Abstract Background In England, during 2009–2014 the ‘Time to Change’ anti-stigma programme has included a social marketing campaign (SMC) using mass media channels, social media and social contact ...events but the efficacy of such approach has not been evaluated yet. Methods The target population included people aged between mid-twenties/mid-forties, from middle-income groups. Participants were recruited through an online market research panel, before and after each burst of the campaign (with a mean number of unique participants per each burst: 956.9 ± 170.2). Participants completed an online questionnaire evaluating knowledge Mental Health Knowledge Schedule (MAKS); attitudes Community Attitudes toward Mental Illness (CAMI); and behaviours Reported and Intended Behaviour Scale (RIBS). Socio-demographic data and level of awareness of the SMC were also collected. Results A total of 10,526 people were interviewed. An increasing usage of the SMC-media channels as well as of the level of awareness of SMC was found ( P < 0.001). Being aware of the SMC was found to be associated with higher score at MAKS (OR = 0.95, CI = 0.68 to 1.21; P < 0.001), at ‘tolerance and support’ CAMI subscale (OR = 0.12, CI = 0.09 to 0.16; P < 0.001), and at RIBS (OR = 0.71, CI = 0.51 to 0.92; P < 0.001), controlling for confounders. Conclusion The SMC represents an important way to effectively reduce stigma. Taking into account these positive findings, further population-based campaigns using social media may represent an effective strategy to challenge stigma.
Household Air Pollution (HAP) from biomass cooking fuels is a major cause of morbidity and mortality in low-income settings worldwide. In Nepal the use of open stoves with solid biomass fuels is the ...primary method of domestic cooking. To assess patterns of domestic air pollution we performed continuous measurement of carbon monoxide (CO) and particulate Matter (PM2.5) in 12 biomass fuel households in Janakpur, Nepal. We measured kitchen PM2.5 and CO concentrations at one-minute intervals for an approximately 48-h period using the TSI DustTrak II 8530/SidePak AM510 (TSI Inc, St. Paul MN, USA) or EL-USB-CO data logger (Lascar Electronics, Erie PA, USA) respectively. We also obtained information regarding fuel, stove and kitchen characteristics and cooking activity patterns. Household cooking was performed in two daily sessions (median total duration 4 h) with diurnal variability in pollutant concentrations reflecting morning and evening cooking sessions and peak concentrations associated with fire-lighting. We observed a strong linear relationship between PM2.5 measurements obtained by co-located photometric and gravimetric monitoring devices, providing local calibration factors of 4.9 (DustTrak) and 2.7 (SidePak). Overall 48-h average CO and PM2.5 concentrations were 5.4 (SD 4.3) ppm (12 households) and 417.6 (SD 686.4) μg/m3 (8 households), respectively, with higher average concentrations associated with cooking and heating activities. Overall average PM2.5 concentrations and peak 1-h CO concentrations exceeded WHO Indoor Air Quality Guidelines. Average hourly PM2.5 and CO concentrations were moderately correlated (r = 0.52), suggesting that CO has limited utility as a proxy measure for PM2.5 exposure assessment in this setting. Domestic indoor air quality levels associated with biomass fuel combustion in this region exceed WHO Indoor Air Quality standards and are in the hazardous range for human health.
•Intensive PM2.5 and CO monitoring was performed in 12 biomass fuel-using households in Janakpur.•Domestic cooking activity patterns and kitchen, stove and fuel characteristics were recorded.•Temporal PM2.5 and CO patterns demonstrated diurnal variability reflecting morning and evening cooking sessions.•Average PM2.5 and peak CO concentrations both exceeded World Health Organization (WHO) Indoor Air Quality Guidelines.•Concentrations of PM2.5 and CO were moderately correlated during cooking periods.
Introduction
The prevalence of depression based on the Patient Health Questionnaire-8 (PHQ-8) may vary depending on the scoring method.
Objectives
1) To describe the prevalence of depression in ...Europe using two PHQ-8 scoring methods. 2) To identify the countries with the highest prevalence according to each method.
Methods
Data from 27 countries included in the European Health Survey (EHIS-2) for the year 2014/2015 were used (n=258,888). All participants who completed the PHQ-8 were included. The prevalence of depression and its 95% Confidence Interval (95%CI) were calculated overall for the whole of Europe and for each country using a PHQ-8≥10 cut-off point and the PHQ-8 algorithm scoring method. Weights derived from the complex sample design were considered for their calculation.
Results
The overall prevalence of depression for all Europe was lower using the PHQ-8>=10 cut-off point (6.38%, 95%CI 6.24-6.52) than the PHQ-8 algorithm (7.01%, 95%CI, 6.86-7.16). Using the PHQ-8≥10 cut-off point, the highest prevalence was observed in Iceland (10.33%, 95%CI, 9.33-11.32), Luxembourg (9.74%, 95%CI, 8.76-10.72) and Germany (9.24%, 95%CI, 8.82-9.66). Using the PHQ-8 algorithm the highest rates were observed in Hungary (10.99%, 95%CI,10.14-11.84), Portugal (10.63%, 95%CI, 9.96-11.29) and Iceland (9.80%, 95%CI, 8.77-10.83).
Conclusions
There is variability in the prevalence of depression rates in Europe according to the PHQ-8 scoring method. These findings suggest the necessity of identify the method of choice for each country comparing with a gold standard measure (clinical diagnosis). Countries with consistent higher prevalence of depression based on PHQ-8 regardless of scoring method deserve further study.
Disclosure
This work has been funded by CIBERESP (ESP21PI05)
Purpose
To compare sex-specific rates of hospital admission and repeat admission following self-harm between ethnic groups in London and test whether differences persist after adjustment for ...socio-economic deprivation.
Methods
A population-based cohort of all individuals aged over 11 admitted to a general hospital for physical health treatment following self-harm between 2008 and 2018, using administrative Hospital Episode Statistics for all people living in Greater London.
Results
There were 59,510 individuals admitted to the hospital following self-harm in the 10 year study period, ethnicity data were available for 94% of individuals. The highest rates of self-harm admission and readmission were found in the White Irish group. Rates of admission and readmission were lower in Black and Asian people compared to White people for both sexes at all ages and in all more specific Black and Asian ethnic groups compared to White British. These differences increased with adjustment for socio-economic deprivation. People of Mixed ethnicity had higher rates of readmission. Rates were highest in the 25–49 age group for Black and Mixed ethnicity men, but in under-25 s for all other groups. There were substantial differences in rates within the broader ethnic categories, especially for the Black and White groups.
Conclusion
In contrast to earlier UK studies, self-harm rates were not higher in Black or South Asian women, with lower self-harm admission rates seen in almost all ethnic minority groups. Differences in rates by ethnicity were not explained by socio-economic deprivation. Aggregating ethnicity into broad categories masks important differences in self-harm rates between groups.
Purpose
The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This ...study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI).
Methods
This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD). Quasi-experimental designs will be employed to quantify the impact of COVID-19 on mental health service use and excess mortality by ethnicity, in people living with severe mental health conditions. Up to 50 qualitative interviews will also be conducted, co-produced with peer researchers; findings will be synthesised with quantitative insights to provide in-depth understanding of observed associations.
Results
81,483 people in CRIS with schizophrenia spectrum, bipolar or affective disorder diagnoses, were alive from 1st January 2019. Psychiatric multimorbidities in the CRIS sample were comorbid somatoform disorders (30%), substance use disorders (14%) and personality disorders (12%). In CPRD, of 678,842 individuals with a prior probable diagnosis of COVID-19, 1.1% (
N
= 7493) had an SMI diagnosis. People in the SMI group were more likely to die (9% versus 2% in the non-SMI sample) and were more likely to have mental and physical multimorbidities.
Conclusion
The effect of COVID-19 on people from minority ethnic backgrounds with SMI and multimorbidities remains under-studied. The present mixed methods study aims to address this gap.
War and violence have a serious negative impact on the wellbeing and mental health of many children. Caregivers play an important role in mitigating or exacerbating this impact.
This study evaluates ...the impact of the nine session Caregiver Support Intervention on improving children's wellbeing and examines putative mediators of changes in children's psychosocial wellbeing.
240 female caregivers were randomly allocated (1:1) to the CSI or a waitlist control comparison condition. The study was implemented in Lebanon, in an area characterized by high levels of poverty and a high number of the Syrian refugees.
A parallel group Randomized Controlled Trial reporting on caregiver-reported child-level wellbeing. We used a combination of the Kid- and Kiddy-KINDL (parent version) for index children ages three to 12. Putative mediators of the CSI on children's psychosocial wellbeing included harsh parenting, caregiver psychological distress, caregiver wellbeing. Measurements were conducted at baseline, post-intervention and 3-months follow-up.
We demonstrated a statistically significant change in caregiver reported children's psychosocial wellbeing at post-intervention (Mdiff =4.39, 95 % CI = 1.12, 7.65, p < 0.01, d = 0.28) but not at follow-up (Mdiff = −0.97, 95 % CI = -4.27, 2.32, p > 0.05). The proportion of the total effect of the CSI intervention on child psychosocial wellbeing mediated by caregiver distress, caregiver wellbeing and harsh parenting was 77 %.
The CSI holds potential for down-stream short-term effect on improving children's psychosocial wellbeing, beyond the previously reported positive caregiver outcomes. This effect was not sustained three months post intervention. The study confirms caregiver wellbeing and parenting support as dual pathways mediating child psychosocial wellbeing.
Prospective trial registration: ISRCTN22321773
In the field of stigma research, an area of interest is the coping strategies that mental health service users can use in response to discriminatory experiences. As a part of the evaluation of the ...Time to Change (TTC) anti-stigma programme, the Viewpoint telephone survey was run annually in order to assess service users' reported levels of discrimination and selected coping strategies. The study aim is to test the extent to which experience of TTC programme is a positive predictor of selected coping strategies.
Telephone interview surveys carried out by peer interviewers were conducted annually. 'Educating others' and 'challenging' coping strategies were assessed alongside anticipated and experienced discrimination.
During 2011-2014, 3903 mental health service users were interviewed. Participants more often adopted the 'educating others' strategy (2.31 ± 0.01) than the 'challenging' strategy (2.15 ± 0.02) (p < 0.001). On the other hand, those who participated in campaign activities endorsed 'challenging' more frequently than people who were not aware of TTC (2.78 ± 1.23 v. 2.09 ± 1.08, p < 0.001). According to the multi-variate linear regression model, we found that being actively involved in TTC activities (OR = 0.74, CI: 0.29-1.19; p < 0.05), having a diagnosis of a depressive disorder (OR = 0.20, CI: 0.04-0.36; p < 0.05) or personality disorder (OR = 0.23, CI: 0.04-0.43; p < 0.05) were good predictors of endorsing a 'challenging' strategy even after adjusted for confounding variables.
A positive relationship between participating in the TTC programme and using the 'challenging' strategy was found. There is still a need to disentangle the complex association between these two coping strategies and the role of anti-stigma campaigns, promoting further local activities led by service users and carers' as well as all others stakeholders' associations.
To cite this article: Bakolis I, Hooper R, Thompson RL, Shaheen SO. Dietary patterns and adult asthma: population-based case-control study. Allergy 2010; 65: 606-615. Epidemiological studies of diet ...and asthma have focused on relations with intakes of individual nutrients and foods and evidence has been conflicting. Few studies have examined associations with dietary patterns. We carried out a population-based case-control study of asthma in adults aged between 16 and 50 in South London, UK. Information about usual diet was obtained by food frequency questionnaire and we used principal components analysis to define five dietary patterns in controls. We used logistic and linear regression, controlling for confounders, to relate these patterns to asthma, asthma severity, rhinitis and chronic bronchitis in 599 cases and 854 controls. Overall, there was weak evidence that a 'vegetarian' dietary pattern was positively associated with asthma adjusted odds ratio comparing top vs bottom quintile of pattern score 1.43 (95% CI: 0.93-2.20), P trend 0.075, and a 'traditional' pattern (meat and vegetables) was negatively associated OR 0.68 (0.45-1.03), P trend 0.071. These associations were stronger amongst nonsupplement users (P trend 0.030 and 0.001, respectively), and the association with the 'vegetarian' pattern was stronger amongst whites (P trend 0.008). No associations were observed with asthma severity. A 'prudent' dietary pattern (wholemeal bread, fish and vegetables) was positively associated with chronic bronchitis OR 2.61 (1.13-6.05), P trend 0.025, especially amongst nonsupplement users (P trend 0.002). Overall there were no clear relations between dietary patterns and adult asthma; associations in nonsupplement users and whites require confirmation. The finding for chronic bronchitis was unexpected and also requires replication.
Exposure to house dust has been associated with asthma in adults, and this is commonly interpreted as a direct immunologic response to dust‐mite allergens in those who are IgE sensitized to house ...dust‐mite. Mattress house dust‐mite concentrations were measured in a population‐based sample of 2890 adults aged between 27 and 56 years living in 22 centers in 10 countries. Generalized linear mixed models were employed to explore the association of respiratory symptoms with house dust‐mite concentrations, adjusting for individual and household confounders. There was no overall association of respiratory outcomes with measured house dust‐mite concentrations, even in those who reported they had symptoms on exposure to dust and those who had physician‐diagnosed asthma. However, there was a positive association of high serum specific IgE levels to HDM (>3.5 kUA/l) with mattress house dust‐mite concentrations and a negative association of sensitization to cat with increasing house dust‐mite concentrations. In conclusion, there was no evidence that respiratory symptoms in adults were associated with exposure to house dust‐mite allergen in the mattress, but an association of house mite with strong sensitization was observed.
IntroductionDietary patterns derived empirically from food frequency questionnaire (FFQ) data using principal components analysis (PCA) are widely employed for the investigation of diet-disease ...relationships. The aim of the study was to investigate whether PCA performed better at identifying associations between diet and disease than an analysis of each individual food in the FFQ separately after adjusting for multiple testing, a process we refer to as exhaustive single food analysis (ESFA).MethodsUsing simulated data employing a known model for the associations between food intakes and disease, and a realistic joint distribution of food intakes, we investigated the performance of PCA and ESFA in correctly identifying associations between diet and disease. Performance was assessed in terms of the power with which we could identify at least one association between a food intake and disease, and the power and false discovery rate (FDR) for identifying specific food intakes that were causally linked to disease in the model.ResultsESFA had greater power than PCA to detect an association of at least one food with disease, and greater power and lower FDR for identifying specific foods causally linked to disease. With both methods FDRs increased with sample size, even using an FDR-controlling adjustment. However, when we adjusted the ESFA for foods that were significant in univariate analyses, FDRs were controlled at the specified level.ConclusionsAn exhaustive analysis of single foods out-performed PCA in identifying associations between diet and disease using FFQ data.
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