44551
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Shuai T, Pei Jing Y, Huang Q, Xiong H, Liu J, Zhu L, Yang K, Jian L. Serum soluble urokinase type plasminogen activated receptor and focal segmental glomerulosclerosis: a systematic review and meta-analysis. BMJ Open 2019; 9:e031812. [PMID: 31594897 PMCID: PMC6797292 DOI: 10.1136/bmjopen-2019-031812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Soluble urokinase plasminogen activated receptor (suPAR) is a biomarker that may predict the occurrence of focal segmental glomerulosclerosis (FSGS); however, there is still controversy about whether suPAR can predict FSGS. In this study, we performed a systematic evaluation and meta-analysis to prove whether suPAR can predict FSGS, and to detect a threshold concentration of suPAR that can be used to diagnose FSGS. In addition, a threshold concentration of suPAR for the diagnosis of FSGS was proposed. DESIGN Systematic review and meta-analysis. DATA SOURCES We systematically searched PubMed, Embase, Cochrane Library, Web of Science and China Biology Medicine databases for studies published from the inception dates to 1 December 2018. ELIGIBILITY CRITERIA: (1) Data involving the suPAR level were from blood samples; (2) FSGS was diagnosed by biopsy; and (3) randomised controlled trials, cohort studies, case-control studies and cross-sectional studies. DATA EXTRACTION AND SYNTHESIS Initially, a total of 364 studies were searched, among which 29 studies were finally included. In addition, seven studies described the cut-off value of suPAR, which ranged from 2992.6 to 5500 pg/mL. RESULTS The results showed that the suPAR levels in the primary FSGS group were significantly higher when compared with that in the normal control group (p<0.001; standard mean difference (SMD): 2.56; 95% CI 1.85 to 3.28), and significant differences were observed in the secondary FSGS and in the normal control group (p<0.001; SMD: 1.68; 95% CI 1.37 to 1.98). A suPAR concentration of 3000 pg/mL may be the best threshold for the diagnosis of primary FSGS (sensitivity=0.72; specificity=0.88; area under the curve=0.85). CONCLUSION Our results suggested that suPAR might be a potential biomarker for predicting primary and secondary FSGS. In addition, our data showed that a suPAR concentration of 3000 pg/mL might be used as a threshold for the diagnosis of FSGS. TRIAL REGISTRATION NUMBER CRD42019120948.
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Affiliation(s)
- Tiankui Shuai
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Yan Pei Jing
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital, Lanzhou, China
| | - Qiangru Huang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Huaiyu Xiong
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Jingjing Liu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Lei Zhu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital, Lanzhou, China
- Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, China
- Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Liu Jian
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China
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44552
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Chkhartishvili N, Holban T, Simonović Babić J, Alexiev I, Matičič M, Kowalska J, Horban A. State of viral hepatitis care in 16 countries of Central and Eastern European Region. Cent Eur J Public Health 2019; 27:212-216. [PMID: 31580556 DOI: 10.21101/cejph.a5486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 07/03/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Survey was conducted to assess state of viral hepatitis care in Central and Eastern Europe (CEE). METHODS Representatives of 16 CEE countries completed on-line survey in April-May 2017 that collected information on basic epidemiology and availability of key services for HCV and HBV infections. Sources of information provided ranged from national surveillance data to expert opinion. RESULTS The burden of viral hepatitis varied between countries, ranging from 6,500 to 2 million for HCV and from 10,000 to 3 million for HBV. Access to routine HCV RNA testing and genotyping was reported by 11 and 9 countries, respectively. HCV resistance testing was available in 7 countries. Direct acting antivirals (DAAs) were available in 13 countries, most frequently Sofosbuvir and Ledipasvir/Sofosbuvir (12 countries apiece) and Ombitasvir/Paritaprevir/Dasabuvir (9 countries). HBV DNA testing and HBV genotyping were routinely available in 10 and 7 countries, respectively. Eleven countries reported available treatment with Tenofovir. CONCLUSIONS There are gaps in viral hepatitis care in CEE. Despite the availability of registered modern drugs for HCV and HBV, the access to treatment is limited. Ensuring quality health care is essential to reduce the epidemic and achieve the WHO's goal of eliminating viral hepatitis as a major public health challenge.
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Affiliation(s)
| | - Tiberiu Holban
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | | | - Ivailo Alexiev
- National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Mojca Matičič
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Justyna Kowalska
- Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Horban
- Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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44553
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Wang X, Liu J, Huang L, Zeng H, He G, Chen L, Ma R, Fu W, Ning B. Anti-diabetic agents for prevention of type 2 diabetes mellitus in people with pre-diabetes: a systematic review and network meta-analysis protocol. BMJ Open 2019; 9:e029073. [PMID: 31594873 PMCID: PMC6797281 DOI: 10.1136/bmjopen-2019-029073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a substantial health problem worldwide. Pre-diabetic state is associated with increased risk for the development of diabetes. There are various pharmacological therapies with glucose-lowering activity for diabetes prevention. Of those, most are being compared with placebo instead of active agents. The relative effects and safety of different glucose-lowering drugs still remain uncertain. To address this gap, we will conduct a systematic review and network meta-analysis (NMA) to evaluate comparative efficacy and safety of glucose-lowering agents for T2DM prevention in patients with pre-diabetes. METHODS AND ANALYSIS PubMed, the Cochrane library and Embase will be searched from inception to December 2019 for relevant randomised controlled trials (RCTs) that examined anti-diabetic drugs for diabetes prevention in patients with pre-diabetes. Two reviewers working independently will screen titles, abstracts and full papers. Data extraction will also be completed by two independent authors. The primary outcome will be the incidence of T2DM in patients with pre-diabetes at baseline. Secondary outcomes will include the achievement of normoglycaemia, all-cause mortality, cardiovascular mortality and hypoglycaemic event. Pairwise meta-analysis and NMA will be conducted for each outcome using a frequentist random-effects model. Additionally, subgroup analyses will also be performed. The comparison-adjusted funnel plot will be used to assess publication bias. The overall quality of evidence will be rated with the Grading of Recommendations Assessment, Development and Evaluation framework. Data analysis will be conducted using Stata V.14.0. ETHICS AND DISSEMINATION Ethics approval is not required. We plan to submit the results of this study to a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42019119157.
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Affiliation(s)
- Xianzhe Wang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiabin Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lijin Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hai Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoxin He
- The First College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling Chen
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Rui Ma
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wenbin Fu
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Shenzhen Bao'an Research Center for Acupuncture and Moxibustion, Shenzhen, China
| | - Baile Ning
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Shenzhen Bao'an Research Center for Acupuncture and Moxibustion, Shenzhen, China
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44554
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Mill JG, Malta DC, Machado ÍE, Pate A, Pereira CA, Jaime PC, Szwarcwald CL, Rosenfeld LG. Estimation of salt intake in the Brazilian population: results from the 2013 National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 02:E190009.SUPL.2. [PMID: 31596380 DOI: 10.1590/1980-549720190009.supl.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/19/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the salt intake in the Brazilian population according to their urinary sodium excretion. METHODS The National Health Survey (2013) aimed to gather data on the health of adults (≥ 18 years) through a random selection of households. In each household, one adult was selected to have their biological data collected (anthropometry, blood pressure, and blood and urine tests). The urine sample was sent to a central laboratory to determine sodium (ion-selective electrode) and creatinine (Jaffé method) concentrations. Sodium excretion was estimated with the Tanaka equation. RESULTS Urinary sodium and creatinine concentrations were measured in 8,083individuals (58% women). The mean salt intake was estimated at 9.34 g/day (95% confidence interval - 95%CI 9.27 - 9.41) and was higher in males (9.63 g/day; 95%CI 9.52 - 9.74) than in females (9.08 g/day; 95%CI 8.99 - 9.17). Wefound no significant differences regarding age group, ethnicity, or schooling. Salt intake was higher in the Southeast and South regions and lower in the Northeast and North. Only 2.4% (95%CI 2.0 - 2.8) of the sample consumed less than 5 g/day, and 58.2% (95%CI 56.7 - 59.6) of participants had an estimated intake of 8 to 12 g/day. CONCLUSION The mean salt intake in the Brazilian population is approximately twice the recommended by the World Health Organization (5g/day).Given the association of high salt intake with hypertension and decreased renal function, these data indicate the need to adopt comprehensive public policies to reduce the consumption in the Brazilian population.
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Affiliation(s)
- José Geraldo Mill
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo - Vitória (ES), Brasil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais- Belo Horizonte (MG), Brasil
| | - Ísis Eloah Machado
- Programa de Pós-Graduação de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Arthur Pate
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Cimar Azeredo Pereira
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - Patrícia Constante Jaime
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde , Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Célia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
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44555
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Nansseu JR, Kameni BS, Assah FK, Bigna JJ, Petnga SJ, Tounouga DN, Tchokfe Ndoula S, Noubiap JJ, Kamgno J. Prevalence of major cardiovascular disease risk factors among a group of sub-Saharan African young adults: a population-based cross-sectional study in Yaoundé, Cameroon. BMJ Open 2019; 9:e029858. [PMID: 31594879 PMCID: PMC6797357 DOI: 10.1136/bmjopen-2019-029858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the prevalence estimates of some major risk factors for cardiovascular disease (CVD) in a young adult-aged population living in Yaoundé, Cameroon. DESIGN A cross-sectional study held from May to July 2017. SETTING PARTICIPANTS: Students aged 18-35 years, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Data were collected on personal and family history as well as lifestyle and nutritional habits; anthropometric parameters and blood pressure were also measured. Prevalence rates were calculated with their respective 95% CI. RESULTS Overall, 931 participants (53.8% males) were included, with a median age of 23 years (IQR 21-25). The prevalence estimates for some major CVD risk factors were: 3.1% (95% CI 2.0 to 4.2) for family history of heart attack, 6.3% (95% CI 4.7 to 7.9) for family history of stroke, 26.7% (95% CI 23.9 to 29.5) for hazardous alcohol consumption, 0.9% (95% 0.3 to 1.5) for current tobacco smoking, 27.6% (95% CI 24.7 to 30.5) for secondhand smoking, 88.9% (95% CI 86.9 to 90.9) for physical inactivity, 99.0% (95% CI 98.4 to 99.6) for inadequate fruits and/or vegetables consumption, 39.8% (95% CI 36.7 to 42.9) for self-reported anxiety, 49.2% (95% CI 46.0 to 52.4) for self-reported depression, 22.1% (95% CI 19.4 to 24.8) for overweight, 3.9% (95% CI 2.7 to 5.1) for obesity, 14.4% (95% CI 12.1 to 16.7) for abdominal obesity, 14.5% (95% CI 12.2 to 16.8) for excess body fat mass, 30.0% (95% CI 27.1 to 32.9) for suspected prehypertension and 2.8% (95% CI 1.7 to 3.9) for suspected hypertension. CONCLUSION The prevalence of some major CVD risk factors is high among young adults living in Yaoundé, Cameroon. Therefore, specific actions should be undertaken in this population to mitigate the upcoming burden of CVD. Accordingly, younger-aged adult populations should be encouraged and accompanied to practice physical activity, eat healthily, and stop or avoid smoking and/or hazardous alcohol consumption.
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Affiliation(s)
- Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
- Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Bibiane Siaheu Kameni
- HIV Care Unit, Ngaoundéré Regional Hospital and Regional Technical Group for the fight against HIV/AIDS, Adamawa Regional Delegation, Ministry of Public Health, Ngaoundere, Cameroon
| | - Felix Kembe Assah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, France
| | - Saint-Just Petnga
- Kousseri Regional Hospital, Far-North Regional Delegation, Ministry of Public Health, Kousseri, Cameroon
| | - Dahlia Noelle Tounouga
- Lafe-Baleng Divisional Health Centre, Western Regional Delegation, Ministry of Public Health, Bafoussam, Cameroon
| | - Shalom Tchokfe Ndoula
- Regional Technical Group of the Expanded Program on Immunization, Far-North Regional Delegation, Ministry of Public Health, Maroua, Cameroon
| | - Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Joseph Kamgno
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
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44556
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Shin J, Han SH, Choi J. Exposure to Ambient Air Pollution and Cognitive Impairment in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193767. [PMID: 31591354 PMCID: PMC6801547 DOI: 10.3390/ijerph16193767] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/14/2019] [Accepted: 10/04/2019] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate the associations between ambient air pollutants and cognitive impairment in Korean older adults. The cognitive function of 2,896 participants aged 70 to 84 years was measured using the Korean version of the mini-mental state examination, the digit span test, the word list learning test, and the frontal assessment battery. After matching the average concentrations of particulate matter (PM) <10 μm in size (PM10) and <2.5 μm (PM2.5), NO2, CO, SO2, and O3 between 2013 and 2017, the association between air pollutants and cognitive scales was analyzed using a linear mixed regression and a multiple logistic regression analysis (after adjusting for age, sex, health related behaviors, socioeconomic status, comorbidity, and meteorological data). Exposure to PM2.5, PM10, NO2, SO2, and CO was associated with cognitive impairment above and beyond age or education level effects. Specifically, PM2.5 was negatively associated with most components of the cognitive scales (interquartile range for PM2.5: 2.0 μg/m3, odds ratio for poor global cognition: 2.28, 95% confidence interval: 1.60-3.26). These associations may be affected by sex, residence area, or alcohol intake. Conclusively, air pollutants, especially PM2.5, were associated with cognitive impairment, including global cognition, attention, memory, and executive function in Korean older adults aged ≥70 years.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Research Institute on Healthy aging, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, Korea.
| | - Seol-Heui Han
- Department of Neurology, Research Institute on Healthy aging, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, Korea.
| | - Jaekyung Choi
- Department of Family Medicine, Research Institute on Healthy aging, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, Korea.
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44557
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Melaku YA, Reynolds AC, Gill TK, Appleton S, Adams R. Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study. Nutrients 2019; 11:nu11102374. [PMID: 31590356 PMCID: PMC6835535 DOI: 10.3390/nu11102374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/21/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
Epidemiological evidence on the association between macronutrient intake and excessive daytime sleepiness (EDS) is scarce. Using data from the North West Adelaide Health Study, we aimed to determine the association between iso-caloric substitution of macronutrients and EDS. Data from 1997 adults aged ≥ 24 years were analyzed. Daytime sleepiness was measured using the Epworth Sleepiness Scale, a score ≥ 11 was considered EDS. Dietary intake data were collected using a food frequency questionnaire. We determined absolute and relative energy intake based on consumption of saturated and unsaturated fats, protein, and carbohydrate. Odds ratios (ORs) were used to determine the associations using log-binomial logistic regression with and without iso-caloric substitution methods, and models were adjusted for confounders. The prevalence of EDS in the sample was 10.6%. After adjusting for potential confounders, substituting 5% energy intake from protein with an equal amount of saturated fat (OR = 1.57; 95% CI: 1.00–2.45) and carbohydrate (OR = 1.23; 95% CI: 0.92–1.65) increased the odds of EDS. When carbohydrate was substituted with saturated fat (OR = 1.27; 95% CI: 0.93–1.59), the odds of EDS were increased. The odds of EDS were lower when saturated fat was substituted with unsaturated fat (OR = 0.74; 95% CI: 0.51–1.06), protein (OR = 0.63; 95% CI: 0.41–0.99) or carbohydrate (OR = 0.79; 95% CI: 0.57–1.08). While these results were consistent over different iso-caloric substitution methods, inconsistent results were found with standard regression. While substitution of fat and carbohydrate with protein was inversely associated with EDS, substitution of protein with fat and carbohydrate was positively associated with EDS. Randomized trials are needed to confirm if dietary interventions can be used to improve daytime alertness in those with EDS.
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Affiliation(s)
- Yohannes Adama Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia.
| | - Amy C Reynolds
- The Appleton Institute, CQ University Australia, Adelaide 5034, SA, Australia.
- School of Health, Medical and Applied Sciences, CQ University Australia Adelaide Campus, Adelaide 5034, SA, Australia.
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide 5005, SA, Australia.
| | - Sarah Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia.
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide 5011, SA, Australia.
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia.
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia.
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide 5011, SA, Australia.
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia.
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44558
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Lemoinne S, Friedman SL. New and emerging anti-fibrotic therapeutics entering or already in clinical trials in chronic liver diseases. Curr Opin Pharmacol 2019; 49:60-70. [PMID: 31590120 DOI: 10.1016/j.coph.2019.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 02/07/2023]
Abstract
Chronic liver diseases with different etiologies represent a major public health issue worldwide. Liver fibrosis is the common feature of almost all chronic liver diseases and remains a key determinant of clinical prognosis. Over the last two decades, basic science studies have uncovered molecular mechanisms underlying the pathophysiology of chronic liver diseases, leading to the recent development of new anti-fibrotic drugs. These new drugs target different steps in the pathophysiology of chronic liver injury: metabolism of glucose, lipids and bile acids, apoptosis, inflammation and fibrosis. Many targets are shared between non-alcoholic steatohepatitis (NASH) and cholestatic diseases, explaining why some drugs have been assessed concurrently in both conditions. This review reports the most recent clinical trials designed to treat liver fibrosis, with a special focus on NASH and cholestatic diseases.
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Affiliation(s)
- Sara Lemoinne
- Division of Liver Diseases, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Scott L Friedman
- Division of Liver Diseases, Icahn Medical School at Mount Sinai, New York, NY, USA.
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44559
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Yin XR, Liu ZH, Liu J, Liu YY, Xie L, Tao LB, Jia JD, Cui FQ, Zhuang GH, Hou JL. First line nucleos(t)ide analog monotherapy is more cost-effective than combination strategies in hepatitis B e antigen-positive chronic hepatitis B patients in China. Chin Med J (Engl) 2019; 132:2315-2324. [PMID: 31567376 PMCID: PMC6819033 DOI: 10.1097/cm9.0000000000000445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nucleos(t)ide analog (NA) in combination with peginterferon (PegIFN) therapy in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) shows better effectiveness than NA monotherapy in hepatitis B surface antigen loss, termed "functional cure," based on previous published studies. However, it is not known which strategy is more cost-effective on functional cure. The aim of this study was to analyze the cost-effectiveness of first-line monotherapies and combination strategies in HBeAg-positive CHB patients in China from a social perspective. METHODS A Markov model was developed with functional cure and other five states including CHB, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death to assess the cost-effectiveness of seven representative treatment strategies. Entecavir (ETV) monotherapy and tenofovir disoproxil fumarate (TDF) monotherapy served as comparators, respectively. RESULTS In the two base-case analysis, compared with ETV, ETV generated the highest costs with $44,210 and the highest quality-adjusted life-years (QALYs) with 16.78 years. Compared with TDF, treating CHB patients with ETV and NA - PegIFN strategies increased costs by $7639 and $6129, respectively, gaining incremental QALYs by 2.20 years and 1.66 years, respectively. The incremental cost-effectiveness ratios were $3472/QALY and $3692/QALY, respectively, which were less than one-time gross domestic product per capita. One-way sensitivity analysis and probabilistic sensitivity analyses showed the robustness of the results. CONCLUSION Among seven treatment strategies, first-line NA monotherapy may be more cost-effective than combination strategies in HBeAg-positive CHB patients in China.
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Affiliation(s)
- Xue-Ru Yin
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Zhi-Hong Liu
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jing Liu
- Health Economics Research Institute, Sun Yat-Sen University, Guangzhou, Guangdong 510085, China
| | - Yuan-Yuan Liu
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Li Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiao Tong University Health Science Center, Xi’an, Shaanxi 710061, China
| | - Li-Bo Tao
- Health Economics Research Institute, Sun Yat-Sen University, Guangzhou, Guangdong 510085, China
| | - Ji-Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Fu-Qiang Cui
- School of Public Health, Peking University, Beijing 100191, China
| | - Gui-Hua Zhuang
- School of Public Health, Xi’an Jiao Tong University Health Science Center, Xi’an, Shaanxi 710061, China
| | - Jin-Lin Hou
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
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44560
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Quality improvement in hospitals in the Russian Federation, 2000-2016: a systematic review. HEALTH ECONOMICS POLICY AND LAW 2019; 15:403-413. [PMID: 31581966 PMCID: PMC7525099 DOI: 10.1017/s1744133119000252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We reviewed published evidence on quality improvement in hospitals in the Russian Federation since 2000. We used three data sources: MEDLINE, 'Rossiiskaia Meditsina' (Central Scientific Medical Library), and elibrary.ru using specific search terms. No language or study design restrictions were imposed. In total, 1717 articles were identified; 51 met the inclusion criteria and were thematically analysed. Russian legislation, government acts and grey literature were sourced to contextualise identified themes. Since 2010, the Federal Ministry of Health has increasingly sought to improve quality of care, providing additional resources and new initiatives across the health system. These include clinical practice guidelines, pay for performance schemes, electronic medical records, more specialist care, paraclinical care, and quality control systems. Quality of care, increasingly a concern of the Russian government, is said to be improving. Yet most initiatives have rarely been evaluated. This reflects the limited capacity for health services research in Russia. It seems likely that the full potential for improvements in quality of care in Russia is still to be realised.
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44561
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Do Older Adults with Multimorbidity Meet the Recommended Levels of Physical Activity? An Analysis of Scottish Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193748. [PMID: 31590293 PMCID: PMC6801591 DOI: 10.3390/ijerph16193748] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022]
Abstract
There is a positive association between physical activity (PA) and improved health in older adults. The objective of this study was to assess the prevalence and determinants of meeting recommended levels of PA among older adults with multimorbidity. Data has been derived from the nationally representative Scottish Health Surveys (2014–2017). A sub-sample of 2230 older adults (aged 65+) with multimorbidity were the study participants. Physical activity was evaluated using current recommended guidelines. Overall, 32.3% of the participants met the recommended levels of PA. Independent predictors of meeting the recommended levels of PA include male gender [odds ratio (OR) 2.00 (95% confidence interval (CI) 1.58–2.54)], living in the least deprived areas [OR 1.79 (95% CI 1.20–2.69)]; being a non-smoker [OR 2.22 (95% CI 1.48–3. 34)]. Also, meeting recommended PA decreased with age [OR 0.92 (95% CI 0.90–0.94)] and body mass index [OR 0.93 (95% CI 0.91–0.95]; but increased per additional portion of fruit and vegetables taken [OR 1.19 (95% CI 1.12–1.25)] and with increase in well-being scale score [OR 1.05 (95% CI 1.03 to 1.06)]. Adherence to PA guidelines seems to be more related to age, BMI, gender (i.e. higher PA adherence in men vs. women), social support (i.e. social deprivation), dietary habits (i.e. fruit and vegetable intake) and social isolation among the elderly. In the one-third of older population, adherence to PA was associated to better mental health. Therefore, adaptation of PA guideline to suit theses determinants factors would reduce the gap difference among older adults with multimorbidity and enhance their mental well-being.
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44562
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Rehm J, Crépault JF, Hasan OSM, Lachenmeier DW, Room R, Sornpaisarn B. Regulatory Policies for Alcohol, other Psychoactive Substances and Addictive Behaviours: The Role of Level of Use and Potency. A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3749. [PMID: 31590298 PMCID: PMC6801613 DOI: 10.3390/ijerph16193749] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
Abstract
The object of this contribution based on a systematic review of the literature is to examine to what degree the level of use and potency play a role in regulatory policies for alcohol, other psychoactive substances and gambling, and whether there is an evidence base for this role. Level of use is usually defined around a behavioural pattern of the user (for example, cigarettes smoked per day, or average ethanol use in grams per day), while potency is defined as a property or characteristic of the substance. For all substances examined (alcohol, tobacco, opioids, cannabis) and gambling, both dimensions were taken into consideration in the formulation of most regulatory policies. However, the associations between both dimensions and regulatory policies were not systematic, and not always based on evidence. Future improvements are suggested.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7, Canada.
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada.
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992 Moscow, Russia.
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Jean-François Crépault
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7, Canada.
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7, Canada
| | - Dirk W Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Strasse 3, 76187 Karlsruhe, Germany.
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria 3086, Australia.
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, 106 91 Stockholm, Sweden.
| | - Bundit Sornpaisarn
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
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44563
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Carrillo-Larco RM, Albitres-Flores L, Barengo NC, Bernabe-Ortiz A. The association between serum lipids and risk of premature mortality in Latin America: a systematic review of population-based prospective cohort studies. PeerJ 2019; 7:e7856. [PMID: 31592360 PMCID: PMC6779113 DOI: 10.7717/peerj.7856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To synthetize the scientific evidence on the association between serum lipids and premature mortality in Latin America (LA). METHODS Five data bases were searched from inception without language restrictions: Embase, Medline, Global Health, Scopus and LILACS. Population-based studies following random sampling methods were identified. The exposure variable was lipid biomarkers (e.g., total, LDL- or HDL- cholesterol). The outcome was all-cause and cause-specific mortality. The risk of bias was assessed following the Newcastle-Ottawa criteria. Results were summarized qualitatively. RESULTS The initial search resulted in 264 abstracts, five (N = 27,903) were included for the synthesis. Three papers reported on the same study from Puerto Rico (baseline in 1965), one was from Brazil (1996) and one from Peru (2007). All reports analysed different exposure variables and used different risk estimates (relative risks, hazard ratios or odds ratios). None of the reviewed reports showed strong association between individual lipid biomarkers and all-cause or cardiovascular mortality. CONCLUSION The available evidence is outdated, inconsistently reported on several lipid biomarker definitions and used different methods to study the long-term mortality risk. These findings strongly support the need to better ascertain the mortality risk associated with lipid biomarkers in LA.
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Affiliation(s)
- Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centro de Estudios de Población, Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Chimbote, Peru
| | - Leonardo Albitres-Flores
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo-SOCEMUNT, Trujillo, Peru
| | - Noël C. Barengo
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, United States of America
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, Rı¯ga Stradiņš University (RSU), Riga, Latvia
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
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44564
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Yang Q, Yin W, Chen Y, Zhu D, Yin J, Zhang C, Gao Y. Betaine alleviates alcohol-induced osteonecrosis of the femoral head via mTOR signaling pathway regulation. Biomed Pharmacother 2019; 120:109486. [PMID: 31586901 DOI: 10.1016/j.biopha.2019.109486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/14/2019] [Accepted: 09/22/2019] [Indexed: 02/07/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is usually caused by chronic and excessive alcohol dependency, and this condition largely suppresses the osteogenic differentiation of bone mesenchymal stem cells (BMSCs). As a trimethyl derivative of glycine, betaine is an important human nutrient that regulates a series of vital biological processes, including oxidative stress, inflammatory responses, osteoblast differentiation and cellular apoptosis. However, no study has investigated the role of betaine in alcohol-induced ONFH. In this study, we hypothesized that betaine might have protective effects on ethanol-treated BMSCs and decrease the morbidity of alcohol-induced ONFH in a rat model. In vitro, we found that ethanol significantly downregulated the expression of osteocalcin (OCN), collagen 1 (COL1) and RUNX2 via activating the mammalian target of rapamycin (mTOR) signaling cascade. However, the inhibitory effects were rescued by betaine co-treatment at concentrations of 1 mM and 10 mM. In vivo, the typical ONFH pathological changes in a rat model of alcohol-induced ONFH were investigated by using multiple methods, including hematoxylin-eosin staining, micro-CT scans, TdT-mediated dUTP nick end labeling (TUNEL) assays and immunohistochemical staining for OCN and COL1. Osteonecrotic lesions of the femoral head could be alleviated by betaine as evidenced by significant histological and radiological improvements. Collectively, betaine plays a protective role against ethanol-induced suppression of osteogenesis and mineralization of hBMSCs and is thus a potential pharmacotherapy for alcohol-induced ONFH in vivo.
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Affiliation(s)
- Qianhao Yang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Wenjing Yin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yixuan Chen
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Daoyu Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Junhui Yin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Institute of Microsurgery on Extremities, Shanghai, 200233, China
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Institute of Microsurgery on Extremities, Shanghai, 200233, China.
| | - Youshui Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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44565
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Rundle CW, Dellavalle RP. Nonsteroidal anti-inflammatory drug associations with nonmelanoma skin cancer - the saga continues. Br J Dermatol 2019; 181:654-656. [PMID: 31576570 DOI: 10.1111/bjd.18345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C W Rundle
- Department of Dermatology, University of Colorado School of Medicine, Denver, CO, U.S.A
| | - R P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, CO, U.S.A.,Department of Public Health, University of Colorado School of Medicine, Denver, CO, U.S.A.,Chief, Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, U.S.A
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44566
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Chen S, Eikermann‐Haerter K. How Imaging Can Help Us Better Understand the Migraine‐Stroke Connection. Headache 2019; 60:217-228. [DOI: 10.1111/head.13664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Shih‐Pin Chen
- Division of Translational Research Department of Medical Research Taipei Veterans General Hospital Taipei Taiwan
- Department of Neurology Neurological InstituteTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine National Yang‐Ming University School of Medicine Taipei Taiwan
- Brain Research Center National Yang‐Ming University School of Medicine Taipei Taiwan
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44567
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Zhu D, Chung HF, Dobson AJ, Pandeya N, Giles GG, Bruinsma F, Brunner EJ, Kuh D, Hardy R, Avis NE, Gold EB, Derby CA, Matthews KA, Cade JE, Greenwood DC, Demakakos P, Brown DE, Sievert LL, Anderson D, Hayashi K, Lee JS, Mizunuma H, Tillin T, Simonsen MK, Adami HO, Weiderpass E, Mishra GD. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. LANCET PUBLIC HEALTH 2019; 4:e553-e564. [PMID: 31588031 PMCID: PMC7118366 DOI: 10.1016/s2468-2667(19)30155-0] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023]
Abstract
Background Early menopause is linked to an increased risk of cardiovascular disease mortality; however, the association between early menopause and incidence and timing of cardiovascular disease is unclear. We aimed to assess the associations between age at natural menopause and incidence and timing of cardiovascular disease. Methods We harmonised and pooled individual-level data from 15 observational studies done across five countries and regions (Australia, Scandinavia, the USA, Japan, and the UK) between 1946 and 2013. Women who had reported their menopause status, age at natural menopause (if postmenopausal), and cardiovascular disease status (including coronary heart disease and stroke) were included. We excluded women who had hysterectomy or oophorectomy and women who did not report their age at menopause. The primary endpoint of this study was the occurrence of first non-fatal cardiovascular disease, defined as a composite outcome of incident coronary heart disease (including heart attack and angina) or stroke (including ischaemic stroke or haemorrhagic stroke). We used Cox proportional hazards models to estimate multivariate hazard ratios (HRs) and 95% CIs for the associations between age at menopause and incident cardiovascular disease event. We also adjusted the model to account for smoking status, menopausal hormone therapy status, body-mass index, and education levels. Age at natural menopause was categorised as premenopausal or perimenopausal, younger than 40 years (premature menopause), 40–44 years (early menopause), 45–49 years (relatively early), 50–51 years (reference category), 52–54 years (relatively late), and 55 years or older (late menopause). Findings Overall, 301 438 women were included in our analysis. Of these 301 438 women, 12 962 (4·3%) had a first non-fatal cardiovascular disease event after menopause, of whom 9369 (3·1%) had coronary heart disease and 4338 (1·4%) had strokes. Compared with women who had menopause at age 50–51 years, the risk of cardiovascular disease was higher in women who had premature menopause (age <40 years; HR 1·55, 95% CI 1·38–1·73; p<0·0001), early menopause (age 40–44 years; 1·30, 1·22–1·39; p<0·0001), and relatively early menopause (age 45–49 years; 1·12, 1·07–1·18; p<0·0001), with a significantly reduced risk of cardiovascular disease following menopause after age 51 years (p<0·0001 for trend). The associations persisted in never smokers, and were strongest before age 60 years for women with premature menopause (HR 1·88, 1·62–2·20; p<0·0001) and early menopause (1·40, 1·27–1·54; p<0·0001), but were attenuated at age 60–69 years, with no significant association observed at age 70 years and older. Interpretation Compared with women who had menopause at age 50–51 years, women with premature and early menopause had a substantially increased risk of a non-fatal cardiovascular disease event before the age of 60 years, but not after age 70 years. Women with earlier menopause need close monitoring in clinical practice, and age at menopause might also be considered as an important factor in risk stratification of cardiovascular disease for women. Funding Australian National Health and Medical Research Council.
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Affiliation(s)
- Dongshan Zhu
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Hsin-Fang Chung
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Annette J Dobson
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Nirmala Pandeya
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Rebecca Hardy
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ellen B Gold
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, CA, USA
| | - Carol A Derby
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Darren C Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Daniel E Brown
- Department of Anthropology, University of Hawaii, Hilo, HI, USA
| | - Lynnette L Sievert
- Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | | | - Jung Su Lee
- Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Therese Tillin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Mette Kildevæld Simonsen
- Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark; Aarhus University, Aarhus, Denmark
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Gita D Mishra
- School of Public Health, University of Queensland, Brisbane, QLD, Australia.
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44568
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Hoffmann A, Ziller M, Spengler D. Progress in iPSC-Based Modeling of Psychiatric Disorders. Int J Mol Sci 2019; 20:E4896. [PMID: 31581684 PMCID: PMC6801734 DOI: 10.3390/ijms20194896] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022] Open
Abstract
Progress in iPSC-based cellular systems provides new insights into human brain development and early neurodevelopmental deviations in psychiatric disorders. Among these, studies on schizophrenia (SCZ) take a prominent role owing to its high heritability and multifarious evidence that it evolves from a genetically induced vulnerability in brain development. Recent iPSC studies on patients with SCZ indicate that functional impairments of neural progenitor cells (NPCs) in monolayer culture extend to brain organoids by disrupting neocorticogenesis in an in vitro model. In addition, the formation of hippocampal circuit-like structures in vitro is impaired in patients with SCZ as is the case for glia development. Intriguingly, chimeric-mice experiments show altered oligodendrocyte and astrocyte development in vivo that highlights the importance of cell-cell interactions in the pathogenesis of early-onset SCZ. Likewise, cortical imbalances in excitatory-inhibitory signaling may result from a cell-autonomous defect in cortical interneuron (cIN) development. Overall, these findings indicate that genetic risk in SCZ impacts neocorticogenesis, hippocampal circuit formation, and the development of distinct glial and neuronal subtypes. In light of this remarkable progress, we discuss current limitations and further steps necessary to harvest the full potential of iPSC-based investigations on psychiatric disorders.
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Affiliation(s)
- Anke Hoffmann
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, 80804 Munich, Germany.
| | - Michael Ziller
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, 80804 Munich, Germany.
| | - Dietmar Spengler
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, 80804 Munich, Germany.
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44569
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Meng E, Mao Y, Yao Q, Han X, Li X, Zhang K, Jin W. Population-based study of environmental/occupational lead exposure and amyotrophic lateral sclerosis: a systematic review and meta-analysis. Neurol Sci 2019; 41:35-40. [DOI: 10.1007/s10072-019-04067-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
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44570
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Qian MB, Chen J, Bergquist R, Li ZJ, Li SZ, Xiao N, Utzinger J, Zhou XN. Neglected tropical diseases in the People's Republic of China: progress towards elimination. Infect Dis Poverty 2019; 8:86. [PMID: 31578147 PMCID: PMC6775666 DOI: 10.1186/s40249-019-0599-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 02/08/2023] Open
Abstract
Since the founding of the People's Republic of China in 1949, considerable progress has been made in the control and elimination of the country's initial set of 11 neglected tropical diseases. Indeed, elimination as a public health problem has been declared for lymphatic filariasis in 2007 and for trachoma in 2015. The remaining numbers of people affected by soil-transmitted helminth infection, clonorchiasis, taeniasis, and echinococcosis in 2015 were 29.1 million, 6.0 million, 366 200, and 166 100, respectively. In 2017, after more than 60 years of uninterrupted, multifaceted schistosomiasis control, has seen the number of cases dwindling from more than 10 million to 37 600. Meanwhile, about 6000 dengue cases are reported, while the incidence of leishmaniasis, leprosy, and rabies are down at 600 or fewer per year. Sustained social and economic development, going hand-in-hand with improvement of water, sanitation, and hygiene provide the foundation for continued progress, while rigorous surveillance and specific public health responses will consolidate achievements and shape the elimination agenda. Targets for poverty elimination and strategic plans and intervention packages post-2020 are important opportunities for further control and elimination, when remaining challenges call for sustainable efforts.
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Affiliation(s)
- Men-Bao Qian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, WHO Collaborating Center for Tropical Diseases, Shanghai, People’s Republic of China
| | - Jin Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, WHO Collaborating Center for Tropical Diseases, Shanghai, People’s Republic of China
| | | | - Zhong-Jie Li
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Shi-Zhu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, WHO Collaborating Center for Tropical Diseases, Shanghai, People’s Republic of China
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, WHO Collaborating Center for Tropical Diseases, Shanghai, People’s Republic of China
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, WHO Collaborating Center for Tropical Diseases, Shanghai, People’s Republic of China
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44571
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Gururajan A, Reif A, Cryan JF, Slattery DA. The future of rodent models in depression research. Nat Rev Neurosci 2019; 20:686-701. [DOI: 10.1038/s41583-019-0221-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 12/15/2022]
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44572
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Cheung AC, Kwo PY. iLFT: A big assist in the recognition of liver disease in general practice. J Hepatol 2019; 71:651-653. [PMID: 31447223 DOI: 10.1016/j.jhep.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/01/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Amanda C Cheung
- Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA 94063, United States
| | - Paul Y Kwo
- Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA 94063, United States.
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44573
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Asarnow JR, Ougrin D. Editorial: Suicide and self-harm: advancing from science to preventing deaths. J Child Psychol Psychiatry 2019; 60:1043-1045. [PMID: 31512762 DOI: 10.1111/jcpp.13131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Globally, suicide is the second leading cause of death among youth ages 15-29-years, and self-harm is one of the strongest known predictors of death by suicide. This editorial introduces the Special Issue on suicide and self-harm, emphasizing the research and policy implications of the included articles. By illustrating advances in our science, the Special Issue both celebrates our achievements and highlights the need to use our science to inform suicide prevention policy and practice to reduce the tragedy of suicide and premature deaths.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dennis Ougrin
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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44574
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Stockings E, Tran LT, Santo T, Peacock A, Larney S, Santomauro D, Farrell M, Degenhardt L. Mortality among people with regular or problematic use of amphetamines: a systematic review and meta-analysis. Addiction 2019; 114:1738-1750. [PMID: 31180607 PMCID: PMC6732053 DOI: 10.1111/add.14706] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/14/2019] [Accepted: 05/31/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Amphetamines are the second most commonly used class of illicit drugs. We aimed to produce pooled estimates of mortality risks among people with regular or dependent use of amphetamines, with a focus upon all-cause mortality as well as specific causes of death. DESIGN Systematic review and meta-analysis of cohorts of people with problematic use or dependence on amphetamines with data on all-cause or cause-specific mortality. SETTING AND PARTICIPANTS Of 4240 papers, 30 were eligible, reporting on 25 cohorts that measured all-cause mortality, drug poisoning, suicide, accidental injuries, homicide and cardiovascular mortality. Cohorts (n = 35-74 139) were in North America, several Nordic countries and Asia Pacific. MEASUREMENT Titles/abstracts were independently screened by one reviewer and excluded those reviewed by a second reviewer. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on crude mortality rates (CMR) per 100 person-years (py), standardized mortality ratios (SMRs). We imputed SMRs where possible if not reported by study authors. We also calculated mortality relative risks. Data were pooled using random-effects models; potential reasons for heterogeneity were explored using subgroup analyses and meta-regressions. FINDINGS Twenty-three cohorts contributed data for the pooled all-cause CMR: 1.14 per 100 py [95% confidence interval (CI) = 0.92-1.42]. Pooled cause-specific mortality rates were: drug poisoning, 0.14 per 100 py (95% CI = 0.06-0.34); cardiovascular disease, 0.13 per 100 py (95% CI = 0.06-0.29); suicide, 0.20 per 100 py (95% CI = 0.07-0.55); accidental injury, 0.20 per 100 py (95% CI = 0.08-0.47) and homicide, 0.03 per 100 py (95% CI = 0.02-0.06). There was substantial heterogeneity for all pooled CMR estimates except homicide. The pooled all-cause SMR was 6.83 (95% CI = 5.27-8.84). Pooled cause-specific SMRS were: poisoning, 24.70 (95% CI = 16.67, 36.58); homicide, 11.90 (95% CI = 7.82-18.12); suicide, 12.20 (95% CI = 4.89-30.47); cardiovascular disease, 5.12 (95% CI = 3.74-7.00) and accidental injury, 5.12 (95% CI = 2.88-9.08). CONCLUSIONS People with regular or dependent amphetamine use are at elevated risk of a range of causes of mortality compared with people without regular or dependent amphetamine use.
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Affiliation(s)
- Emily Stockings
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia
| | - Damian Santomauro
- Queensland Centre for Mental Health Research and School of Public Health, University of Queensland, Locked Bag 500, Archerfield, 4108, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, 2052, Australia
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44575
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Chaudhary N, Pandey AS, Wang X, Xi G. Hemorrhagic stroke-Pathomechanisms of injury and therapeutic options. CNS Neurosci Ther 2019; 25:1073-1074. [PMID: 31583834 PMCID: PMC6776738 DOI: 10.1111/cns.13225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Neeraj Chaudhary
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichigan
- Department of RadiologyUniversity of MichiganAnn ArborMichigan
| | - Aditya S. Pandey
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichigan
- Department of RadiologyUniversity of MichiganAnn ArborMichigan
| | - Xiaoying Wang
- Departments of Neurosurgery and NeurologyTulane UniversityNew OrleansLouisiana
| | - Guohua Xi
- Department of NeurosurgeryUniversity of MichiganAnn ArborMichigan
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44576
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Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019; 16:589-604. [PMID: 31439937 PMCID: PMC6813818 DOI: 10.1038/s41575-019-0186-y] [Citation(s) in RCA: 2371] [Impact Index Per Article: 474.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.
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Affiliation(s)
- Ju Dong Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pierre Hainaut
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Amina Amadou
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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44577
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Evidence for bidirectional and trans-synaptic parasympathetic and sympathetic propagation of alpha-synuclein in rats. Acta Neuropathol 2019; 138:535-550. [PMID: 31254094 PMCID: PMC6778265 DOI: 10.1007/s00401-019-02040-w] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 01/06/2023]
Abstract
The conversion of endogenous alpha-synuclein (asyn) to pathological asyn-enriched aggregates is a hallmark of Parkinson’s disease (PD). These inclusions can be detected in the central and enteric nervous system (ENS). Moreover, gastrointestinal symptoms can appear up to 20 years before the diagnosis of PD. The dual-hit hypothesis posits that pathological asyn aggregation starts in the ENS, and retrogradely spreads to the brain. In this study, we tested this hypothesis by directly injecting preformed asyn fibrils into the duodenum wall of wild-type rats and transgenic rats with excess levels of human asyn. We provide a meticulous characterization of the bacterial artificial chromosome (BAC) transgenic rat model with respect to initial propagation of pathological asyn along the parasympathetic and sympathetic pathways to the brainstem, by performing immunohistochemistry at early time points post-injection. Induced pathology was observed in all key structures along the sympathetic and parasympathetic pathways (ENS, autonomic ganglia, intermediolateral nucleus of the spinal cord (IML), heart, dorsal motor nucleus of the vagus, and locus coeruleus (LC)) and persisted for at least 4 months post-injection. In contrast, asyn propagation was not detected in wild-type rats, nor in vehicle-injected BAC rats. The presence of pathology in the IML, LC, and heart indicate trans-synaptic spread of the pathology. Additionally, the observed asyn inclusions in the stomach and heart may indicate secondary anterograde propagation after initial retrograde spreading. In summary, trans-synaptic propagation of asyn in the BAC rat model is fully compatible with the “body-first hypothesis” of PD etiopathogenesis. To our knowledge, this is the first animal model evidence of asyn propagation to the heart, and the first indication of bidirectional asyn propagation via the vagus nerve, i.e., duodenum-to-brainstem-to-stomach. The BAC rat model could be very valuable for detailed mechanistic studies of the dual-hit hypothesis, and for studies of disease modifying therapies targeting early pathology in the gastrointestinal tract.
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44578
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Wu R. The carbon footprint of the Chinese health-care system: an environmentally extended input-output and structural path analysis study. Lancet Planet Health 2019; 3:e413-e419. [PMID: 31625513 DOI: 10.1016/s2542-5196(19)30192-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND The health sector plays an important part in adapting to climate change; however, the sector is also responsible for significant greenhouse gas (GHG) emissions. In high-income countries, the carbon footprints of health-care systems have been estimated to be 3-10% of the total national GHG emissions, but no in-depth investigation has been done for China. This study aims to examine the carbon footprint of the Chinese health-care system and identify emission hotspots. METHODS Environmentally extended input-output analysis and structural path analysis were used to assess the lifecycle GHG emissions of the Chinese health-care system. A satellite account of GHG emissions was constructed for 46 economic sectors in China using energy data from the National Bureau of Statistics based on the numbers reported by a large number of enterprises. Data on health expenditure for medical institutions, pharmaceuticals, construction, administration, and research were obtained from multiple Chinese official statistics yearbooks and the national input-output table. FINDINGS In 2012, China spent CNY 2539 billion on health care, leading to emissions of 315 (68% CI 267-363) megatonnes CO2 equivalent. Health care accounted for 2·7% (68% CI 2·3-3·1) of China's total GHG emissions. The major contributors of GHG emissions in the health-care system were public hospitals (148 megatonnes [47%]), non-hospital purchased pharmaceuticals (56 megatonnes [18%]), and construction (46 megatonnes [15%]). In medical institutions, energy use for buildings and transport accounted for only 16% of the total carbon footprint, whereas 84% was embodied in the purchased goods and services. INTERPRETATION China has a much smaller health-care carbon footprint per capita than developed countries, such as the USA and Australia. However, its carbon emissions per unit of health expenditure are relatively high because of the expenditure structure and the carbon intensity of the country's entire economy. The results suggest the need for a nationwide carbon-efficient target for health care and use of low-carbon alternatives in making supply chain choices to achieve reductions in the carbon footprint. FUNDING Natural Science Foundation of China.
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Affiliation(s)
- Rui Wu
- School of Business, Nanjing Normal University, Nanjing, 210023, China.
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44579
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Wu Z, Ma Y, Gong X, Zhang Y, Zhao L, Cheng G, Cai S. Rhus chinensis Mill. fruits prevent high-fat/ethanol diet-induced alcoholic fatty liver in rats via AMPK/SREBP-1/FAS signaling pathway. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.103498] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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44580
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Agarwal A, Kandula NR. Closing Gaps in Cardiovascular Disease Prevention Through Community-Centered Primary Health Care Interventions. JAMA Cardiol 2019; 4:986-987. [DOI: 10.1001/jamacardio.2019.3129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anubha Agarwal
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Namratha R. Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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44581
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Gardner MJ, Thomas HJ, Erskine HE. The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2019; 96:104082. [PMID: 31374447 DOI: 10.1016/j.chiabu.2019.104082] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Child maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders. METHODS Published cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment. RESULTS All forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14-2.87]; sexual abuse [OR = 2.11, 1.83-2.44]; physical abuse [OR = 1.78, 1.57-2.01]; emotional abuse [OR = 2.35, 1.74-3.18]; neglect [OR = 1.65, 1.35-2.02]; and exposure to IPV [OR = 1.68, 1.34-2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders ('any child maltreatment' [OR = 1.68, 1.33-2.4]; sexual abuse [OR = 1.90, 1.6-2.25]; physical abuse [OR = 1.56, 1.39-1.76]; and neglect [OR = 1.34, 1.09-1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD). CONCLUSIONS There is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.
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Affiliation(s)
- M J Gardner
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
| | - H J Thomas
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - H E Erskine
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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44582
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Donald M, Beanlands H, Straus S, Ronksley P, Tam-Tham H, Finlay J, Smekal M, Elliott MJ, Farragher J, Herrington G, Harwood L, Large CA, Large CL, Waldvogel B, Delgado ML, Sparkes D, Tong A, Grill A, Novak M, James MT, Brimble KS, Samuel S, Tu K, Hemmelgarn BR. Preferences for a self-management e-health tool for patients with chronic kidney disease: results of a patient-oriented consensus workshop. CMAJ Open 2019; 7:E713-E720. [PMID: 31822502 PMCID: PMC6905858 DOI: 10.9778/cmajo.20190081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Electronic health (e-health) tools may support patients' self-management of chronic kidney disease. We aimed to identify preferences of patients with chronic kidney disease, caregivers and health care providers regarding content and features for an e-health tool to support chronic kidney disease self-management. METHODS A patient-oriented research approach was taken, with 6 patient partners (5 patients and 1 caregiver) involved in study design, data collection and review of results. Patients, caregivers and clinicians from across Canada participated in a 1-day consensus workshop in June 2018. Using personas (fictional characters) and a cumulative voting technique, they identified preferences for content for 8 predetermined topics (understanding chronic kidney disease, diet, finances, medication, symptoms, travel, mental and physical health, work/school) and features for an e-health tool. RESULTS There were 24 participants, including 11 patients and 6 caregivers, from across Canada. The following content suggestions were ranked the highest: basic information about kidneys, chronic kidney disease and disease progression; reliable information on diet requirements for chronic kidney disease and comorbidities, renal-friendly foods; affordability of medication, equipment, food, financial resources and planning; common medications, adverse effects, indications, cost and coverage; symptom types and management; travel limitations, insurance, access to health care, travel checklists; screening and supports to address mental health, cultural sensitivity, adjusting to new normal; and support to help integrate at work/school, restrictions. Preferred features included visuals, the ability to enter and track health information and interact with health care providers, "on-the-go" access, links to resources and access to personal health information. INTERPRETATION A consensus workshop developed around personas was successful for identifying detailed subject matter for 8 predetermined topic areas, as well as preferred features to consider in the codevelopment of a chronic kidney disease self-management e-health tool. The use of personas could be applied to other applications in patient-oriented research exploring patient preferences and needs in order to improve care and relevant outcomes.
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Affiliation(s)
- Maoliosa Donald
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Heather Beanlands
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Sharon Straus
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Paul Ronksley
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Helen Tam-Tham
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Juli Finlay
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Michelle Smekal
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Meghan J Elliott
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Janine Farragher
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Gwen Herrington
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Lori Harwood
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Chantel A Large
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Claire L Large
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Blair Waldvogel
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Maria L Delgado
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Dwight Sparkes
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Allison Tong
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Allan Grill
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Marta Novak
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Matthew T James
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - K Scott Brimble
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Susan Samuel
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Karen Tu
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta
| | - Brenda R Hemmelgarn
- Department of Medicine (Donald, Tam-Tham, Finlay, Smekal, Elliott, Farragher, James, Hemmelgarn), University of Calgary; Interdisciplinary Chronic Disease Collaboration (Donald, Ronksley, Elliott, James, Hemmelgarn), University of Calgary; Department of Community Health Sciences (Donald, Ronksley, Elliott, Hemmelgarn), University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Can-SOLVE CKD patient partner (Herrington, Chantel Large, Claire Large, Waldvogel, Delgado, Sparkes), Vancouver, BC; London Health Sciences Centre (Harwood), London, Ont.; Sydney School of Public Health (Tong), The University of Sydney, Sydney, Australia; Department of Family & Community Medicine (Grill, Tu), University of Toronto; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Department of Pediatrics (Samuel), University of Calgary, Calgary, Alta.
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44583
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Thapa G, Jhalani M, García-Saisó S, Malata A, Roder-DeWan S, Leslie HH. High quality health systems in the SDG era: Country-specific priorities for improving quality of care. PLoS Med 2019; 16:e1002946. [PMID: 31581260 PMCID: PMC6776256 DOI: 10.1371/journal.pmed.1002946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hannah Leslie and co-authors discuss priorities in individual countries for health system reform.
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Affiliation(s)
- Gagan Thapa
- Federal Parliament of Nepal, Kathmandu, Nepal
| | - Manoj Jhalani
- National Health Mission, Ministry of Health and Family Welfare, New Delhi, India
| | - Sebastián García-Saisó
- General Directorate for Quality of Healthcare and Education, Ministry of Health, Ciudad de México, Mexico
| | - Address Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | - Sanam Roder-DeWan
- Health Section, UNICEF, Dar es Salaam, Tanzania
- Health Systems: Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Hannah H. Leslie
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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44584
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Clinical utility of HBV surface antigen quantification in HBV e antigen-negative chronic HBV infection. Nat Rev Gastroenterol Hepatol 2019; 16:631-641. [PMID: 31477873 DOI: 10.1038/s41575-019-0197-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 12/17/2022]
Abstract
Chronic hepatitis B virus (HBV) infection is a serious problem owing to its worldwide distribution and potential adverse sequelae that include cirrhosis and/or hepatocellular carcinoma. Current antiviral therapies have much improved outcomes, but few patients achieve the ultimate goal of hepatitis B surface antigen (HBsAg) loss (functional cure). As hepatitis B e antigen (HBeAg)-negative chronic HBV infection is the final phase prior to HBsAg loss, the management of patients in this phase together with quantification of HBsAg has attracted increasing clinical and research interest. This Review integrates the findings from research in HBsAg kinetics and discusses how they might inform our understanding and management of HBeAg-negative chronic HBV infection. Studies have shown that HBsAg levels are highly predictive of the presence of inactive HBV infection and that serial changes in HBsAg levels might predict HBsAg loss within 1-3 years. Data also suggest that quantitative HBsAg monitoring is important during hepatitis flare and antiviral therapy, especially in the timing of the decision to stop therapy and to start off-therapy retreatment. These findings have shed new light on the natural course of HBV infection and might lead to optimization of the management of HBeAg-negative chronic HBV infection and contribute to the paradigm shift from indefinite to finite therapy for patients with HBV infection.
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44585
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Costanzo S, de Gaetano G, Di Castelnuovo A, Djoussé L, Poli A, van Velden DP. Moderate alcohol consumption and lower total mortality risk: Justified doubts or established facts? Nutr Metab Cardiovasc Dis 2019; 29:1003-1008. [PMID: 31400826 DOI: 10.1016/j.numecd.2019.05.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/20/2022]
Abstract
For almost a century, the scientific community is aware of the J-shaped curve between alcohol consumption and all-cause mortality. Moderate drinkers seem to live longer than both abstainers and heavy drinkers. These epidemiological observations regarding moderate alcohol consumption and beneficial health effects have been incessantly scrutinised for confounding and bias. This viewpoint discusses previous and recent criticisms regarding the J-shaped curve between alcohol consumption and total mortality risk. The controversies regarding the J-shaped curve between alcohol consumption and mortality are ongoing, as well as the debate among scientists in this area of research, resulting in conflicting messages in media and in different alcohol guidelines. Although it appears quite difficult to come up with a position statement only based on the currently available scientific data, it is imperative to fairly inform the public, without creating confusion and, worst case, disbelief in science.
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Affiliation(s)
- Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy.
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | | | - Luc Djoussé
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston Veterans Affairs Healthcare System, Boston, MA, USA
| | - Andrea Poli
- NFI (Nutrition Foundation of Italy), Viale Tunisia 38, 20124, Milan, Italy
| | - David P van Velden
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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44586
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Peterson MD, Kamdar N, Whitney DG, Ng S, Chiodo A, Tate DG. Psychological morbidity and chronic disease among adults with nontraumatic spinal cord injuries: a cohort study of privately insured beneficiaries. Spine J 2019; 19:1680-1686. [PMID: 31153961 DOI: 10.1016/j.spinee.2019.05.591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Individuals living with a spinal cord injury (SCI) are at heightened risk for a number of chronic health conditions such as secondary comorbidities that may develop or be influenced by the injury, the presence of impairment, and/or the process of aging. However, very little is known about the development of secondary comorbidities among individuals living with nontraumatic SCIs (NTSCIs). PURPOSE The objective of this study was to compare the prevalence of psychological morbidities and chronic diseases among adults with and without NTSCIs. DESIGN Cross-sectional cohort from a nationwide insurance claims database. METHODS Privately insured beneficiaries were included if they had an ICD-9-CM diagnostic code for a NTSCI and accompanying diagnosis of paraplegia, tetraplegia, quadriplegia, or unspecified paralysis (n=10,006). Adults without SCIs were also included (n=779,545). Prevalence estimates of common psychological morbidities, chronic diseases, and multimorbidity (≥2 conditions) were compared. RESULTS Adults with NTSCIs had a higher prevalence of adjustment reaction (11.4% vs 5.1%), anxiety disorders (23.7% vs 14.5%), depressive disorders (31.6% vs 9.6%), drug dependence (3.4% vs 0.8%), episodic mood disorders (15.9% vs 5.4%), central pain syndrome (1% vs 0%), psychogenic pain (1.9% vs 0.2%), dementia (5.2% vs 1.5%), and psychological multimorbidity (29.3% vs 11.6%), as compared to adults without SCIs. The adjusted odds of psychological multimorbidity were 1.86 (95% confidence interval: 1.76-2.00). Adults with NTSCIs also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity (73.5% vs 18%), except HIV/AIDS. After propensity matching for age, education, race, sex, and the chronic diseases (n=7,419 matched pairs), there was still a higher prevalence of adjustment reaction (9.2% vs 5.4%), depressive symptoms (23.5% vs 16.0%), central pain syndrome (1% vs 0%), psychogenic pain (1.5% vs 0.3%), and psychological multimorbidity (20.2% vs 17.4%) among adults with NTSCIs. CONCLUSIONS Adults with NTSCIs have a significantly increased prevalence of psychological morbidities, chronic disease, and multimorbidity, as compared to adults without SCIs. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of disease onset/progression in this higher risk population.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Ng
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anthony Chiodo
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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44587
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44588
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Hassan M, Cargill T, Harriss E, Asciak R, Mercer RM, Bedawi EO, McCracken DJ, Psallidas I, Corcoran JP, Rahman NM. The microbiology of pleural infection in adults: a systematic review. Eur Respir J 2019; 54:13993003.00542-2019. [PMID: 31248959 DOI: 10.1183/13993003.00542-2019] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/14/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Pleural infection is a major cause of morbidity and mortality among adults. Identification of the offending organism is key to appropriate antimicrobial therapy. It is not known whether the microbiological pattern of pleural infection is variable temporally or geographically. This systematic review aimed to investigate available literature to understand the worldwide pattern of microbiology and the factors that might affect such pattern. DATA SOURCES AND ELIGIBILITY CRITERIA Ovid MEDLINE and Embase were searched between 2000 and 2018 for publications that reported on the microbiology of pleural infection in adults. Both observational and interventional studies were included. Studies were excluded if the main focus of the report was paediatric population, tuberculous empyema or post-operative empyema. STUDY APPRAISAL AND SYNTHESIS METHODS Studies of ≥20 patients with clear reporting of microbial isolates were included. The numbers of isolates of each specific organism/group were collated from the included studies. Besides the overall presentation of data, subgroup analyses by geographical distribution, infection setting (community versus hospital) and time of the report were performed. RESULTS From 20 980 reports returned by the initial search, 75 articles reporting on 10 241 patients were included in the data synthesis. The most common organism reported worldwide was Staphylococcus aureus. Geographically, pneumococci and viridans streptococci were the most commonly reported isolates from tropical and temperate regions, respectively. The microbiological pattern was considerably different between community- and hospital-acquired infections, where more Gram-negative and drug-resistant isolates were reported in the hospital-acquired infections. The main limitations of this systematic review were the heterogeneity in the method of reporting of certain bacteria and the predominance of reports from Europe and South East Asia. CONCLUSIONS In pleural infection, the geographical location and the setting of infection have considerable bearing on the expected causative organisms. This should be reflected in the choice of empirical antimicrobial treatment.
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Affiliation(s)
- Maged Hassan
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK .,Oxford Respiratory Trial Unit, University of Oxford, Oxford, UK.,Chest Diseases Dept, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Tamsin Cargill
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK
| | - Elinor Harriss
- Bodleian Healthcare Libraries, University of Oxford, Oxford, UK
| | - Rachelle Asciak
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.,Oxford Respiratory Trial Unit, University of Oxford, Oxford, UK
| | - Rachel M Mercer
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.,Oxford Respiratory Trial Unit, University of Oxford, Oxford, UK
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.,Oxford Respiratory Trial Unit, University of Oxford, Oxford, UK
| | - David J McCracken
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.,Oxford Respiratory Trial Unit, University of Oxford, Oxford, UK
| | - Ioannis Psallidas
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.,Oxford Respiratory Trial Unit, University of Oxford, Oxford, UK
| | - John P Corcoran
- Interventional Pulmonology Service, Dept of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.,Oxford Respiratory Trial Unit, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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44589
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Britton A. Moderate alcohol consumption and total mortality risk: Do not advocate drinking for 'health benefits'. Nutr Metab Cardiovasc Dis 2019; 29:1009-1010. [PMID: 31362849 DOI: 10.1016/j.numecd.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/20/2022]
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44590
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Distinguishing suicide ideation from suicide attempts: Further test of the Integrated Motivational-Volitional Model of Suicidal Behaviour. J Psychiatr Res 2019; 117:100-107. [PMID: 31376620 DOI: 10.1016/j.jpsychires.2019.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 11/21/2022]
Abstract
Suicidal behaviour poses a significant public health concern. Research into the factors that distinguish between the emergence of suicide ideation and the enactment of a suicide attempt is crucial. This study tests central tenets of the Integrated Motivational-Volitional Model of suicidal behaviour (IMV, O'Connor and Kirtley, 2018) which posits that volitional phase factors govern the transition from thinking to attempting suicide. 299 adults completed a face-to-face interview and were allocated to groups based on their suicidal history: Suicide attempt group (N = 100), suicide ideation group (N = 105), and a control group (N = 94). Measures were taken at baseline, at 1-month and 6-months follow-up. As predicted, the attempt group differed from the ideation group on all volitional phase factors. Those who had attempted suicide reported higher capability for suicide, were more likely to have a family member or friend who had self-injured or attempted suicide, and were more impulsive. In keeping with the IMV model, the ideation and attempt groups had similar scores on the motivational factors. Defeat and entrapment were significant predictors of ideation at baseline, and mediation analyses indicated that defeat had an indirect effect on ideation through entrapment at baseline and at 1-month follow-up. The results support the IMV model and suggest that entrapment should be routinely included in suicide risk assessments. Further research to test predictors of the transition from suicide ideation to suicide attempts is crucial to inform future intervention development and health care delivery.
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44591
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Costa R, Teasdale S, Abreu S, Bastos T, Probst M, Rosenbaum S, Ward PB, Corredeira R. Dietary Intake, Adherence to Mediterranean Diet and Lifestyle-Related Factors in People with Schizophrenia. Issues Ment Health Nurs 2019; 40:851-860. [PMID: 31339786 DOI: 10.1080/01612840.2019.1642426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to examine the dietary intake of both inpatients and outpatients with schizophrenia in the Portuguese population as a potential key contributing factor to the poor physical health profiles, and understand the relationship of diet quality to other lifestyle factors. Participants of this cross-sectional study completed a semi quantitative food frequency questionnaire. Diet quality was determined by adherence to the Mediterranean Diet. In addition participants completed the International Physical Activity Questionnaire-Short-Form and Pittsburgh Sleep Quality Index. Tobacco smoking was assessed through a series of general questions. A total of 100 patients (50% inpatients and 28% female) with schizophrenia were included in the final analysis. Patients reported a high consumption of caffeine, while deficits were evident for fibre and folate intakes, when compared to the European Food Safety Authority recommendations. Both inpatients and outpatients reported poor to moderate diet quality. Smokers reported poorer diet quality when compared to non-smokers (p < 0.001). Dietary intake, and its relationship to other lifestyle components, should be considered for intervention, in order to improve physical health of people living with schizophrenia.
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Affiliation(s)
- Raquel Costa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District , Bondi Junction , Australia.,School of Psychiatry, UNSW Sydney , Australia
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Tânia Bastos
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto , Porto , Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI , Maia , Portugal
| | - Michel Probst
- Faculty of Kinesiology and Rehabilitation Sciences, Research Group for Adapted Physical Activity and Psychomotor Rehabilitation , KU Leuven , Leuven , Belgium
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney , Australia.,Black Dog Institute, Prince of Wales Hospital, Sydney , Randwick , Australia
| | - Philip B Ward
- School of Psychiatry, UNSW Sydney , Australia.,Schizophrenia Research Unit, South Western Sydney Local Health District & Ingham Institute for Applied Medical Research , Liverpool , Australia
| | - Rui Corredeira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
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44592
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Schwingshackl L, Krause M, Schmucker C, Hoffmann G, Rücker G, Meerpohl JJ. Impact of different types of olive oil on cardiovascular risk factors: A systematic review and network meta-analysis. Nutr Metab Cardiovasc Dis 2019; 29:1030-1039. [PMID: 31378629 DOI: 10.1016/j.numecd.2019.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM This network meta-analysis (NMA) compares the effects of different types of olive oil (OO) on cardiovascular risk factors. METHODS AND RESULTS Literature search was conducted on three electronic databases (Medline, Web of Science, and Cochrane Central). INCLUSION CRITERIA Randomized controlled trials (RCTs) (≥3 weeks duration of intervention) comparing at least two of the following types of OO: refined OO (ROO), mixed OO (MOO), low phenolic (extra) virgin OO (LP(E)VOO), and high phenolic (extra) virgin OO (HP(E)VOO). Random-effects NMA was performed for seven outcomes; and surface under the cumulative ranking curve (SUCRA) was estimated, using an analytical approach (P-score). Thirteen RCTs (16 reports) with 611 mainly healthy participants (mean age: 26-70 years) were identified. No differences for total cholesterol, HDL-cholesterol, triacylglycerols, and diastolic blood pressure were observed comparing ROO, MOO, LP(E)VOO and HP(E)VOO. HP(E)VOO slightly reduce LDL-cholesterol (LDL-C) compared to LP(E)VOO (mean difference [MD]: -0.14 mmol/L, 95%-CI: -0.28, -0.01). Both, HP(E)VOO and LP(E)VOO reduces SBP compared to ROO (range of MD: -2.99 to -2.87 mmHg), and HP(E)VOO may improve oxidized LDL-cholesterol (oxLDL-C) compared to ROO (standardized MD: -0.68, 95%-CI: -1.31, -0.04). In secondary analyses, EVOO may reduce oxLDL-C compared to ROO, and a dose-response relationship between higher intakes of phenolic compounds from OO and lower SBP and oxLDL-C values was detected. HP(E)VOO was ranked as best treatment for LDL-C (P-score: 0.83), oxLDL-C (0.88), and SBP (0.75). CONCLUSIONS HP(E)VOO may improve some cardiovascular risk factors, however, public health implications are limited by overall low or moderate certainty of evidence.
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Affiliation(s)
- Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
| | - Marc Krause
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Austria
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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44593
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Jo Y, LeFevre AE, Healy K, Singh N, Alland K, Mehra S, Ali H, Shaikh S, Haque R, Christian P, Labrique AB. Costs and cost-effectiveness analyses of mCARE strategies for promoting care seeking of maternal and newborn health services in rural Bangladesh. PLoS One 2019; 14:e0223004. [PMID: 31574133 PMCID: PMC6773420 DOI: 10.1371/journal.pone.0223004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022] Open
Abstract
Objective We examined the incremental cost-effectiveness between two mHealth programs, implemented from 2011 to 2015 in rural Bangladesh: (1) Comprehensive mCARE package as an intervention group and (2) Basic mCARE package as a control group. Methods Both programs included a core package of census enumeration and pregnancy surveillance provided by an established cadre of digitally enabled community health workers (CHWs). In the comprehensive mCARE package, short message service (SMS) and home visit reminders were additionally sent to pregnant women (n = 610) and CHWs (n = 70) to promote the pregnant women’s care-seeking of essential maternal and newborn care services. Economic costs were assessed from a program perspective inclusive of development, start-up, and implementation phases. Effects were calculated as disability adjusted life years (DALYs) and the number of newborn deaths averted. For comparative purposes, we normalized our evaluation to estimate total costs and total newborn deaths averted per 1 million people in a community for both groups. Uncertainty was assessed using probabilistic sensitivity analyses with Monte Carlo simulation. Results The addition of SMS and home visit reminders based on a mobile phone-facilitated pregnancy surveillance system was highly cost effective at a cost per DALY averted of $31 (95% uncertainty range: $19–81). The comprehensive mCARE program had at least 88% probability of being highly cost-effective as compared to the basic mCARE program based on the threshold of Bangladesh’s GDP per capita. Conclusion mHealth strategies such as SMS and home visit reminders on a well-established pregnancy surveillance system may improve service utilization and program cost-effectiveness in low-resource settings.
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Affiliation(s)
- Youngji Jo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Amnesty E. LeFevre
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katherine Healy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Neelu Singh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kelsey Alland
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sucheta Mehra
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hasmot Ali
- JiVitA Program, Johns Hopkins University, Gaibandha, Bangladesh
| | | | - Rezawanul Haque
- JiVitA Program, Johns Hopkins University, Gaibandha, Bangladesh
| | - Parul Christian
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alain B. Labrique
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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44594
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Hanson M. The inheritance of cardiovascular disease risk. Acta Paediatr 2019; 108:1747-1756. [PMID: 30964948 DOI: 10.1111/apa.14813] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease (CVD) is foremost among the non-communicable diseases (NCDs) which account for 71% of deaths globally each year. CVD is also prominent among the pre-existing conditions still accounting for nearly 25% of maternal deaths and is linked to gestational diabetes and pre-eclampsia. Markers of CVD risk have been reported even in young children, related to prenatal factors such as mother's diet or body composition. The underlying mechanisms include epigenetic changes which can alter the trajectory of risk across the life course. Preventive interventions need to commence before conception, to reduce transmission of CVD risk by promoting healthy behaviours in prospective parents, as well as in pregnancy, and postpartum through breastfeeding and healthy complementary feeding. Surprisingly, these opportunities are not emphasised in the 2018 United Nations Political Declaration on NCDs. NCDs such as CVD have communicable risk components transmitted across generations by socio-economic as well as biological factors, although the former can also become embodied in the offspring by epigenetic mechanisms. The inheritance of CVD risk, and social inequalities in such risk, thus raises wider questions about responsibility for the health of future generations at societal as well as individual levels.
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Affiliation(s)
- Mark Hanson
- Institute of Developmental Sciences University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton Southampton UK
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44595
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Cao Z, Liu Y, Wang S, Lu X, Yin S, Jiang S, Chen L, Cai M, Zeng B, Yao Y, Tang W, Zhao G, Xiang X, Wang H, Cai W, Zhu C, Li H, Xie Q. The impact of HBV flare on the outcome of HBV-related decompensated cirrhosis patients with bacterial infection. Liver Int 2019; 39:1943-1953. [PMID: 31206235 DOI: 10.1111/liv.14176] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/23/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) flare can occur in HBV patients either naïve or have interruption to treatment. Bacterial infection (BI) is a common complication of cirrhosis with potential severe outcomes. We aimed to assess the impact of HBV flare on the outcome of patients with HBV-related decompensated cirrhosis and BI. METHODS This was a retrospective study from 2 tertiary academic hospitals in Shanghai, China of HBV patients admitted with or developed BI during admission. The characteristics of BI, prevalence of HBV flare, its impact on organ failure, acute-on-chronic liver failure (ACLF) and 90-day survival were evaluated. RESULTS A total of 360 hospitalized patients (median age: 50 years, male: 79%, BI: at admission: 58.6%; during admission: 41.4%) were included. All patients including those with HBV flare (21%) received antiviral therapy after admission. Patients with HBV flare and BI had significantly higher percentage of liver (93.3% vs 48.8%), coagulation (64.0% vs 39.6%), cerebral (40.0% vs 21.8%) (all P < 0.01), and kidney failure (38.7% vs 26.3%, P < 0.05) compared to BI alone, associated with a higher risk of developing ACLF with a subdistribution hazard ratio (sHR) of 2.23 (95% confidence interval [CI]: 1.68-2.96). Multivariate analysis showed that ACLF development was the strongest risk factor for 90-day mortality (sHR, 95%CI: 7.36, 4.12-13.16). CONCLUSIONS In HBV-related decompensated cirrhosis patients admitted with BI, HBV flare increased the risk of additional organ failures and ACLF, raising the risk of 90-day mortality by seven-fold. Optimization of HBV treatment in these patients should minimize the risk of HBV flare with improved outcomes.
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Affiliation(s)
- Zhujun Cao
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhan Liu
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shijin Wang
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobo Lu
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shan Yin
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaowen Jiang
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liuying Chen
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minghao Cai
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Zeng
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujing Yao
- Department of Biostatistics, Columbia University, New York City, New York
| | - Weiliang Tang
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gangde Zhao
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaogang Xiang
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Cai
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanwu Zhu
- Department of Infectious Diseaseas, The Affiliated Infectious Diseaseas Hospital of Soochow University, Jiangsu, China
| | - Hai Li
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Xie
- Department of infectious disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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44596
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Ben Shoham A, Liberant-Taub S, Sharon M, Zucker I. The number of acute cerebrovascular events in Israel: a forecast until 2040. Isr J Health Policy Res 2019; 8:67. [PMID: 31570095 PMCID: PMC6771084 DOI: 10.1186/s13584-019-0337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute cerebrovascular event is one of the leading causes of death in Israel and is the primary cause of neurological disability in adults. Although some evidence indicates that the incidence rate of acute cerebrovascular events in developed countries is stable or has been decreasing over the past decades, the number of events is expected to increase in these countries due to projected changes in size and composition of the population. The purpose of this study was to provide a forecast of the number of acute cerebrovascular events in Israel for the coming decades. METHODS We used data from the National Stroke Registry at the Israel Center for Disease Control and data from the long-term population forecasts of the Israeli Central Bureau of Statistics. We generated forecasts of the annual number of acute cerebrovascular events based on the mean annual incidence rates during 2014-2016 within population subgroups defined by gender, age, and ethnicity, and on the projected population size of these subgroups for 2015-2040. The forecasts were generated for various assumptions as to trends in the incidence rate and for alternatives as to the projected population growth. RESULTS Based on the intermediate population growth alternative, the annual number of acute cerebrovascular events is expected to increase from 18,400 to 38,500, 34,800 or 26,400 events, assuming constant annual incidence rates, decreasing annual incidence rates at a rate of 2% every 5 years, or decreasing annual incidence rates at a rate of 7.25% every 5 years, respectively. Whereas, presently, events affecting Arab patients account for 15% of acute cerebrovascular events and events affecting patients over 80 account for 33% of acute cerebrovascular events, by 2040 events affecting Arab patients will account for more than 21% of the events and events affecting patients over 80 will account for 42% of the events. CONCLUSIONS In view of the expected increase in the number of acute cerebrovascular events and the changes in the demographic composition of adults suffering from such events, and in order to allow for optimal care and equity, it is imperative to evaluate the preparedness of care provision and the geographical deployment of treatment services in the short and long term.
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Affiliation(s)
- Assaf Ben Shoham
- Smokler center for health policy research, Myers-JDC-Brookdale Institute, P.O.B. 3886, 91037, Jerusalem, Israel. .,Family Medicine, Clalit health services, Jerusalem, Israel.
| | | | - Mor Sharon
- General medicine, Ministry of Health, Jerusalem, Israel
| | - Inbar Zucker
- Israeli Center for Disease Control (ICDC), Ministry of Health, Jerusalem, Israel.,School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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44597
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Howe MD, Furr JW, Munshi Y, Roy-O’Reilly MA, Maniskas ME, Koellhoffer EC, d’Aigle J, Sansing LH, McCullough LD, Urayama A. Transforming growth factor-β promotes basement membrane fibrosis, alters perivascular cerebrospinal fluid distribution, and worsens neurological recovery in the aged brain after stroke. GeroScience 2019; 41:543-559. [PMID: 31721012 PMCID: PMC6885082 DOI: 10.1007/s11357-019-00118-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022] Open
Abstract
Aging and stroke alter the composition of the basement membrane and reduce the perivascular distribution of cerebrospinal fluid and solutes, which may contribute to poor functional recovery in elderly patients. Following stroke, TGF-β induces astrocyte activation and subsequent glial scar development. This is dysregulated with aging and could lead to chronic, detrimental changes within the basement membrane. We hypothesized that TGF-β induces basement membrane fibrosis after stroke, leading to impaired perivascular CSF distribution and poor functional recovery in aged animals. We found that CSF entered the aged brain along perivascular tracts; this process was reduced by experimental stroke and was rescued by TGF-β receptor inhibition. Brain fibronectin levels increased with experimental stroke, which was reversed with inhibitor treatment. Exogenous TGF-β stimulation increased fibronectin expression, both in vivo and in primary cultured astrocytes. Oxygen-glucose deprivation of cultured astrocytes induced multiple changes in genes related to astrocyte activation and extracellular matrix production. Finally, in stroke patients, we found that serum TGF-β levels correlated with poorer functional outcomes, suggesting that serum levels may act as a biomarker for functional recovery. These results support a potential new treatment strategy to enhance recovery in elderly stroke patients.
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Affiliation(s)
- Matthew D. Howe
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - J. Weldon Furr
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - Yashasvee Munshi
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - Meaghan A. Roy-O’Reilly
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - Michael E. Maniskas
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - Edward C. Koellhoffer
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - John d’Aigle
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - Lauren H. Sansing
- Department of Neurology, Yale University School of Medicine, 1450 Chapel Street, New Haven, CT 06511 USA
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
| | - Akihiko Urayama
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin St., Houston, TX 77030 USA
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44598
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Shaffer RM, Sellers SP, Baker MG, de Buen Kalman R, Frostad J, Suter MK, Anenberg SC, Balbus J, Basu N, Bellinger DC, Birnbaum L, Brauer M, Cohen A, Ebi KL, Fuller R, Grandjean P, Hess JJ, Kogevinas M, Kumar P, Landrigan PJ, Lanphear B, London SJ, Rooney AA, Stanaway JD, Trasande L, Walker K, Hu H. Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:105001. [PMID: 31626566 PMCID: PMC6867191 DOI: 10.1289/ehp5496] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/20/2019] [Accepted: 09/25/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals. OBJECTIVES We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease-Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden-both current and projected. METHODS We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment. DISCUSSION A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure-risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD's current methods do not fully account for lead's impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk-outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD's estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496.
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Affiliation(s)
- Rachel M. Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Samuel P. Sellers
- Center for Health and the Global Environment, University of Washington, Seattle, Washington, USA
| | - Marissa G. Baker
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Rebeca de Buen Kalman
- Evans School of Public Policy and Governance, University of Washington, Seattle, Washington, USA
| | - Joseph Frostad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | - Megan K. Suter
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Susan C. Anenberg
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - John Balbus
- Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Niladri Basu
- Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, Quebec, Canada
| | - David C. Bellinger
- Department of Neurology, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Linda Birnbaum
- Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron Cohen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Health Effects Institute, Boston, Massachusetts, USA
| | - Kristie L. Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, Washington, USA
| | | | - Philippe Grandjean
- Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jeremy J. Hess
- Center for Health and the Global Environment, University of Washington, Seattle, Washington, USA
| | | | - Pushpam Kumar
- United Nations Programme on the Environment, Nairobi, Kenya
| | - Philip J. Landrigan
- Program in Global Public Health and the Common Good, Boston College, Chestnut Hill, Massachusetts, USA
- Global Observatory on Pollution and Health, Boston College, Chestnut Hill, Massachusetts, USA
| | - Bruce Lanphear
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Stephanie J. London
- Epidemiology Branch, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Andrew A. Rooney
- Division of the National Toxicology Program, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Jeffrey D. Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
- NYU Global Institute of Public Health, New York University, New York, New York, USA
| | - Katherine Walker
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Howard Hu
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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44599
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Khan MA, Khan SA, Hamayun M, Ali M, Idrees M. Sequence variability of HCV 3a isolates based on core gene in patients from Lahore, Pakistan. Future Virol 2019. [DOI: 10.2217/fvl-2019-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: To investigate the HCV 3a core sequence variation and amino acid substitutions of patients from Lahore, Pakistan. Materials & methods: Blood samples from HCV positive patients (n = 232) were collected for viral genotypes. Moreover, the nucleotide sequencing was performed for core gene of 20 samples. Results: Viral genotyping showed that 69.82% (n = 162) belonged to 3a genotype, 9.05% (1a; n = 21), 2.15% (3b; n = 5) and 18.98% were untypable (n = 44). Phylogenetic analyses suggest majority of our isolates clustered with previously reported reference isolates from Pakistan. The remaining isolates clustered with HCV-core sequences reported from Vietnam, Japan, Thailand, Iran, USA, Bangladesh, Malaysia and Morocco. Conclusion: We report HCV-core substitutions (G60E, R70Q, C91A, A94Q and Q63E/D) that could be associated with treatment response in Pakistani patients.
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Affiliation(s)
- Muhammad Ajmal Khan
- Center for Biotechnology & Microbiology (COBAM), University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sumera Afzal Khan
- Center for Biotechnology & Microbiology (COBAM), University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Hamayun
- Department of Botany, Abdul Wali Khan University Mardan, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Ali
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Idrees
- National Center of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
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44600
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Lin SY, Chien JY, Chiang HT, Lu MC, Ko WC, Chen YH, Hsueh PR. Ambulatory independence is associated with higher incidence of latent tuberculosis infection in long-term care facilities in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 54:319-326. [PMID: 31624017 DOI: 10.1016/j.jmii.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Tuberculosis (TB) in the elderly population remains a major challenge in areas with intermediate disease burden like Taiwan. Despite the increasing burden and high risks of TB in the elderly population, particularly those living in long-term care facilities (LTCFs), diagnostic testing for latent tuberculosis infection (LTBI) has not been carefully evaluated in this group. This study aimed to investigate the prevalence and predictors of LTBI in older adults living in LTCFs. METHODS Older adults living in seven LTCFs in Taiwan were prospectively enrolled between January and July 2017. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-tube was used to determine presence of LTBI. Predictors for LTBI were analyzed. RESULTS A total of 258 participants were enrolled, including 240 older residents (mean age, 81.6 years; male, 51.2%) and 18 employees (mean age, 64.8 years; male, 22.2%). The proportion of independent status in ambulation assessments significantly declined with aging (p < 0.001). The IGRA-positivity rate in LTCFs was 31.4% (81/258), which consisted of 73 (30.4%) residents and 8 (44.4%) employees. The IGRA results were different with respect to the ambulation status (p = 0.052). In the multivariate logistic regression analysis, the only independent predictor of LTBI among older adults in LTCFs was independent ambulation (odds ratio, 2.16; 95% confidence interval, 1.09-4.28; p = 0.027). CONCLUSIONS There was a high prevalence of LTBI among older adults in LTCFs in Taiwan. Independent ambulation was the only independent predictor of LTBI.
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Affiliation(s)
- Shang-Yi Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Sepsis Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Hsiu-Tzy Chiang
- Infection Control Centre, MacKay Memorial Hospital, Taipei, Taiwan
| | - Min-Chi Lu
- Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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