MPH Master pieces

Protect the vulnerable

This paper estimates the scale of maltreatment (abuse?) of children in New Zealand. Maltreatment included: neglect, emotional abuse, physical abuse, and sexual abuse. 1 in 4 children had been subject to at least one report to Child Protection Services at age 17 years (23.5%), and 9.7% had been a victim of substantiated abuse or neglect. These numbers are staggeringly high, and we shouldn't think our own society is any different from New Zealand. 

An accompanying editorial tells the story of what happened when similar data were presented at a conference in the USA. Marietta Higgs probably got it wrong, but this is very, very difficult territory. 

Smoking cessation

We don't talk much about smoking nowadays - obesity seems to dominate. But smoking remains deadly and we must keep up our efforts. Here is an interesting trial of economic incentives as a quit strategy. Two points of interest for me - even with all incentives switched on the quit rates are very low (you, it's an addiction!); and the financial offer was substantial at 600USD. Previous efforts have involved quite modest sums of £30 - £50. Large rewards can be tricky, particularly if coming from public funds. 

Whoa!

Retraction and republication of a much-cited paper from 2013 in the world's top medical journal - that doesn't happen very day. But

a. I think we can be quietly pleased that science is working as intended, with scrutiny and peer review; 

b. brave decision by the authors to admit error and good decision by the Editors to give space for a republication; 

c. doesn't seem to have changed the results or conclusions in any substantive way.

Lung cancer in women

Lung cancer is now commoner in women than in men, at least among younger people. What's going on? Differences in smoking are not the answer; this paper discussed various other possibilities, including greater imaging of women than men, but with no definite conclusions. The paper gives an example of the rarely used age-period-cohort analysis required to unpick any secular trend.

 

What is frailty?

We worry, for all sorts of good reasons, about frail old people. But what do we mean by 'frail'? Here's a paper which tackled the question scientifically. 

Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity.

That's #6 of Jerry Morris' seven Uses of Epidemiology - defining syndromes.  Note that frailty is not disability and it's not co-morbidity; it's a different entity - a cluster of symptoms (a syndrome) which predicts various outcomes. 

Without a definition science does not progress. Here the definition of frailty has prompted some research on diet as a predictor (but note the conclusion - most diets are not diets: they're part of a lifestyle).

Of course most people, most researchers even, still use the word 'frailty' loosely, with no definition at all. We could tell the same story about 'stress'.