14 research outputs found
Breeding performance, natal dispersal, and nest site fidelity of the three-toed woodpecker in the German Alps
No full textSequence stratigraphy of Middle to Upper Pennsylvanian fill of the Central Appalachian Basin
No full textThe sedimentary fill of Middle to Upper Pennsylvanian strata in the central Appalachian Basin reveals complex sequence stratigraphy in predominantly fluvial strata. Sequence stratigraphy is commonly used to interpret deposits containing marine strata, but these marine units are largely absent in the rocks of the Upper Breathitt Group and Conemaugh Group within the study area. The effects of eustasy weaken up-dip as fluvial-dominant sequences see increasing influence from climate and tectonics. A more applicable fluvial sequence stratigraphic model that places focus on accommodation state rather than relative sea level is adopted in this study in order to determine the stratigraphy of Upper Breathitt Group and Lower Conemaugh Group rocks in the area of the Kentucky/West Virginia state line and use this information to understand the relationship between facies of the floodplain and the channel belts that filled the Appalachian Basin in the context of the basin fluvial sequence stratigraphy
Foraging behavior of Eurasian three-toed woodpeckers Picoides tridactylus in relation to sex and season in Germany
No full textComputational evaluation of the η6-arene during the ATH of imines on Noyori’s RuII catalyst
No full textLaw as a Tool for Preventing Chronic Diseases: Expanding the Range of Effective Public Health Strategies
No full textChemInform Abstract: Practical Aspects and Mechanism of Asymmetric Hydrogenation with Chiral Half‐Sandwich Complexes
No full textChemInform Abstract: Experimental and Theoretical Perspectives of the Noyori‐Ikariya Asymmetric Transfer Hydrogenation of Imines
No full textReductions in cardiovascular, cerebrovascular, and respiratory mortality following the national Irish smoking ban: Interrupted time-series analysis
No full textCopyright @ 2013 Stallings-Smith et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Previous studies have shown decreases in cardiovascular mortality following the implementation of comprehensive smoking bans. It is not known whether cerebrovascular or respiratory mortality decreases post-ban. On March 29, 2004, the Republic of Ireland became the first country in the world to implement a national workplace smoking ban. The aim of this study was to assess the effect of this policy on all-cause and cause-specific, non-trauma mortality. Methods: A time-series epidemiologic assessment was conducted, utilizing Poisson regression to examine weekly age and gender-standardized rates for 215,878 non-trauma deaths in the Irish population, ages ≥35 years. The study period was from January 1, 2000, to December 31, 2007, with a post-ban follow-up of 3.75 years. All models were adjusted for time trend, season, influenza, and smoking prevalence. Results: Following ban implementation, an immediate 13% decrease in all-cause mortality (RR: 0.87; 95% CI: 0.76-0.99), a 26% reduction in ischemic heart disease (IHD) (RR: 0.74; 95% CI: 0.63-0.88), a 32% reduction in stroke (RR: 0.68; 95% CI: 0.54-0.85), and a 38% reduction in chronic obstructive pulmonary disease (COPD) (RR: 0.62; 95% CI: 0.46-0.83) mortality was observed. Post-ban reductions in IHD, stroke, and COPD mortalities were seen in ages ≥65 years, but not in ages 35-64 years. COPD mortality reductions were found only in females (RR: 0.47; 95% CI: 0.32-0.70). Post-ban annual trend reductions were not detected for any smoking-related causes of death. Unadjusted estimates indicate that 3,726 (95% CI: 2,305-4,629) smoking-related deaths were likely prevented post-ban. Mortality decreases were primarily due to reductions in passive smoking. Conclusions: The national Irish smoking ban was associated with immediate reductions in early mortality. Importantly, post-ban risk differences did not change with a longer follow-up period. This study corroborates previous evidence for cardiovascular causes, and is the first to demonstrate reductions in cerebrovascular and respiratory causes
The effect of a smoking ban on exposure and cardio-respiratory health of non-smoking hospitality workers in Switzerland
No full textSummary: Background
The first scientific studies on negative health effects of passive smoking published in
the 1980s instigated an intense battle between the tobacco industry, who fear the
loss of social acceptance of smoking and resultant financial damages, and diverse
interest groups defending the health of the non-smoking population. In 2003 the
World Health Organisation issued a Framework Convention for Tobacco Control,
which was signed by 168 member states and has been ratified by 176.
Since then, several countries have implemented smoking bans in public indoor
spaces and workplaces. At the same time studies on second hand smoke (SHS)
exposure and related health effects in hospitality workers have been conducted
using various, albeit unreliable, methods. For example, exposure is typically
assessed by means of a questionnaire or by measuring a proxy such as PM2.5.
Likewise, measuring nicotine in biological samples such as urine, blood or saliva
may be influenced by personal metabolism. Most health-related studies focus on
respiratory examinations and have completely neglected long-term effects of SHS
exposure on cardiovascular health. This study aims to address some of these
knowledge gaps.
In May 2010 Switzerland implemented the first national smoking ban to protect the
population from passive smoking. Loose regulation left room for exceptions; there
remained a possibility to establish small smoking venues or separate smoking
rooms of limited size. The COSIBAR study utilized the transition as a natural
intervention to examine exposure and the cardio-respiratory health of non-smoking
hospitality workers.
Methods
An intervention group that experienced a change in smoking regulation was to be
compared with a control group that continued to work in a smoke-exposed
environment. To this end, the air was measured in 193 hospitality venues before the
ban in the cantons of Basel City, Basel County and Zurich. 92 workers were recruited
and invited to three medical examinations, once before implementation of the ban
and twice afterwards. Exposure was also measured each time, and at the first and
second time points a questionnaire on behaviour and acceptance was mailed to
participants. In this non-medical target group also smokers were included.
Exposure was measured by means of a passive nicotine-specific sampler. One was
placed at the workplace for a week and a second one was worn by the participants
for a personal 24-hour measurement. In addition, we took a salivary sample during
the medical examination to determine nicotine and cotinine content. A
questionnaire contained further questions on personal exposure.
Height, weight and blood pressure were measured in the medical component. We
did an ECG to assess heart rate variability (HRV)- a quantitative marker of
autonomic activity of the nervous system. We also measured pulse wave velocity
(PWV) to determine arterial stiffness which is an indicator of cardiovascular risk
factors and atherosclerosis. Respiratory health was examined by measuring lung
function and fractional exhaled nitric oxide (FeNO), an inflammatory marker in the
lungs. Furthermore we did an allergy test at baseline and performed an extensive
interview at each appointment.
To analyse the health data we developed several models; exposure was compared to
all health parameters in a cross-sectional baseline analysis. A longitudinal model
correlated exposure at every time point with corresponding health data taking into
account within-subject correlation. Finally, a pre/post comparison of health
parameters was done without taking exact exposure into account. All models were
adjusted for appropriate covariates.
The behaviour and acceptance questionnaire contained questions on personal
knowledge and attitude towards the smoking ban and factors influencing these as
well as on smoking status and behaviour. Responses were analysed with suitable
statistical tests.
Results
Average SHS exposure in the intervention group decreased by 2.4 cigarette
equivalents/day (CE/d) after the smoking ban while the change in the exposed
control group was significantly smaller.
In the cross-sectional analysis of the baseline data we found that mean lung function
of all exposed hospitality workers was below the recorded average for the Swiss
population. FeNO values were directly associated with exposure, meaning we
observed decreased inflammation with increased exposure.
In the longitudinal model that compared exposure to health measures, several HRV
parameters significantly correlated with exposure. A decrease by one unit CE/d was
linked to an increase in the root mean square of successive differences (RMSSD), the
standard deviation of N-N intervals (SDNN), high frequency (HF) and Total Power
(TP) as well as a decrease in PWV. These associations were consistent with the
original hypothesis that predicted better health with lower exposure.
In the pre/post model not taking exact exposure into account, there was a
significantly different development of several parameters in the intervention group
compared to the control group. SDNN, RMSSD, HF and TP increased in the
intervention group while decreasing in the control group. The inverse was true for
the low frequency/HF ratio (LF/HF), an effect that also corresponded to our
expectations. FeNO decreased in the intervention group, while the control group
showed a significantly different slight increase. No changes could be observed in
lung function.
Acceptance of the smoking ban was higher in non-smokers than in smokers
throughout the study. It rose from baseline to follow-up in both groups in the canton
of Basel Land which had a comprehensive smoking ban in place but not in the two
other cantons that had a regulation allowing exceptions.
Discussion
In this study there were clear indications for an improvement of cardiovascular
health in non-smoking hospitality workers after implementation of a smoking ban.
Summary
xiv
Risk factors for myocardial infarction or arteriosclerosis had significantly decreased
in the intervention group. No change in lung function was observed while FeNO
showed a decrease that cannot be considered clinically relevant. Hence, heart rate
variability and pulse wave velocity seem to be the most sensitive markers, while
lung function may take longer to recover or may remain irreversibly damaged. FeNO
is influenced by many factors and is in need of further research.
All these results speak for a comprehensive smoking ban without exceptions. The
higher acceptance that we observed with this type of regulation further supports
this recommendation.
Nevertheless an initiative by the lung association demanding exactly this
consolidation of the law was rejected in September 2012. During the animated
voting campaign, first study results were published. The failure of the campaign
raises the question if health is an attractive political argument when personal
freedom of decision is threatened. What more, the tobacco industry holds a
powerful position as an important employer and tax payer in Switzerland and its
role must be considered and moved into the people’s conscience. The alleged
personal freedom of Swiss citizens to decide on their smoking behaviour seems to
be an illusion, caused by concealed brainwashing by the world’s most manipulative
industry. ---------- Zusammenfassung: Hintergrund
Seit in den 1980er Jahren erste wissenschaftliche Studien die negativen
gesundheitlichen Folgen von Passivrauchen nachgewiesen haben, herrscht ein
unerbittlicher Kampf zwischen der Tabaklobby, die den Verlust der sozialen
Akzeptanz des Rauchens und damit verbundene finanzielle Einbussen fürchtet, und
verschiedenen Interessengruppen, die sich für die Gesundheit der nichtrauchenden
Bevölkerung einsetzen. Die Weltgesundheitsorganisation erliess 2003 ein
Rahmenübereinkommen zur Eindämmung des Tabakkonsums, das von 168 Staaten
unterschrieben und inzwischen von 176 ratifiziert wurde. Seither wurden in
mehreren Ländern Rauchverbote in öffentlichen Räumen und an Arbeitsplätzen
eingeführt. Dabei wurden oft Studien zu Rauchexposition und Gesundheitsfaktoren
von Gastgewerbemitarbeitern durchgeführt, mit unterschiedlichen Methoden. Die
Exposition wurde meistens anhand von Fragebogen oder unter Anwendung eines
Proxys wie PM2.5 eingeschätzt, was jedoch ungenau sein kann. Die Nikotinmessung
von biologischen Proben wie Urin, Blut oder Speichel kann ausserdem vom
persönlichen Metabolismus beeinflusst werden. Bezüglich der Gesundheit
konzentrierten sich die meisten Studien auf respiratorische Untersuchungen und
vernachlässigten kardiovaskuläre Langzeitauswirkungen der Passivrauchexposition
völlig. Mit dieser Studie sollten einige dieser Lücken gefüllt werden.
Im Mai 2010 wurde in der Schweiz das erste Bundesgesetz zum Schutz der
Bevölkerung vor Passivrauchen eingeführt. Da die lose Regelung Raum für
Ausnahmen liess, war es weiterhin möglich, kleine Raucherlokale oder abgetrennte
Rauchräume von begrenzter Grösse, zu führen. Die COSIBAR Studie nutzte die
Umsetzung als natürliche Intervention für eine Untersuchung der Exposition und
kardio?respiratorischen Gesundheit bei nichtrauchenden Gastgewerbemitarbeitern.
Methoden
Eine Interventionsgruppe, die eine Änderung der Rauchregel erfuhr, sollte mit einer
Kontrollgruppe verglichen werden, die weiterhin im Rauch arbeiten musste.
Dazu wurde vor dem Rauchverbot die Luft in 193 Betrieben in den Kantonen Basel
Stadt, Basel Land und Zürich gemessen. 92 Mitarbeiter konnten rekrutiert werden
und wurden zu drei medizinischen Untersuchungen eingeladen, einmal vor
Einführung des Rauchgesetzes und zweimal danach. Parallel wurde jeweils die
Exposition gemessen, sowie beim ersten und zweiten Erhebungszeitpunkt ein
Verhaltens?und Akzeptanzfragebogen verschickt, in dessen Zielgruppe auch
Raucher eingeschlossen wurden.
Die Exposition wurde mit Hilfe eines passiven Nikotinbadges gemessen, einerseits
während einer Woche am Arbeitsplatz und andererseits mit einer persönlichen
Messung, bei der der Proband den Badge 24 Stunden auf sich trug. Darüber hinaus
wurde während der medizinischen Untersuchung eine Speichelprobe genommen,
um den Nikotin? und Kotiningehalt festzustellen. Ein Fragebogen enthielt
zusätzliche Fragen zur Exposition.
Im medizinischen Teil wurde neben Grösse, Gewicht und Blutdruck ein EKG zur
Untersuchung der Herzrhythmusvariabilität (HRV), einem quantitativen Marker des
autonomen Nervensystems, durchgeführt. Anhand der Pulswellengeschwindigkeit
(PWV) wurde die arterielle Steifheit gemessen, die ein Indikator für kardiovaskuläre
Risikofaktoren und Arteriosklerose ist. Die respiratorische Gesundheit wurde mit
einer Messung des ausgeatmeten Stickstoffoxids (FeNO), einem Entzündungsmarker
in der Atemluft, und einem Lungenfunktionstest untersucht. Darüber hinaus wurden
beim ersten Termin ein Allergietest und jedes Mal ein ausführliches Interview
durchgeführt.
Für die Analyse der Gesundheitsdaten wurden mehrere Modelle entwickelt:
Einerseits wurde die Korrelation der Exposition mit den verschiedenen Parametern
vor Einführung des Rauchverbots in einer Querschnittsuntersuchung angeschaut.
Darüber hinaus wurde die Exposition in einem longitudinalen Modell zu jedem
Zeitpunkt mit den jeweiligen Gesundheitsdaten verglichen unter Berücksichtigung
der Tatsache, dass mehrere Untersuchungen von einer Person stammen konnten.
Als letztes wurde in einem Prä/Post?Modell ein Vergleich der Gesundheitsparameter
vor und nach dem Rauchgesetz gemacht ohne Berücksichtigung der
genauen Exposition. Die Modelle wurden jeweils für geeignete Kovariablen
adjustiert.
Der Verhaltens? und Akzeptanzfragebogen enthielt Fragen zum persönlichen
Wissenstand und zur Einstellung zum Rauchverbot, zu Faktoren, die diese
beeinflussen sowie zum Rauchstatus und –verhalten. Antworten wurden anhand
von angemessenen statistischen Tests verglichen.
Ergebnisse
Die durchschnittliche Rauchexposition in der Interventionsgruppe sank um 2.4
Zigarettenäquivalente/Tag nach dem Rauchverbot während die Veränderung in der
exponierten Kontrollgruppe signifikant kleiner war.
In einer Querschnittsuntersuchung der Baseline Daten wurde festgestellt, dass die
mittleren Lungenfunktionswerte der exponierten Gastgewerbemitarbeiter unter der
schweizerischen Durchschnittsbevölkerung lag. Die FeNO Werte waren direkt mit
der Exposition assoziiert, wobei eine Erhöhung der Exposition eine Verminderung
des Entzündungsmarkers bedeutete.
Im longitudinalen Modell, das die Exposition mit den Gesundheitsmassen verglich,
korrelierten mehrere HRV Parameter signifikant mit der Exposition. Die Abnahme
um ein Zigarettenäquivalent/Tag war mit einer Erhöhung der RMSSD
(Quadratwurzel der Summe der quadrierten Differenzen zwischen benachbarten
RR?Intervallen), der SDNN (Standardabweichung der RR?Intervalle), der HF? (High
Frequency) und der TP? (Total Power) Komponente verbunden, sowie mit einer
Abnahme der Pulswellengeschwindigkeit. Diese Assoziationen entsprachen der
ursprünglichen Hypothese, die eine bessere Gesundheit mit niedrigerer Exposition
voraussagte.
Im Prä/Post?Modell ohne Berücksichtigung der genauen Exposition wurde bei
mehreren Parametern eine signifikant unterschiedliche Entwicklung in der
Interventionsgruppe im Vergleich zur Kontrollgruppe gestellt. So stiegen SDNN,
RMSSD, HF, und TP in der Interventionsgruppe alle an, während sie in der
Kontrollgruppe absanken. Der HF/LF (High Frequency/Low Frequency) Quotient
verhielt sich umgekehrt, ein Effekt, der auch den Erwartungen entsprach. FeNO sank
in der Interventionsgruppe ab, während sich die Kontrollgruppe mit einem kleinen
Anstieg signifikant anders verhielt. Bei den Lungenfunktionsparametern konnte
keine Veränderung beobachtet werden.
Die Akzeptanz des Rauchverbots war von Anfang an höher bei den Nichtrauchern
als bei den Rauchern. Sie erhöhte sich jedoch in beiden Gruppen im Kanton Basel
Land, in dem ein umfassendes Rauchverbot eingeführt wurde, während das in den
andern beiden Kantonen, die Ausnahmen zuliessen, nicht der Fall war.
Diskussion
In dieser Studie wurden klare Anzeichen einer verbesserten kardiovaskulären
Gesundheit der nichtrauchenden Gastronomiemitarbeiter nach Einführung des
Rauchverbots gefunden. Die Risikofaktoren für einen Herzinfarkt oder eine
Arteriosklerose hatten sich in der Interventionsgruppe signifikant vermindert. Bei
der Lungenfunktion konnte keine Veränderung festgestellt werden während beim
FeNO zwar eine Abnahme beobachtet wurde, die jedoch nicht als klinisch relevant
betrachtet werden kann. Somit scheinen die Herzrhythmusvariabilität und die
Pulswellengeschwindigkeit die sensitivsten Marker zu sein, während die
Lungenfunktion womöglich entweder länger braucht, um sich zu erholen oder
dauerhaft geschädigt bleibt. FeNO wird von sehr vielen Faktoren beeinflusst und
sollte daher noch weiter erforscht werden.
All diese Resultate sprechen für ein umfassendes Rauchverbot ohne Ausnahmen. Die
erhöhte Akzeptanz dieser Form der Regelung, die wir fanden, unterstützt diese
Empfehlung weiter.
Trotzdem wurde eine Initiative der Lungenliga, die genau diese Vereinheitlichung
des Gesetzes verlangte, im September 2012 abgelehnt. Während des lebhaften
Abstimmungskampfes wurden auch erste Studienresultate publiziert. Der
Misserfolg der Kampagne wirft die Frage auf, ob Gesundheit als politisches
Argument attraktiv ist, wenn dabei eine Einschränkung der persönlichen
Entscheidungsfreiheit droht. Ausserdem muss die Rolle der Tabakindustrie, die in
der Schweiz als wichtiger Arbeitgeber und Steuerzahler eine übermächtige Stellung
hat, näher betrachtet und ins Bewusstsein der Bürger gerückt werden. Die
vermeintliche persönliche Freiheit der Schweizer über ihr Rauchverhalten zu
entscheiden scheint doch eher eine Selbsttäuschung zu sein, herbeigeführt mittels
einer verdeckten Gehirnwäsche durch die wohl manipulativste Industrie der Welt
Personalized nutrition advice : an everyday-life perspective
No full textThis thesis presents societal preconditions for Personalized Nutrition Advice (PNA) that result from an everyday-life perspective on this innovative approach. Generally, PNA is regarded as promising, because it provides users with highly specific information on individual health risks and benefits of eating habits and the desirable changes, which may induce a high sense of personal relevance. Rapid developments in interactive computer technology (ICT) and nutrigenomics science are the innovative drivers in this area. Although indicated as promising, the limited impact of personalized advice on eating practices up to now, signals a mismatch with consumers’ everyday life. In our studies, we found that the pursuance of nutrition advices assumes that consumers have a focal concern on health, which is not always the case. Consumers value uncomplicatedness and convenience of healthful eating and the flexibility to eat for pleasure as well. More flexible advice would therefore better match with consumers’ complicated everyday life, in which health is just one of several ambitions, including social ones. A change of eating practices requires the alteration of other practices besides those directly related to the food choice chain. Advice should provide for consumers’ ability to organize healthful eating within existing chains of social practices, including discursive ones. In everyday-life, consumers have to persist in their intentions to eat healthfully vis-a-vis relevant others. In our study, consumers presented themselves as being uncomplicated, to avoid the image of health freakiness. Based on the finding that being someone who makes great effort in relation to healthful eating is a disfavored image, we conclude that for structural change, the healthy choice should become a ‘practically and socially easy choice’. We propose that PNA can contribute to this goal by using an ‘Action Approach’. The basic idea of this approach is that, besides being well-informed and motivated, consumers need to become actively involved in eating for health. By this, we mean that they are able to practically and socially organize their eating practices in order to ensure health benefits. This would involve the stimulation of a process of critical reflection on the uncomplicatedness of healthful eating and the integration of advice on the practical and social organization of changing eating practices towards health. Consumers themselves should become co-designers of this advice, as they are experts on everyday-life problems and solutions which occur when they try to pursue their healthful eating intentions. The integration of a diversity of expertise on social, ethical and practical requirements in early stages of the development process of innovative PNA is essential. Yet, our study showed that actors in diverse societal sectors were reluctant to engage in the development process of ICT and gene-based PNA. Their evidence-based working practices required that first, scientific support on the effectiveness should become available. Based on their expertise on public needs and wants, they called for a request to slow down the innovation process on behalf of the public. Current working life also does not allow for much change in roles and responsibilities, which may be needed to integrate the innovation in working practices of societal actors. In our qualitative study amongst general practitioners (GPs), we found that participants hold rather critical views on nutrition advice, and certainly on the innovative drivers. A lack of robustness, a low match with patients’ needs and equivocalness of nutritional studies were perceived as blocking GPs involvement. The social acceptability of PNA requires a participatory process. But an invitation to join the innovation process does not of necessity elicit pro-active involvement. This requires the stimulation of a critical reflection process on the meaning of ‘evidence’ from the perspectives of concerned actors and the consequences for the innovation processes. Such an exercise should aim at finding solutions, as to overcome the block about involvement. It should also target reflection on the meaning of expertise, keeping in mind the required increasing role of consumers in the design of PNA. In sum, we conclude that the alignment of PNA with societal preconditions is possible if the development process evolves as a participatory process, in which all societal actors are convinced about the valuable contribution their experience and expertise offers to this search for new ways to effectively promote healthful eating. <br/
