The health and economic burden of osteoporotic fractures in Singapore and the potential impact of increasing treatment rates through more pharmacological options.

PURPOSE: This study aims to estimate the health and economic burden of osteoporosis in Singapore from 2017 to 2035, and to quantify the impact of increasing the treatment rate of osteoporosis. METHODS: Population forecast data of women and men aged 50 and above in Singapore from 2017 to 2035 was used along with prevalence rates of osteoporosis to project the osteoporosis population over time. The population projections by sex and age group were used along with osteoporotic fracture incidence rates by fracture type (hip, vertebral, other), and average direct and indirect costs per case to forecast the number of fractures, the total direct health care costs, and the total indirect costs due to fractures in Singapore. Data on treatment rates and effects were used to model the health and economic impact of increasing treatment rate of osteoporosis, using different hypothetical levels. RESULTS: Between 2017 and 2035, the incidence of osteoporotic fractures is projected to increase from 15,267 to 24,104 (a 57.9% increase) F 10,717 to 17,225 (a 60.7% increase) and M 4550 to 6878 (a 51.2% increase). The total economic burden (including direct costs and indirect costs to society) associated with these fractures is estimated at S$183.5 million in 2017 and is forecasted to grow to S$289.6 million by 2035. However, increasing the treatment rate for osteoporosis could avert up to 29,096 fractures over the forecast period (2017-2035), generating cumulative total cost savings of up to S$330.6 million. CONCLUSION: Efforts to improve the detection, diagnosis, and treatment of osteoporosis are necessary to reduce the growing clinical, economic, and societal burden of fractures in Singapore.

The impact of addressing modifiable risk factors to reduce the burden of cardiovascular disease in Turkey.

OBJECTIVE: Our study aimed to estimate the impact of addressing modifiable risk factors on the future burden of cardiovascular diseases (CVD) in the general population and in two high-risk populations (heterozygous familial hypercholesterolemia and secondary prevention) for Turkey. METHODS: One model investigated the impact of reaching the World Health Organization (WHO) voluntary targets for tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity in the general population. Another model estimated the impact of reducing LDL-cholesterol in two high-risk populations through increased access to effective treatment. Inputs for the models include disease and risk factor prevalence rates, a population forecast, baseline CVD event rates, and treatment effectiveness, primarily derived from the published literature. Direct costs to the public health care system and indirect costs from lost production are included, although the cost of programs and pharmacological interventions to reduce risk factors were not considered. RESULTS: The value of reaching WHO risk factor reduction targets is estimated at US$9.3 billion over the next 20 years, while the value of reducing LDL-cholesterol is estimated at up to US$8.1 billion for high-risk secondary prevention patients and US$691 million for heterozygous familial hypercholesterolemia patients. CONCLUSION: Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to treatment for high-risk patients are projected to greatly reduce the growing clinical and economic burden of CVD in Turkey.

Modeling the burden of cardiovascular disease in Turkey.

OBJECTIVE: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey. METHODS: A burden-of-disease model was developed that included inputs on population growth, prevalence, and incidence of ischemic disease (IHD) and cerebrovascular disease (CeVD), prevalence of modifiable risk factors, mortality rates, and relationship between risk factors and IHD/CeVD. Direct costs to the public health-care system and indirect costs from lost production due to premature mortality, hospitalizations, disability, and absenteeism were considered. RESULTS: We estimated that in 2016, 3.4 million Turkish adults were living with CVD, including 2.5 million affected by IHD, and 0.9 million by CeVD. This prevalence is projected to increase to 5.4 million by 2035. The economic burden of CVD was estimated at US$10.2 billion in 2016, projected to increase twofold to US$19.4 billion by 2035. CONCLUSION: Our study confirms that the current burden of CVD is significant, and that it is projected to increase at a steep rate over the next two decades. This growing burden of disease will likely create significant pressure on the public health-care system in the form of direct health-care costs, as well as on society in the form of lost productivity.

Researchers must be aware of their roles at the interface of ecosystem services science and policy.

Scientists working on ecosystem service (ES) science are engaged in a mission-driven discipline. They can contribute to science-policy interfaces where knowledge is co-produced and used. How scientists engage with the governance arena to mobilise their knowledge remains a matter of personal choice, influenced by individual values. ES science cannot be considered neutral and a discussion of the values that shape it forms an important part of the sustainability dialogue. We propose a simple decision tree to help ES scientists identify their role and the purpose of the knowledge they produce. We characterise six idealised scientific postures spanning possible roles at the science-policy interface (pure scientist, science arbiter-guarantor, issue advocate-guardian, officer, honest broker and stealth issue advocate) and illustrate them with feedbacks from interviews. We encourage ES scientists to conduct a reflexive exploration of their attitudes regarding knowledge production and use, with the intention of progressing toward a higher recognition of the political and ethical importance of ES assessments.

Learning and the transformative potential of citizen science.

The number of collaborative initiatives between scientists and volunteers (i.e., citizen science) is increasing across many research fields. The promise of societal transformation together with scientific breakthroughs contributes to the current popularity of citizen science (CS) in the policy domain. We examined the transformative capacity of citizen science in particular learning through environmental CS as conservation tool. We reviewed the CS and social-learning literature and examined 14 conservation projects across Europe that involved collaborative CS. We also developed a template that can be used to explore learning arrangements (i.e., learning events and materials) in CS projects and to explain how the desired outcomes can be achieved through CS learning. We found that recent studies aiming to define CS for analytical purposes often fail to improve the conceptual clarity of CS; CS programs may have transformative potential, especially for the development of individual skills, but such transformation is not necessarily occurring at the organizational and institutional levels; empirical evidence on simple learning outcomes, but the assertion of transformative effects of CS learning is often based on assumptions rather than empirical observation; and it is unanimous that learning in CS is considered important, but in practice it often goes unreported or unevaluated. In conclusion, we point to the need for reliable and transparent measurement of transformative effects for democratization of knowledge production.

The right time for the job? Insights into practices of time in contemporary field sciences.

ARGUMENT: Temporal issues appear to be crucial to the relationship between life scientists and their field sites and to the making of science in the field. We elaborate on the notion of practices of time to describe the ways life scientists cope with multiple and potentially conflicting temporal aspects that influence how they become engaged and remain engaged in a field-site, such as pleasure, long-term security, scientific productivity, and timeliness. With this notion, we seek to bring enhanced visibility and coherence to the extensive but rather scattered and limited treatments of temporal practices in field sciences that already exist.

[The surplus weight among the Francophones and Anglophones]. / Le surplus de poids chez les francophones et les anglophones.

OBJECTIVES: Recent studies show a higher prevalence of being obese or overweight in Francophones living in minority settings compared to Canada's Anglophone majority. The objective of our study was to determine whether belonging to the linguistic minority constituted a social determinant of having a weight problem. METHODS: Descriptive variables (n=128,986) from five cycles of the Canadian Community Health Survey were stratified by respondents' language and sex. Two logistic regression models tested the association between being overweight/obese (as defined by the measure of body mass index) and language, for men and women, while adjusting for social and behavioural determinants. RESULTS: Prevalence of excess weight was higher among Francophones compared to Anglophones of Ontario, although the difference was not significant after adjustment for socio-economic and behavioural determinants. However, Francophones were older, less educated and more likely to live in rural areas than their Anglophone counterparts, a situation which makes them more vulnerable. CONCLUSION: The study confirms the role of social and behavioural determinants of being obese/overweight. Although language does not have a direct influence on having a weight problem, the socio-economic reality of the Francophone minority makes them more likely than the Anglophone majority to fall in vulnerable strata of the population with regards to being overweight/obese. This situation should be considered when planning health services.

Physical inactivity among Francophones and Anglophones in Canada.

OBJECTIVE: Leisure-time physical activity participation is influenced by various socio-demographic factors. Recent evidence suggests that being part of a minority negatively impacts an individual's health status. The objective of this study was to compare inactive leisure-time physical activity between the Francophone minority and the Anglophone majority in Canada. METHODS: Data from the fusion of cycles 2.1, 3.1, 4.1, 2008 and 2009 of the Canadian Community Health Survey (CCHS) were used. The linguistic variable was determined by languages spoken at home, first language learned and still understood, language of interview, and language of preference. Leisure-time physical activity was based on a questionnaire provided during the interview. Factors associated with inactive leisure time were examined using logistic regression models. RESULTS: Francophones were more likely than Anglophones to be physically inactive in their leisure time (49.1% vs. 47.2%). A greater percentage of Francophones had poor self-perceived health, were older, were single, had lower education, had higher rate of unemployment and lived in rural areas compared to Anglophones. When these socio-demographic factors were taken into account, there were no further differences in the likelihood of being inactive between Francophones and Anglophones. CONCLUSION: The Francophone minority in Canada is characterized by socio-demographic factors that have a negative impact on leisure-time physical activity participation.

Comparison of dietary intake between Francophones and Anglophones in Canada: data from CCHS 2.2.

OBJECTIVE: To compare the dietary intake and food choices between Francophone Canadians in a state of linguistic minority (outside of Quebec) and the English-speaking majority. METHODS: We used the 2004 Canadian Community Health Survey (CCHS) cycle 2.2 (general health and 24-hour dietary recalls) to describe dietary intake of Francophone Canadians (excluding Quebec) and compare them to the English-speaking majority. The linguistic variable was determined by languages spoken at home, first language learned and still understood, language of interview, and language of preference. The mean differences in daily nutrient and food intake were assessed by t and chi-square tests. RESULTS: Differences in total energy and daily food intakes by language groups were not observed in the sample; however, significant differences in weekly consumption were found in different age and sex categories: lower fruits and vegetables consumption, and vitamins and macronutrients intakes for older Francophone men and higher intakes of energy and saturated fat from "unhealthy" foods for Francophone men 19-30 years of age. Based on the Acceptable Macronutrients Distribution Range (AMDR), approximately 50% of the sample exceeded their acceptable energy intake from saturated fats, and 80% were below their required intake of linoleic fatty acid. CONCLUSION: We confirmed that belonging to Francophone minorities in Canada affects food choices and nutritional well-being of this population. The most vulnerable groups identified by our study were Francophone men in the youngest (19-30) and older (50 and over) age categories. The extent to which the cultural setting influences the diet and, in turn, the health of the minority population needs further examination.

Perceived health status of Francophones and Anglophones in an officially bilingual Canadian province.

OBJECTIVE: It has been reported that being part of a minority group may be negatively associated with self-perceived health. The objective of this analysis was to determine whether there are differences in perceived health between the Francophone minority and Anglophone majority in New Brunswick, the only officially bilingual province in Canada. METHODS: Data from the first four primary cycles of the Canadian Community Health Survey (2001 to 2007) were obtained for 17,729 New Brunswick residents. Odds of reporting good health among Francophones and Anglophones were compared using multivariate logistic regressions accounting for age, health-related behaviours, socio-demographic variables, and medical conditions. RESULTS: In the final models, Francophone men and women were less likely than Anglophones to report their health as being good, although these differences were not statistically significant (Odds ratio, 95% confidence interval: 0.88, 0.61-1.26; 0.71, 0.49-1.04, in men and women, respectively). CONCLUSION: This study suggests that being part of the linguistic minority in New Brunswick is not associated with statistically significant differences in self-perceived health.