Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages.

Background Manufacturers of harmful products engage in misinformation tactics long employed by the tobacco industry to emphasize uncertainty about scientific evidence and deflect negative attention from their products. This study assessed the effects of one type of tactic, the use of "alternative causation" arguments, on public understanding. Methods In five trials (one for each industry) anonymized Qualtrics panel respondents were randomized to receive a message on the risk in question from one of four industry sponsored organizations (exposure), or from one of four independent organizations (control), on risks related to alcohol, tobacco, fossil fuel and sugar sweetened beverages. Logistic regression models were used to evaluate the effect of industry arguments about uncertainty on the primary outcome of public certainty about product risk, adjusting for age, gender and education. The results from all five trials were pooled in a random-effects meta-analysis. Findings In total, n=3284 respondents were exposed to industry-sponsored messaging about product-related risks, compared to n=3297 exposed to non-industry messages. Across all industries, exposure to industry-sponsored messages led to greater reported uncertainty or false certainty about risk, compared to non-industry messages [Summary odds ratio (OR) 1·60, confidence interval (CI) 1·28-1·99]. The effect was greater among those who self-rated as not/slightly knowledgeable (OR 2·24, CI 1·61-3·12), or moderately knowledgeable (OR 1·85, CI 1·38-2·48) compared to those very/extremely knowledgeable (OR 1·28, CI 1·03-1·60). Conclusions This study demonstrates that exposure to industry sponsored messages which appear intended to downplay risk significantly increases uncertainty or false certainty, with the effect being greater in less knowledgeable participants.

Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation.

BACKGROUND AND PURPOSE: The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to atrial fibrillation (AF) is unknown. We investigated the safety of early initiation of direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) or no anticoagulation. METHODS: This observational, retrospective, single-centre study included consecutive patients with recent (<4 weeks) ischaemic stroke and AF. The primary outcome was the rate of major (intracranial and extracranial) bleeding in patients on different treatment schemes, i.e. DOACs, VKAs and not anticoagulated. We also investigated the rate of ischaemic cerebrovascular events and mortality. RESULTS: We included 959 consecutive patients with AF and ischaemic stroke followed up for an average of 16.1 days after the index event. A total of 559 out of 959 patients (58.3%) were anticoagulated with either VKAs (n = 259) or DOACs (n = 300). Anticoagulation was started after a mean of 7 ± 9.4 days in the DOAC group and 11.9 ± 19.7 days in the VKA group. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding [odds ratio (OR), 0.49; 95% confidence intervals (CI), 0.21-1.16] and in particular of intracranial bleeding (OR, 0.47; 95% CI, 0.17-1.29; P = 0.143) compared with no anticoagulation. In contrast to VKAs (OR, 0.78; 95% CI, 0.28-2.13), treatment with DOACs (OR, 0.32; 95% CI, 0.10-0.96) reduced the rate of major bleeding compared with no anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups. CONCLUSIONS: Starting DOACs within a mean of 7 days after stroke appeared to be safe. Randomized controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.

Job insecurity, financial difficulties and mental health in Europe.

BACKGROUND: The recession has increased job insecurity in the European Union (EU) which may result in higher levels of psychological distress, burnout and anxiety. AIMS: To investigate the association of job insecurity and financial difficulties with mental health in 27 member states of the EU and to explore the moderating effect of having financial difficulties on the relationship between job insecurity and mental health. METHODS: The sample consisted of employed people from 27 European countries where the Eurobarometer survey (73.2 wave, 2010) was administered by the European Commission. Mental well-being and psychological distress were measured using the Vitality and Mental Health Index (MHI-5) subscales from the Short-Form 36-item health survey (SF-36v2). Linear regression including an interaction term was used to test the underlying factors in this study. RESULTS: Among the 12594 respondents, experiencing job insecurity was associated with lower Vitality [ß = -3.82, 95% confidence interval (CI) -5.29 to -2.36] and MHI-5 (ß = -3.48, 95% CI -4.91 to -2.04). Similarly, having financial difficulties was significantly correlated with lower Vitality (ß = -8.65, 95% CI -12.07 to -5.24) and MHI-5 (ß = -11.51, 95% CI -15.08 to -7.94). However, having financial difficulties did not moderate the relationship between job insecurity and both mental health scales. CONCLUSIONS: This study highlights the negative effect of job insecurity and financial difficulties on mental health in the EU. Support to employees facing job security issues should be a priority regardless of the financial circumstances.

Geographic variation and socio-demographic determinants of the co-occurrence of risky health behaviours in 27 European Union member states.

BACKGROUND: Risky health behaviours such as tobacco and alcohol abuse, physical inactivity and poor diet may play an important role in disease development. The aim of the present study was to assess the geographical distribution and socio-demographic determinants of risky health-related behaviours in 27 member states (MSs) of the European Union (EU). METHODS: Data from the 2009 Eurobarometer survey (wave 72.3; n = 26 788) were analysed. Tobacco use, alcohol consumption, physical activity and fruit consumption were assessed through a self-reported questionnaire provided to participants from 27 EU MSs. Within the analyses, participants with three or more lifestyle risk factors were classified as individuals with co-occurrence of risk factors. RESULTS: Among respondents aged 15 or older, 28.2% had none of the aforementioned behavioural risk factors, whereas 9.9% had three or more lifestyle risk factors. Males [adjusted odds ratio (aOR) = 2.50; 95% confidence interval (95% CI): 2.17-2.88] and respondents of middle (aOR = 1.60; 95% CI: 1.36-1.89) or lower income (aOR = 2.63; 95% CI: 2.12-3.26) were more likely to report co-occurrence of behavioural risk factors, as well as respondents in Northern (aOR = 1.43; 95% CI: 1.14-1.78), Western (aOR = 1.28; 95% CI: 1.06-1.56) and Eastern Europe (aOR = 1.28; 95% CI: 1.06-1.55), when compared with Southern European respondents. CONCLUSIONS: The above analyses indicate significant geographical and social variation in the distribution of the co-occurrence of behavioural risk factors for disease development.

Compliance with a healthy lifestyle in a representative sample of the Greek population: preliminary results of the Hellas Health I study.

OBJECTIVES: To investigate lifestyle health behaviours, such as smoking, physical activity, weight status and dietary habits, in a representative sample of the adult Greek population. STUDY DESIGN: Cross-sectional, household interviews (Hellas Health I survey, 2006). METHODS: A stratified representative sample (n = 1005, 483 males, 522 females) of the Greek adult population (mean age 47.39 years, median age 46 years, range 18-99 years) was interviewed. Self-reported demographic and lifestyle behaviour data were obtained. The Food Frequency Questionnaire (FFQ) was used to record dietary habits, and a Mediterranean score was derived from the FFQ to assess adherence to the Mediterranean diet. A higher Mediterranean score indicates greater adherence to the Mediterranean diet. Physical activity was evaluated using the International Physical Activity Questionnaire. RESULTS: Smoking is highly prevalent in the Greek population (43.1%), particularly among people aged 18-36 (52.9%) and 37-56 years (51.9%). Smoking prevalence was 52.4% in men and 34.5% in women (P < 0.001). In total, 54.1% of men and 45.3% of women were classified as physically active (P = 0.007). The proportion of physically active subjects decreased with age (P for trend<0.001). The prevalence of obesity was higher in women (18.3%) than men (14.3%, P < 0.001), and increased with age (P for trend<0.001). Men were found to have higher Mediterranean scores than women (27.09 vs 26.14, P < 0.05). Dietary habits also differed between younger and older participants, and the Mediterranean score increased with age. CONCLUSIONS: The prevalence rates for smoking, physical inactivity and obesity are high, and compliance with the Mediterranean diet is low in Greece. Nationwide interventions focused on health promotion and primary prevention are urgently needed.