ALBERT

Description: Injury prevention policy is crucial for the safety of Canada’s children; however legislation is not adopted uniformly across the country. This study aimed to identify key barriers and enablers to enacting injury prevention legislation. Purposive snowball sampling identified individuals involved in injury prevention throughout Canada. An online survey asked respondents to identify policies that were relevant to them, and whether legislation existed in their province. Respondents rated the importance of barriers or enablers using a 5-point Likert type scale and included open-ended comments. Fifty-seven respondents identified the most common injury topics: bicycle helmets (44, 77%), cell phone-distracted driving (36, 63%), booster seats (28, 49%), ski helmets (24, 42%), and graduated driver’s licensing (21, 37%). The top enablers were research/surveillance, managerial/political support and professional group consultation, with much variability between injury topics. Open-ended comments emphasized the importance of a united opinion as an enabler and barriers included costs of protective equipment and inadequate enforcement of legislation. The results highlighted the importance of strategies that include research, management and community collaboration and that injury prevention topics should be addressed individually as information may be lost if topics are considered together. Findings can inform the process of turning injury prevention evidence into action.

Description: Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children’s outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children’s diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1) children have a natural propensity towards risky play; and, (2) keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children “as safe as necessary,” not “as safe as possible.” This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children’s safety.

Description: There is a lack of research examining secondary stalking and its effect on children who, in many cases, can be direct targets, or secondary survivors, of the stalking of their parent. The present study examines trauma reactions in children of stalking survivors in a Danish sample. It investigates the differences and similarities of such reactions across three age groups. Fifty-seven children were divided into groups depending on their age. The symptoms of the youngest group, 0–6-year-olds, were investigated by way of a maternal diagnostic interview. The two older groups, 7–11- and 12–19-year-olds completed the age-appropriate questionnaires, “Darryl” and “HTQ”, respectively, online. Twenty-two percent of the youngest group met the criteria for Post-Traumatic Stress Disorder (PTSD). Eighty-five percent of the middle age group and 58% of the older age group met PTSD diagnostic criteria. The findings illustrate that reactions to secondary stalking were predominantly within the arousal cluster of PTSD symptomology, with sleep disturbances and irritability commonly reported. The overall prevalence of children meeting PTSD diagnostic criteria in the sample was 56%. Future studies will benefit from larger samples and from knowledge of any pre-existing relationship between parent and stalker.

Description: Introduction: With two thirds of adults in paid employment and one third physically inactive, workplaces are an important setting for promoting more physical activity. We explored the attitudes and practices of employees and managers from different industries towards sitting and moving at work, to inform the development of acceptable solutions for encouraging businesses to adopt activity-promoting workplaces. Method: We conducted focus groups with employees and structured interviews with upper/middle managers from 12 organisations in a range of industries (e.g., education, healthcare, manufacturing, construction, insurance, mining). Topics focused on past and current workplace health and wellness initiatives, workplace culture and environment related to physical activity, responsibility for employee physical activity patterns at work, and enablers of/barriers to activity promoting workplaces. Results: Physical activity was not an explicit priority in existing occupational health and wellness initiatives. Instead, there was a strong focus on education about preventing and managing injuries, such as manual handling among non-office workers and desk-based ergonomics for office workers. Physical activity was viewed as a strategy for maintaining work ability and preventing injury, particularly in blue-collar staff, rather than for chronic disease prevention. Managers noted structural/organisational barriers/enablers to promoting physical activity at work (e.g., regulations, costs, competing concerns), while employees tended to focus on individual constraints such as time and geographic location. The issues of "initiative overload" and making physical activity a part of “business as usual” emerged as strong themes from employees and managers. Conclusions: While there is stakeholder enthusiasm for creating activity-promoting workplaces, multi-level support is needed to make physical activity an integral part of day-to-day business. The synergism between occupational health and safety priorities could be leveraged to facilitate the creation of activity-promoting workplaces.

Description: IJERPH, Vol. 15, Pages 1832: Prenatal Exposure to Perfluoroalkyl Substances and Birth Outcomes; An Updated Analysis from the Danish National Birth Cohort International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091832 Authors: Meng Inoue Ritz Olsen Liew Perfluoroalkyl substances (PFASs) are widespread industrial pollutants that are extremely persistent in the environment. A previous study in the Danish National Birth Cohort (DNBC) found prenatal perfluorooctanoate (PFOA) exposure was associated with decreased birth weight, but had insufficient statistical power to evaluate adverse birth outcomes. Here, we conducted additional analyses in three samples originating from the DNBC for 3535 mothers and infant pairs to evaluate associations between prenatal PFASs exposures and low birth weight and preterm birth. Maternal plasma concentrations were measured for six types of PFASs in early pregnancy. Several PFASs were associated with a reduction in birth weight and gestational age. We estimated a nearly 2-fold increase in risks of preterm birth for the higher quartiles of PFOA and perflourooctanesulfonate (PFOS) exposure. In spline models, risk of preterm birth was increased for perfluorononanoic acid (PFNA), perfluoroheptane sulfonate (PFHpS) and perfluorodecanoic acid (PFDA) in higher exposure ranges. We also observed some elevated risks for low birth weight but these estimates were less precise. Our findings strengthen the evidence that in-utero PFASs exposures affect fetal growth. Future studies are needed to evaluate whether these associations persist with the decline of PFOA and PFOS in populations and should also investigate newer types of fluorinated compounds introduced more recently.

Description: IJERPH, Vol. 15, Pages 1854: Perceived Neighbourhood Problems over Time and Associations with Adiposity International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091854 Authors: Anne Ellaway Ruth Dundas Jonathan R. Olsen Paul G. Shiels There is growing interest in understanding which aspects of the local environment influence obesity. Using data from the longitudinal West of Scotland Twenty-07 study (n = 2040) we examined associations between residents’ self-reported neighbourhood problems, measured over a 13-year period, and nurse-measured body weight and size (body mass index, waist circumference, waist–hip ratio) and percentage body fat. We also explored whether particular measures such as abdominal obesity, postulated as a marker for stress, were more strongly related to neighbourhood conditions. Using life course models adjusted for sex, cohort, household social class, and health behaviours, we found that the accumulation of perceived neighbourhood problems was associated with percentage body fat. In cross-sectional analyses, the strongest relationships were found for contemporaneous measures of neighbourhood conditions and adiposity. When analyses were conducted separately by gender, perceived neighbourhood stressors were strongly associated with central obesity measures (waist circumference, waist–hip ratio) among both men and women. Our findings indicate that chronic neighbourhood stressors are associated with obesity. Neighbourhood environments are modifiable, and efforts should be directed towards improving deleterious local environments to reduce the prevalence of obesity.

Description: The aim was to assess pneumoproteins and a certain biomarker of systemic inflammation in drill floor workers exposed to airborne contaminants generated during drilling offshore, taking into consideration serum biomarkers of smoking, such as nicotine (S-Nico) and cotinine. Blood samples of club cell protein 16 (CC-16), surfactant protein D (SP-D) and C-reactive protein (CRP) were collected before and after a 14-day work period from 65 drill floor workers and 65 referents. Air samples of oil mist, drilling mud components and elemental carbon were collected in person. The drill floor workers were exposed to a median air concentration of 0.18 mg/m3 of oil mist and 0.14 mg/m3 of airborne mud particles. There were no differences in the concentrations of CC-16 and SP-D across the 14-day work period and no difference between drill floor workers and referents at baseline after adjusting for differences in sampling time and smoking. CRP decreased across the work period. There was a strong association between the CC-16 concentrations and the time of sampling. Current smokers with S-Nico 〉 detection limit (DL) had a statistically significantly lower CC-16 concentration, while smokers with S-Nico 〈 DL had CC-16 concentrations similar to that of the non-smokers. Fourteen days of work offshore had no effect on serum pneumoprotein and CRP concentrations. However, the time of blood sampling was observed to have a strong effect on the measured concentrations of CC-16. The effect of current smoking on the CC-16 concentrations appears to be dependent on the S-Nico concentrations.

Description: IJERPH, Vol. 14, Pages 1473: Are Changes in Neighbourhood Perceptions Associated with Changes in Self-Rated Mental Health in Adults? A 13-Year Repeat Cross-Sectional Study, UK International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14121473 Authors: Jonathan Olsen Ruth Dundas Anne Ellaway The aim of this study was to examine changes in neighbourhood perceptions on self-rated mental health problems over time, and to explore demographic, geographic and socio-economic factors as determinants of increased or decreased anxiety and depression symptoms. We conducted a repeat cross-sectional study of individuals (N: 4480) living in the same areas of west central Scotland in 1997 and 2010. Individuals were asked to complete a questionnaire at both time-points, containing 14 questions relating to neighbourhood perceptions and the Hospital Anxiety and Depression Scale (HADS). A three-level linear regression model was fitted to HADS scores and changes in neighbourhood perceptions over time; controlling for a number of individual and area-level variables. Overall, area-level mean HADS scores decreased from 1997 to 2010. When adjusted for individual and area-level variables, this decrease did not remain for HADS anxiety. Applying an overall 14-scale neighbourhood perception measure, worsening neighbourhood perceptions were associated with small increases in depression (0.04, 95% confidence interval (CI) 0.01 to 0.07) and anxiety (0.04, 95% CI 0.00 to 0.08) scores over time. This highlights a need for local and national policy to target areas where neighbourhood characteristics are substantially deteriorating in order to ensure the mental health of individuals does not worsen.

Description: IJERPH, Vol. 14, Pages 1363: Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14111363 Authors: Troels Kristensen Frans Waldorff Jørgen Nexøe Christian Skovsgaard Kim Olsen Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for the remuneration of POCT of HbA1c in general practice. According to secondary research, only the Capital Region of Denmark has allowed GPs to use this new incentive for POCT. The aim of this study is to use patient data to characterize patients with diabetes who have received POCT of HbA1c and analyze the variation in the use of POCT of HbA1c among patients with diabetes in Danish general practice. Methods: We use register data from the Danish Drug Register, the Danish Health Service Register and the National Patient Register from the year 2011 to define a population of 44,981 patients with diabetes (type 1 and type 2 but not patients with gestational diabetes) from the Capital Region. The POCT fee is used to measure the amount of POCT of HbA1c among patients with diabetes. Next, we apply descriptive statistics and multilevel logistic regression to analyze variation in the prevalence of POCT at the patient and clinic level. We include patient characteristics such as gender, age, socioeconomic markers, health care utilization, case mix markers, and municipality classifications. Results: The proportion of patients who received POCT was 14.1% and the proportion of clinics which were “POCT clinics” was 26.9%. There were variations in the use of POCT across clinics and patients. A part of the described variation can be explained by patient characteristics. Male gender, age differences (older age), short education, and other ethnicity imply significantly higher odds for POCT. High patient costs in general practice and other parts of primary care also imply higher odds for POCT. In contrast, high patient costs for drugs and/or morbidity in terms of the Charlson Comorbidity index mean lower odds for POCT. The frequency of patients with diabetes per 1000 patients was larger in POCT clinics than Non-POCT clinics. A total of 22.5% of the unexplained variability was related to GP clinics. Conclusions: This study demonstrates variation in the use of POCT which can be explained by patient characteristics such as demographic, socioeconomic, and case mix markers. However, it appears relevant to reassess the system for POCT. Further studies are warranted in order to assess the impacts of POCT of HbA1c on health care outcomes.

Description: Point-of-care testing (POCT) of HbA1c means instant test results and more coherent counseling that is expected to improve diabetes management and affect ambulatory visits and hospitalizations. From late 2008, POCT has been implemented and adopted by a segment of the general practices in the capital region of Denmark. The aim of this study is to assess whether the introduction of POCT of HbA1c in general practice (GP) has affected patient outcomes for T2 diabetes patients in terms of hospital activity. We apply difference-in-differences models at the GP clinic level to assess the casual effects of POCT on the following hospital outcomes: (1) admissions for diabetes, (2) admissions for ambulatory care sensitive diabetes conditions (ACSCs), (3) ambulatory visits for diabetes. The use of POCT is remunerated by a fee, and registration of this fee is used to measure the GP’s use of POCT. The control group includes clinics from the same region that did not use POCT. The sensitivity of our results is assessed by an event study approach and a range of robustness tests. The panel data set includes 553 GP clinics and approximately 30,000 diabetes patients from the capital region of Denmark, observed in the years 2004–2012. We find that voluntary adoption of POCT of HbA1c in GP has no effect on hospital admissions and diabetes-related hospital ambulatory visits. Event study analysis and different treatment definitions confirm the robustness of these results. If implementation of POCT of HbA1c improves other parts of diabetes management as indicated in the literature, it seems worthwhile to implement POCT of HbA1c in the capital region of Denmark. However, doubts around the quality of POCT of HbA1c testing and a desire to capture data at central labs may prevent implementation of more value based HbA1c testing.