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BACKGROUND: Colorectal cancer (CRC) is a common, fatal cancer. Identifying subgroups who may benefit more from intervention is of critical public health importance. Previous studies have assessed multiplicative interaction between genetic risk scores and environmental factors, but few have assessed additive interaction, the relevant public health measure. METHODS: Using resources from CRC consortia, including 45,247 CRC cases and 52,671 controls, we assessed multiplicative and additive interaction (relative excess risk due to interaction, RERI) using logistic regression between 13 harmonized environmental factors and genetic risk score, including 141 variants associated with CRC risk. RESULTS: There was no evidence of multiplicative interaction between environmental factors and genetic risk score. There was additive interaction where, for individuals with high genetic susceptibility, either heavy drinking (RERI = 0.24, 95% confidence interval [CI] = 0.13, 0.36), ever smoking (0.11 [0.05, 0.16]), high body mass index (female 0.09 [0.05, 0.13], male 0.10 [0.05, 0.14]), or high red meat intake (highest versus lowest quartile 0.18 [0.09, 0.27]) was associated with excess CRC risk greater than that for individuals with average genetic susceptibility. Conversely, we estimate those with high genetic susceptibility may benefit more from reducing CRC risk with aspirin/nonsteroidal anti-inflammatory drugs use (-0.16 [-0.20, -0.11]) or higher intake of fruit, fiber, or calcium (highest quartile versus lowest quartile -0.12 [-0.18, -0.050]; -0.16 [-0.23, -0.09]; -0.11 [-0.18, -0.05], respectively) than those with average genetic susceptibility. CONCLUSIONS: Additive interaction is important to assess for identifying subgroups who may benefit from intervention. The subgroups identified in this study may help inform precision CRC prevention.
- MeSH
- dieta MeSH
- dospělí MeSH
- genetická predispozice k nemoci * MeSH
- index tělesné hmotnosti MeSH
- interakce genů a prostředí * MeSH
- jednonukleotidový polymorfismus MeSH
- kolorektální nádory * genetika epidemiologie MeSH
- kouření škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- pití alkoholu MeSH
- rizikové faktory MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: This study aimed to determine trend in polyphenol consumption in the Czech Republic during the last three decades. Additionally, it provides a brief overview of the beneficial effects of polyphenols in several body systems. METHODS: Data from the Phenol-Explorer 3.6, a specialized database of polyphenolic substances, were assigned to the resources of the Czech Statistical Office on the consumption of food and beverages in the Czech Republic for the years 1989-2022. The average daily intake of polyphenols was determined by multiplying the average annual consumption of each type of food by the polyphenol content obtained from the database; results were given in milligrams of polyphenols per inhabitant and day. Since the food items in the data sources are not identical, it was necessary to create an extensive model of food categories. RESULTS: The current value of polyphenol intake is 1,673 mg per day per inhabitant; however, this level most likely reflects methodological underestimation. The favourable increase in dietary polyphenol intake in the Czech population - doubling, to be precise - which we observed from 1989 to 2007, has been replaced by the opposite trend in the last 15 years. The current intake of polyphenols corresponds to the level that was already achieved in 2004. Hydroxycinnamic acids (from the group of phenolic acids) are the most prevalent dietary polyphenols, followed by flavanols (from the group of flavonoids). The most frequent source of polyphenols in the Czech population are non-alcoholic beverages such as coffee, tea and juices, followed by fruits, cereals, and vegetables, respectively. CONCLUSION: Current trend of dietary polyphenol intake in the Czech population is slightly decreasing. This tendency, lasting since 2008, is indisputably negative. Plant polyphenols offer opportunities for inexpensive interventions in health promotion.
- MeSH
- dieta statistika a číselné údaje MeSH
- lidé MeSH
- polyfenoly * aplikace a dávkování analýza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Cryoballoon ablation for treatment of atrial fibrillation (AF) reduces procedure times, but limited data is available about its impact on electrophysiology (EP) lab efficiency in Central and Eastern Europe (CEE). Using CEE-specific procedure data, the present study modeled cryoballoon ablation procedures on EP lab resource consumption to improve efficiency. METHODS: A discrete event simulation model was developed to assess EP efficiency with cryoballoon ablation. Model inputs were taken from CEE sites within the Cryo Global Registry, namely Czech Republic, Hungary, Poland, Serbia, and Slovakia. The main endpoints were percentage of days that resulted in overtime and percentage of days with time for one extra simple EP procedure. Use of the 'figure of 8' (Fo8) closure technique to reduce procedure time was also examined. RESULTS: The mean lab occupancy time across all CEE sites was 133 ± 47 minutes (min: 104 minutes, max:181 minutes). Cryoballoon ablation in the base-case scenario resulted in 14.6% of days with overtime and 64.8% of days with time for an extra simple EP procedure. Use of the Fo8 closure technique enhanced these values to 5.5% and 85.3%, respectively. Model endpoints were most sensitive to changes in lab occupancy times and overtime start time. CONCLUSIONS: In this CEE-specific analysis of EP lab efficiency it was found that 3 cryoballoon ablation procedures could be performed in 1 lab day, leaving time for a 4th simple EP procedure on most days. As such, use cryoballoon ablation for PVI is an effective way to improve EP lab efficiency.
- MeSH
- časové faktory MeSH
- délka operace MeSH
- elektrofyziologické techniky kardiologické MeSH
- fibrilace síní * chirurgie patofyziologie diagnóza MeSH
- kryochirurgie * MeSH
- lidé MeSH
- registrace * MeSH
- venae pulmonales * chirurgie patofyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- východní Evropa MeSH
BACKGROUND: Healthy behaviors, that is, engaging in regular physical activities, maintaining a healthy diet, limiting alcohol consumption, and avoiding tobacco and drug use, decrease the risk of developing late adverse health conditions in childhood cancer survivors. However, childhood cancer survivors may experience barriers to adopting and maintaining healthy behaviors. This study aimed to assess these barriers and facilitators to health behavior adoption and maintenance in childhood cancer survivors. METHODS: A focus group ( n = 12) and semi-structured telephone interviews ( n = 20) were conducted with a selected sample of European and Dutch childhood cancer survivors, respectively. The Theoretical Domains Framework (TDF) was used to inform the topic guide and analysis. Inductive thematic analysis was applied to identify categories relating to barriers and facilitators of health behavior adoption and maintenance, after which they were deductively mapped onto the TDF. RESULTS: Ten TDF domains were identified in the data of which "Knowledge," "Beliefs about consequences," "Environmental context and resources," and "Social influences" were most commonly reported. Childhood cancer survivors expressed a need for knowledge on the importance of healthy behaviors, possibly provided by healthcare professionals. They indicated physical and long-term benefits of healthy behaviors, available professional support, and a supporting and health-consciously minded work and social environment to be facilitators. Barriers were mostly related to a lack of available time and an unhealthy environment. Lastly, (social) media was perceived as both a barrier and a facilitator to healthy behaviors. CONCLUSION: This study has identified education and available professional support in health behaviors and the relevance of healthy behaviors for childhood cancer survivors as key opportunities for stimulating health behavior adoption in childhood cancer survivors. Incorporating health behavior support and interventions for this population should therefore be a high priority.
BACKGROUND: The populations in Ethiopia have developed their indigenous knowledge to use, manage and conserve wild edible plants (WEPs). In the eastern part of Ethiopia, wild edible plants are used as a means of survival during times of food shortage and as dietary supplements. Documenting the traditional and cultural use of wild food plants is a vital step in obtaining baseline data for investigating nutritional values and possible side effects, preserving indigenous knowledge, and ultimately interesting in wild edible plant conservation. However, their significance, management and utilization have not been documented in Mieso District. Therefore, this study aimed to provide documentation of wild edible plant use associated with ethnobotanical knowledge in Mieso District, eastern Ethiopia. METHODS: An ethnobotanical study of wild edible plant species was conducted from March 2021 to May 2022. A total of 120 (72 males and 48 females) informants were selected using the snowball method. Data collection methods, including semistructured interviews, direct observation and field walks were used. Data were analysed using descriptive statistics, including independent sample t test and analysis of variance (ANOVA). We calculated use values (UVs) to analyse the relative cultural importance of each plant species. RESULTS: A total of 41 wild edible plant species belonging to 33 genera in 21 families were documented to be used as food sources both during times of food shortage and as dietary supplements. Family Malvaceae was best-represented with 6 species, followed by Fabaceae and Rhamnaceae (4 species each). The dominant growth form (habit) was shrubs (30 species), followed by trees (11 species). The most widely used plant parts were fruits (covering 39 species, 95%). The largest number (23 species) was collected from forest habitats only, followed by both village and forest habitats (8 species). The majority of wild edible plants (28 species or 68%) were consumed only during famine or in the time of food shortage followed by supplementing staple foods (9 species or 22%). Wild edible plants in Mieso are used for multiple other uses, including for fodder, fuel, medicine, construction, cosmetics and bee keeping. Twenty-three species were mentioned for fodder use, followed by fuel purpose (21 species) and medicinal value (13 species). The species that had the highest use values were Flacourtia indica (Burm.f.) Merr. (1.4), Carissa spinarum L. (1.1), Ziziphus spina-christi (L.) Desf. (0.6), Grewia villosa Willd. (0.5), Cordia monoica Roxb. (0.3) and Opuntia ficus-indica (L.) Mill. (L.) (0.2). Most WEPs were collected from March to May (Badheysa) (33 species). The highest mentioned wild edible plant sold in the market was F. indica (Burm.f.) Merr. mentioned by 20 informants, followed by Z. spina-christi (L.) Desf. (14). CONCLUSION: The people in Mieso use wild plants as supplementary food to cultivated crops, during famine, and many could be utilized for day-to-day human consumption. Some plants in the district provide cash income for local people. However, deforestation (54%), drought (22%) and agricultural expansion (12%) were the highest threats to wild plants in Mieso District. Hence, on-site and off-site conservation would help protect wild plant resources in Mieso, eastern Ethiopia.
- Publikační typ
- časopisecké články MeSH
Makana Local Municipality is located in the Eastern Cape Province of South Africa. The area is water-scarce and has been undergoing aridification in recent years, ie, there has been a 7-year long drought. At the same time, there has been a breakdown in provision of municipal services, such as drinking water, to the population since at least 2008. Mi-crobial water quality has been a result of this, and monitoring has been a challenge. Given the drought and the prob-lems with drinking water delivery, it was necessary to conduct this study to investigate the microbial quality of alterna-tive water resources that the Makana population can use during the municipal water outage. The microbial water quality of alternative sources of drinking water in the Makana Local Municipality was examined using the H2S test kit and enumeration of the fecal coliforms. Storage of the collected water was examined for potential factors influencing the microbial water quality of the alternative sources of drinking water. The costs of the water provision from the most suitable alternative sources of potable water were calculated. There was a general correlation between the H2S test kit results and the fecal coliform concentrations, with the latter values ranging from <0 to 23 ± 7 colony-forming units/100 mL. The bottled water from two retail outlets was provided the best alternative source of potable/drinking water, which is microbially safe, for the Makana population. If the consumption of the drinking water from an alternative source takes place within 24 hours of collection, then the Fairview spring could also be used as a source of drinking water for Maka-na residents. The total cost per 1 L of drinking water from alternative sources was estimated to be from 1.51 to 5.81 ZAR. Therefore, the maximum cost of daily provision of drinking water from alternative sources would account for a maximum of 0.88 percent of the monthly household expenditure in the middle-to-high-income household. However, the daily costs of such provision of drinking water would account for a maximum of 8.11 percent of the monthly household expenditure in the low-income household. Provision of the drinking water from the alternative sources would have a minor impact of the monthly ex-penditure in the middle-to-high-income households. However, it is likely that the low-income households would not be able to sustain their water supply from alternative sources for longer than 24 hours, during a municipal outage in the drinking water supply.
- Publikační typ
- časopisecké články MeSH
Udržitelnost života obecně, přežití lidstva a planety, ale i udržitelnost současných civilizačních výdobytků, mezi něž v Evropě patří i rozvinuté zdravotnictví, je globální výzvou. Udržitelnost je novou veřejnou agendou, novým tématem ve vzdělávání od mateřských po vysoké školy, novým občanským projevem, ale nesnadno řešitelným politickým tématem. Diskurs o zelené ekonomice znamená ohled na úsporu zdrojů a recyklaci v každém bodě podnikatelského či hospodářského řetězce. Politicky je udržitelnost nejpregnantněji vyjádřena v dokumentu OSN (Cíle udržitelného života). Udržitelnost znamená především přehodnocení našich dosavadních přístupů, které jsou energeticky, finančně, materiálově i materiálně velmi náročné, přispívají ke znečištění životního prostředí, a ne vždy vedou k žádoucím efektům. Týká se i medicíny a zdravotnictví jako celku. Udržitelnost bývá příliš často interpretována jen v environmentálním slova smyslu, ale zejména ve zdravotnictví má kromě ekologické dimenze také finanční a morální stránku. Tento příspěvek se ale zaměřuje na to, jak v české a evropské medicíně a zdravotnictví rezonuje téma ochrany životní přírody, ekologické odpovědnosti a environmentální udržitelnosti.
Sustainability of global life, mankind and the planet is the central focus in the ecological debate. Moreover, also the sustainability of modern advancements like modern medicine and health care is a global challenge. Sustainability is a new public agenda, new education theme on the whole scale of educational settings, new civic engagement and a political task with no simple solutions. The discourse on green economy primarily means reduction in use of resources in each moment of the production and consumption cycle. The most significant political document is represented by the United Nations 19 goals of sustainable development. Sustainability requires a fundamental revision of our current behaviours and practice, that are resource intensive, contaminating and not always effective in terms of achievement the stated goals. The debate is also inevitable in medicine and health care. Sustainability is too often considered in environmental terms but especially in health care it also involves sustainability in financial and moral terms. This paper focuses on environmental dimension and how this is reflected in medicine and health care in The Czech Republic and European context.
INTRODUCTION: The study protocol is focused on qualitative and quantitative analysis and reflection of the media image and presentation of direct and hidden alcohol advertising in the Czech mass media, with an emphasis on social network platforms with a high degree of influence on young people. It responds to the need for verified resource points for discussion of the effectiveness and extent of the existing statutory regulation of alcoholic beverage advertising and methods for its possible tightening. METHODS: For the analysis of traditional (printed) media, the method of content analysis (human coding) will be used, and quantification will be achieved through the scaling technique. For digital media, individual submissions will be assessed by using the Content Appealing to Youth Index (CAY), which has been designed and validated to quantify specific features of audio-visual alcohol advertising content. DISCUSSION: The goal of the study is to review up-to-date evidence- based materials for health policy decision making related to preventive interventions to reduce alcohol usage. The study will reveal the degree of influence and the identification of the risk factors not only of direct but especially hidden advertising also presented on social media, which in particular affect young people at a risk age for starting alcohol consumption. The attitudes, approaches, persuasive strategies, and ethical opinions on alcohol consumption are presented and preferred by the community of social network users (especially influencers and celebrities). CONCLUSIONS: The innovativeness of the project is determined by the methodology used, which will produce comprehensive up-to-date evidence-based data for decision making in health policy.
AIMS: Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding. The aim of this study is to examine the literature exploring community-based pharmacist-initiated and/or -led deprescribing and to evaluate the impact on the success of deprescribing and clinical outcomes. METHODS: Library and clinical trials databases were searched from inception to March 2020. Studies were included if they explored deprescribing in adults, by community-based pharmacists and were available in English. Two reviewers extracted data independently using a pre-agreed data extraction template. Meta-analysis was not performed due to heterogeneity of study designs, types of intervention and outcomes. RESULTS: A total of 24 studies were included in the review. Results were grouped based on intervention method into four categories: educational interventions; interventions involving medication review, consultation or therapy management; pre-defined pharmacist-led deprescribing interventions; and pharmacist-led collaborative interventions. All types of interventions resulted in greater discontinuation of medications in comparison to usual care. Educational interventions reported financial benefits as well. Medication review by community-based pharmacist can lead to successful deprescribing of high-risk medication, but do not affect the risk or rate of falls, rate of hospitalisations, mortality or quality of life. Pharmacist-led medication review, in patients with mental illness, resulting in deprescribing improves anticholinergic side effects, memory and quality of life. Pre-defined pharmacist-led deprescribing did not reduce healthcare resource consumptions but can contribute to financial savings. Short follow-up periods prevent evaluation of long-term sustainability of deprescribing interventions. CONCLUSION: This systematic review suggests community-based pharmacists can lead deprescribing interventions and that they are valuable partners in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.
- MeSH
- depreskripce * MeSH
- dospělí MeSH
- farmaceuti * MeSH
- kvalita života MeSH
- lidé MeSH
- poskytování zdravotní péče MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
BACKGROUND: Health economic evaluations of the implementation of evidence-based interventions (EBIs) into practice provide vital information but are rarely conducted. We evaluated the health economic impact associated with implementation and intervention of the INTERCARE model-an EBI to reduce hospitalisations of nursing home (NH) residents-compared to usual NH care. METHODS: The INTERCARE model was conducted in 11 NHs in Switzerland. It was implemented as a hybrid type 2 effectiveness-implementation study with a multi-centre non-randomised stepped-wedge design. To isolate the implementation strategies' costs, time and other resources from the NHs' perspective, we applied time-driven activity-based costing. To define its intervention costs, time and other resources, we considered intervention-relevant expenditures, particularly the work of the INTERCARE nurse-a core INTERCARE element. Further, the costs and revenues from the hotel and nursing services were analysed to calculate the NHs' losses and savings per resident hospitalisation. Finally, alongside our cost-effectiveness analysis (CEA), a sensitivity analysis focused on the intervention's effectiveness-i.e., regarding reduction of the hospitalisation rate-relative to the INTERCARE costs. All economic variables and CEA were assessed from the NHs' perspective. RESULTS: Implementation strategy costs and time consumption per bed averaged 685CHF and 9.35 h respectively, with possibilities to adjust material and human resources to each NH's needs. Average yearly intervention costs for the INTERCARE nurse salary per bed were 939CHF with an average of 1.4 INTERCARE nurses per 100 beds and an average employment rate of 76% of full-time equivalent per nurse. Resident hospitalisation represented a total average loss of 52% of NH revenues, but negligible cost savings. The incremental cost-effectiveness ratio of the INTERCARE model compared to usual care was 22'595CHF per avoided hospitalisation. As expected, the most influential sensitivity analysis variable regarding the CEA was the pre- to post-INTERCARE change in hospitalisation rate. CONCLUSIONS: As initial health-economic evidence, these results indicate that the INTERCARE model was more costly but also more effective compared to usual care in participating Swiss German NHs. Further implementation and evaluation of this model in randomised controlled studies are planned to build stronger evidential support for its clinical and economic effectiveness. TRIAL REGISTRATION: clinicaltrials.gov ( NCT03590470 ).
