commitment to reducing harm, allowing TTCs to rebuild their credibility ...

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European Journal of Public Health, Vol. 23, Supplement 1, 2013

commitment to reducing harm, allowing TTCs to rebuild their credibility, and re-enter the health policy arena from which it had increasingly been excluded Key messages  Our findings show that TTCs’ rhetoric on harm reduction has been inconsistent with historical and recent documents and business actions.  Care should be taken that industry’s harm reduction rhetoric does not undermine gains hitherto secured in efforts to reduce the ability of the tobacco industry to inappropriately influence policy. The effects of vitamin D on skeletal muscle strength: a meta-analysis of randomized controlled trials Charlotte Beaudart C Beaudart1, F Buckinx1, V Rabenda1, E Cavalier2, J Petermans3, JY Reginster1, O Bruye`re1 1 Department of Public Health, Epidemiology and Health Economics, University of Lie`ge, Lie`ge, Belgium 2 Department of Clinical Chemistry, University of Lie`ge, CHU Sart-Tilman, Lie`ge, Belgium 3 Geriatric Department, CHU Lie`ge, Lie`ge, Belgium Contact: [email protected]

Background Currently, there is growing evidence that vitamin D plays a role on several tissues including skeletal muscle. Previous studies suggested that vitamin D deficiency is associated with low muscular strength. The objective of this meta-analysis is to summarize the effects of vitamin D supplementation on muscle strength. Methods A systematic research of randomized controlled trials (RCTs) assessing the effect of vitamin D supplementation on muscle strength and performed between 1966 and February 2013 has been conducted (Medline, Cochrane Database of Systematics Reviews, Cochrane Central Register of Controlled Trials, manual review of the literature and congressional abstracts). All forms and doses of vitamin D supplementation, with or without calcium supplementation, compared with placebo or control were included. The quality of the RCTs was evaluated using the Jadad criteria. Results Out of the 214 potentially relevant articles, 19 RCTs involving 4824 individuals (mean age: 66.0 years) met the inclusion criteria. Studies showed a mean quality score of 3.8/5 points. Results revealed a significant positive effect of vitamin D supplementation on global muscle strength with a standardized mean difference (SMD) of 0.096 (95% CI = 0.007-0.184; p = 0.034). No significant between-study heterogeneity was found (Q-value = 23.6; p = 0.21; I2 = 19.6%). Regarding the individual type of strength, results showed no significant effect on vitamin D supplementation on grip strength (SMD: 0.062, p = 0.264), but a significant positive effect on lower limb muscle strength (SMD: 0.169, p = 0.03). Conclusions Based on the studies included in this meta-analysis, vitamin D supplementation has a positive impact on global muscle strength, and more especially, on lower limb muscle strength. Key messages  Vitamin D supplements increase muscle strength mainly at the lower limb. However, the exact effective dose needs to be assessed.  People with affection including low muscular strength, such as sarcopenia, should be supplemented with vitamin D. Patients’ knowledge about coronary artery disease risk factors after coronary artery bypass surgery and adherence to medication and lifestyle in Armenia Anahit Demirchyan A Giloyan1, G Yenokyan2, Y Amirkhanyan3 1 School of Public Health, American University of Armenia, Yerevan, Armenia

2 Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States 3 Global Fund to Fight AIDS, TB and Malaria Primary Recipient Implementation Unit, Mission East Armenia Contact: [email protected]

Background Medication non-adherence is a complex problem, especially for people with chronic diseases. Non adherence to lifestyle change and prescribed medication may worsen the disease and can prohibit attaining treatment goals sufficiently. Nonadherence after bypass surgery is a serious problem and it may increase the rate of death, myocardial infarction, stroke, transient ischemic attack, or the need for re-operation. Methods The study design was analytical cross-sectional. This study evaluates the associations between knowledge about coronary artery disease risk factors and adherence to medication and lifestyle changes among patients with a history coronary artery bypass grafting at Nork Marash Medical Center in Armenia. A questionnaire was designed to measure adherence to medication, diet, physical activity, and smoking status. Results Mean age of 233 study participants was 58  9 years, of whom 85.8% were men. A total of 17% of patients adhered to medication. There was a statistically significant association between subjects’ self-reported specific knowledge and the degree of self-reported lifestyle changes. Adjusted odds of smoking cessation was 2.13 times higher among those who reported smoking as risk factor of CAD compare to those who did not OR = 2.13 (95%CI: 1.06 to 4.28). Adjusted odds of being physically active was 2.4 times higher among those who have reported physical activity as risk factor for CAD compare to those who did not OR = 2.44 (95%CI: 1.20 to 4.98). No statistically significant association was detected between general knowledge about risk factors of CAD and adherence to medication. Medication affordability showed the largest effect on adherence to medication: 2.6 higher odds of adherence for those to whom medication was affordable. Conclusions Further investigations into the complex issue of adherence and its determinants in patients with history of CAD including longitudinal changes in adherence might help better understand this phenomenon. Patients with increased specific knowledge of risk factors may benefit in terms of adherence to lifestyle changes after a cardiac event. Key message  Adherence to medication and lifstyle. Associations between unemployment and self-rated health: results from cross-sectional studies in Lithuania Sandra Kucenoviene S Kucinoviene1, M Stankunas1,2, G Macassa3, A Baltkojyte1, J Lindert4,5,6 1 Lithuanian University of Health Sciences, Kaunas, Lithuania 2 Griffith University, Gold Coast, Australia 3 University of Gavle, Gavle, Sweden 4 Protestant University of Ludwigsburg, Ludwigsburg, Germany 5 University of Leipzig, Leipzig, Germany 6 Harvard School of Public Health, Boston, United States Contact: [email protected]

Background This economic recession caused dramatic increase of unemployment level in Lithuania. Last few years showed economic growth, however unemployment rates still remains very high. The aim of this study was to compare evaluations of self-rated health among unemployed in Kaunas (Lithuania) during the period of economic growth (2005) and economic recession (2012). Methods The data was collected in two cross-sectional studies, which were performed in 2005 and 2012. We received 887 filled-in questionnaires (429 questionnaires in 2005 study (response rate – 53.6%) and 448 questionnaires (response rate – 58.0%)