Sir, the recent report on "extreme temperatures and paediatric
emergency" is very interesting
[1]. Xu et al. concluded that "children are at particular risk of a
variety of diseases which
might be triggered by extremely high temperatures [1]."Xu et al. also
mentioned for the effect
of climate change. In fact, Xu et al. reported a highly similar
publication in Occup Environ
Med and also noted for the effect of climate chan...
Sir, the recent report on "extreme temperatures and paediatric
emergency" is very interesting
[1]. Xu et al. concluded that "children are at particular risk of a
variety of diseases which
might be triggered by extremely high temperatures [1]."Xu et al. also
mentioned for the effect
of climate change. In fact, Xu et al. reported a highly similar
publication in Occup Environ
Med and also noted for the effect of climate change on childhood illness
with special focus
on asthma [2]. The two works should share the same groups of patients but
the conclusion is
different. In the present report, Xu et al. make a conclusion that
"children aged 10-14 years
were more sensitive to both hot and cold effects [1]" whereas they
proposed that "children
aged 10-14 years were most vulnerable to cold effects [2]." This implies
that there are many
bias in both reports. Hence, it cannot conclude on any effects from hot
and cold temperature
on pediatric illness. In addition, not only temperature but also other
climatic factors can affect
the disease incidence. The good example is the effect of humidity [3],
pollutants [3] and
ozone levels [4].
References
1. Xu Z, Hu W, Su H, Turner LR, Ye X, Wang J, Tong S. Extreme
temperatures and
paediatric emergency department admissions. J Epidemiol Community Health.
2013
Nov 23. doi: 10.1136/jech-2013-202725. [Epub ahead of print]
2. Xu Z, Huang C, Hu W, Turner LR, Su H, Tong S. Extreme temperatures and
emergency department admissions for childhood asthma in Brisbane,
Australia.
Occup Environ Med. 2013 Oct;70(10):730-5.
3. Vandini S, Corvaglia L, Alessandroni R, Aquilano G, Marsico C, Spinelli
M, Lanari
M, Faldella G. Respiratory syncytial virus infection in infants and
correlation with
meteorological factors and air pollutants. Ital J Pediatr. 2013 Jan
11;39(1):1.
4. Jones GN, Sletten C, Mandry C, Brantley PJ. Ozone level effect on
respiratory illness:
an investigation of emergency department visits. South Med J. 1995
Oct;88(10):1049-
56.
Dear Editor,
The published paper by Paananen et al, entitled "Social determinants of
mental health: a Finnish nationwide follow up study on mental disorders"1
was an interesting and rigorous study. Through a longitudinal approach,
all Finnish children who were born in a certain year (1987) were followed
through adolescence in order to examine the development of mental
disorders and assess potential SDH-related risk fact...
Dear Editor,
The published paper by Paananen et al, entitled "Social determinants of
mental health: a Finnish nationwide follow up study on mental disorders"1
was an interesting and rigorous study. Through a longitudinal approach,
all Finnish children who were born in a certain year (1987) were followed
through adolescence in order to examine the development of mental
disorders and assess potential SDH-related risk factors. For this purpose,
the authors created six multivariate models between different groups of
variables and the outcome. In addition, a full model was developed to
include the variables which showed significant associations with the
outcome in at least one of these six models. In Table 2 of that paper, the
determinants of mental disorders according to various models were
demonstrated. Nevertheless, it was not clear for us why parent's highest
educational level, parent's highest SES, parental social assistance,
cohort member's education and cohort member's received social assistance
which showed association with the outcome in models 2, 3 or 5, were not
included in the full model. At the first look, one might speculate that
these variables were included in the full model, but were not shown in
Table 2; as they might not have proved significant. But, this might not be
the correct justification as some non-significant variables e.g. "mother's
age (<20)" and "single mothers" could be found in the full model within
the same table without being significant in the full model. It would be
very kind of the authors to respond to this question and explain whether
it would be a concern in the main findings of the full model or not.
Sincerely Yours,
* Narjes Hazar, MD, Resident in Community Medicine, Department of
Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
* Mojgan Karbakhsh, MD, Associate Professor in Community Medicine,
Department of Community Medicine, Tehran University of Medical Sciences,
Tehran, Iran
Reference:
1. Paananen R, Ristikari T, Merikukka M, Gissler M. Social determinants of
mental health: a Finnish nationwide follow-up study on mental disorders. J
Epidemiol Community Health. 2013 Aug 1. doi:10.1136/jech-2013-202768
________________________________________________________________________
Corresponding author:
Dr Narjes Hazar, MD, Resident in Community Medicine, Department of
Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
Address: Department of Community Medicine, School of Medicine, Tehran
University of Medical Sciences, PoorSina St, Qods St, Enqelab Av, Tehran,
Iran
Email: n-hazar@razi.tums.ac.ir
Tel/Fax: +9821 88962357
This is a great contribution to the literature on fuel poverty, cold
housing, and health.
The authors call for a review of qualitative and intervention
research
related to this topic. It may be useful for readers to be made aware of
a recently updated version of a systematic review of the health and
socio-economic impacts of housing improvement published by the Campbell
and Cochrane Collaborations 1. In this revi...
This is a great contribution to the literature on fuel poverty, cold
housing, and health.
The authors call for a review of qualitative and intervention
research
related to this topic. It may be useful for readers to be made aware of
a recently updated version of a systematic review of the health and
socio-economic impacts of housing improvement published by the Campbell
and Cochrane Collaborations 1. In this review we looked at physical
improvements to housing infrastructure and this included a group of 15
quantitative (including five RCTs) and seven qualitative studies of
warmth & energy efficiency improvements. We did not include studies
which only looked at financial help with fuel bills, for example the
winter fuel allowance distributed to the elderly in the UK.
1. Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing
improvements
for health and associated socio-economic outcomes. Cochrane Database of
Systematic Reviews 2013;2:Art. No.: CD008657 DOI:
10.1002/14651858.CD008657.pub2.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008657.pub2/pdf/standard
Pesticide Action Network Europe
It cannot be denied that TTC (Threshold of Toxicological Concern) was
originally proposed in the U.S., as Dr Harris states in her commentary on
our article,[1] but her industry-sponsored organisation, the International
Life Sciences Institute (ILSI) played a major role in developing it
further to the form in which it was accepted by European Food Safety
Authority (EFSA).
This process took p...
Pesticide Action Network Europe
It cannot be denied that TTC (Threshold of Toxicological Concern) was
originally proposed in the U.S., as Dr Harris states in her commentary on
our article,[1] but her industry-sponsored organisation, the International
Life Sciences Institute (ILSI) played a major role in developing it
further to the form in which it was accepted by European Food Safety
Authority (EFSA).
This process took place in an EFSA working group, in which ten out of 13
members had previously developed and promoted the tool with ILSI.[2] While
EFSA communicators have attempted damage control in their online Q&A, the
biased work on TTC raised such concerns in the European Parliament that
EFSA was forced to ban ILSI-linked people from being members of expert
panels and working groups. Any link with ILSI now has to be cut in order
to qualify as an EFSA expert.
Apart from this industry infiltration of EFSA, the tool as delivered by
ILSI is far from being "scientifically supported", as Dr Harris suggests.
The database underpinning the TTC for non-genotoxic substances[3] is
entirely made up of (potentially biased) industry studies. Many of these
studies are 40-60 years old and non-retrievable (cannot be accessed),
meaning that their quality cannot be assessed. In addition, the old
protocols used means that current scientific knowledge will not be taken
into account in calculating TTCs. In utero exposure is generally missing
and important risks will be overlooked because of the limited endpoints
considered at that time. The grouping of chemicals for TTC is artificial
and is based on the Cramer classification,[4] which relies on expert
judgement only and is subjective. ILSI has also manipulated the genotoxin
database to get to an apparently desired outcome. For example, it has
removed aflatoxin-like, azo- and N-nitroso- substances.[5] Another
unscientific shortcoming of TTC is its disregard of cumulative effects.
The TTC is derived by arbitrarily removing from the calculation the most
toxic effects found in the database of NOELs (no adverse effect levels).
The TTC sets the 'level of no concern' at the 5th percentile, resulting in
a 1 in 20 chance that a random substance in any one group of chemicals is
toxic at this exposure level. Thus 5% of the chemicals in the group are
more toxic than the 'level of no concern' that is set for any one group of
chemicals.
TTC is promoted as a screening tool while in practice it is already being
used as a cut-off criterion (safe level) for pesticide metabolites.[6]
Industry is now trying to extend TTC to other fields such as any chemical
found in food,[7] outcomes of developmental testing,[8] drinking water,[9]
and inhaled chemicals.[10] In many cases, and not coincidentally,
advocates of TTC are pursuing these aims through opinions published in
Regulatory Toxicology and Pharmacology, the controversial
chemical/pharmaceutical industry-sponsored journal. The journal was one of
several entities that were investigated by a US Congressional Committee in
2008 over their role in the Food and Drug Administration (FDA) decision
allowing bisphenol A in infant formula and other foods.[11-13]
Analysing the TTC tool and the background of its development can only lead
to the conclusion that industry has invested massively in a tool that does
not safeguard human health, as Dr Harris misleadingly claims, but exactly
the opposite. The tool serves industry's agenda of fast-tracking chemicals
to the market and avoids the costs of testing. The tool undermines
European legislation and policy. It aims to replace the existing EU policy
of 'no safe level' for genotoxic substances with claimed 'safe levels'
arrived at through the TTC. It also aims to replace the EU policy that
health of citizens should be protected by adequate testing and the
precautionary principle with a tool that enables avoidance of testing for
chemicals, metabolites and impurities.
The tool, which serves industry's agenda but places public health at risk,
has been introduced into European agencies by people who have served as
members of expert panels while maintaining conflicts of interest with
industry. Dr Harris's reference to the Danish study[14] as a balanced
review of TTC is a case in point. Its author, John Christian Larsen,
worked in ILSI scientific bodies from 2002 till 2008[15] and has published
studies with ILSI-affiliated people who have promoted TTC.[16] TTC has
made its way into the regulatory policy of the food safety authority EFSA
because of industry's massive resources and a lack of awareness on the
part of EFSA's staff, not for reasons of sound science.
References
1. Robinson C, Holland N, Leloup D, et al. Conflicts of interest at
the European Food Safety Authority erode public confidence. J Epidemiol
Community Health Published Online First: 8 March 2013. doi:10.1136/jech-
2012-202185
2. Muilerman H, Tweedale T. A toxic mixture? Industry bias found in
EFSA working group on risk assessment for toxic chemicals, Pesticide
Action Network Europe 2011.
3. EFSA Scientific Committee. Scientific opinion on exploring options
for providing advice about possible human health risks based on the
concept of Threshold of Toxicological Concern (TTC). EFSA Journal 2012;10:
2750.
4. Cramer GM, Ford RA, Hall RL. Estimation of toxic hazard - a
decision tree approach. Food Cosmet Toxicol 1978;16: 255-276.
5. Kroes R, Renwick AG, Cheeseman M, et al. Structure-based
thresholds of toxicological concern (TTC): guidance for application to
substances present at low levels in the diet. Food Chem Toxicol 2004; 42:
65-83.
6. European Commission Health and Consumer Protection Directorate-
General (DG SANCO). Guidance document on the assessment of the relevance
of metabolites in groundwater of substances regulated under Council
Directive 91/414/EEC: Sanco/221/2000-rev.10-final. 25 February 2003.
7. Koster S, Boobis AR, Cubberley R, et al. Application of the TTC
concept to unknown substances found in analysis of foods, Food and
Chemical Toxicology 2011; 49: 1643-1660.
8. Van Ravenzwaay B, Dammann M, Buesen R, et al. The threshold of
toxicological concern for prenatal developmental toxicity. Regulatory
Toxicology and Pharmacology 2011;59: 81-90.
9. Melching-Kollmuss S, Dekant W, Kalberlah F. Application of the
''threshold of toxicological concern" to derive tolerable concentrations
of ''non-relevant metabolites" formed from plant protection products in
ground and drinking water. Regulatory Toxicology and Pharmacology 2010;
56: 126-134.
10. Escher SE, Tluczkiewicz I, Batke M, et al. Evaluation of
inhalation TTC values with the database RepDose. Regulatory Toxicology and
Pharmacology 2010; 58: 259-274.
11. Michaels, D. Doubt Is Their Product: How Industry's Assault on
Science Threatens Your Health. Oxford University Press. 2008: 53-54.
12. Layton L. Studies on chemical in plastics questioned. Washington
Post 27 April 2008.
13. Dingell JD. Letter to Jack N Gerard, president and CEO, American
Chemistry Council. 2 April 2008. http://bit.ly/ZWMbi6 (accessed 15 April
2013).
14. Nielsen E, Larsen JC. The Threshold of Toxicological Concern
(TTC) concept: Development and regulatory applications. Danish Ministry of
the Environment, Environmental Protection Agency. Environmental Project
No. 1359. 2011. http://www2.mst.dk/udgiv/publications/2011/03/978-87-92708
-86-1.pdf (accessed 15 April 2013).
15. European Food Safety Authority (EFSA). Declarations of interests
(DoIs). http://www.efsa.europa.eu/en/efsawho/doi.htm (accessed 15 April
2013).
16. Pratt I, Barlow S, Kleiner J, et al. The influence of thresholds
on the risk assessment of carcinogens in food. Mutation Research 2009;
678: 113-117.
Conflict of Interest:
Hans Muilerman is employed at Pesticide Action Network Europe, which receives funding from trusts and foundations, including the European Endocrine Health Initiative.
It cannot be denied that TTC (Threshold of Toxicological Concern) was
originally proposed in the U.S., as Dr Harris states in her commentary on
our article,[1] but her industry-sponsored organisation, the International
Life Sciences Institute (ILSI) played a major role in developing it
further to the form in which it was accepted by European Food Safety
Authority (EFSA).
It cannot be denied that TTC (Threshold of Toxicological Concern) was
originally proposed in the U.S., as Dr Harris states in her commentary on
our article,[1] but her industry-sponsored organisation, the International
Life Sciences Institute (ILSI) played a major role in developing it
further to the form in which it was accepted by European Food Safety
Authority (EFSA).
This process took place in an EFSA working group, in which ten out of
13 members had previously developed and promoted the tool with ILSI.[2]
While EFSA communicators have attempted damage control in their online
Q&A, the biased work on TTC raised such concerns in the European
Parliament that EFSA was forced to ban ILSI-linked people from being
members of expert panels and working groups. Any link with ILSI now has to
be cut in order to qualify as an EFSA expert.
Apart from this industry infiltration of EFSA, the tool as delivered
by ILSI is far from being "scientifically supported", as Dr Harris
suggests. The database underpinning the TTC for non-genotoxic
substances[3] is entirely made up of (potentially biased) industry
studies. Many of these studies are 40-60 years old and non-retrievable
(cannot be accessed), meaning that their quality cannot be assessed. In
addition, the old protocols used means that current scientific knowledge
will not be taken into account in calculating TTCs. In utero exposure is
generally missing and important risks will be overlooked because of the
limited endpoints considered at that time. The grouping of chemicals for
TTC is artificial and is based on the Cramer classification,[4] which
relies on expert judgement only and is subjective. ILSI has also
manipulated the genotoxin database to get to an apparently desired
outcome. For example, it has removed aflatoxin-like, azo- and N-nitroso-
substances.[5] Another unscientific shortcoming of TTC is its disregard
of cumulative effects.
The TTC is derived by arbitrarily removing from the calculation the
most toxic effects found in the database of NOELs (no adverse effect
levels). The TTC sets the 'level of no concern' at the 5th percentile,
resulting in a 1 in 20 chance that a random substance in any one group of
chemicals is toxic at this exposure level. Thus 5% of the chemicals in the
group are more toxic than the 'level of no concern' that is set for any
one group of chemicals.
TTC is promoted as a screening tool while in practice it is already
being used as a cut-off criterion (safe level) for pesticide
metabolites.[6] Industry is now trying to extend TTC to other fields such
as any chemical found in food,[7] outcomes of developmental testing,[8]
drinking water,[9] and inhaled chemicals.[10] In many cases, and not
coincidentally, advocates of TTC are pursuing these aims through opinions
published in Regulatory Toxicology and Pharmacology, the controversial
chemical/pharmaceutical industry-sponsored journal. The journal was one of
several entities that were investigated by a US Congressional Committee in
2008 over their role in the Food and Drug Administration (FDA) decision
allowing bisphenol A in infant formula and other foods.[11-13]
Analysing the TTC tool and the background of its development can only
lead to the conclusion that industry has invested massively in a tool that
does not safeguard human health, as Dr Harris misleadingly claims, but
exactly the opposite. The tool serves industry's agenda of fast-tracking
chemicals to the market and avoids the costs of testing. The tool
undermines European legislation and policy. It aims to replace the
existing EU policy of 'no safe level' for genotoxic substances with
claimed 'safe levels' arrived at through the TTC. It also aims to replace
the EU policy that health of citizens should be protected by adequate
testing and the precautionary principle with a tool that enables avoidance
of testing for chemicals, metabolites and impurities.
The tool, which serves industry's agenda but places public health at
risk, has been introduced into European agencies by people who have served
as members of expert panels while maintaining conflicts of interest with
industry. Dr Harris's reference to the Danish study[14] as a balanced
review of TTC is a case in point. Its author, John Christian Larsen,
worked in ILSI scientific bodies from 2002 till 2008[15] and has published
studies with ILSI-affiliated people who have promoted TTC.[16] TTC has
made its way into the regulatory policy of the food safety authority EFSA
because of industry's massive resources and a lack of awareness on the
part of EFSA's staff, not for reasons of sound science.
References
1. Robinson C, Holland N, Leloup D, et al. Conflicts of interest at
the European Food Safety Authority erode public confidence. J Epidemiol
Community Health Published Online First: 8 March 2013.
doi:10.1136/jech-2012-202185
2. Muilerman H, Tweedale T. A toxic mixture? Industry bias found in
EFSA working group on risk assessment for toxic chemicals, Pesticide
Action Network Europe 2011.
3. EFSA Scientific Committee. Scientific opinion on exploring options
for providing advice about
possible human health risks based on the concept of Threshold of
Toxicological Concern (TTC). EFSA Journal 2012;10: 2750.
4. Cramer GM, Ford RA, Hall RL. Estimation of toxic hazard - a
decision tree approach. Food Cosmet Toxicol 1978;16: 255-276.
5. Kroes R, Renwick AG, Cheeseman M, et al. Structure-based
thresholds of toxicological concern (TTC): guidance for application to
substances present at low levels in the diet. Food Chem Toxicol 2004; 42:
65-83.
6. European Commission Health and Consumer Protection Directorate-
General (DG SANCO). Guidance document on the assessment of the relevance
of metabolites in groundwater of substances regulated under Council
Directive 91/414/EEC: Sanco/221/2000-rev.10-final. 25 February 2003.
7. Koster S, Boobis AR, Cubberley R, et al. Application of the TTC
concept to unknown substances found in analysis of foods, Food and
Chemical Toxicology 2011; 49: 1643-1660.
8. Van Ravenzwaay B, Dammann M, Buesen R, et al. The threshold of
toxicological concern for prenatal developmental toxicity. Regulatory
Toxicology and Pharmacology 2011;59: 81-90.
9. Melching-Kollmuss S, Dekant W, Kalberlah F. Application of the
''threshold of toxicological concern" to derive tolerable concentrations
of ''non-relevant metabolites" formed from plant protection products in
ground and drinking water. Regulatory Toxicology and Pharmacology 2010;
56: 126-134.
10. Escher SE, Tluczkiewicz I, Batke M, et al. Evaluation of
inhalation TTC values with the database RepDose. Regulatory Toxicology and
Pharmacology 2010; 58: 259-274.
11. Michaels, D. Doubt Is Their Product: How Industry's Assault on
Science Threatens Your Health. Oxford University Press. 2008: 53-54.
12. Layton L. Studies on chemical in plastics questioned. Washington
Post 27 April 2008.
13. Dingell JD. Letter to Jack N Gerard, president and CEO, American
Chemistry Council. 2 April 2008.
http://bit.ly/ZWMbi6 (accessed 15 April 2013).
14. Nielsen E, Larsen JC. The Threshold of Toxicological Concern
(TTC) concept: Development and regulatory applications. Danish Ministry of
the Environment, Environmental Protection Agency. Environmental Project
No. 1359. 2011. http://www2.mst.dk/udgiv/publications/2011/03/978-87-92708
-86-1.pdf (accessed 15 April 2013).
15. European Food Safety Authority (EFSA). Declarations of interests
(DoIs). http://www.efsa.europa.eu/en/efsawho/doi.htm (accessed 15 April
2013).
16. Pratt I, Barlow S, Kleiner J, et al. The influence of thresholds
on the risk assessment of carcinogens in food. Mutation Research 2009;
678: 113-117.
Conflict of Interest:
Hans Muilerman is employed at Pesticide Action Network Europe, which receives funding from trusts and foundations, including the European Endocrine Health Initiative.
I am responding on behalf of the International Life Sciences
Institute (ILSI) to the Commentary published on Online First on 8 March
2013: "Conflicts of interest at the European Food Safety Authority erode
public confidence" by Robinson et al.
In their Commentary, the authors raise questions about practical
scientific tools being studied by a variety of private and public sector
groups, including the European F...
I am responding on behalf of the International Life Sciences
Institute (ILSI) to the Commentary published on Online First on 8 March
2013: "Conflicts of interest at the European Food Safety Authority erode
public confidence" by Robinson et al.
In their Commentary, the authors raise questions about practical
scientific tools being studied by a variety of private and public sector
groups, including the European Food Safety Authority (EFSA). EFSA has
previously and thoroughly responded to the questions posed by the authors
on plant biotechnology; the Threshold of Toxicological Concern (TTC)
concept; and scientific integrity.(1) My goal is to address the specific
section of the Commentary under the heading "EFSA Promotes Industry
Concept to Assess Chemicals Risk" by providing additional context on TTC
as a risk assessment tool.
The concept underlying TTC was initially proposed in 1967(2) and
formally articulated by the US Food and Drug Administration in 1986(3). It
was developed to identify, characterize, and prioritize risk when data on
substances of concern were extremely limited or nonexistent. As the
authors state, ILSI has supported a number of activities designed to test
the validity of the TTC approach since then, and we have worked with
industry and public partners to hone the tool as more data becomes
available.
We encourage JECH readers to learn more about the TTC concept by
reading the report "The Threshold of Toxicological Concern (TTC) concept:
Development and regulatory applications."(4) This document, produced by
the Danish Ministry of the Environment, Environmental Protection Agency
and available in English, provides an extremely comprehensive, detailed,
and readable review of the TTC concept's scientific principles; its
development over the years; its current uses; and its strengths and
weaknesses.
ILSI's actions on TTC have been with the primary goal to help improve
response to safety assessment needs in situations when it is analytically
difficult to identify a substance or when an assessment is needed urgently
and existing data are insufficient. We fully recognize TTC is not a
blanket solution and our own publications describe its limitations.(5)
However, to diminish well-studied, scientifically supported tools that can
be used to safeguard human health is both inappropriate and irresponsible.
2 Frawley JP (1967). Scientific evidence and common sense as a basis
for food packaging regulations. Fd Cosmet Toxicol 5, 293-308.
3 Rulis AM (1986). De minimis and the threshold of regulation. In:
Felix CW (Ed.) Food Protection Technology. Lewis Publishers Inc., Chelsea,
Michigan, 29-37.
4 Nielsen E and Larsen JC (2011). The Threshold of Toxicological
Concern (TTC) concept: Development and regulatory applications. Danish
Ministry of the Environment, Environmental Protection Agency.
Environmental Project No. 1359 2011. This report can be downloaded at
http://www2.mst.dk/udgiv/publications/2011/03/978-87-92708-86-1.pdf
online.]
5 Koster S et al. (2011). Application of the TTC concept to unknown
substances found in analysis of foods . Food Chem. Toxicol. 1643 - 1660.
Conflict of Interest:
I am employed by the International Life Sciences Institute, which is primarily funded by the food, drug, and agriculture industries.
Hamer et al. conducted a 13-year longitudinal study on the predictive
ability of self-reported physical activity on physical activity measured
by accelerometers (1). Participants were 394 healthy men and women aged 54
years on average. They concluded that the habits of physical activity in
adulthood are partly tracked into older age. About their attractive
report, I have several concerns on their statistical outcomes....
Hamer et al. conducted a 13-year longitudinal study on the predictive
ability of self-reported physical activity on physical activity measured
by accelerometers (1). Participants were 394 healthy men and women aged 54
years on average. They concluded that the habits of physical activity in
adulthood are partly tracked into older age. About their attractive
report, I have several concerns on their statistical outcomes.
First, Hamer et al. categorized self-reported physical activity into
four groups, and analysis of variance on accelerometer-derived physical
activities was made by adjusting several confounders. They adopted general
linear models as multivariate analysis in combination with correlation
coefficient (CC). Although they concluded their outcome from that
statistical significance, the level of association presented by CC was
weak and there was no presentation of explanation rate to predict
accelerometer-derived physical activities from multivariate analysis.
Second, I appreciate their long term follow-up of the target
participants, but their analysis was the trend analysis, presenting that
groups who declared high levels of self-reported physical activity
subsequently showed high objective physical activity on average. On this
point, individual agreement of physical activity over 13 years should be
presented such as intra-class CC, concordance CC and the Bland-Altman
plot, which would improve the quality of study.
Third, I understand that the self-reported physical activity and
objective physical activity by accelerometers have different meaning on
activity monitoring (2). If the authors assume the physical activity by
accelerometers as a gold standard, please present validation data for the
accelerometer around the waist to monitor physical activity. Relating to
the selection of indicators on physical activity, predictive ability of
self-reported physical activity for the same indicator after 13 years is
also a simple and understandable for their study. In this case, (weighted)
kappa statistics would become useful statistical indicator for the
agreement.
Anyway, caution should be paid on the validity of accelerometer as a
monitoring tool for physical activity or sedentary behaviour from mid-life
to early old age (3).
References
1. Hamer M, Kivimaki M, Steptoe A. Longitudinal patterns in physical
activity and sedentary behaviour from mid-life to early old age: a
substudy of the Whitehall II cohort. J Epidemiol Community Health
2012;66:1110-5.
2. Martinez-Gomez D, Gomez-Martinez S, Ruiz JR, et al. Objectively-
measured and self-reported physical activity and fitness in relation to
inflammatory markers in European adolescents: the HELENA Study.
Atherosclerosis 2012;221:260-7.
3. Evenson KR, Buchner DM, Morland KB. Objective measurement of
physical activity and sedentary behavior among US adults aged 60 years or
older. Prev Chronic Dis 2012;9:E26.
"Traffic-related pollution," especially diesel combustion produced,
may be shown to increase testosterone. It is my hypothesis that increased
maternal testosterone increases preeclampsia
(http://anthropogeny.com/Incresing%20Testosterone%20and%20Preeclampsia.htm
).
I suggest the findings of Pereira, et al., may be explained by
increased maternal testosterone.
"Traffic-related pollution," especially diesel combustion produced,
may be shown to increase testosterone. It is my hypothesis that increased
maternal testosterone increases preeclampsia
(http://anthropogeny.com/Incresing%20Testosterone%20and%20Preeclampsia.htm
).
I suggest the findings of Pereira, et al., may be explained by
increased maternal testosterone.
We all know eating together as a family can boost conversation,
foster closeness and encourage healthy ways with food. However, a 2011
survey of 1354 people for the insurance firm Cornish Mutual found 48% of
British households do not share a meal every day. [1]
This study shows that by having a family dinner together it can
increase children's daily fruit and vegetable intake to reach the 5 A Day
target. It rei...
We all know eating together as a family can boost conversation,
foster closeness and encourage healthy ways with food. However, a 2011
survey of 1354 people for the insurance firm Cornish Mutual found 48% of
British households do not share a meal every day. [1]
This study shows that by having a family dinner together it can
increase children's daily fruit and vegetable intake to reach the 5 A Day
target. It reinforces the view that children learn more from what adults
do than what they say, therefore it is the parental role modelling that
helps shape their future habits.
The strengths of this study are its large sample size (2383 children)
and reliable methods of assessing dietary intake through a validated food
intake tool. However, there are limitations which have not been noted by
the researchers.
This is a single sample of London schoolchildren taking part in
trials assessing school gardening and diet. We do not know whether the
children who were taking part in this trial may have particular
characteristics that make them different from, for example, children
selected from a completely random primary school sample. Also, the
children in this London area may not be representative of the entire UK
population in terms of culture and ethnicity, which may be related to
family eating patterns.
While home environment and parental food attitudes are likely to
influence the child's food intake, there may be other factors such as
children's preference, social factors or peer pressure. One or a
combination of these factors could directly influence the child's food
intake.
In the United States, the month of October is the national "Eat
Better, Eat Together Month". [2] A tool kit has been developed to promote
family meal time. [3]
If your family isn't already making dining together a priority, now
is the perfect time to start!
REFERENCES
1. Deborah Clark Associates. Press release: Half of UK families are
not eating together. 24 February 2011. http://www.dca-pr.co.uk/Latest-
News/Cornish-Mutual/Half-of-UK-families-are-not-eating-together-123.aspx
We welcome the glossary of theories presented last month by Smith
& Katikireddi (2012) and applaud the intention to introduce wider
thinking from the political sciences on these subjects to health
researchers. Drawing on our practical experiences in the fields of
healthcare management and health services research, we would like to
identify three related areas which may also be useful for the public
health audience....
We welcome the glossary of theories presented last month by Smith
& Katikireddi (2012) and applaud the intention to introduce wider
thinking from the political sciences on these subjects to health
researchers. Drawing on our practical experiences in the fields of
healthcare management and health services research, we would like to
identify three related areas which may also be useful for the public
health audience. We suggest this commentary solely to help the glossary to
be more widely used and increase its impact.
Firstly, although several useful definitions of policymaking are
described, we feel that 'policy' tends to be interpreted too broadly by
public health practitioners, and narrowing down the definition of policy
in relation to the concepts of 'management' and 'governance' might be
useful. Management' refers to the organisation and leadership of practice,
and is primarily concerned with execution and implementation(Mitchell
& Shortell, 2000)). 'Governance' in non-profit contexts most
frequently refers to the funding and oversight roles of government
agencies (Provan & Kenis, 2008). We believe that understanding the
differences between policy, management and governance are essential for
public health researchers to explore how public health, and indeed health
services and public policy more generally operate and can be influenced.
As it stands, the glossary predominantly focuses on policy, rather than
management and governance. However, the theories of policymaking should
not be blindly transferred to the fields of management and governance as
these are often concerned with policy implementation, rather than
policymaking.
Secondly, the glossary notes the existence of knowledge brokerage and
policy entrepreneurship, which are part of a wider debate about how policy
is made, and the role of evidence in policy making. The degree to which
research evidence can, should and actually is used in policy making has
been an area of extensive debate, and it is worth highlighting a number of
seminal sources dealing with these issues. Nutley, Walter and Davies
describe the importance of evidence use by policy makers (Nutley et al.,
2007). Much of the work in this area is informed by the work of Carol
Weiss (1979) with her helpful categorisation of the meanings of research
utilisation into seven categories: as' knowledge-driven', 'problem
solving', 'interactive' 'enlightenment', 'political',' tactical'
'instrumental', and 'research as an intellectual enterprise'(Weiss, 1979).
More recently, Lomas and colleagues have contributed the 'linkage and
exchange' model, focusing on relationships between researchers and
policymakers, now acknowledged to be a fundamental part of knowledge
translation (Lomas & Brown, 2009). Ray Pawson and colleagues have
worked extensively on bringing realist interpretations to the use of
evidence in policy (Greenhalgh et al., 2004; Pawson, 2006). More recently,
a more critical stance about the definitions and uses of evidence has
been taken by Marston and watts (Marston & Watts, 2003)) with the
impact of evidence-use on population outcomes also in doubt (Macintyre,
2003).
Thirdly and finally, we note that the impetus for producing the
glossary was an observation that "public health's efforts to influence
policy often appear to be uninformed by the empirically-based theories
about policymaking developed within social and political sciences". We
welcome the focus on empirically-led theory, but questions remain about
the extent to which the models and rhetoric around policymaking are indeed
data-, as opposed to theory-driven. While it is true that many models of
policy making exist, we believe that it is not clear whether models are
employed analytically to understand empirical datasets, or tested across
different scenarios. This would be a useful exercise for all researchers
interested in evidence-based policy.
Reference List
Greenhalgh, T., Robert, T., MAcfarlane, F., Bate, P., &
Kyriakidou, O. (2004). Diffusion of Innovations in Service Organizations:
Systematic Review and Recommendations. The Milbank Quarterly, 82.
Lomas, J. & Brown, A. D. M. A. (2009). Research and advice
giving: A functional view of evidence-informed policy advice in a Canadian
ministry of health. [References]. Milbank Quarterly., 87, 903-926.
Macintyre, S. (2003). Evidence based policy making. BMJ, 326, 5-6.
Marston, G. & Watts, R. (2003). Tampering with the evidence: A
critical appraisal of evidence-based policy-making. The Drawing Board: An
Australian Review of Public Affairs, 3, 143-163.
Mitchell, S. & Shortell, S. (2000). The Governance and Management
of Effective Community Health Partnerships: A typology for Research,
Policy and Practice. The Milbank Quarterly, 78, 241-289.
Nutley, S., Walter, I., & Davies, H. T. O. (2007). Using
Evidence: How Research Can Inform Public Services. The Policy Press.
Pawson, R. (2006). Evidence-based Policy.
Provan, K. G. & Kenis, P. (2008). Modes of Network Governance:
Structure, Management, and Effectiveness. Journal of Public Administration
Research and Theory, 18, 229-252.
Weiss, C. H. (1979). The Many Meanings of Research Utilization.
Public Administration Review, 39, 426-431.
Sir, the recent report on "extreme temperatures and paediatric emergency" is very interesting [1]. Xu et al. concluded that "children are at particular risk of a variety of diseases which might be triggered by extremely high temperatures [1]."Xu et al. also mentioned for the effect of climate change. In fact, Xu et al. reported a highly similar publication in Occup Environ Med and also noted for the effect of climate chan...
Dear Editor, The published paper by Paananen et al, entitled "Social determinants of mental health: a Finnish nationwide follow up study on mental disorders"1 was an interesting and rigorous study. Through a longitudinal approach, all Finnish children who were born in a certain year (1987) were followed through adolescence in order to examine the development of mental disorders and assess potential SDH-related risk fact...
This is a great contribution to the literature on fuel poverty, cold housing, and health.
The authors call for a review of qualitative and intervention research related to this topic. It may be useful for readers to be made aware of a recently updated version of a systematic review of the health and socio-economic impacts of housing improvement published by the Campbell and Cochrane Collaborations 1. In this revi...
Pesticide Action Network Europe It cannot be denied that TTC (Threshold of Toxicological Concern) was originally proposed in the U.S., as Dr Harris states in her commentary on our article,[1] but her industry-sponsored organisation, the International Life Sciences Institute (ILSI) played a major role in developing it further to the form in which it was accepted by European Food Safety Authority (EFSA). This process took p...
It cannot be denied that TTC (Threshold of Toxicological Concern) was originally proposed in the U.S., as Dr Harris states in her commentary on our article,[1] but her industry-sponsored organisation, the International Life Sciences Institute (ILSI) played a major role in developing it further to the form in which it was accepted by European Food Safety Authority (EFSA).
This process took place in an EFSA workin...
I am responding on behalf of the International Life Sciences Institute (ILSI) to the Commentary published on Online First on 8 March 2013: "Conflicts of interest at the European Food Safety Authority erode public confidence" by Robinson et al.
In their Commentary, the authors raise questions about practical scientific tools being studied by a variety of private and public sector groups, including the European F...
Hamer et al. conducted a 13-year longitudinal study on the predictive ability of self-reported physical activity on physical activity measured by accelerometers (1). Participants were 394 healthy men and women aged 54 years on average. They concluded that the habits of physical activity in adulthood are partly tracked into older age. About their attractive report, I have several concerns on their statistical outcomes....
"Traffic-related pollution," especially diesel combustion produced, may be shown to increase testosterone. It is my hypothesis that increased maternal testosterone increases preeclampsia (http://anthropogeny.com/Incresing%20Testosterone%20and%20Preeclampsia.htm ).
I suggest the findings of Pereira, et al., may be explained by increased maternal testosterone.
Conflict of Interest:
...We all know eating together as a family can boost conversation, foster closeness and encourage healthy ways with food. However, a 2011 survey of 1354 people for the insurance firm Cornish Mutual found 48% of British households do not share a meal every day. [1]
This study shows that by having a family dinner together it can increase children's daily fruit and vegetable intake to reach the 5 A Day target. It rei...
We welcome the glossary of theories presented last month by Smith & Katikireddi (2012) and applaud the intention to introduce wider thinking from the political sciences on these subjects to health researchers. Drawing on our practical experiences in the fields of healthcare management and health services research, we would like to identify three related areas which may also be useful for the public health audience....
Pages