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PubMed2006

The good, the bad, and the ugly: weighing the risks and benefits of seafood consumption.

The health benefits that long chain omega-3 fatty acids contribute in the reduction of coronary heart disease are well established through a number of scientific publications. A number of studies are also examining their potential role in mitigating other diseases and health conditions such as Alzheimer's and mental disorders. Some of the latest research have shown the importance of omega-3 fatty acids such as docosahexaenoic acid in cognitive development in infants. Extensive scientific research and recommendations to consume fish regularly from professional societies, health organizations, and government agencies consistently support dietary guidance to consume fish regularly. Nevertheless, increasingly consumers are being warned to eliminate or minimize their consumption of certain species. The warnings, which have been issued due to risks associated with chemical contaminates such as mercury, PCB, and dioxin in fish, have received extensive coverage in news articles and stories in popular magazines. There have been a series of mixed messages to the consumer about the benefits or risks in eating seafood. In some cases, the warnings have been issued by government agencies such as the Food and Drug Administration and Environmental Protection Agency's Joint Fish Advisory on methylmercury. In other cases, the warnings have come from advocacy groups and others. Unfortunately, the advice is often miscommunicated and misunderstood by consumers. The emerging news about the benefits and risks of fish consumption will be discussed in the context of their impacts on consumer's health and well-being.

Animals↗
PubMedDate not supplied

Omission bias and pertussis vaccination.

BACKGROUND: Several laboratory studies have suggested that many people favor potentially harmful omissions over less harmful acts. The authors studied the role of this omission bias in parents' decisions whether to vaccinate their children against pertussis. METHODS: Two hundred mail surveys were sent to subscribers to a magazine that had published articles favoring and opposing pertussis vaccination. Subjects were asked about their beliefs about the vaccine and the disease, and whether they had vaccinated their own children or planned to, and they were given test items to identify omission bias in their reasoning. RESULTS: One hundred and three subjects (52%) responded to the survey. Respondents who reported they did not or would not allow their children to be vaccinated (n = 43; 41%) were more likely to believe that vaccinating was more dangerous than not vaccinating (p < 0.001). They were also more likely to exhibit omission bias (p = 0.004), holding constant their stated beliefs about the danger of the vaccine. CONCLUSIONS: Omission bias plays a role in decisions not to vaccinate with pertussis vaccine, beyond the role played by belief about the risk of vaccination.

Adult↗
PubMed1993

Awareness under anaesthesia: the patients' point of view.

The collective experience of 187 patients who suffered awareness during general anaesthesia is presented. This has been collated from letters solicited in September 1992 by a women's magazine widely distributed throughout Australia and New Zealand. The responses cover anaesthetics given during a period from the 1950s to the present. The findings show a disturbing symptomatology ranging over all modalities of sensation and of postoperative psychological and psychiatric disturbances. The letters also reveal that in most cases understanding of awareness and its proper management by medical personnel was poor or totally lacking.

Adult↗
PubMed1997

Toxicology of melatonin.

Despite the fact that melatonin has been released for public use in the United States by the Food and Drug Administration and is available over the counter nationwide, there currently is a total lack of information on the toxicology of melatonin. In Europe, melatonin has a completely different status in that it is considered a "neurohormone" and cannot be sold over the counter. Even though administration of melatonin in humans, as well as in animals (even at supraphysiological doses), has not shown evidence of toxicological effects (i.e., no deaths), a drug toxicological file still would need to be prepared and approved by the regulatory authorities. Several features that are specific to this neurohormone need to be taken into consideration. Whatever the species concerned, melatonin is secreted during the night; it is the "hormone of darkness." It presents a circadian rhythm and a circannual rhythm (in photoperiodic species). The duration of these secretions could have an impact on the reproductive system, for example, showing the importance of the pharmacodynamics of melatonin. An inappropriate time schedule of melatonin administration could induce supraphysiological concentrations of the neurohormone and a desensitization of melatonin receptors. A long duration of exposure to melatonin also could mimic an "artificial darkness" condition when a circadian rhythm with a basal zero level during the day needs to be conserved for a physiological function. Furthermore, administration of large doses of melatonin could induce high concentrations of melatonin and of different metabolites that could have deleterious effects per se. Numerous books, magazines, and articles have praised melatonin as a "miraculous cure-all" for ailments ranging from sleeplessness, to aging, without any clinical evidence of efficacy (with the exception of its chronobiotic and resynchronizing effect). Very little attention has been paid to the possible side effects of melatonin. Nightmares, hypotension, sleep disorders, abdominal pain, etcetera, have been reported. In fact, analysis of the known pharmacological profile of melatonin and/or of its metabolites, based on scientific preclinical studies, constitutes a basis for prediction of adverse drug reactions or side effects. These include (1) the central nervous system, (2) the cardiovascular system and platelet aggregation, (3) glucose metabolism, (4) immunology, and (5) cancer. The knowledge of the fundamental mechanism of action of melatonin, including molecular biology, also needs to be taken into account for evaluation of possible side effects. Two types of melatonin receptors have been cloned (related to cyclic AMP), and the possibility of intracellular action of melatonin cannot be excluded. Melatonin receptors are present in the periphery and also at the level of the central nervous system, particularly on the suprachiasmatic nucleus that "drives" a circadian rhythm to many other areas on which it projects. Among those, the hypothalamus (which has melatonin receptors) plays a fundamental role in the hormonal homeostasis and modulation control of the organism. Special preclinical and pharmacological studies that take into account all these parameters need to be designed for safety evaluation and risk assessment of this specific neurohormone.

Animals↗
PubMed1997

Do consumer infant feeding publications and products available in physicians' offices protect, promote, and support breastfeeding?

The purpose of this study was to determine if consumer infant feeding publications and products distributed by physicians' offices protect, promote, and support breastfeeding. A total of 127 physician office practices completed a mailed questionnaire that measured the types of print and nonprint materials available and policies and practices regarding these resources. Commercially produced pamphlets were available in 114 (90%) of the offices surveyed, and were twice as likely to be routinely distributed as pamphlets from nonprofit agencies and government. Many publications contained outdated recommendations about breastfeeding; the most accurate publications were available in only 29 (23%) of practices surveyed. Magazines contravening the WHO Code were widely available (91 offices; 72%) and routinely distributed (58 offices; 46%). One hundred one offices (80%) accepted free formula and 48 (38%) routinely distributed it. Few offices had a policy (n = 25; 20%) or criteria (n = 17; 13%) for selecting infant feeding resources. Those with policies were less likely to distribute commercial pamphlets. In the majority of offices surveyed, physicians' offices accepted and routinely distributed publications and products which do not "protect, promote, and support" breastfeeding. Offices are encouraged to have policies guiding the distribution of infant feeding materials.

Adult↗
PubMed1993

Natural products and the athlete: facts and folklore.

OBJECTIVE: To contrast scientific facts with suggested manufacturers' claims regarding food supplements (natural products) marketed for enhanced athletic prowess. DATA SOURCES: A MEDLINE search was performed to obtain documentation supporting the claims of natural-product manufacturers. In addition, several references pertaining to pharmacognosy, natural products, herbs, pharmacy practice, and sports medicine were reviewed. Claims were obtained from promotional advertisements in bodybuilding magazines, product labels, and fact sheets for sales representatives in nutrition and health-food stores. DATA EXTRACTION: We reviewed all of the clinical trials, published between 1966 and 1992, relative to the manufacturers' claims regarding these products. DATA SYNTHESIS: Pertinent human and/or animal studies supporting each natural product were compared with the manufacturers' claims. CONCLUSIONS: We found that there was no published scientific evidence to support the promotional claims for a large proportion of the products (8/19, 42 percent). Only 4 of 19 products (21 percent) were associated with any documented human clinical trials supporting their promotional claims. Six of 19 agents (32 percent) had some scientific documentation to support their promotional claims; however, these products were judged to be marketed in a misleading manner.

Diet Fads↗
PubMed1996

The asthma year in Swedish pharmacies: a nationwide information and pharmaceutical care program for patients with asthma.

OBJECTIVE: To increase the understanding of asthma among patients and the general public in Sweden and to increase the collaboration among healthcare personnel for the benefit of asthma patients. DESIGN: Based on the results from problem detection studies, Apoteksbolaget, the national organization for pharmacies in Sweden, designed a program to educate healthcare professionals and the public about asthma. Entitled the "Asthma Year," all pharmacy staffs were offered education on asthma, patients were provided written information and audiovisual materials, and the general public was made more aware of asthma through local media. SETTING: Pharmacies, healthcare centers, hospital outpatient areas, libraries, places of work, and domestic airports. PARTICIPANTS: All pharmacy staffs (12,000 persons) were offered an education on asthma. Patients with asthma were offered brochures and leaflets in pharmacies and information in the pharmacy magazine Apoteket. The general public received information about asthma through posters, radio, and television. MAIN OUTCOME MEASURES: The evaluations of the Asthma Year indicate that the activities had an impact on the public, on patients with asthma, and on the pharmacy staffs. RESULTS: About 4.5 million people in Sweden (42% of the population) observed the Asthma Year or received information about asthma, and 49% of the patients learned something new about their disease. Twice as many patients used steroid therapy regularly after the campaign than before. Of the pharmacy staffs, 96% were favorable to the idea of working with campaign years and 85% believed that they were personally involved with the activities. CONCLUSIONS: Patient outcomes in terms of reduced morbidity have not been possible to document, but the number of deaths from asthma in Sweden decreased from 438 during the previous year to 398 during the Asthma Year.

Adolescent↗
PubMed2002

Do you know your brain? A survey on public neuroscience literacy at the closing of the decade of the brain.

What does the public know about the developments offered by brain research? What factors influence public neuroscience literacy? What issues need to be emphasized to the public? To address these questions, a survey was conducted using a questionnaire with 95 assertions, answered by indicating yes, no, or I don't know. The opinions of 35 senior neuroscientists and 2158 members of the public of Rio de Janeiro were heard on issues such as the mind-brain relationship, the senses, learning, and memory. The incidence of "correct" answers among the public improved the most with schooling, followed by reading of popular science magazines and of newspapers. An analysis of the responses to each assertion revealed which themes are well- or poorly known to the public. The results attest for the importance of popular scientific communication and indicate issues on which communication efforts should be concentrated in order to increase public awareness about the brain.

Adolescent↗
PubMed2006

Use of computer kiosks for breast cancer education in five community settings.

Finding ways to bring effective computer-based behavioral interventions to those with limited access to technology is a continuing challenge for health educators. Computer kiosks placed in community settings may help reach such populations. The Reflections of You kiosk generates individually tailored magazines on breast cancer and mammography and was adapted from an evidence-based intervention that increased mammography use in African American women. This usage study tracked patterns of use and characteristics of kiosk users in beauty salons, churches, neighborhood health centers, Laundromats, and social service agencies in St. Louis. Kiosks were used 4,527 times in 470 kiosk days at 40 different host sites. Highly significant differences among community settings were found in rates and patterns of kiosk use as well as user characteristics, breast cancer knowledge, and use of mammography. Findings inform strategic decision making about technology dissemination and community outreach to women needing information about breast cancer and mammography.

Adolescent↗
PubMed1985

Tobacco industry response to public health concern: a content analysis of cigarette ads.

Public awareness of the health hazards of smoking intensified when the subject received national publicity. To assess tobacco industry tactics to counter adverse publicity, we performed a content analysis of cigarette ads in selected issues of Time magazine, for selected years from 1929-84. The analysis showed direct responses to health concerns in all of the years of major smoking-and-health "events," with the possible exception of 1964, the year of the first Surgeon General's report. During these years large percentages of ads emphasized health themes instead of the conventional cigarette ad imagery. On average, health-theme ads have a higher verbal content than the more pictorial traditional ads. Correspondingly, they employ many fewer models. Health-theme ads tend to emphasize the "technological fix," such as the scientifically designed filter and the low-tar cigarette. Subtle changes in cigarette advertising include the elimination of visible smoke from ads. A decade's concentration on standard health themes, prompted by the "tar wars" of the 1970s, appears to have ended in the 1980s. Advertisers seem to have reverted to the "good times" nonhealth imagery of a bygone era, though possibly to deliver a subtle implicit health message. Understanding industry advertising tactics can assist public health professionals in developing insights into the promotion of smoking and in formulating smoking control strategies. Though highly exploratory and tentative in nature, this study is offered in the spirit of increasing such understanding.

Advertising↗
PubMed1990

Evaluating understanding of popular press reports of health research.

This research assessed the ability of a sample of persons on a college campus to understand media reports of health research. Three or four articles on each of five contemporary health topics (dietary cholesterol and heart disease, treatment for breast cancer, starch blockers, drug treatment for heart disease, test tube skin) were selected from widely circulated newspapers (e.g., New York Times) and magazines (e.g., Newsweek). A sample of 144 college students responded to content-based and application-based questions derived from photocopies of these popular press articles. The overall rate of reader misunderstanding approached 40% and generally fell between one third and one half for each of 16 articles representing five health topics. Several strengths and weaknesses of the research are considered as they relate to the accuracy of estimated error rates and to the generality of study findings. The implications of these findings for other areas of health (e.g., AIDS risk factor research) are also discussed.

Adolescent↗
PubMed2004

Tobacco industry direct marketing after the Master Settlement Agreement.

Although Master Settlement Agreement (MSA) provisions have led to significant changes in tobacco marketing, expenditures and emphasis on marketing strategies and populations not bound by the MSA have increased significantly. This article discusses tobacco industry direct marketing practices, including direct mail, coupons, sweepstakes, brand loyalty programs, event sponsorship, and tobacco industry magazines, and the implications of such strategies. An analysis of a survey of New Jersey adult smokers provides context and documents notable rates of participation. In addition to bypassing marketing restrictions, many of these strategies operate out of sight of the public health community and most of the public and so go unchecked by either tobacco control advocates or public opinion. This article suggests that a first step in countering these practices is to increase awareness and understanding of them, followed by development of strategies to address them and to limit or eliminate their use in tobacco marketing.

Humans↗
PubMed2004

The effect of enforcement of the Master Settlement Agreement on youth exposure to print advertising.

Enforcement of the Master Settlement Agreement's (MSA) prohibitions on youth targeting and the use of cartoons has resulted in a significant reduction in youth exposure to tobacco advertising. The MSA between the states and the tobacco companies has provided state officials with a new and powerful tool to address tobacco company marketing practices that may promote underage smoking. In the area of print advertising, enforcement of the MSA's prohibitions on youth targeting (MSA III[a]) and on the use of cartoons (MSA III[b]) has resulted in a significant reduction in youth exposure to tobacco advertising. The recent court decisions finding that R. J. Reynolds violated the youth targeting prohibition in its tobacco advertising in national magazines affirm the viability of the MSA's various restrictions and its enforcement mechanisms as a key way that state Attorneys General are responding to a range of tobacco company practices affecting youth.

Adolescent↗
PubMedDate not supplied

Excessive and disproportionate advertising in peer-reviewed journals.

The International Committee of Medical Journal Editors (ICMJE) has outlined ethical guidelines concerning the advertising practices of peer-reviewed journals that briefly discuss issues of excessive and disproportionate advertising. The authors evaluated these guidelines using quantitative data, assessing the types and frequencies of advertising in 2001 print issues of NEJM and JAMA, two principal members of ICMJE. Advertising ratios (ratio of advertisements to editorial content) were near unity in NEJM and 0.30 in JAMA, compared with reported ratios of 0.15 among low-circulation specialty science journals and 0.80 among high-circulation consumer magazines. In both journals, five corporations placed more than 50% of all display advertisements. The findings suggest a dissonance between the ethical guidelines and the de facto advertising practices of arguably the two most important member journals of the ICMJE. There is a need to define and apply standards for excessive and disproportionate advertising.

Advertising↗
PubMed2004

Dissemination of information to General Practitioners: a questionnaire survey.

BACKGROUND: Early identification of permanent hearing impairment in children enables appropriate intervention which reduces adverse developmental outcomes. The UK Government has introduced a universal hearing screening programme for neonates. All involved health professionals, including those in Primary Care, need to be aware of the service to enable them to offer appropriate support to their patients. A programme of information dissemination within Primary Care was therefore undertaken. The aim of the current study was to determine the extent to which the information had reached General Practitioners (GPs), the GPs' preferred mode of dissemination and the sources from which GPs accessed information METHODS: Postal questionnaire survey of a randomised sample of 1000 GPs in the Phase I pilot sites of the Neonatal Hearing Screening Programme (NHSP). RESULTS: Responses were received from 54.2% of the sample. Just under 50% of those responding had received information, 62.2% of respondents said they would like to receive more information and the preferred methods of dissemination were the written word and web-sites to allow access when needed. Few GPs perceive themselves to have a core role in the delivery of the NHSP and thence a need for knowledge in the subject. Many are keen to delegate detail to a third party, usually the health visitor, who has traditionally had responsibility for hearing screening. CONCLUSIONS: Dissemination efforts for service developments of relevance to GPs should concentrate on advertising a website address via brief but memorable posted literature and/or articles in relevant journals and magazines. The website should be GP-friendly, and have a dedicated area for GPs including information of specific relevance and downloadable information sheets.

Attitude of Health Personnel↗
PubMed2006

Substance use and sexual behaviours of Japanese men who have sex with men: a nationwide internet survey conducted in Japan.

BACKGROUND: Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM. METHODS: Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet. RESULTS: In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N, N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge. CONCLUSION: This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population.

5-Methoxytryptamine↗
PubMed2002

What kind of evidence is it that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to?

BACKGROUND: In 1992, Evidence-Based Medicine advocates proclaimed a "new paradigm", in which evidence from health care research is the best basis for decisions for individual patients and health systems. Hailed in New York Times Magazine in 2001 as one of the most influential ideas of the year, this approach was initially and provocatively pitted against the traditional teaching of medicine, in which the key elements of knowing for clinical purposes are understanding of basic pathophysiologic mechanisms of disease coupled with clinical experience. This paper reviews the origins, aspirations, philosophical limitations, and practical challenges of evidence-based medicine. DISCUSSION: EBM has long since evolved beyond its initial (mis)conception, that EBM might replace traditional medicine. EBM is now attempting to augment rather than replace individual clinical experience and understanding of basic disease mechanisms. EBM must continue to evolve, however, to address a number of issues including scientific underpinnings, moral stance and consequences, and practical matters of dissemination and application. For example, accelerating the transfer of research findings into clinical practice is often based on incomplete evidence from selected groups of people, who experience a marginal benefit from an expensive technology, raising issues of the generalizability of the findings, and increasing problems with how many and who can afford the new innovations in care. SUMMARY: Advocates of evidence-based medicine want clinicians and consumers to pay attention to the best findings from health care research that are both valid and ready for clinical application. Much remains to be done to reach this goal.

Decision Making↗
PubMed2006

Specific food intake, fat and fiber intake, and behavioral correlates of BMI among overweight and obese members of a managed care organization.

BACKGROUND: The study examined correlates of body mass index (BMI) in overweight and obese members of a managed care organization seeking treatment for obesity. It assessed intake of specific foods, dietary fat or fiber, and behaviors attempted to control weight. METHODS: Participants were 508 men and 1293 women who were > 18 years and had a self-reported BMI > 27.0. This paper reports analyses of baseline and 24-month follow-up data from a randomized weight-loss trial. Cross-sectional and prospective relationships between BMI and behaviors were examined with regression analyses controlling for age and education. RESULTS: At baseline, hamburger and beef consumption were associated with higher BMI for men; for women, hamburger, fried chicken, hot dog, bacon or sausage, egg, French fry, and overall fat consumption were associated with higher BMI, while eating high fiber cereal, fruit, and overall fiber intake were associated with lower BMI. Virtually all forms of weight control behavior were reported more often in heavier people. Subscribing to exercise magazines, however, was associated with lower BMI. Decreased fat intake and increased fruit/vegetable/fiber intake over the course of the study were associated with reductions in BMI at 24 months. CONCLUSION: The same behaviors that differentiate individuals with different body weight in the general population also differentiate between individuals of different body weights at the high end of the weight distribution. Educational efforts aimed at preventing weight gain and reducing obesity might benefit from focusing on specific foods known to be associated empirically with body weight and weight change over time.

Journal Article↗