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1.
BMJ ; 372: m4957, 2021 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-33504472

RESUMEN

OBJECTIVE: To examine county level associations between the prevalence of medical and recreational cannabis stores (referred to as dispensaries) and opioid related mortality rates. DESIGN: Panel regression methods. SETTING: 812 counties in the United States in the 23 states that allowed legal forms of cannabis dispensaries to operate by the end of 2017. PARTICIPANTS: The study used US mortality data from the Centers for Disease Control and Prevention combined with US census data and data from Weedmaps.com on storefront dispensary operations. Data were analyzed at the county level by using panel regression methods. MAIN OUTCOME MEASURE: The main outcome measures were the log transformed, age adjusted mortality rates associated with all opioid types combined, and with subcategories of prescription opioids, heroin, and synthetic opioids other than methadone. The associations of medical dispensary and recreational dispensary counts with age adjusted mortality rates were also analyzed. RESULTS: County level dispensary count (natural logarithm) is negatively related to the log transformed, age adjusted mortality rate associated with all opioid types (ß=-0.17, 95% confidence interval -0.23 to -0.11). According to this estimate, an increase from one to two storefront dispensaries in a county is associated with an estimated 17% reduction in all opioid related mortality rates. Dispensary count has a particularly strong negative association with deaths caused by synthetic opioids other than methadone (ß=-0.21, 95% confidence interval -0.27 to -0.14), with an estimated 21% reduction in mortality rates associated with an increase from one to two dispensaries. Similar associations were found for medical versus recreational storefront dispensary counts on synthetic (non-methadone) opioid related mortality rates. CONCLUSIONS: Higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl. While the associations documented cannot be assumed to be causal, they suggest a potential association between increased prevalence of medical and recreational cannabis dispensaries and reduced opioid related mortality rates. This study highlights the importance of considering the complex supply side of related drug markets and how this shapes opioid use and misuse.


Asunto(s)
Analgésicos Opioides/envenenamiento , Comercio/estadística & datos numéricos , Sobredosis de Droga/mortalidad , Uso de la Marihuana/legislación & jurisprudencia , Marihuana Medicinal , Trastornos Relacionados con Opioides/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Comercio/legislación & jurisprudencia , Sobredosis de Droga/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/prevención & control , Análisis de Regresión , Estados Unidos/epidemiología
2.
PLoS One ; 16(1): e0245261, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33465121

RESUMEN

We investigated what degree of risk of infection with COVID-19 is necessary so that people intend to stay home, even when doing so means losing their salary. We conducted an online survey across Brazil during the initial outbreak, in which 8,345 participants answered a questionnaire designed to identify the maximum tolerated risk (k') necessary for them to disregard social distancing recommendations and guarantee their salaries. Generalized linear mixed models, path analysis structural equation, and conditional interference classification tree were performed to further understand how sociodemographic factors impact k' and to establish a predictive model for the risk behavior of leaving home during the pandemic. We found that, on average, people tolerate 38% risk of infection to leave home and earn a full salary, but this number decreased to 13% when the individual risk perception of becoming ill from severe acute respiratory syndrome coronavirus-2 is considered. Furthermore, participants who have a medium-to-high household income and who are older than 35 years are more likely to be part of the risk-taking group who leave home regardless of the potential COVID-19 infection level; while participants over 45 years old and with good financial health are more likely to be part of the risk-averse group, who stay home at the expense of any salary offered. Our findings add to the political and public debate concerning lockdown strategies by showing that, contrary to supposition, people with low socioeconomic status are not more likely to ignore social distancing recommendations due to personal economic matters.


Asunto(s)
/psicología , Asunción de Riesgos , Trabajo/psicología , Adolescente , Adulto , Factores de Edad , Brasil , Comercio/estadística & datos numéricos , Empleo/estadística & datos numéricos , Femenino , Humanos , Renta/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuarentena/psicología , Conducta Social , Trabajo/estadística & datos numéricos
3.
JAMA Netw Open ; 3(12): e2031083, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33369659

RESUMEN

Importance: Health taxes are policy tools used to reduce harmful consumption of products and raise tax revenue, and they may also be associated with signaling (ie, informational and educational) factors that enhance their impact. Objectives: To examine changes in prices and volume sold of sweetened beverages following the implementation and repeal of the Cook County, Illinois, Sweetened Beverage Tax (SBT) compared with the comparison site of St Louis County and city, Missouri, which did not impose a tax. Design, Setting, and Participants: This study used interrupted time series analyses to assess changes in price and volume sold of taxed (based on beverage type and sweetener status) and untaxed beverages in Cook County compared with St Louis following the implementation of the SBT on August 2, 2017, and its repeal effective December 1, 2017. Statistical analysis was performed from January to June 2020. Exposures: Implementation and repeal of the Cook County SBT. Main Outcomes and Measures: Changes in taxed and untaxed beverage prices and volume sold. Nielsen food store scanner data were obtained for weekly volume and dollar amount sold of nonalcoholic beverage universal product codes (UPCs) for each site in supermarkets and mass merchandise, grocery, drug, convenience, and dollar stores. Results: The analytic samples included 16 510 UPCs for volume and 2141 UPCs (balanced sample) for prices for 122 pretax weeks, 16 tax weeks, and 35 postrepeal weeks. Compared with St Louis, posttax implementation in Cook County resulted in a level increase in taxed beverage prices of 1.13 cents per fluid ounce (95% CI, 1.01 to 1.25 cents per fluid ounce), representing a slight overshifting, followed by a posttax repeal level decrease of -1.19 cents per fluid ounce (95% CI, -1.33 to -1.04 cents per fluid ounce), with no resulting change pretax to posttax repeal. Volume sold of taxed beverages in Cook County compared with St Louis exhibited a posttax implementation level decrease of 25.7% (ß = -0.297; 95% CI, -0.415 to -0.179) and a posttax repeal level increase of 30.5% (ß = 0.266, 95% CI, 0.124 to 0.408), with no net change in volume sold from pretax to 8 months after repeal. Conclusions and Relevance: This study using interrupted time series analysis found no net change in volume sold of taxed beverages following the implementation and repeal of the Cook County SBT, suggesting the tax had no signaling association. Repeals of such taxes may fully reverse their associations with reduced demand and harms associated with sweetened beverage intake.


Asunto(s)
Comercio/estadística & datos numéricos , Comportamiento del Consumidor/economía , Bebidas Azucaradas/economía , Impuestos/economía , Implementación de Plan de Salud , Humanos , Illinois , Análisis de Series de Tiempo Interrumpido
4.
Biomedica ; 40(Supl. 2): 139-147, 2020 10 30.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33152197

RESUMEN

Introduction: Rapid IgM-IgG combined antibody tests can play an important role in the COVID-19 surveillance by supporting the diagnosis of infection, assessing the immune response, and verifying the progress towards herd immunity. Objective: To evaluate the performance of rapid IgM-IgG combined antibody tests in COVID-19 occupational surveillance in a group of Colombian enterprises. Materials and methods: We used the occupational surveillance data from companies that had performed periodic serological tests on all personnel from the end of April to the beginning of July, 2020. Workers were organized in small groups ("social bubbles") to prevent outbreaks and optimize surveillance. The sensitivity was estimated as if the sampling had a prospective design. We describe here the changes in serological testing through periodic rounds. Results: Data were obtained from 4,740 workers, of whom only 23 were symptomatic showing changes from IgM(-)/IgG(-) to IgM(+) and then to IgM(+)/IgG(+) and IgG(+). The sensitivity was 40.94% for IgM(+) and 47.95% for IgM(+)/IgG(+). This implies that a little less than half of the cases can be detected. Conclusion: Antibody rapid tests have a role in the diagnostic process of infection and they must be evaluated taking into account the moment of the epidemic, the type of test purchased, and the populations at risk since their results depend on the number of infections and cases. In the context of a health crisis, they can be optimized by organizing workers into "social bubbles"


Asunto(s)
Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Técnicas de Laboratorio Clínico , Comercio/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Medicina del Trabajo/métodos , Pandemias , Neumonía Viral/diagnóstico , Adulto , Infecciones Asintomáticas/epidemiología , Colombia/epidemiología , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/inmunología , Femenino , Humanos , Relaciones Interpersonales , Masculino , Neumonía Viral/sangre , Neumonía Viral/inmunología , Estudios Prospectivos , Sensibilidad y Especificidad , Evaluación de Síntomas
5.
Artículo en Inglés | MEDLINE | ID: mdl-33096757

RESUMEN

Given the disturbing effects of the coronavirus disease 2019 (COVID-19) outbreak, we are motivated to examine whether the continued increase of the provincial public health threats affects the firms' accumulative abnormal return. Using the 178,805 firm-day observations from Chinese listed firms from 10 January to 31 March 2020, we find that the accumulative abnormal return is significantly lower among firms located in the provinces where face the continued increase of new confirmed COVID-19 cases. The relations remain constant after several robustness tests. These findings suggest that investors concern about the potential risk when firms are located in the provinces with higher threats to public health. We also find that the negative effect of increasing public health threats on abnormal return is weaker for firms surrounded by a provincial environment with stronger information accessibility and economic growth. Overall, this study extends the literature by presenting systematic evidence on the effect of the continued increase of provincial public health threats on the market reaction in Chinese listed firms.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Salud Pública , Medición de Riesgo , Betacoronavirus , China/epidemiología , Comercio/estadística & datos numéricos , Humanos , Pandemias
6.
Artículo en Inglés | MEDLINE | ID: mdl-33050600

RESUMEN

Disparities in dietary behaviors have been directly linked to the food environment, including access to retail food outlets. The Coronavirus Disease of 2019 (COVID-19) pandemic has led to major changes in the distribution, sale, purchase, preparation, and consumption of food in the United States (US). This paper reflects on those changes and provides recommendations for research to understand the impact of the pandemic on the retail food environment (RFE) and consumer behavior. Using the Retail Food Environment and Customer Interaction Model, we describe the impact of COVID-19 in four key areas: (1) community, state, tribal, and federal policy; (2) retail actors, business models, and sources; (3) customer experiences; and (4) dietary intake. We discuss how previously existing vulnerabilities and inequalities based on race, ethnicity, class, and geographic location were worsened by the pandemic. We recommend approaches for building a more just and equitable RFE, including understanding the impacts of changing shopping behaviors and adaptations to federal nutrition assistance as well as how small food business can be made more sustainable. By better understanding the RFE adaptations that have characterized the COVID-19 pandemic, we hope to gain greater insight into how our food system can become more resilient in the future.


Asunto(s)
Comercio/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Dieta Saludable , Alimentos/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Humanos , Estados Unidos/epidemiología
7.
Artículo en Inglés | MEDLINE | ID: mdl-32899954

RESUMEN

To improve urban adolescents' dietary behaviors and health, factors that influence them to buy meals in convenience stores with regard to urban food environments must be determined. This study investigated the factors which influence adolescents' substitution of meals with convenience store meals and its impact on their health in Seoul (South Korea). Multilevel analysis and logistic regression analysis were conducted using data from the Korea Youth Risk Behavior Survey, a national health survey with a representative sample of Korean adolescents. Among 17,624 teenagers who responded to surveys in 2017 and 2019, 30.5% of them substituted meals with convenience store meals more than three times a week. Girls and students with a lower family economic level were more likely to frequently consume food from convenience stores. Unhealthy lifestyles and poor mental health status also influenced their decisions to substitute meals with convenience store food. Those who frequently consumed meals from convenience stores were more likely to have unhealthy lifestyles, featuring bad diets, smoking, drinking, and sedentary behaviors. They also reported significantly poorer self-rated health and mental health. To promote healthy lifestyles among adolescents, efforts to raise awareness and develop supportive environments for healthy diets are strongly recommended.


Asunto(s)
Comercio/estadística & datos numéricos , Dieta , Comida Rápida , Conducta Alimentaria , Abastecimiento de Alimentos/estadística & datos numéricos , Adolescente , Conducta de Elección , Femenino , Humanos , Masculino , República de Corea , Seúl , Medio Social , Población Urbana
8.
PLoS One ; 15(9): e0239113, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32946463

RESUMEN

Social distancing interventions can be effective against epidemics but are potentially detrimental for the economy. Businesses that rely heavily on face-to-face communication or close physical proximity when producing a product or providing a service are particularly vulnerable. There is, however, no systematic evidence about the role of human interactions across different lines of business and about which will be the most limited by social distancing. Here we provide theory-based measures of the reliance of U.S. businesses on human interaction, detailed by industry and geographic location. We find that, before the pandemic hit, 43 million workers worked in occupations that rely heavily on face-to-face communication or require close physical proximity to other workers. Many of these workers lost their jobs since. Consistently with our model, employment losses have been largest in sectors that rely heavily on customer contact and where these contacts dropped the most: retail, hotels and restaurants, arts and entertainment and schools. Our results can help quantify the economic costs of social distancing.


Asunto(s)
Comercio/tendencias , Infecciones por Coronavirus/prevención & control , Empleo/tendencias , Control de Infecciones/economía , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus/patogenicidad , Comercio/normas , Comercio/estadística & datos numéricos , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Conjuntos de Datos como Asunto , Empleo/economía , Empleo/estadística & datos numéricos , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Estados Unidos
9.
PLoS One ; 15(9): e0239494, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32946503

RESUMEN

We propose the epsilon-tau procedure to determine up- and down-trends in a time series, working as a tool for its segmentation. The method denomination reflects the use of a tolerance level ε for the series values and a patience level τ in the time axis to delimit the trends. We first illustrate the procedure in discrete random walks, deriving the exact probability distributions of trend lengths and trend amplitudes, and then apply it to segment and analyze the trends of U.S. dollar (USD)/Japanese yen (JPY) market time series from 2015 to 2018. Besides studying the statistics of trend lengths and amplitudes, we investigate the internal structure of the trends by grouping trends with similar shapes and selecting clusters of shapes that rarely occur in the randomized data. Particularly, we identify a set of down-trends presenting similar sharp appreciation of the yen that are associated with exceptional events such as the Brexit Referendum in 2016.


Asunto(s)
Comercio/estadística & datos numéricos , Administración Financiera/estadística & datos numéricos , Mercadotecnía/estadística & datos numéricos , Internacionalidad , Japón , Modelos Estadísticos , Probabilidad , Factores de Tiempo , Estados Unidos
10.
MMWR Morb Mortal Wkly Rep ; 69(37): 1313-1318, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32941416

RESUMEN

Since electronic cigarettes (e-cigarettes) entered the U.S. marketplace in 2007, the landscape has evolved to include different product types (e.g., prefilled cartridge-based and disposable products) and flavored e-liquids (e.g., fruit, candy, mint, menthol, and tobacco flavors), which have contributed to increases in youth use (1,2). E-cigarettes have been the most commonly used tobacco product among U.S. youths since 2014; in 2019, 27.5% of high school students reported current e-cigarette use (3). To assess trends in unit sales of e-cigarettes in the United States by product and flavor type, CDC, CDC Foundation, and Truth Initiative analyzed retail scanner data during September 14, 2014-May 17, 2020, from Information Resources, Inc. (IRI). During this period, total e-cigarette sales increased by 122.2%, from 7.7 million to 17.1 million units per 4-week interval. By product type, the proportion of total sales that was prefilled cartridge products increased during September 2014-August 2019 (47.5% to 89.4%). During August 2019-May 2020, the proportion of total sales that was disposable products increased from 10.3% to 19.8%, while the proportion that was prefilled cartridge products decreased (89.4% to 80.2%). Among prefilled cartridge sales, the proportion of mint sales increased during September 2014-August 2019 (<0.1% to 47.6%); during August 2019-May 2020, mint sales decreased (47.6% to 0.3%), as menthol sales increased (10.7% to 61.8%). Among disposable e-cigarette sales during September 2014-May 2020, the proportion of mint sales increased (<0.1% to 10.5%), although tobacco-flavored (52.2% to 17.2%) and menthol-flavored (30.3% to 10.2%) sales decreased; during the same period, sales of all other flavors combined increased (17.2% to 62.1%). E-cigarette sales increased during 2014-2020, but fluctuations occurred overall and by product and flavor type, which could be attributed to consumer preferences and accessibility. Continued monitoring of e-cigarette sales and use is critical to inform strategies at the national, state, and community levels to minimize the risks of e-cigarettes on individual- and population-level health. As part of a comprehensive approach to prevent and reduce youth e-cigarettes use, such strategies could include those that address youth-appealing product innovations and flavors.


Asunto(s)
Comercio/estadística & datos numéricos , Sistemas Electrónicos de Liberación de Nicotina/economía , Aromatizantes/economía , Productos de Tabaco/economía , Humanos , Estados Unidos
11.
Cochrane Database Syst Rev ; 9: CD012415, 2020 09 11.
Artículo en Inglés | MEDLINE | ID: mdl-32914461

RESUMEN

BACKGROUND: Overweight and obesity are increasing worldwide and are considered to be a major public health issue of the 21st century. Introducing taxation of the fat content in foods is considered a potentially powerful policy tool to reduce consumption of foods high in fat or saturated fat, or both. OBJECTIVES: To assess the effects of taxation of the fat content in food on consumption of total fat and saturated fat, energy intake, overweight, obesity, and other adverse health outcomes in the general population. SEARCH METHODS: We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase, and 15 other databases and trial registers on 12 September 2019. We handsearched the reference lists of all records of included studies, searched websites of international organizations and institutions (14 October 2019), and contacted review advisory group members to identify planned, ongoing, or unpublished studies (26 February 2020). SELECTION CRITERIA: In line with Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria, we included the following study types: randomized controlled trials (RCTs), cluster-randomized controlled trials (cRCTs), non-randomized controlled trials (nRCTs), controlled before-after (CBA) studies, and interrupted time series studies. We included studies that evaluated the effects of taxes on the fat content in foods. Such a tax could be expressed as sales, excise, or special value added tax (VAT) on the final product or an intermediary product. Eligible interventions were taxation at any level, with no restriction on the duration or the implementation level (i.e. local, regional, national, or multinational). Eligible study populations were children (zero to 17 years) and adults (18 years or older) from any country and setting. We excluded studies that focused on specific subgroups only (e.g. people receiving pharmaceutical intervention; people undergoing a surgical intervention; ill people who are overweight or obese as a side effect, such as those with thyroiditis and depression; and people with chronic illness). Primary outcomes were total fat consumption, consumption of saturated fat, energy intake through fat, energy intake through saturated fat, total energy intake, and incidence/prevalence of overweight or obesity. We did not exclude studies based on country, setting, comparison, or population. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods for all phases of the review. Risk of bias of the included studies was assessed using the criteria of Cochrane's 'Risk of bias' tool and the EPOC Group's guidance. Results of the review are summarized narratively and the certainty of the evidence was assessed using the GRADE approach. These steps were done by two review authors, independently. MAIN RESULTS: We identified 23,281 records from searching electronic databases and 1173 records from other sources, leading to a total of 24,454 records. Two studies met the criteria for inclusion in the review. Both included studies investigated the effect the Danish tax on saturated fat contained in selected food items between 2011 and 2012. Both studies used an interrupted time series design. Neither included study had a parallel control group from another geographic area. The included studies investigated an unbalanced panel of approximately 2000 households in Denmark and the sales data from a specific Danish supermarket chain (1293 stores). Therefore, the included studies did not address individual participants, and no restriction regarding age, sex, and socioeconomic characteristics were defined. We judged the overall risk of bias of the two included studies as unclear. For the outcome total consumption of fat, a reduction of 41.8 grams per week per person in a household (P < 0.001) was estimated. For the consumption of saturated fat, one study reported a reduction of 4.2% from minced beef sales, a reduction of 5.8% from cream sales, and an increase of 0.5% to sour cream sales (no measures of statistical precision were reported for these estimates). These estimates are based on a restricted number of food types and derived from sales data; they do not measure individual intake. Moreover, these estimates do not account for other relevant sources of fat intake (e.g. packaged or processed food) or other food outlets (e.g. restaurants or cafeterias); hence, we judged the evidence on the effect of taxation on total fat consumption or saturated fat consumption to be very uncertain. We did not identify evidence on the effect of the intervention on energy intake or the incidence or prevalence of overweight or obesity. AUTHORS' CONCLUSIONS: Given the very low quality of the evidence currently available, we are unable to reliably establish whether a tax on total fat or saturated fat is effective or ineffective in reducing consumption of total fat or saturated fat. There is currently no evidence on the effect of a tax on total fat or saturated fat on total energy intake or energy intake through saturated fat or total fat, or preventing the incidence or reducing the prevalence of overweight or obesity.


Asunto(s)
Grasas de la Dieta/administración & dosificación , Obesidad/prevención & control , Impuestos , Adolescente , Adulto , Niño , Comercio/estadística & datos numéricos , Dinamarca , Humanos , Análisis de Series de Tiempo Interrumpido , Sobrepeso/prevención & control
12.
Zoonoses Public Health ; 67(7): 796-804, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32812389

RESUMEN

Wet markets are a critical part of South-East Asian culture and economy. However, their role in circulation and transmission of both endemic and emerging disease is a source of concern in a region considered a hotspot of disease emergence. In the Lao People's Democratic Republic (Lao PDR, Laos), live and dead wild animals are frequently found in wet markets, despite legislation against the bushmeat trade. This is generally considered to increase the risk of disease transmission and emergence, although whether or not wildlife vendors themselves have indeed increased incidence of zoonotic disease has rarely been assessed. In preparation for a future longitudinal study of market vendors investigating vendors' exposure to zoonotic pathogens, we conducted a pilot survey of Lao market vendors of wildlife meat, livestock meat and vegetables, to identify demographic characteristics and potential control groups within markets. We also investigated baseline risk perception for infectious diseases among market vendors and assessed the association between risk perception and risk mitigation behaviours. The surveys conducted with 177 vendors revealed similar age, sex, ethnic background and geographical origin between vendor types, but differences in professional background and work history for livestock meat vendors. The perception of disease risk was very low across all vendors, as was the reported use of personal protective equipment, and the two appeared unrelated. Personal risk discounting and assumptions about transmission routes may explain this lack of association. This information will help inform the development of future research, risk communication and risk mitigation policy, especially in the light of the COVID-19 pandemic.


Asunto(s)
Animales Salvajes/virología , Comercio/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Pandemias/prevención & control , Zoonosis/transmisión , Adolescente , Adulto , Anciano , Animales , Estudios Transversales , Femenino , Humanos , Laos/epidemiología , Ganado/virología , Estudios Longitudinales , Masculino , Carne/virología , Persona de Mediana Edad , Proyectos Piloto , Factores de Riesgo , Adulto Joven , Zoonosis/epidemiología , Zoonosis/virología
13.
Public Health ; 186: 28-30, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32758710

RESUMEN

OBJECTIVES: The objective of this short communication is to provide a previous empirical analysis to locate the regions that have distortions in per capita tobacco consumption. The location of these regions and their proximity to other countries allow us to detect the need that governments have to harmonize policies. STUDY DESIGN: The design of this study is a cross-sectional spatial descriptive analysis. METHODS: By using panel data from the 47 Spanish provinces from 2002 to 2017, we implement the Moran's I test which allows us to detect areas where low or high per capita tobacco consumption clusters are generated. RESULTS: The results show that areas of Spain bordering countries with high price differentials, such as Gibraltar and France, generate clusters of low and high per capita tobacco consumption, respectively. Indeed, maintaining a low price differential seems not to generate distortions, as revealed by the Portugal case. CONCLUSIONS: Spatial clusters of per capita tobacco consumption are located in regions close to countries where there is high price differential.


Asunto(s)
Uso de Tabaco/epidemiología , Comercio/estadística & datos numéricos , Estudios Transversales , Humanos , Política Pública , Fumar/epidemiología , España/epidemiología , Análisis Espacial
14.
PLoS One ; 15(8): e0237459, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32776971

RESUMEN

A surveillance system for sales volumes of antimicrobial agents for veterinary use was established in Germany in 2011. Since then, pharmaceutical companies and wholesalers have been legally obliged to report annual volumes of veterinary antimicrobial products sold to veterinary practices or clinics located in Germany. The evaluation of sales volumes for eight consecutive years resulted in a considerable total decrease by 58% from 1706 tons to 722 tons. During the investigation period, two legally binding measures to control the risk of antimicrobial resistance resulting from the veterinary use of antimicrobials were introduced, a) the German treatment frequencies benchmarking in 2014 and b) the obligation to conduct susceptibility testing for the use of cephalosporins of the 3rd and 4th generation and of fluoroquinolones in 2018. Both had a marked impact on sales volumes. Nonetheless, the category of Critically Important Antimicrobials as defined by the World Health Organization kept accounting for the highest share on sales volumes in Germany in 2018 with 403 tons, despite an overall reduction by 53%. Sales surveillance is considered essential for data retrieval on a global scale and inter-country comparison. However, the usability of a surveillance system based on sales data for risk management of antimicrobial resistance has limitations. The German system does not include off-label use of antimicrobial products authorized for human medicine and does not allow for identification of areas of high risk according to animal species, farm and production types and indications for treatment. For further reduction and enhanced promotion of a prudent use of antimicrobials, targeted measures would be required that could only be deducted from use data collected at farm or veterinary practice level. A surveillance system based on use data is currently lacking in Germany but will be established according to Regulation (EU) 2019/6 on veterinary medicinal products.


Asunto(s)
Antiinfecciosos/economía , Comercio/estadística & datos numéricos , Percepción , Vigilancia de Productos Comercializados , Drogas Veterinarias/economía , Alemania , Control Social Formal , Tetraciclina/economía , Organización Mundial de la Salud
15.
Nat Hum Behav ; 4(10): 1011-1020, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32778802

RESUMEN

We use aggregated and anonymized information based on international expenditures through corporate payment cards to map the network of global business travel. We combine this network with information on the industrial composition and export baskets of national economies. The business travel network helps to predict which economic activities will grow in a country, which new activities will develop and which old activities will be abandoned. In statistical terms, business travel has the most substantial impact among a range of bilateral relationships between countries, such as trade, foreign direct investments and migration. Moreover, our analysis suggests that this impact is causal: business travel from countries specializing in a specific industry causes growth in that economic activity in the destination country. Our interpretation of this is that business travel helps to diffuse knowledge, and we use our estimates to assess which countries contribute or benefit the most from the diffusion of knowledge through global business travel.


Asunto(s)
Comercio , Economía , Internacionalidad , Conocimiento , Viaje , Comercio/estadística & datos numéricos , Economía/estadística & datos numéricos , Humanos , Modelos Estadísticos , Viaje/estadística & datos numéricos
16.
PLoS One ; 15(8): e0237513, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32790798

RESUMEN

INTRODUCTION: The tobacco industry (TI) has used small cigarette pack sizes to encourage brand-switching and consumption, and to mitigate the impacts of tobacco tax increases. Since 2016, the European Union (EU) Tobacco Products Directive (TPD) specifies a minimum pack size of 20 cigarettes. We examined cigarette pack sizes in the EU and whether pack size composition differed between cheap and expensive price segments, as well as the impact of the revised TPD. METHODS: We conducted a longitudinal analysis of pricing data from 23 EU countries between 2006-2017. We examined pack sizes over time to assess the impact of the TPD, differences in pack size composition between cheap and expensive price segments, and compared gaps in median prices between products using actual and 'expected' prices (price if all packs contained 20 sticks). RESULTS: Cigarette pack sizes changed over time, across the EU. The distribution of pack sizes varied between price segments, with small pack sizes especially frequent in the cheap segment of the cigarette market, but this varied over time and across countries. Packs of <20 cigarettes almost disappeared from the data samples after implementation of the TPD. CONCLUSION: Implementation of the TPD appears to have virtually eliminated packs with <20 cigarettes, restricting their use by the TI. Our analysis suggests pack sizes have been used differentially across the EU. Country-level analyses on the industry's use of pack sizes, consumer responses, and evaluations of restricting certain pack sizes are needed to confirm our findings and strengthen policy.


Asunto(s)
Comercio/estadística & datos numéricos , Embalaje de Productos/métodos , Industria del Tabaco/métodos , Productos de Tabaco/estadística & datos numéricos , Unión Europea , Humanos , Estudios Longitudinales , Productos de Tabaco/economía , Productos de Tabaco/provisión & distribución
17.
Rev Bras Epidemiol ; 23: e200089, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32725091

RESUMEN

OBJECTIVE: To investigate the association between the alcohol outlet density in residential areas and the current and lifetime alcohol consumption, adjusted for individual and family factors. METHOD: Information from a three-stage household stratified probabilistic cluster sampling survey (census tract, household, adult and adolescent), conducted in Belo Horizonte, Brazil ("Health in BH", 2008-2009) and data of the establishments were obtained from official sources and subsequently georeferenced. The outcome was the adolescents' report of current and lifetime alcohol consumption. The exposure variable was the alcohol outlet density, defined as the number of establishments within a 200-meter range from the adolescents' residence. The association was estimated by Poisson regression adjusted by individual and family variables. RESULTS: In total, 601 adolescents aged 14 to 17 years were included in this study. Of these, 53.3% were males and 71.0% lived in a family with income up to five minimum wages. The prevalence of lifetime alcohol consumption was 57.0% (95%CI 51.5 - 62.6) and the current was 11.9% (95%CI 8.7 - 15.0). The multivariate analysis showed a significant association between current alcohol consumption and density of snack bars (PR = 1.13; 95%CI 1.03 - 1.24), bars (PR = 1.21; 95CI% 1.05 - 1.38), and restaurants (PR = 1.11; 95%CI 1.02 - 1.21). Significant interactions between density of establishments with sex and age were found. CONCLUSION: Current alcohol consumption may be enhanced by the availability of some types of establishments located within a range of 200 meters from the adolescents' residence.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Comercio/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Adolescente , Brasil/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Restaurantes/estadística & datos numéricos
18.
Public Health ; 185: 332-337, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32721771

RESUMEN

OBJECTIVES: In 2017, one in four French 17-year-olds was a daily smoker, even though France prohibited the sale of tobacco to under-18 minors in 2009. This research aims to evaluate the retail violation rate for sale to minors (RVRms) and the associated factors. STUDY DESIGN: The study design used is observational mystery shopping study. METHODS: We conducted a mystery shopping study enlisting 12-year-old and 17-year-old youths in a representative sample of 527 tobacco outlets during three weeks in spring 2019. Multinomial Logit and Probit regressions were estimated on the data collected. RESULTS: The law is not respected. Two of three sellers (65.2%) were willing to make an illegal sale to a 17-year-old minor, and almost one in 12 (8.1%) were willing to sell to a 12-year-old child attempting to buy tobacco. Illegal sales were more likely to be made by male sellers, retailing in big cities, when there were no in-shop queues, and to 17-year-old females. The absence of the mandatory enforcement poster flagging up the ban on the sale of tobacco to minors appears to be a strong factor associated with RVRm. CONCLUSIONS: These findings show that progress needs to be made to better enforce tobacco control legislation to help decrease underage smoking in France. Rate of compliance with the law could be improved by stronger enforcement measures and tougher sanctions, but also by training and the provision of age-verification tools for sellers, as demonstrated by experiments in other countries.


Asunto(s)
Comercio/legislación & jurisprudencia , Menores/legislación & jurisprudencia , Productos de Tabaco/legislación & jurisprudencia , Adolescente , Conducta del Adolescente , Niño , Comercio/estadística & datos numéricos , Femenino , Francia/epidemiología , Humanos , Masculino , Mercadotecnía , Menores/estadística & datos numéricos , Fumar/epidemiología , Fumar/legislación & jurisprudencia , Tabaco , Productos de Tabaco/economía , Productos de Tabaco/estadística & datos numéricos
19.
Int J Behav Nutr Phys Act ; 17(1): 86, 2020 07 06.
Artículo en Inglés | MEDLINE | ID: mdl-32631366

RESUMEN

BACKGROUND: Hospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS's health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options. METHODS: Hospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models. RESULTS: Data from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = - 1.84, p < .001) and sugar (γ = - 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = - 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold. CONCLUSIONS: Simple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops. TRIAL REGISTRATION: Retrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793 ).


Asunto(s)
Comercio/estadística & datos numéricos , Comportamiento del Consumidor/estadística & datos numéricos , Dieta Saludable , Preferencias Alimentarias/psicología , Tiendas en Hospital , Bocadillos/psicología , Grasas de la Dieta , Azúcares de la Dieta , Ingestión de Energía , Promoción de la Salud , Humanos , Valor Nutritivo , Escocia
20.
BMC Public Health ; 20(1): 1075, 2020 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-32641022

RESUMEN

BACKGROUND: Solid waste management is both an urban and rural problem because every person is considered a producer of wastes. It has been noted to be a global universal issue, which affects every individual, families, communities and governments and thus, needs to be addressed through sustainable strategies. This study aimed at characterizing solid wastes; assessing the levels of awareness of vendors on the sustainable solid waste management measures; and identifying techniques used to handle solid waste generated at the Majengo market in Dodoma City, Tanzania. METHODS: The study adopted an exploratory descriptive case study, with a mixed research approaches with a minimum sample of 196 conviniently selected respondents. Semi-structured questionnaires developed by the researcher were the main data collection tools to characterize solid wastes, measure levels of awareness about sustainable solid waste management approaches (SWM) and identify solid waste handling techniques among vendors at the market. Quantitative and Qualitative data were analyzed by using the Statistical Product for Social Sciences version 23 and thematic analysis respectively. RESULTS: Findings showed that 55% of vendors were males. Majority of the sampled vendors (56%) were not aware of SWM. On the other hand, crops/food and animal product remains were reported to be the most generated solid wastes (94.4%) with the rate of > 2 tons/day equivalent to 72.4% of the overall solid waste generation at the market. SWM services were reported to be provided by City council (85.7%) with the main equipment/tool used to store solid wastes (SW) being containers without lids (88.3%). The dumpsite was the main site for SW disposal (80.1%). Nevertheless, 92.9% of the sampled vendors reported that SWM strategies were there at the market though not adhered to accordingly. CONCLUSION: Vendors were not aware of sustainable solid waste management measures existing at the market. However, vendors' education levels and the duration of doing business at the market were related to their levels of awareness on SWM (p < 0.05). The SWM measures were found to exist at the market, however, they were not sustainable because it was reported that they were ineffectively and inefficiently used to control SW generation, collection, storage, and disposal. There is a need of regular awareness-raising activities about sustainable SWM measures among vendors. Moreover, city council and market authorities need to have sustainable and scheduled implementation, supervision, monitoring and evaluation of SWM measures to maintain the management of solid wastes at Majengo market premises.


Asunto(s)
Comercio/estadística & datos numéricos , Residuos Sólidos , Administración de Residuos/métodos , Adulto , Concienciación , Ciudades , Países en Desarrollo , Femenino , Humanos , Masculino , Tanzanía , Adulto Joven
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