the risk of spontaneous abortion at levels above those observed in the general population. The study could not evaluate the effect of father's childhood or prenatal TCDD exposure on subsequent sex ratio.

Hemoglobin adducts and sister chromatid exchanges in hospital workers exposed to ethylene oxide: effects of glutathione S-transferase T1 and M1 genotypes.

Ethylene oxide (EtO) is a genotoxic carcinogen with widespread uses as an industrial chemical intermediate and sterilant. We examined the effects of glutathione S-transferase T1 (GSTT1) and M1 (GSTM1) genotypes on the levels of N-(2-hydroxyethyl)valine (HEV) adducts in the erythrocytes and sister chromatid exchange (SCE) in lymphocytes from a group of 58 operators of sterilizers that used EtO and nonexposed workers from nine hospitals in the United States and one hospital in Mexico City. Cumulative exposure to EtO was estimated during the 4-month period before the collection of blood samples. Results showed that EtO exposure was significantly associated with the levels of HEV adducts and SCE after adjusting for cigarette smoking and other potential confounders. A significantly higher HEV adduct level (0.17 +/- 0.03 versus 0.08 +/- 0.01, mean +/- SE; P = 0.02) but lower SCE frequency (5.31 +/- 0.39 versus 6.21 +/- 0.17; P = 0.04) was observed in subjects with homozygous deletion of the GSTT1 gene (null genotype) as compared with those with at least one copy of the gene (positive genotype). In multiple regression analysis, the GSTT1-null genotype was associated with an increase in HEV adduct level (beta = 1.62; P = 0.02) and a decrease in SCE frequency (beta = -1.25; P = 0.003) after adjusting for age, gender, race, education, cigarette smoking, and EtO exposure status. The inverse SCE-GSTT1 relationship remained unchanged when SCE was further examined in relation to HEV adducts as an indicator of the internal EtO dose. The GSTM1 genotype was not associated with the level of either HEV adduct or SCE. These data indicate that the GSTT1-null genotype is associated with increased formation of EtO-hemoglobin adducts in relation to occupational EtO exposure, suggesting that individuals with homozygous deletion of the GSTT1 gene may be more susceptible to the genotoxic effects of ETO: The unexpected finding of decreased SCEs, which is less clear, may be attributed to the nonchemical specificity of this end point and the lack of expression of the GSTT1 enzyme in lymphocytes.

Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices.

CONTEXT: The US primary care safety net is composed of a loose network of community health centers, hospital outpatient departments, and physicians' offices. National data on how the mix of patients and services differ across sites are needed. OBJECTIVE: To develop and contrast national profiles of patient and service mix for primary care. DESIGN, SETTING, AND PATIENTS: Comparative analyses of 3 national surveys of primary care visits occurring in 1994: for data on physician's office visits, the National Ambulatory Medical Care Survey (NAMCS); for hospital outpatient department data, the National Hospital Ambulatory Medical Care Survey (NHAMCS); and for data on community health centers, the Bureau of Primary Health Care's 1994 Survey of Visits to Community Health Centers. A time trend analysis also was conducted using the 1998 NAMCS and NHAMCS. MAIN OUTCOME MEASURES: National estimates of primary care visit rates, types of patient presentation, patient case-mix, disposition of patients, and management interventions in 1994, and compared with 1998 data. RESULTS: The US population made 1.3 primary care visits per person in 1994, which accounted for 43.5% of all ambulatory visits to physicians' offices, community health centers, and hospital outpatient departments. Primary care visits per person were 20% lower for Hispanics and 33% lower for black, non-Hispanic persons compared with white, non-Hispanic persons. Visits to community health centers were more likely to be made by ethnic minorities, patients with Medicaid or no insurance, and rural dwellers than visits made to the other delivery sites. Visits at hospital outpatient departments were made by sicker populations and were characterized by less continuity than the other delivery sites. Controlling for patient mix, visits made to hospital outpatient departments were more commonly associated with imaging studies, minor surgery, and specialty referrals than those made to physicians' offices. In 1998, the US population made an estimated 3. 4 visits per person, 45.6% of which were primary care visits. National estimates of primary care visit rates and patient mix and practice pattern comparisons between hospital outpatient departments and physicians' offices were similar in 1998 and 1994. CONCLUSIONS: Expanding community health centers will likely improve access to primary care for vulnerable US populations. However, enhancing access to of physicians' offices is also needed to bolster the safety net. The greater service intensity and poorer continuity for primary care visits in hospital outpatient departments that we observed raises concern about the suitability of these clinics as primary care delivery sites. JAMA. 2000;284:2077-2083.

The health effects of moderate alcohol intake in humans: an epidemiologic review.

A large body of scientific evidence associates the moderate intake of alcohol with reduced mortality among middle-aged and older people in industrialized societies. This association is due largely to a reduced risk of death from coronary heart disease, which appears to outweigh any possible adverse effects of moderate drinking. The regular consumption of small amounts of alcohol is more healthful than the sporadic consumption of larger amounts. No beneficial effect of moderate drinking on mortality has been demonstrated in young adults (premenopausal women and men who have not reached their forties). It is theoretically possible that moderate drinking in young adulthood might reduce the risk of later heart disease; however, this has not been clearly demonstrated. For some individuals (e.g., those who cannot keep their drinking moderate, pregnant women, and those who are taking medications that may interact adversely with alcoholic beverages), the risks of alcohol consumption, even in moderation, outweigh any potential benefits. Because even small amounts of alcohol can impair judgment and coordination, no one should drink alcoholic beverages, even in moderation, before driving a motor vehicle or performing other activities that involve attention and skill.

The association between childhood feeding problems and maternal eating disorder: a community study.

BACKGROUND: A possible association between childhood feeding problems and maternal eating disorder has been suggested by a clinic-based self-report questionnaire study. A community study was conducted, using standardized psychiatric interviews, to investigate the strength and specificity of this putative association. METHODS: Four-year-old children were screened using a self-report version of the Behaviour Screening Questionnaire, completed by mothers, and the Pre-School Behaviour Checklist, completed by teachers. Three groups of children were identified for follow-up: children with feeding problems (N = 42), children with a non-feeding form of disturbance (i.e. shyness, fearfulness or behavioural disturbance; N = 79), and a random sample of children with no disturbance (N = 29). The presence of feeding problems was confirmed by assessment of a filmed family meal, with ratings made blind to child group and maternal mental state. Maternal current and past affective disorder and current and past eating disorder were systematically assessed, blind to child status, using the Anxiety Disorders Interview Schedule and the Eating Disorder Examination respectively. RESULTS: Compared with the mothers of the two comparison groups of children, the mothers of the children with feeding problems had no raised rate of any affective disorder, either current or past, but they did have a markedly raised rate of both current and past DSM-IV eating disorder. The odds ratio of maternal eating disorder for the children with feeding problems was significantly raised at 11.1 (CI 1.4-91.8). CONCLUSION: There is a strong and specific association between childhood feeding problems and maternal eating disorder.

Menstrual and reproductive risk factors for ischemic heart disease.

The role of hormones in ischemic heart disease is of considerable interest, but limited data are available pertaining to risk factors associated with endogenous hormones. We examined the association between menstrual and reproductive factors and ischemic heart disease in a cohort of 867 white, college-educated women who prospectively recorded menstrual cycle data for at least 5 years from their early 20s through their menopause. Ischemic heart disease history was obtained from a self-administered (N = 714) or proxy-administered (N = 153) questionnaire completed at a mean age of 73 years. The analysis included 44,899 person-years of follow-up and 45 cases of myocardial infarction, angioplasty, heart bypass surgery, or ischemic heart disease-related mortality. Ischemic heart disease risk decreased with increasing age at menarche (age-adjusted RR 0.76 per year, 95% CI = 0.60-0.95). Considering menstrual cycle characteristics ages 28-32, there was little overall association with length, variability, or bleeding duration. Ischemic heart disease risk increased with later age at first birth (age-adjusted RR 2.90 for ages 33-43 compared with 25-29) and later age at last birth (age-adjusted RR 3.79 for ages > or =40 compared with 35-39), but there was little association with high parity.

Elevated blood lead levels in children of construction workers.

OBJECTIVES: This study examined whether children of lead-exposed construction workers had higher blood lead levels than neighborhood control children. METHODS: Twenty-nine construction workers were identified from the New Jersey Adult Blood Lead Epidemiology and Surveillance (ABLES) registry. Eighteen control families were referred by workers. Venous blood samples were collected from 50 children (31 exposed, 19 control subjects) under age 6. RESULTS: Twenty-six percent of workers children had blood lead levels at or over the Centers for Disease Control and Prevention action level of 0.48 mumol/L (10 micrograms/dL), compared with 5% of control children (unadjusted odds ratio = 6.1; 95% confidence interval = 0.9, 147.2). CONCLUSIONS: Children of construction workers may be at risk for excessive lead exposure. Health care providers should assess parental occupation as a possible pathway for lead exposure of young children.