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1.
Rev Saude Publica ; 53: 91, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644722

RESUMO

OBJECTIVE: To develop and assess the reliability of an instrument that enables auditing information on consumer food environment indicators, such as availability, price, promotional and advertising strategies, and quantity of brands available, using the food recommendations adopted by the Dietary Guidelines for the Brazilian Population as a theoretical basis. METHODS: This is a methodological study in two phases: 1. development of the audit instrument and 2. assessment of its reliability and reproducibility . The Content Validity Index was estimated for each instrument item (>0.80 satisfactory). Inter-rater and test-retest reliability were assessed by percentage agreement and Kappa coefficients. Pearson's correlation coefficient and Scatter-plots were used to measure the degree of linear correlation between two quantitative variables. RESULTS: The Content Validity Index was 0.91. Inter-rater and test-retest reliability were mostly high (Kappa> 0.80), for food availability indicators. Among the items that measure advertising, Kappa values for inter-rater reliability ranged from 0.57 to 1.00 and for the test-retest ranged from 0.18 to 0.90. Prices and quantity of brands showed a positive linear correlation between measurements performed by researcher 1 and 2 and between visits 1 and 2. CONCLUSIONS: AUDITNOVA is reliable for measuring aspects such as availability, price, quantity of brands, and advertising of foods available in the consumer food environment.


Assuntos
Comércio/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Alimentos/estatística & dados numéricos , Inquéritos e Questionários/normas , /estatística & dados numéricos , Brasil , Abastecimento de Alimentos/normas , Humanos , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes
2.
Rev Saude Publica ; 53: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644724

RESUMO

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Comércio/tendências , Serviços Comunitários de Farmácia/tendências , Medicamentos Genéricos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Programas Nacionais de Saúde/tendências , Brasil , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Diabetes Mellitus/tratamento farmacológico , Política de Saúde , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Programas Nacionais de Saúde/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmácias/tendências , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Estudos Retrospectivos , Fatores de Tempo
3.
BMC Public Health ; 19(1): 1128, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419983

RESUMO

BACKGROUND: Food safety has long been the subject of scholarly research, and street food is a weak link in food safety supervision. Street food not only provides convenience for many people, but is also the livelihood for millions of low income people, making a great contribution to the economy of many developing countries. METHODS: Street food safety is essential, and yet it has been rarely studied in China. Therefore, a typical city in China was selected as the research object to assess food safety knowledge, attitudes, and street food suppliers and consumer behaviors using questionnaires based on previous studies, and considering China's particular characteristics and reasonable impacts identified in previous studies, such as increased income, work experience, licenses, and locations. The food safety knowledge and attitude questionnaire conformed with the national conditions in China. It was used to assess the food safety knowledge and attitudes toward food suppliers and consumers, where three main areas were addressed in the surveys and statistical analysis, as follows. (1) Statistical information including gender, age, education, income, food safety training, and specific elements related to the work experience of suppliers. (2) Knowledge of food safety including the awareness of consumers and suppliers regarding food poisoning pathogens, food and personal hygiene, high-risk groups, and correct cleaning. (3) A list of food handling behaviors was used to determine the behaviors and characteristics of subjects. RESULTS: The results show that street food suppliers have generally poor food handling practices, and most are operating under unsanitary conditions. Food safety knowledge of street vendors in the High-tech Industries Development Zone was the lowest, most likely because these regions are located in rural-urban fringe zones, where education levels are generally relatively low. Food safety attitudes of the youngest consumers were significantly better than those of older age groups. Their educational level was also different, with correspondingly relatively high income for younger individuals. Most vendors chose locations near schools or supermarkets. Consumers and street food vendors had good understanding of food safety, but street vendors were relatively poor in carrying out safe food handling, with only 26.7% using or being fully equipped withhand-washing facilities, although more than 60% of vendors wore clean and tidy clothes and masks. CONCLUSIONS: Street food vendor training should be prioritized to improve the safety of street food. Other policies and measures should also be propagated to improve the food safety knowledge, attitudes, and behavior of vendors in Handan. Steps should be taken to improve street food stall operating conditions and facilities, including providing clean protected structures, access to potable water, and efficient waste collection and disposal systems. These findings should encourage government agencies to further promote strategies to improve street food safety.


Assuntos
Comércio/estatística & dados numéricos , Comportamento do Consumidor , Inocuidade dos Alimentos , Serviços de Alimentação , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , China , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
BMC Public Health ; 19(1): 1037, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375089

RESUMO

BACKGROUND: Patient package inserts (PPIs) should provide accurate, sufficient, and clear information for patients as well as health care professionals. The goal of this study was to evaluate and compare the PPIs of local and imported anti-diabetic agents in the Palestinian market. METHODS: Eighteen leaflets were collected and analysed based on the completeness of 31 criteria using a scoring method, then the quantity of information was assessed by applying word counting of 17 headings and subheadings. Statistical comparisons of the word count for all products were performed using the Mann-Whitney U test with mean ranks. Then the mean ranks for differences in word counts were adjusted to calculate the fold-difference statistic by dividing the higher mean rank by the lower mean rank. RESULTS: In general, the PPIs of imported agents scored better than local PPIs, but none of the inserts fulfilled the whole criteria. Thirteen out of thirty-one criteria were available in all products. None of these agents had provided any information about duration of use, instructions to convert tablets into liquids forms, pharmacokinetics, or shelf life. Moreover, mechanism of action and maximum dose were deficient in all local PPIs (0.0%), while they were included in 37.5 and 62.5% of imported PPIs, respectively. Furthermore, 90.0% of local PPIs lacked information about drug dose, 80.0% didn't mention any instructions regarding effects on ability to drive or possibility of tablet splitting, and 60.0% didn't involve orders about possibility of tablet crushing. Local PPIs provided inadequate and less detailed instructions regarding many aspects, since the estimated mean rank of local and imported PPIs demonstrated a range of difference from 1.04-fold for missing dose to 2.64-fold for warning and precautions. CONCLUSIONS: Significant differences were being identified, with excellence being assigned to imported PPIs. So, it is worth suggesting some necessary modifications in PPI topography and sequence structure of local diabetic agents. Experts in Palestinian Ministry of Health should implement regulatory guidelines to improve the quality and quantity of information provided by local PPIs. This optimisation could become a step forward toward optimal health practice in our society.


Assuntos
Rotulagem de Medicamentos/normas , Hipoglicemiantes , Administração Oral , Comércio/estatística & dados numéricos , Humanos , Hipoglicemiantes/administração & dosagem , Oriente Médio
5.
BMC Health Serv Res ; 19(1): 536, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366363

RESUMO

BACKGROUND: Many low- and middle-income countries (LMIC) are moving towards enforcing prescription-only access to antibiotics. This systematic literature review aims to assess the interventions used to enforce existing legislation prohibiting over-the-counter (OTC) sales of antibiotics in LMICs, their impact and examine the methods chosen for impact measurement including their strengths and weaknesses. METHODS: Both PubMed and Embase were systematically searched for studies reporting on impact measurement in moving towards prescription only access to antibiotics in LMICs. The PRISMA methodological review framework was used to ensure systematic data collection and analysis of literature. Narrative data synthesis was used due to heterogeneity of study designs. RESULTS: In total, 15 studies were included that assessed policy impact in 10 different countries. Strategies employed to enforce regulations prohibiting OTC sales of systemic antibiotics included retention of prescriptions for antibiotics by pharmacies, government inspections, engaging pharmacists in the design of interventions, media campaigns for the general public and educational activities for health care workers. A variety of outcomes was used to assess the policy impact; changes in antimicrobial resistance rates, changes in levels of antibiotic use, changes in trends of antibiotic use, changes in OTC supply of antibiotics, and changes in reported practices and knowledge of pharmacists, medicine sellers and the general public. Differences in methodological approaches and outcome assessment made it difficult to compare the effectiveness of law enforcement activities. Most effective appeared to be multifaceted approaches that involved all stakeholders. Monitoring of the impact on total sales of antibiotics by means of an interrupted time series (ITS) analysis and analysis of pharmacies selling antibiotics OTC using mystery clients were the methodologically strongest designs used. CONCLUSIONS: The published literature describing activities to enforce prescription-only access to antibiotics in LMICs is sparse and offers limited guidance. Most likely to be effective are comprehensive multifaceted interventions targeting all stakeholders with regular reinforcement of messages. Policy evaluation should be planned as part of implementation to assess the impact and effectiveness of intervention strategies and to identify targets for further activities. Robust study designs such as ITS analyses and mystery client surveys should be used to monitor policy impact.


Assuntos
Antibacterianos , Comércio/legislação & jurisprudência , Aplicação da Lei , Legislação de Medicamentos , Medicamentos sem Prescrição , Comércio/estatística & dados numéricos , Países em Desenvolvimento , Humanos , Análise de Séries Temporais Interrompida
6.
Artigo em Inglês | MEDLINE | ID: mdl-31323981

RESUMO

Cigarette affordability measures the price smokers pay for cigarettes in relation to their incomes. Affordability can be measured using the relative income price of cigarettes (RIP), or the price smokers pay to purchase 100 packs of 20 cigarettes divided by their per capita household income. Using longitudinal data from 7046 smokers participating in the International Tobacco Control (ITC) US Survey, the purpose of this study was to test whether affordability significantly changed following the US federal tax increase implemented on 1 April 2009. This study also estimated temporal trends in affordability from 2003-2015 at state and national levels using small area estimation methods and segmented linear mixed effects regression models. RIP increased slightly during 2003-2008. This was followed by a 30% increase during 2008-2010, indicating cigarettes were less affordable after the federal tax increase. RIP continued to increase during 2010-2013 but decreased during 2013-2015, suggesting cigarettes have recently become more affordable for US smokers. State-level trends in RIP were consistent with overall national trends. Controlling for other factors, a $1 increase in the state excise tax was significantly associated with a 9% increase in RIP, indicating state taxes reduced affordability. Tax-induced price increases must keep pace with underlying economic conditions to ensure cigarettes do not become more affordable over time.


Assuntos
Comércio/economia , Comportamento do Consumidor/economia , Custos e Análise de Custo/economia , Renda/estatística & dados numéricos , Fumantes/psicologia , Impostos/economia , Produtos do Tabaco/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comércio/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumantes/estatística & dados numéricos , Inquéritos e Questionários , Impostos/estatística & dados numéricos , Tabaco , Produtos do Tabaco/estatística & dados numéricos , Estados Unidos , Adulto Jovem
7.
BMC Public Health ; 19(1): 974, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331307

RESUMO

BACKGROUND: The current field experiment demonstrates the effectiveness of nudging to promote healthy food choices. METHODS: Three types of nudges were implemented at a take-away food vendor: 1) an accessibility nudge that placed fruits at the front counter; 2) a salience nudge that presented healthy bread rolls to be more visually attractive; and 3) a social proof nudge that conveyed yoghurt as a popular choice. We additionally assessed whether nudging effects would remain robust when a disclosure message was included. The field experiment was conducted over a seven-week period. The measured outcome was the sales of the targeted healthy food products. RESULTS: The accessibility nudge significantly increased the sales of the fresh fruits. The impact of the salience nudge was limited presumably due to existing preferences or habits that typically facilitate bread purchases. As the sales of the yoghurt shakes remained consistently low over the seven-week period the impact of the social proof nudge remained unexamined. Critically, disclosing the purpose of the nudges did not interfere with effects. CONCLUSIONS: Current findings suggest nudging as an effective strategy for healthy food promotion, and offer implications for topical debate regarding the ethics of nudges.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Sinais (Psicologia) , Revelação/estatística & dados numéricos , Preferências Alimentares/psicologia , Promoção da Saúde/métodos , Pão , Comércio/estatística & dados numéricos , Humanos
8.
BMC Res Notes ; 12(1): 426, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315655

RESUMO

OBJECTIVE: Previous research suggests that wine glass size affects sales of wine in bars, with more wine purchased when served in larger glasses. The current four studies, conducted in one restaurant (Studies 1 and 2) and two bars (Studies 3 and 4) in Cambridge, England, aim to establish the reproducibility of this effect of glass size on sales. A multiple treatment reversal design was used, involving wine being served in sequential fortnightly periods in different sized glasses of the same design (290 ml, 350 ml, and 450 ml). The primary outcome was daily wine volume (ml) sold. RESULTS: Restaurant: Daily wine volume sold was 13% (95% CI 2%, 24%) higher when served with 350 ml vs. 290 ml glasses in Study 1. A similar direction of effect was seen in Study 2 (6%; 95% CI - 1%, 15%). Bars: Daily wine volume sold was 21% (95% CI 9%, 35%) higher when served with 450 ml vs. 350 ml glasses in Study 3. This effect was not observed in Study 4 (- 7%, 95% CI - 16%, 3%). Meaningful differences were not demonstrated with any other glass comparison. These results partially replicate previous studies showing that larger glasses increase wine sales. Considerable uncertainty remains about the magnitude of any effect and the contexts in which it might occur. Trial registration Study 1: ISRCTN17958895 (21/07/2017), Study 2: ISRCTN17097810 (29/03/2018), Study 3 and 4: ISRCTN39401124 (10/05/2018).


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Comércio/estatística & dados numéricos , Tamanho da Porção/psicologia , Restaurantes/economia , Vinho , Comportamento do Consumidor/economia , Utensílios de Alimentação e Culinária/economia , Inglaterra , Vidro , Humanos
9.
BMC Public Health ; 19(1): 882, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272435

RESUMO

BACKGROUND: Over the past two decades, Rwanda has experienced impressive economic growth, resulting in considerable improvements in living standards and poverty reduction. Despite these gains, progress on reducing the level of stunting in smallholder rural children, particularly boys, continues to be a serious concern. METHODS: Policies, dietary diversity and socio-economic factors that may influence stunting in rural Rwandan children were evaluated using a logit model with clustered variance-covariance estimators based on village membership of the household. RESULTS: Stunting of rural children was found to be multidimensionally related to the child's gender, weight and age; the dietary diversity, marriage status and education level of the head of household; mother's height; presence of a family garden or if they owned livestock; environmental factors such as altitude and soil fertility and location relative to a main road en route to a market; and a policy that promoted food production. CONCLUSIONS: Findings suggest that agricultural policies may be subsidizing poor dietary behavior in that the aggregation of production encourages households to sell high quality nutritious food such as fruit and vegetables, for more voluminous amounts of nutritionally substandard goods, hence low dietary diversity. However, it is less clear if rural food markets are capable of supplying diverse and nutritious foods at affordable prices on a consistent basis, resulting in a lack of diversity and hence, low nutrient quality diets. Rwanda's next round of food security policies should focus on nutrition insecurity with special emphasis on the lack of protein, micronutrients and calories. Multipronged policies and programs focused on income growth, food security, enhanced access to markets and gender-related nutrition risks from inception through 2 years of age in the rural areas are required to improve rural household health outcomes, stunting in particular.


Assuntos
Comércio/estatística & dados numéricos , Dieta/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Disparidades nos Níveis de Saúde , Política Nutricional , Saúde da População Rural/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Ruanda/epidemiologia , Distribuição por Sexo , Fatores Socioeconômicos
10.
Public Health ; 173: 126-129, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276890

RESUMO

OBJECTIVES: Cuba is a tobacco-producing country that has been economically isolated as a consequence of an embargo imposed by the USA. It has also experienced a severe economic depression in the 1990s after the withdrawal of support by the former Soviet Union. These characteristics provide a unique opportunity to study the relation between large changes in economic activity, cigarette price and demand for cigarettes in a relatively isolated socialist economy. STUDY DESIGN: This is an observational epidemiological study. METHODS: Data were obtained on the annual price of a packet of cigarettes and the mean number of cigarettes consumed per adult living in Cuba from 1980 to 2014. Descriptive and regression analysis were used to explore the relationship between cigarette consumption and price in Cuba. RESULTS: In 1980, the mean price of a packet of cigarettes was 1.53 Cuban peso (CUP) in 1997 prices and the mean annual per capita consumption was 2237 cigarettes. In 2014, the mean price had increased to 5.57 CUP (1997 prices) per packet of cigarettes, and consumption had fallen to 1527 cigarettes per capita. There were significant negative associations between annual cigarette consumption and both price and living through an economic depression. The elasticity was approximately -0.31 with price, and living through an economic depression was also associated with lower consumption of cigarettes (a reduction of 9%, 95% confidence intervals -0.18 to -0.001). CONCLUSIONS: Higher cigarette pricing, along with other public health interventions, are required to protect the national population from the adverse effects of tobacco smoke exposure.


Assuntos
Fumar Cigarros/economia , Comércio/estatística & dados numéricos , Recessão Econômica , Produtos do Tabaco/economia , Adulto , Fumar Cigarros/epidemiologia , Cuba/epidemiologia , Humanos
11.
Artigo em Inglês | MEDLINE | ID: mdl-31336749

RESUMO

Chronic diseases have added to the economic burden of the U.S. healthcare system. Most Americans spend most of their waking time at work, thereby, presenting employers with an opportunity to protect and promote health. The purpose of this study was to assess the implementation of workplace health governance and safety strategies among worksites in the State of Nebraska, over time and by industry sector using a randomized survey. Weighted percentages were compared by year, industry sector, and worksite size. Over the three study periods, 4784 responses were collected from worksite representatives. Adoption of workplace health governance and planning strategies increased over time and significantly varied across industry sector groups. Organizational safety policies varied by industry sector and were more commonly reported than workplace health governance and planning strategies. Time constraints were the most common barrier among worksites of all sizes, and stress was reported as the leading employee health issue that negatively impacts business. Results suggest that opportunities exist to integrate workplace health and safety initiatives, especially in blue-collar industry sectors and small businesses.


Assuntos
Promoção da Saúde , Serviços de Saúde do Trabalhador , Saúde do Trabalhador , Local de Trabalho , Comércio/estatística & dados numéricos , Promoção da Saúde/métodos , Humanos , Indústrias , Nebraska , Política Organizacional , Empresa de Pequeno Porte , Inquéritos e Questionários , Local de Trabalho/organização & administração
12.
Artigo em Inglês | MEDLINE | ID: mdl-31159492

RESUMO

This article provides the first comprehensive picture and independent estimates of both illicit cigarette consumption and the resulting government tax revenue loss in Vietnam using data from a representative survey of cigarette smokers in 12 Vietnamese provinces. The survey consisted of face-to-face interviews and on-site cigarette pack examinations. We find that more than 720 million illicit cigarette packs, or 20.7% of total cigarette consumption, circulated in Vietnam in 2012. Consequently, government tax revenue loss due to illicit trade ranged from US $223 to 295 million. Our estimates also indicate that 1) the most popular illicit brands were Jet and Hero, both were sold at higher prices than the average legal brand; 2) the average price of illicit cigarettes was 51% higher than the average price of legal cigarettes; and 3) majority of illicit cigarettes were sold at convenience stores, which were registered and licensed businesses. Our findings suggest that prices are not a driver of illicit cigarette consumption in Vietnam, and this illicit trade is at least partially a consequence of weak market control enforcement.


Assuntos
Fumar/legislação & jurisprudência , Impostos/legislação & jurisprudência , Produtos do Tabaco , Comércio/estatística & dados numéricos , Coleta de Dados , Governo , Humanos , Linguagem , Exame Físico , Vietnã
13.
BMC Public Health ; 19(1): 775, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215435

RESUMO

BACKGROUND: The food environment can influence opportunities and barriers to food access. This study aimed to investigate whether access to healthy foods varies according to store types and the socioeconomic status of the users of the public health promotion program in Brazil, known as the Health Academy Program. METHODS: A total of 18 Health Academy Program centers were selected via simple conglomerate sampling. Health Academy Program users living up to 1 km from the food stores were evaluated (n = 2831). Their socioeconomic status was investigated via face-to-face interviews. The food stores were audited through direct observation. Variables included the community nutrition environment (type and location) and consumer nutrition environment (healthy food store index, involving variables such as availability, variety, and advertising of healthy and unhealthy products). Multiple linear regression analysis was performed to examine the association between access to healthy foods, socioeconomic status, and food store type. RESULTS: A total of 336 stores were investigated. The majority were specialty fruit and vegetable markets/stores or open-air food markets. Access to healthy food was only associated with the food store type. An increase of 1% in the availability of specialized fruits and vegetable markets or open-air food markets and supermarket raised healthy food store index values by 0.12 and 0.07, respectively. CONCLUSIONS: Public food supply policies aimed at improving the diet quality of the population and reducing inequality in access should prioritize the implementation of stores of better quality, such as specialty fruit and vegetable markets and open-air food markets.


Assuntos
Comércio/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Frutas , Classe Social , Verduras , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
BMC Public Health ; 19(1): 787, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221122

RESUMO

BACKGROUND: Alcohol consumption is a significant cause of disease, death and social harm, and it clusters with smoking tobacco and an unhealthy diet. Using automatically registered retail data for research purposes is a novel approach, which is not subject to underreporting bias. Based on loyalty card data (LoCard) obtained by a major Finnish retailer holding a market share of 47%, we examined alcohol expenditure and their associations with food and tobacco expenditures. METHODS: The data consisted of 1,527,217 shopping events in 2016 among 13,274 loyalty card holders from southern Finland. A K-means cluster analysis was applied to group the shopping baskets according to their content of alcoholic beverages. The differences in the absolute and relative means of food and tobacco between the clusters were tested by linear mixed models with the loyalty card holder as the random factor. RESULTS: By far, the most common basket type contained no alcoholic beverages, followed by baskets containing a small number of beers or ciders. The expenditure on food increased along with the expenditure on alcoholic beverages. The foods most consistently associated with alcohol purchases were sausages, soft drinks and snacks. The expenditure on cigarettes relative to total basket price peaked in the mid-price alcohol baskets. CONCLUSION: Clustering of unhealthy choices occurred on the level of individual shopping events. People who bought many alcoholic beverages did not trim their food budget. Automatically registered purchase data provide valuable insight into the health behaviours of individuals and the population.


Assuntos
Bebidas Alcoólicas/economia , Comércio/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Alimentos/economia , Produtos do Tabaco/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
Jpn J Infect Dis ; 72(5): 326-329, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31061356

RESUMO

The National Action Plan on Antimicrobial Resistance in Japan aims to achieve a 50% reduction in the use of broad-spectrum oral antimicrobials (cephalosporins, macrolides, and quinolones) from 2013 to 2020. Based on the national sales data for antimicrobials, we estimated the regional antimicrobial use (AMU) from 2013-2016 and evaluated the differences in the use of broad-spectrum oral antimicrobials among three regions in which differences had been identified previously. The AMU was standardized based on the defined daily dose (DDD) and described as the DDDs/1,000 inhabitants/day (DID). Annual combined total oral and parenteral AMU during 2013-2016 was 14.9, 14.5, 14.7, and 14.6 DID, respectively. The change in mean ± standard deviation in the total AMU at the prefectural level was - 0.2 ± 0.8 DID. Among the 47 prefectures, decreasing trends were observed in 34, while in the remaining 13 prefectures increasing trends were recorded. In 2016, no significant differences in the mean usage of oral cephalosporins among the three regions were observed. The mean usage of oral macrolides in the eastern (4.1 DID) was significantly lower than that in the central region (4.7 DID) (p = 0.009) and the western (4.8 DID) (p = 0.002). The mean usage of oral quinolones in the western (3.2 DID) was significantly higher than that in the eastern (2.3 DID) (p < 0.001) and central (2.7 DID) (p = 0.001) regions. To determine appropriate targets for the implementation of antimicrobial stewardship for reducting the use of broad-spectrum oral antimicrobials, further studies are required to identify the reasons underlying these differences.


Assuntos
Antibacterianos/uso terapêutico , Comércio/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Comércio/tendências , Uso de Medicamentos/tendências , Humanos , Japão
16.
J Manag Care Spec Pharm ; 25(5): 612-620, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039058

RESUMO

BACKGROUND: Chronic disease is associated with increased health care resource utilization and costs. Effective development and implementation of health care management and clinical intervention programs require an understanding of health plan member enrollment and disenrollment behavior. OBJECTIVE: To examine the health plan enrollment and disenrollment behavior of commercially insured and Medicare Advantage members with established chronic disease compared with matched members without the disease of interest, using data from a large national health insurer in the United States. METHODS: This retrospective matched cohort study used administrative claims data from the HealthCore Integrated Research Database from January 1, 2006, to November 30, 2015, to identify adults with chronic disease (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], chronic obstructive pulmonary disease [COPD], rheumatoid arthritis [RA], and breast cancer [BC]). Members with no established chronic disease (controls) were directly matched to members with established chronic disease (cases) on demographic characteristics. The earliest date on which members met the criteria for a given disease was defined as the index date. Controls had the same index date as the matched cases. All members had ≥ 12 months of continuous health plan enrollment before the index date. Outcomes included health plan member disenrollment and enrollment duration. Incidence rates per 1,000 member-years for member disenrollment were evaluated along with incidence rate ratios (relative risk) using a Poisson model. Time to disenrollment was analyzed by Cox proportional hazard models and Kaplan-Meier survival curves. Sensitivity analyses were conducted where death was included as a disenrollment event. RESULTS: 70,907 health plan members with BC (99.7% female, mean age 60.5 years); 28,883 members with COPD (52.3% female, mean age 66.7); 835,358 members with CVD (50.5% female, mean age 62.7 years); 210,936 members with T2DM (45.2% female, mean age 53.6 years); and 31,954 members with RA (72.0% female, mean age 55.5 years) were matched to controls and met the study criteria. The incidence rates of health plan disenrollment ranged from 155 to 192 members per 1,000 members per year. Compared with controls, members with chronic disease were 30%-40% less likely to disenroll from a health plan (P < 0.001 for all comparisons). Among those who disenrolled, enrollment duration ranged from 2.3 to 2.7 years among cases and 1.5 to 1.8 years among matched controls (P ≤ 0.001 for all comparisons). CONCLUSIONS: This real-world study demonstrated that members with chronic disease had a significantly lower rate of disenrollment and a longer duration of enrollment compared with matched controls and were continuously enrolled for almost a year longer than members without a diagnosed chronic disease. Understanding health plan enrollment and disenrollment behavior may provide a valuable context for determining the time frame for the effect of health care programs and initiatives. DISCLOSURES: Funding for this study was provided by HealthCore, a wholly owned subsidiary of Anthem. Chung, Deshpande, Zolotarjova, Quimbo, and Willey are employees of HealthCore. Kern and Cochetti are former employees of HealthCore. Quimbo, Cochetti, and Willey are shareholders of Anthem. HealthCore receives funding from multiple pharmaceutical companies to perform various research studies outside of the submitted work. The preliminary results of this study were presented at AMCP Nexus 2015; March 26-29, 2015; Orlando, FL, and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2017 Conference; May 20-24, 2017; Boston, MA.


Assuntos
Artrite Reumatoide/economia , Comércio/estatística & dados numéricos , Diabetes Mellitus Tipo 2/economia , Medicare Part C/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/economia , Adulto , Idoso , Artrite Reumatoide/terapia , Doença Crônica/economia , Doença Crônica/terapia , Comércio/economia , Diabetes Mellitus Tipo 2/terapia , Feminino , Custos de Cuidados de Saúde , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicare Part C/economia , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Estados Unidos
17.
BMC Public Health ; 19(1): 632, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122231

RESUMO

BACKGROUND: We examined the indoor air quality (IAQ) perceptions of workers and their relationships with the symptoms of sick-building syndrome (SBS) and store types in underground shopping centers. METHODS: In 2017, 314 store workers in nine underground shopping centers in Seoul, Korea, were assessed. The all participants' stores were partially opened onto a passage. Using questionnaires, they were asked about their demographics, job characteristics, 16 SBS symptoms, and seven IAQ perceptions. The SBS symptoms were categorized as skin, eye irritation, respiratory, or general. An IAQ perception score was calculated by adding the number of positive responses to each type of IAQ and categorized into three levels. RESULTS: The prevalence of SBS symptom groups in the previous month was 43.6% for skin symptoms, 62.4% for eye irritation symptoms, 65.6% for respiratory symptoms, and 64.7% for general symptoms. Participants who perceived IAQ were more likely to have SBS symptoms (odds ratio: 1.81-7.84). The type of store employing the workers was associated with several IAQ perceptions. Subjects who worked in clothing and fashion-accessory stores were more likely to have high IAQ perception scores than those who worked in food services. CONCLUSIONS: About half of the store workers in underground shopping centers had experienced SBS symptom groups in the previous month. The SBS symptom groups were associated with almost all IAQ perceptions. Because IAQ perception was associated with store type, studies of IAQ in working areas might need to improve store workers' health in underground shopping centers.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Comércio/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Síndrome do Edifício Doente/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Prevalência , Seul/epidemiologia , Inquéritos e Questionários
18.
Aust N Z J Public Health ; 43(5): 451-456, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30994968

RESUMO

OBJECTIVE: This study examined the distribution of alcohol consumption in Australia, identifying the heaviest drinking 10% of the population and examining their sociodemographic characteristics and their alcohol consumption and purchasing practices. METHODS: Data came from the 2016 National Drug Strategy Household Survey and the 2013 International Alcohol Control Study. The heaviest drinking 10% of the population identified based on estimates of annual alcohol consumption. Logistic regression was then used to assess the factors that distinguished these heaviest drinkers from the rest of the drinking population. RESULTS: The heaviest drinking 10% of the population consumed 54.4% of all alcohol consumed. These heavy drinkers were more likely to be men and to live in regional and remote areas. They were more likely to drink cask wine and full-strength beer and to purchase cheaper alcohol than other drinkers. CONCLUSIONS: Australian alcohol consumption is heavily skewed. Alcohol consumption practices appear to differentiate the heaviest drinkers from others more clearly than sociodemographic factors. Implications for public health: Public health interventions that reduce drinking among the heaviest 10% of drinkers in Australia have the potential to markedly reduce per-capita consumption and reduce alcohol-related harm. Interventions focused on cheap alcohol may be effective with these drinkers.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas , Intoxicação Alcoólica/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Austrália/epidemiologia , Cerveja , Comércio/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Formulação de Políticas , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
19.
Traffic Inj Prev ; 20(2): 134-139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971137

RESUMO

OBJECTIVES: Though there is a growing body of literature on crash risks in the developed world, little is known about how well these models apply to motoring in developing countries, the context in which the majority of road traffic fatalities occur. This qualitative study explores factors perceived to influence crash risks for commercial drivers in Ghana. METHOD: Twenty commercial drivers of varied ages and experience were sampled from 7 major lorry terminals in 3 regions (Greater Accra, Ashanti, and Volta) of Ghana. Data were collected through semistructured interviews. RESULTS: The participants identified some issues that are shared with drivers in the developed world, though moderated by the Ghanaian context. These included work pressures (e.g., fatigued driving), speeding, distracted driving, and inadequate vehicle maintenance. Other factors identified by participants are less frequently considered in research addressing driving behavior in developed countries. These included aggressive competition over passengers and corruption (e.g., improper licensing practices), among others. CONCLUSION: The findings have implications for building a research base to support the development of road safety policy and interventions in developing countries.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/normas , Comércio/estatística & dados numéricos , Adulto , Agressão , Direção Distraída/estatística & dados numéricos , Fadiga , Feminino , Gana , Humanos , Licenciamento/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Veículos Automotores/normas , Pesquisa Qualitativa , Fatores de Risco , Adulto Jovem
20.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-30939289

RESUMO

INTRODUCTION: Fruit and vegetable prescription (FVRx) programs provide increased access to produce to food-insecure, at-risk populations, yet many lack the educational and social components to support long-term disease prevention. OBJECTIVES: To address these barriers, students at Penn State College of Medicine designed "Prevention Produce"-a modified FVRx program that integrated a community-based, month-long educational curriculum-and undertook preliminary evaluation. METHODS: Nine families deemed by clinicians as at risk of chronic disease and food insecurity received weekly $40 "prescriptions" for produce at partnering farmers markets. Participants were paired with medical student mentors who delivered weekly nutrition education modules and assisted in produce shopping. Preprogram and postprogram surveys were administered, categorizing perceptions and practices of healthy eating. All participants were interviewed by phone 3 years later to assess long-term impact. Medical students provided written reflections via online survey. RESULTS: Postprogram fruit and vegetable consumption increased, and more patients expressed efforts to include produce in every meal. More participants strongly agreed that fruits and vegetables prevented chronic diseases. In reflective interviews, participants praised the program's ease of use, mentor-patient relationship, and increased access to produce. Student mentors expressed gratitude for one-on-one interaction and felt empowered to learn and deliver nutrition education. CONCLUSION: Integration of an FVRx program with education, mentorship, and community-based focus may increase produce consumption and improve opinions about healthy eating. This program serves as a model for integrating preventive strategies within larger health care systems. Additionally, the model can facilitate early clinical interventions that may benefit medical trainees' professional development.


Assuntos
Abastecimento de Alimentos , Frutas , Promoção da Saúde/métodos , Tutoria/métodos , Estudantes de Medicina , Verduras , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Comércio/estatística & dados numéricos , Currículo , Dieta/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Projetos Piloto , Adulto Jovem
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