Water fluoridation is a common but debated public policy. In this paper, we use Swedish registry data to study the causal effects of fluoride in drinking water. We exploit exogenous variation in natural fluoride stemming from variation in geological characteristics at water sources to identify its effects. First, we reconfirm the long-established positive effect of fluoride on dental health. Second, we estimate a zero effect on cognitive ability in contrast to several recent debated epidemiological studies. Third, fluoride is furthermore found to increase labor income. This effect is foremost driven by individuals from a lower socioeconomic background.
Parents are the primary source of support for children with cancer. To inform clinical practice and health policies, the socioeconomic consequences of childhood cancer for fathers and mothers in Sweden were investigated. A total of 3865 mothers and 3865 fathers of 3865 children diagnosed with cancer in Sweden when 0 to 18 years were followed for 5 years before and 10 years after diagnosis. Socioeconomic consequences of the cancer diagnosis on earnings and employment, and mental health (number of inpatient diagnoses), were investigated exploiting variation in timing of cancer diagnosis. Data were obtained from the Swedish Childhood Cancer Registry, Intergenerational Registry and Inpatient Registry. Childhood cancer has a negative short‐term effect on fathers' and mothers' earnings; a negative long‐term effect on fathers' earnings; a positive long‐term effect on mothers' earnings; negative short‐ and long‐term effects on fathers' and mothers' employment; and no effect on the number of inpatient diagnosis of mental and behavioral disorders for fathers or mothers. Taken together, findings show that in Sweden childhood cancer has negative effects on parents' employment, a more negative impact on fathers' than mothers' earnings and no effect on inpatient diagnosis of mental and behavioral disorders. Future research should explore mechanisms possibly explaining, for example, mental health, social support and priorities regarding work and private life potentially resulting in changes from full‐time to part‐time work or vice versa. The novel findings should change clinical practice and help inform health policies for parents of children with cancer in Sweden and countries with a similar health and welfare system.
The CT method is inferior to epiaortic ultrasound, today's gold standard, in diagnosing the extent and location of atherosclerosis of the ascending aorta. Other methods, possibly magnetic resonance imaging, should be considered.
Background Recruitment into clinical trials is challenging and there is a lack of evidence on effective recruitment strategies. Personalisation of invitation letters is a potentially pragmatic and feasible way of increasing recruitment rates at a low-cost. However, there is a lack of evidence concerning the effect of personalising of study invitation letters on recruitment rates. Methods We undertook a Study Within A Trial (SWAT) to investigate the effect of personalised versus non-personalised study invitation letters on recruitment rates into the host feasibility trial ENGAGE, a feasibility study of an internet-administered, guided, Low Intensity Cognitive-Behavioural Therapy based self-help intervention for parents of children previously treated for cancer. An intervention group (n = 254) received a personalised study invitation letter and the control group (n = 255) received a non-personalised study invitation letter. The primary outcome was the proportion of participants in the intervention group and the control group enrolled into the ENGAGE host feasibility trial. Secondary outcomes relating to the recruitment and screening process, and retention were examined. Differences in proportions between groups for the primary and secondary outcomes were estimated using logistic regression. Results Of the 509 potential participants, 56 (11.0%) were enrolled into the ENGAGE host feasibility trial: personalised: 30/254 (11.8%) and non-personalised: 26/255 (10.2%). No statistically significant effect on personalisation of enrolment was found (OR 1.18, 95% CI 0.68–2.06). No statistically significant differences were found for any secondary outcome. Conclusions Personalisation of study invitations had no effect on recruitment. However, given the small study sample size in the present SWAT, and lack of similar embedded recruitment RCTs to enable a meta-analysis, additional SWATs to examine the personalisation of study invitation letters are warranted. Trial registration ISRCTN57233429; ISRCTN18404129; SWAT 112, Northern Ireland Hub for Trials Methodology Research SWAT repository (2018 OCT 1 1231) (https://www.qub.ac.uk/sites/TheNorthernIrelandNetworkforTrialsMethodologyResearch/FileStore/Filetoupload,939618,en.pdf).
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