Family health effects: complements or substitutes

The Impact of Receiving Predictive Genetic Information about Lynch Syndrome on Individual Colonoscopy and Smoking Behaviors

BACKGROUND

This study investigated whether receiving the results of predictive genetic testing for Lynch syndrome, indicating the presence or absence of an inherited predisposition to various cancers, including colorectal cancer, was associated with change in individual colonoscopy and smoking behaviors, which could prevent colorectal cancer.

METHODS

The study population included individuals with no previous diagnosis of colorectal cancer, whose families had already identified deleterious mutations in the mismatch repair or EPCAM genes. Hypotheses were generated from a simple health economics model and tested against individual-level panel data from the Australasian Colorectal Cancer Family Registry.

RESULTS

The empirical analysis revealed evidence consistent with some of the hypotheses, with a higher likelihood of undergoing colonoscopy in those who discovered their genetic predisposition to colorectal cancer and a lower likelihood of quitting smoking in those who discovered their lack thereof.

CONCLUSIONS

Predictive genetic information about Lynch syndrome was associated with change in individual colonoscopy and smoking behaviors but not necessarily in ways to improve population health.

IMPACT

The study findings suggest that the impact of personalized medicine on disease prevention is intricate, warranting further analyses to determine the net benefits and costs. Cancer Epidemiol Biomarkers Prev; 25(11); 1524-33. ©2016 AACR.

The Comparison of Under-5-year Nutritional Status among Fars-native, Turkman and Sistani Ethnic Groups in the North of Iran

Background:

Under nutrition is a health problem in developing countries and the main aim of this study was determine of the nutritional status and some sociodemographic factors among rural under-5-year children in the North of Iran in 2013.

Methods:

This was a descriptive, cross-sectional study, which carried out on 2530 children (637 = Fars-native, 1002 = Turkman and 891 = Sistani) from 21 villages in the North of Iran. Villages were chosen by random sampling among 118, and all of under-five children were chosen by simple sampling. For all of cases, a questionnaire with contain questions on the socialdemographic condition was completed and anthropometric indexes were measured by a learned team. Anthropometric data were compared with those in Centers for Disease Control and Prevention reference population. SPSS 18.0 software was used for statistical data analysis and P value under 0.05 included significations.

Results:

Generally, under nutrition (Z-score ≤ −2) was observed in 6.6%, 18.5% and 3.3% based on underweight, stunting and wasting, respectively and there were in boys more than girls and in Sistani more than other ethnic groups. Based on underweight and stunting, under nutrition was seen in Sistani more than other ethnic groups. Among three ethnic groups, stunting was significant both in boys (P = 0.013) and in girls (P = 0.004), but wasting was significant only in girls (P = 0.001). The estimated odds ratio (OR) with 95% confidence interval of under nutrition was obtained from logistic regression. Compared with good economic group, the OR was 1.831 in poor economic groups (P = 0.001). The risk of under nutrition in Sistanish ethnic group was 1.754 times more than Fars-native group (P = 0.001).

Conclusions:

Under nutrition is a health problem among under-5-year children in rural area in the North of Iran and stunting was seen in an alarming rate among them. Among ethnic groups, Sistanish children more than others were under nourished. Poor economic status is a risk factor for under nutrition in this area.

The Comparison of Under-Five-Children's Nutrition Status Among Ethnic Groups in North of Iran, 1998 - 2013; Results of a Three Stages Cross-Sectional Study

BACKGROUND

Despite improvements in child health, malnutrition still remains one of the main public health challenges in Iran.

OBJECTIVES

The aim of this study was to compare under nutrition among under-five children with regard to ethnicity in rural area in north Iran.

PATIENTS AND METHODS

In three cross-sectional studies 7575 subjects in three time-periods including 2339 children in 1998, 2749 in 2004, and 2487 in 2013, were evaluated. All under-five-children in 20 out of 118 villages were chosen by random sampling and assessed. Under nutrition was defined as underweight, stunting and wasting lower than -2 SD (Z < -2 SD).

RESULTS

Generally, stunting was declined 17.1% and underweight and wasting were increased 0.9% and 1%, respectively during 15 years (1998 - 2013). Underweight increased 0.5% in Fars-natives and 3.2% in Turkmans and it was decreased 0.9% in Sistanis. Statistical difference in Turkman children among the three stages of the study was significant (P = 0.001). Stunting has decreased 28.7% in Fars-natives and 35.1% in Sistanis, it was increased 9.3% in Turkman group. Statistical differences among three stages in inter-ethnic groups were significant (P = 0.001 for all). Compared the group with good economic status, the odds ratio was 1.831 in poor economic group (P = 0.001). The risk of under nutrition in Sistanis was 1.754 times more than in Fars-natives (P = 0.001).

CONCLUSIONS

Under nutrition remains one of the main health problems in under-five-year children in north Iran being more common in Sistani children. Stunting in Sistani children deeply decreased while in Turkman children slightly increased during the 15-year period study. Poor economic status is a risk factor for under nutrition in this area.

Substitutes or complements? Diagnosis and treatment with non-conventional and conventional medicine

BACKGROUND

Portugal has a strong tradition of conventional western healthcare. So it provides a natural case study for the relationship between Complementary/Alternative Medicine (CAM) and Western Medicine (WM). This work aims to test the relationship between CAM and WM users in the diagnosis and treatment stages and to estimate the determinants of CAM choice.

METHODS

The forth Portuguese National Health Survey is employed to estimate two single probit models and obtain the correlation between the consumption of CAM and WM medicines in the diagnosis and treatment stages.

RESULTS

Firstly, both in the diagnosis and the treatment stage, CAM and WM are seen to be complementary choices for individuals. Secondly, self-medication also shows complementarity with the choice of CAM treatment. Thirdly, education has a non-linear relationship with the choice of CAM. Finally, working status, age, smoking and chronic disease are determinant factors in the decision to use CAM.

CONCLUSION

The results of this work are relevant to health policy-makers and for insurance companies. Patients need freedom of choice and, for the sake of safety and efficacy of treatment, WM and CAM healthcare ought to be provided in a joint and integrated health system.

Patients' diagnosis decisions in Alzheimer's disease: the influence of family factors

It is surprising to observe that the number of patients receiving a late diagnosis for Alzheimer's disease (AD) remains high even in countries promoting early diagnosis campaigns. We explore the impact of family history and family support on the risks of receiving a delayed diagnosis. We use French data of 1131 patients diagnosed between 1991 and 2005. We find that the presence of AD history in the family increased the risks of receiving a delayed diagnosis. This was true especially when AD history involved brothers, sisters and other relatives (uncles or cousins). The presence of an informal caregiver at the time of the first warning signs reduced the risks of receiving a late diagnosis, regardless of the informal caregiver concerned (spouse, son, daughter etc.). We identify several opportunities for early detection campaigns. Families with history of disease should be targeted. Campaigns should also target isolated patients, who do not benefit from informal care. Our results underline the importance of improving the diagnosis access for old patients and for men.

Economic rationality in choosing between short-term bad-health choices and longer-term good-health choices

Non-contagious, chronic disease has been identified as a global health risk. Poor lifestyle choices, such as smoking, alcohol, drug and solvent abuse, physical inactivity, and unhealthy diet have been identified as important factors affecting the increasing incidence of chronic disease. The following focuses on the circumstance affecting the lifestyle or behavioral choices of Aboriginal and Torres Strait Islander peoples in remote-/very remote Australia. Poor behavioral choices are the result of endogenous characteristics that are influenced by a range of stressful exogenous variables making up the psychosocial determinants including social disenfranchisement, cultural loss, insurmountable tasks, the loss of volitional control and resource constraints. It is shown that poor behavioral choices can be economically rational; especially under highly stressful conditions. Stressful circumstances erode individual capacity to commit to long-term positive health alternatives such as self-investment in education. Policies directed at removing the impediments and providing incentives to behaviors involving better health choices can lead to reductions in smoking and alcohol consumption and improved health outcomes. Multijurisdictional culturally acceptable policies directed at distal variables relating to the psychosocial determinants of health and personal mastery and control can be cost effective. While the content of this paper is focused on the conditions of colonized peoples, it has broader relevance.

Non-pecuniary returns to higher education: the effect on smoking intensity in the UK

This paper investigates whether higher education (HE) produces non-pecuniary returns via a reduction in the intensity of consumption of health-damaging substances. In particular, it focuses on current smoking intensity of the British individuals sampled in the 29-year follow-up survey of the 1970 British Cohort Study. We estimate endogenous dummy ordinal response models for cigarette consumption and show that HE is endogenous with respect to smoking intensity and that even when endogeneity is accounted for, HE is found to have a strong negative effect on smoking intensity. Moreover, pecuniary channels, such as occupation and income, mediate only a minor part of the effect of HE. Our results are robust to modelling individual self-selection into current smoking participation (at age 29) and to estimating a dynamic model in which past smoking levels affect current smoking levels.

Family history of chronic disease and participation in healthy behaviours

This article presents an investigation into whether individuals incorporate information on their family genetic (health) endowment into decision making regarding participation in behaviours related to the production of health capital. Competing theoretical perspectives exist as to how genetic endowment should affect participation in health-related behaviours. There is also a growing consensus that the availability of genetic information holds important consequences for the individual in terms of investment in human capital, the pricing and availability of health insurance, and labour market opportunity. Therefore, the question of how individuals use the greater availability of genetic data is important. Our empirical results indicate that poor genetic endowment tends to be associated with a lower probability of participation in cigarette smoking, but also a lower probability of participation in regular exercise.