Risk Factor For Disease Burden Research Articles

Abstract P152: Chromatin Accessibility Landscape Of The Proximal Tubule And Thick Ascending Limb In Humans And Rats

Hypertension is a major risk factor for disease burden and mortality. A decrease in the kidney’sability to excrete sodium can lead to hypertension. Specifically, the proximal tubule (PT) and thickascending limb (TAL) of the nephron play crucial roles in the reabsorption of filtered sodium toregulate blood pressure (BP). Understanding the genetic and epigenetic factors that influence PTand TAL functions is essential for unraveling the molecular mechanisms underlying hypertension.GWAS identified over 1,000 BP-associated genomic loci comprising > 26,000 SNPs. Most (~90%)are in intronic and intergenic regions and may influence BP-relevant gene expression by yetunexplored epigenetic mechanisms. Better understanding of how non-coding genomic regionsregulate BP is critical to defining the genetic underpinnings of hypertension. To address this, weestablished chromatin state (open and closed chromatin) maps for PT and TAL from humans andinbred salt-sensitive rats (SS/JrHsdMcwi) using the Assay for Transposase-Accessible Chromatinwith Sequencing (ATAC-Seq). Linear dimensional reduction revealed that in both species, PT andTAL segments clearly separated, indicating their chromatin states were distinct. ATAC-seq “peaks”represent regions of open chromatin, and therefore likely to be within regulatory elements. Ahigher number of differential peaks was identified between human PT and TAL (65,823) comparedto rat (1,063). The number of PT and TAL enriched peaks also differs between species. Genomicdistribution of these differential peaks indicates the bulk fall within distal intergenic and intronicregions (human: 71.64%, rat: 88.81%) rather than the gene promoters or exonic regions for bothspecies. This indicates that the chromatin accessibility of regulatory regions is significantlydifferent between these two segments for both species. Our next steps are to identify upstreamregulators that differ between the kidney segments and species and integrate ATAC-Seq data withexpression data to define the association of non-coding regions with transcript levels. Our workhas generated chromatin state maps that may improve the understanding of the role of noncodinggenomic regions in the transcriptional regulation in PT and TAL in human and rat.

Low ambient temperature increases the risk and burden of atrial fibrillation episodes: A nationwide case-crossover study in 322 Chinese cities

BackgroundNon-optimum ambient temperature has recently been acknowledged as an independent risk factor for disease burden, but its impact on atrial fibrillation (AF) episodes was rarely evaluated. ObjectivesTo examine the associations between ambient non-optimum temperature and symptom onset of AF episodes and calculate the corresponding disease burden. MethodsWe conducted an individual-level, time-stratified, case-crossover analysis based on a nationwide registry, which comprises of 94,711 eligible AF patients from 1993 hospitals in 322 Chinese cities from January 2015 to December 2021. Multiple moving 24 h average temperatures prior to the symptom onset of AF episodes were calculated as lag days. The associations were analyzed using conditional logistic regression combined with distributed lag non-linear models with a duration of lag 0–7 days, after controlling for criteria air pollutants. Stratification analyses were performed to explore possible effect modifiers. ResultsThere was a monotonically increasing relationship of AF onset risk with decreasing temperature. The excess AF risk occurred at lag 1 d and lasted for 5 days. Nationally, the cumulative relative risk of AF episode onset associated with extremely low temperature (−9.3 °C) over lag 0–7 d was 1.25 (95 % confidence interval: 1.08, 1.45), compared with the reference temperature (31.5 °C). The exposure-response curve was steeper in the south than in the north where there was levelling-off at lower temperature. Nationally, 7.59 % of acute AF episodes could be attributable to non-optimum temperatures. The attributable fraction was larger for southern residents, males and patients <65 years. ConclusionThis nationwide study provides novel and robust evidence that declining ambient temperature could increase the risk of AF episode onset. We also provide the first-hand evidence that a considerable proportion of acute AF episodes could be attributable to non-optimum temperatures.

Fossil-fuel and combustion-related air pollution and hypertension in the Sister Study

Hypertension is a leading risk factor for disease burden, with more than 200 million disability-adjusted life-years attributed to high blood pressure in 2015. While outdoor air pollution is associated with cardiovascular disease, the joint effect of exposure to air pollution from combustion products on hypertension has rarely been studied. We conducted a cross-sectional analysis to explore the association between combustion-related air pollution and hypertension. Census-tract levels of ambient concentrations of nine fossil-fuel and combustion-related air toxics (biphenyl, naphthalene, polycyclic organic matter, diesel emissions, 1,3-butadiene, acetaldehyde, benzene, acrolein, and formaldehyde) from the 2005 National Air Toxics Assessment database and NO2 from 2005 monitoring data were linked to baseline residential addresses of 47,467 women in the Sister Study cohort. Hypertension at enrollment (2003–2009) was defined as high systolic (≥140 mm Hg) or diastolic (≥90 mm Hg) blood pressure or taking antihypertensive medication. We used log-binomial regression and quantile-based g-computation to estimate the individual and joint effects of fossil-fuel and combustion-related air pollution on hypertension. Comparing the highest to lowest quartiles, diesel emissions (prevalence ratio (PR) = 1.05, 95% confidence interval (CI) = 1.01,1.08), 1,3-butadiene (PR = 1.04, 95%CI = 1.00,1.07), acetaldehyde (PR = 1.08, 95%CI = 1.04,1.12), benzene (PR = 1.05, 95%CI = 1.02,1.08), formaldehyde (PR = 1.08, 95%CI = 1.04,1.11), and NO2 (PR = 1.08, 95%CI = 1.05,1.12) were individually associated with higher prevalence of hypertension. The PR for the joint effect of increasing all ambient air toxics and NO2 by one quartile was 1.02 (95%CI = 1.01,1.04). Associations varied by race/ethnicity, with stronger associations observed among women reporting races/ethnicities (Hispanic/Latina, non-Hispanic Black and other) other than non-Hispanic White. In conclusion, we found that air pollution from fossil fuel and combustion may be a risk factor for hypertension.

Near-term prognostic impact of integrated muscle mass and function in upper gastrointestinal cancer

Despite the known association between muscle mass/function and malnutrition-related mortality in upper gastrointestinal (UGI) cancer, no comprehensive study to determine the impact of muscle mass-dominant nutritional status on cancer prognosis has been conducted. The present study aimed to investigate the prognostic significance of integrated muscle mass and function in UGI cancer. Between July 2013 and March 2018, we enrolled 2546 cancer patients with risks of malnutrition (Nutrition Risk Screening 2002, ≥3 points) from a multicenter cohort study and split 527 patients with primary UGI cancer into an internal validation group. We prospectively performed instant nutritional assessment and recorded all general clinical characteristics of the participants, such as weight loss, body mass index, anthropometric measurements of muscle mass and function, dietary intake conditions, and disease burden and/or inflammation status based on the validated tools. Prognostic analyses were performed with post-assessment overall survival (OS). According to the entire set, UGI cancer was identified as the dominant risk factor for disease burden and inflammation criteria (hazard ratio (HR), 2.08, 95% confidence interval (Cl), 1.81-2.39, P<0.001). Integrated muscle mass/function analysis with validated cutoff values showed that hand grip strength/weight followed by triceps skinfold thickness and maximum calf circumference are the most potent predictors. Univariate and multivariate analyses revealed that reduced muscle mass/function (74.8%) and dietary intake (66.2%) independently affect OS of patients with UGI cancer. Significant associations were found between the reduced muscle mass/reduced dietary intake and the shortest OS (HR, 4.48; 95% Cl, 3.07-6.53; P<0.001). Appending subgroups of muscle mass/function and dietary intake to the pre-existing risk model increased the efficiency of the time-dependent receiver operating characteristic curve analysis for OS in UGI cancer, particularly within 2 years of instant nutritional assessment. Impaired muscle mass/function adversely affects the near-term prognosis in patients with UGI cancer. Along with a comprehensive evaluation of dietary intake conditions, the timely nutritional assessment might be useful for risk stratification of UGI cancers with potential for enteral and parenteral nutrition interventions. ChiCTR1800020329.

Second-hand tobacco exposure in children: evidence for action

Tobacco is one of the leading risk factors for disease burden and death in the world. This burden is related to both tobacco consumption and second-hand exposure. Children are particularly exposed; in 2019, it was estimated that passive smoking was responsible for 50 000 deaths and 4 500 000 disability-adjusted life-years among children younger than 14 years.1

Serum neutrophil gelatinase-associated lipocalin and oxidized neutrophil proteins in patients with nephropathy caused by acute alcohol poisoning

Introduction: Alcohol use has been identified as a major risk factor for disease burden and premature mortality. Objectives: We studied the serum neutrophil gelatinase-associated lipocalin (NGAL) and advanced oxidation protein product (AOPP) concentrations in neutrophils to assess the possibility of their using for the early detection of kidney damage in patients with acute alcohol poisoning (AAP). The impact of eGFR (estimated glomerular filtration rate) on the NGAL and AOPP levels was also studied. Patients and Methods: The study included 89 patients with AAP. Healthy individuals and patients with chronic kidney disease (CKD) served as comparison groups. Participants were represented by men, aged between 20 and 40 years. Results of laboratory tests of kidney function were also taken into account. Serum NGAL level was measured using ELISA kit. AOPP was determined using the method of Witko-Sarsat et al. Results: We detected a significant increase in serum NGAL and AOPP level both in toxic nephropathy with a clinical picture of acute kidney injury (AKI) and in the preclinical stage of kidney damage. Hence a single trend in the changes of these indicators existed in patients with AAP. At the same time, our study revealed opposite trends in patients with CKD. There was no significant increase in serum NGAL in patients with CKD. Conclusion: We propose to consider an increased eGFR together with an increased serum NGAL concentration in patients with AAP as the stage, preceding the nephropathy or AKI, even in the absence of clinical and laboratory signs of impaired renal function.

The associations between housing quality and acute lower respiratory infection among under-5 children: a multi-country analysis across sub-Saharan Africa

Background/objectives: Acute lower respiratory infection (ALRI) among children under five years old (under-5) is a leading risk factor for disease burden in sub-Saharan Africa (SSA), but its association with housing quality is not fully explored. We aim to investigate their spatial and temporal associations within and across 34 SSA countries. Methods: Data were extracted from the Demographic and Health Surveys (DHS) conducted 1990-2018 that collected data on both housing and ALRI. Housing quality were derived as a binary variable: 1) finished and unfinished built based on materials used for wall, roof and floor; 2) improved and unimproved house based on data on built materials as well as access to safe water and sanitation. ALRI was defined as having cough in combination with short/rapid breathing, or difficult breathing at any time in the two weeks preceding the surveys. Conditional logistic regression was ran to model the associations in each country and then the odds ratios (OR) were pooled via meta-analysis, controlling for cluster-level effects and adjusting for child’s age, sex, breastfeeding, size at birth, maternal education and type of cooking fuel. Results: Preliminary analysis currently included the most recent DHS surveys from 12 SSA countries, consisting of 56,519 under-5 children. The percentage of urban residence ranged from 16% to 61%; majority of mothers were educated up to primary-school level and most households did not have access to clean cooking fuel. Prevalence of unfinished built ranged from 43% to 95% across countries whilst using the stricter definition, over 90% of houses in each country were classified as unimproved. Pooling all country-specific ORs, we observed a higher ALRI risk in association with housing with unfinished built (OR: 1.07, 95%CI: 0.99-1.16). Conclusion: Poor housing quality is associated with higher ALRI prevalence in SSA and necessary interventions should be considered to reduce the ALRI burden.

CCL2 Mediates Early Renal Leukocyte Infiltration During Salt‐Sensitive Hypertension

BackgroundHypertension is reported to be the largest independent risk factor for disease burden globally. Despite the prevalence and burden of hypertension on human health, the mechanisms leading to the development of hypertension in most individuals remain unknown. Both human and animal experimental evidence indicate that immune mechanisms may play a key role in the development of hypertension and associated end‐organ damage. Studies examining mechanisms of Dahl Salt‐Sensitive (SS) hypertension have implicated the infiltration of leukocytes into the kidneys as a key contributor to the hypertension and renal damage. However, the signaling pathways by which leukocytes traffic to the kidneys remain poorly understood.AimThe aim of the present set of studies was to use a unique unbiased discovery‐based approach to nominate signaling pathways which was followed by functional testing of the role of the identified pathways in renal leukocyte infiltration.Methods and ResultsWe analyzed a kidney RNA‐seq dataset from SS rats fed either a Low Salt (LS‐0.4% NaCl) or a High Salt (HS‐4.0% NaCl) diet. From this analysis, the chemokine (C‐C motif) ligand 2 (CCL2) and receptor CCR2 were nominated as a potential pathway modifying renal leukocyte infiltration. The functional role of the CCL2/CCR2 pathway was tested by daily administration of CCR2 antagonist (RS102895 at 5mg/kg/day in DMSO) or DMSO Vehicle for 3 days (n=13–15/group) or 21 days (n=9–11/group) by intraperitoneal injections to male SS rats during the HS challenge. A variety of parameters were measured throughout the study including blood pressure (measured continuously using radio‐telemetry), circulating leukocytes and renal leukocyte infiltration (by flow cytometry) and renal damage (assessed histologically and using urinary injury markers), body weight, food intake and electrolyte excretion. Results demonstrate that RS201895 treatment, compared to vehicle‐treated rats ameliorated renal damage (urinary albumin excretion; 43.4±5.1 vs 114.7±15.2 mg/day, P&lt;001) and hypertension (144.3±2.2 vs 158.9±4.8 mmHg, P&lt;0.001) after 21 days of HS diet. It was determined that renal leukocyte infiltration was blunted by day 3 of the HS diet (1.4±0.1 vs 1.9±0.2 ×106 CD45+ cells/kidney, P=0.034) in drug‐treated rats. A unique adaptation of an in vitro chemotaxis assay validated the ability of RS102895 to block leukocyte chemotaxis towards CCL2 at in vivo concentrations.Conclusion/SignificanceThe results demonstrate that increased CCL2 in SS kidney is important in early recruitment of leukocytes and blockade of this recruitment by administering RS102895, which subsequently ameliorated the renal damage and hypertension. These results provide a unique understanding to an important disease process that has potential therapeutic implications.Support or Funding InformationSupported by HL137748, HL116264.

Prevalence of hypertension and its associated risk factors among adults residing in urban slum: a population-based door-to-door study

Background: High blood pressure (HBP) is the single most common risk factor for disease burden all over world. In India, HBP has now emerged as a leading risk factor for morbidity and mortality. This study was carried out to find out prevalence of hypertension and its association with major risk factors among adults residing in urban slum.Methods: A population based door to door study was carried out in urban slum coming under field practice area of urban health training centre, Department of Community Medicine People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh.Results: The mean systolic BP was 121.4 mmHg whereas mean diastolic BP was 79.4 mmHg. Overall, 64.6% respondents were normotensive, 15.4% were in the category of pre-hypertension, and 5% in stage 1 hypertension (HTN) and 15% were in stage 2 HTN, giving the overall prevalence of high blood pressure 20.07%.Conclusions: It can be concluded from present study that the prevalence of hypertension is quite high. Hence it is necessary to increase the public awareness about hypertension.

Alcohol consumption and consequences in adolescents in 68 low and middle-income countries – a multi-country comparison of risks by sex

AimsAlcohol use is a leading risk factor for disease burden among youth. This study estimated sex differences in the prevalence of alcohol use and consequences among adolescents living in low and middle-income countries (LMIC). DesignMulti-staged cross-sectional international standardized self-report questionnaires administered in the classroom. SettingThe Global school-based student health survey (GSHS) comprised adolescents from 68 LMIC between 2003–2014. Participants271,156 students aged 13–17 years old. MeasurementsAlcohol measures included: past month alcohol consumption, history of intoxication and alcohol-related problems. Regions were based on the World Health Organization definitions: Africa, America, Eastern Mediterranean, Europe, South-east Asia, and Western Pacific. FindingsOverall, males had higher odds of alcohol use (OR = 2.38 [1.91–2.96]), a history of intoxication (OR = 2.64 [2.11–3.31]), and alcohol-related problems (OR = 1.72 [1.41–2.10]) than females. All regions recorded overall greater odds of alcohol use by males versus females; five regions (excluding Europe) recorded greater odds of intoxication in males; and three regions (America, South-east Asia, and Western Pacific) recorded greater odds of alcohol-related problems amongst males. However, there were country-level differences – in some countries, adolescent drinking rates and consequences were comparable by sex. Countries with the highest odds of alcohol use among males compared to females were Indonesia, Myanmar, Cambodia, Tuvalu, Morocco, Senegal, Kiribati, and Thailand. ConclusionsAmong adolescents living in LMIC, males had on average two-fold higher odds of drinking alcohol and experiencing adverse consequences. Growing affluence and improvements in sex equality in societies may increase the future prevalence of hazardous drinking in females in LMICs.

The burden of child and maternal malnutrition and trends in its indicators in the states of India: the Global Burden of Disease Study 1990–2017

SummaryBackgroundMalnutrition is a major contributor to disease burden in India. To inform subnational action, we aimed to assess the disease burden due to malnutrition and the trends in its indicators in every state of India in relation to Indian and global nutrition targets.MethodsWe analysed the disease burden attributable to child and maternal malnutrition, and the trends in the malnutrition indicators from 1990 to 2017 in every state of India using all accessible data from multiple sources, as part of Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three groups using their Socio-demographic Index (SDI) calculated by GBD on the basis of per capita income, mean education, and fertility rate in women younger than 25 years. We projected the prevalence of malnutrition indicators for the states of India up to 2030 on the basis of the 1990–2017 trends for comparison with India National Nutrition Mission (NNM) 2022 and WHO and UNICEF 2030 targets.FindingsMalnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68·2% (95% UI 65·8–70·7) of the total under-5 deaths, and the leading risk factor for health loss for all ages, responsible for 17·3% (16·3–18·2) of the total disability-adjusted life years (DALYs). The malnutrition DALY rate was much higher in the low SDI than in the middle SDI and high SDI state groups. This rate varied 6·8 times between the states in 2017, and was highest in the states of Uttar Pradesh, Bihar, Assam, and Rajasthan. The prevalence of low birthweight in India in 2017 was 21·4% (20·8–21·9), child stunting 39·3% (38·7–40·1), child wasting 15·7% (15·6–15·9), child underweight 32·7% (32·3–33·1), anaemia in children 59·7% (56·2–63·8), anaemia in women 15–49 years of age 54·4% (53·7–55·2), exclusive breastfeeding 53·3% (51·5–54·9), and child overweight 11·5% (8·5–14·9). If the trends estimated up to 2017 for the indicators in the NNM 2022 continue in India, there would be 8·9% excess prevalence for low birthweight, 9·6% for stunting, 4·8% for underweight, 11·7% for anaemia in children, and 13·8% for anaemia in women relative to the 2022 targets. For the additional indicators in the WHO and UNICEF 2030 targets, the trends up to 2017 would lead to 10·4% excess prevalence for wasting, 14·5% excess prevalence for overweight, and 10·7% less exclusive breastfeeding in 2030. The prevalence of malnutrition indicators, their rates of improvement, and the gaps between projected prevalence and targets vary substantially between the states.InterpretationMalnutrition continues to be the leading risk factor for disease burden in India. It is encouraging that India has set ambitious targets to reduce malnutrition through NNM. The trends up to 2017 indicate that substantially higher rates of improvement will be needed for all malnutrition indicators in most states to achieve the Indian 2022 and the global 2030 targets. The state-specific findings in this report indicate the effort needed in each state, which will be useful in tracking and motivating further progress. Similar subnational analyses might be useful for other low-income and middle-income countries.FundingBill & Melinda Gates Foundation; Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Mixed-method evaluation of a community-wide physical activity program in Launceston, Australia.

Physical inactivity is a leading risk factor for disease burden and premature mortality. Interventions to increase physical activity are common, though few examples of multi-strategy, wide-scale community programs exist. Active Launceston is a community-wide program aimed at improving health and well-being through physical activity. We report on the process evaluation of Active Launceston and changes in community physical activity participation between 2008 and 2015, as a measure of program effectiveness. Mixed-method evaluation of Active Launceston combined process evaluation-consisting of participant numbers, socio-demographic characteristics, campaign awareness, focus groups and stakeholder interviews-with impact evaluation consisting of a random-sample cross-sectional serial telephone survey. Active Launceston attracted 11887 attendees, participating in 30342 sessions, amounting to 38088hours of physical activity between 2008 and 2015. Participant focus groups highlighted benefits including increased engagement in exercise, better health and social connectedness. While telephone surveys found the proportion of people participating in any physical activity in the last 12months to be similar between the 3years (2008, 77.7%; 2012, 77.1%; 2015, 73.6%), a higher proportion participated in vigorous physical activity in 2012 and 2015 compared to 2008 (P<0.01), when adjusting for age and gender differences. A higher proportion also achieved sufficient activity for health in 2015 compared to 2008 (P=0.01). Mixed-method evaluation suggests Active Launceston is an effective community-wide program supporting community members to engage in regular physical activity and increase levels of social engagement. SO WHAT?: This work provides a model for implementing high-reach, community-wide interventions that improve physical activity outcomes.

Visualizing data: Trends in smoking tobacco prices and taxes in India

Background : Tobacco smoking remains a leading risk factor for disease burden globally. In India alone, about 1 million deaths are caused annually by smoking. Although increasing tobacco prices has consistently been found to be the most effective intervention to reduce tobacco use, the documentation of prices and taxes across time and space has not been an essential component of tobacco control surveillance in most jurisdictions. This study aimed to examine, using graphical methods, trends in smoking tobacco taxes and prices in India at national and state-level. Methods : We used retail prices, price indices, and unit values (household expenditures on a commodity divided by the quantity purchased) collected and reported by government agencies. For bidis and cigarettes, we examined current and real (inflation-adjusted) prices, affordability (cost in terms of income), and key tax changes at both national and state-level. Results : We show that real prices of bidis and cigarettes were relatively flat (even decreasing in the case of bidis) between 2000 and 2007, and clearly increasing from 2010. When rising income is taken into account, however, both cigarettes and bidis have become more affordable since 2000. We found that some but not all tax changes were accompanied by price changes and in particular, that tax decreases did not result in price decreases. Conclusion : It is feasible to evaluate tax and price policies at national and regional level using routinely collected data.

Prevalence of vitamin deficiencies in an apparently healthy urban adult population: Assessed by subclinical status and dietary intakes.

Studies in children and pregnant women consistently showed pandemic proportions of micronutrient deficiencies in the Indian subcontinent. However, vitamin deficiencies in apparently healthy adults are seldom recognized, hence the aim of this exploratory study was to assess their subclinical vitamin status and dietary intakes. In all, 270 apparently healthy urban adults 30 to 70 y of age, from Hyderabad city, India participated in this study. Blood levels of vitamins (A, B1, B2, B6, total and active B12, D, and folate) and homocysteine were assessed. Anthropometric parameters were measured; dietary intake was obtained by food frequency questionnaire, and probability of adequacy (PA) was calculated by the estimated average requirement. Among the study population, the overall prevalence of deficiency of vitamin B2 was strikingly high (50%) followed by the vitamins B6 (46%), active B12 (46%), total B12 (37%), folate (32%), D (29%), B1 (11%), and A (6%). Hyperhomocysteinemia (HHcys) was widely prevalent (52%) in the study participants. In case of dietary intakes, PA was lowest for vitamin B12 (4%) and folate (9%) followed by vitamins A (22%), B2 (33%), B6 (30%), and B1 (59%). The mean PA of these vitamins was noticeably low (28%). The unadjusted logistic regression analysis found men and those with a deficiency of folate and total and active B12 to be at higher risk for HHcys. In the adjusted model, the risk for active B12 deficiency almost doubled. The study demonstrated a high prevalence of multiple subclinical vitamin deficiencies, dietary inadequacies, and HHcys, which are possible risk factors for disease burden among apparently healthy adults.

Visualizing data: Trends in smoking tobacco prices and taxes in India.

Background : Tobacco smoking remains a leading risk factor for disease burden globally. In India alone, about 1 million deaths are caused annually by smoking. Although increasing tobacco prices has consistently been found to be the most effective intervention to reduce tobacco use, the documentation of prices and taxes across time and space has not been an essential component of tobacco control surveillance in most jurisdictions. This study aimed to examine, using graphical methods, trends in smoking tobacco taxes and prices in India at national and state-level. Methods : We used retail prices, price indices, and unit values (household expenditures on a commodity divided by the quantity purchased) collected and reported by government agencies. For bidis and cigarettes, we examined current and real (inflation-adjusted) prices, affordability (cost in terms of income), and key tax changes at both national and state-level. Results : We show that real prices of bidis and cigarettes were relatively flat (even decreasing in the case of bidis) between 2000 and 2007, and clearly increasing from 2010. When rising income is taken into account, however, both cigarettes and bidis have become more affordable since 2000. We found that some but not all tax changes were accompanied by price changes and in particular, that tax decreases did not result in price decreases. Conclusion : It is feasible to evaluate tax and price policies at national and regional level using routinely collected data.

Brief intervention on Smoking, Nutrition, Alcohol and Physical (SNAP) inactivity for smoking relapse prevention after release from smoke-free prisons: a study protocol for a multicentre, investigator-blinded, randomised controlled trial

IntroductionSmoking remains the leading risk factor for disease burden and mortality worldwide. Heavy Smoking is often associated with poor Nutrition, Alcohol abuse and Physical inactivity (known as ‘SNAP’). Australia’s first...

Improving the cardiometabolic health of people with psychosis: A protocol for a randomised controlled trial of the Physical Health Nurse Consultant service

BackgroundOver 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. ObjectivesTo describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. Design/MethodsIn this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the ‘Access’, ‘Acceptability’ and ‘Shared Decision Making’ dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. ResultsData collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. ConclusionsThe PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health care.

Food Consumption, Nutrient Intake, and Prevalence of Malnutrition in Relation with Geographical and Socio-Economic Factors Among Older Chinese: Findings from Chinese National Nutrition and Healthy Survey 2010-2013

Background: China has been undergoing tremendous demographic transitions towards an aging society. Although suboptimal diets and malnutrition are the leading risk factors for disease burden, capturing nutrition challenges faced by the aging population is challenging due to the limited national representative information available. This study aimed to provide a comprehensive picture of the nutrition status of mid-aged and elderly Chinese and its relation to geographical and socioeconomic factors. Methods: A total of 75,758 non-institutionalized adults aged 45-80 years from the 2010-2013 Chinese National Nutrition and Health Survey were included in this study to evaluate their nutritional status and prevalence of malnutrition problems including anemia, underweight, overweight and obesity. Dietary data from 33,418 participants in this sample were obtained through 24 hour-recall over three consecutive days combined with weighted food inventory. Nutrient intakes were estimated based on dietary records and comparison with Chinese Dietary Reference Intakes 2013 (DRIs). Malnutrition problems were reported with stratification for demographic, geographic, and socioeconomic variables. Odd ratios of risks factors for malnutrition were estimated through multilevel multiple logistic regression analysis. Findings: Chinese population mean intakes of nutrient-dense food groups including fruits, dairy, soy and nuts, eggs, fish and seafood, as well as vegetables were lower than recommendations. Conversely, consumption of fat- and sodium- contributing groups such as meat and poultry, cooking oil, salt and condiments were higher than recommendations.The low adherence to dietary recommendations led to inadequate micronutrient intakes compared to DRIs, especially for eight micronutrients (calcium, folate, magnesium, selenium, vitamin A, vitamin B1, vitamin B2, and vitamin C), with more than 50% of participants have intakes lower than Estimated Average Requirements (EAR). Older age groups showed lower percentages of nutrient adequacy. The overall prevalences of anemia, underweight, overweight and obesity were 10.9%, 3.7%, 36% and 14%, respectively. The combined prevalence of overweight and obesity was 51.3% for the middle-aged group (45-59 years) and 45.2% for the elderly group (60-80 years). After adjusting for confounders at both individual and province levels, being older, female, a rural resident and having lower education were factors associated with higher risk for anemia and underweight, while younger age, female, urban residency and higher income were factors associated with greater risk for being overweight and obese. Interpretation: The results provide reference data for the development of policy and interventions to substantiate the China National Nutrition Plan 2017-2030. Within Chinese adults, older people have the highest prevalence of malnutrition. We suggest three priorities which require attention and solution: addressing anemia and underweight in high risk groups, curbing overweight and obesity, and supporting healthy eating and balanced diets. Funding Statement: The China National Nutrition and Healthy Survey (CNNHS), the Chinese Center for Disease Control and Prevention (CDC). This secondary data analysis received financial support from the Nestle Research Center. Declaration of Interests: This secondary data analysis received financial support from Nestle Research Center. Co-author Kai Yu, Jing Yin, and Fabrizio Arigoni are employed by Nestle Research Center. These authors contributed to the development of the manuscript, with no roles in the survey design and data analysis. Ethics Approval Statement: The study protocol was approved by the ethical review committee of the Chinese CDC. Written informed consent was obtained from all participants.

Geographical variations in hypertension prevalence, awareness, treatment and control in China: findings from a nationwide and provincially representative survey.

Hypertension has been the most important risk factor for disease burden in China. We aimed to conduct the first national spatial analysis of hypertension status, awareness, treatment and control in China. Choropleth maps were used to examine the spatial patterning of hypertension, awareness, treatment and control in a nationally and provincially representative sample of 174 389 adults from the 2013 to 2014 China Chronic Disease and Risk Factors Surveillance. Multilevel regressions were used to analyze each outcome across provinces, counties, towns and villages/residential committees and to test the proportion of area-level variances explained by known risk factors. Hypertension prevalence was highest in the north (e.g. Liaoning = 37.7%) and lowest in the south (e.g. Hainan = 17.9%). Among participants found to have hypertension, awareness was generally low, especially in the south (e.g. Guizhou = 18.0%). Receipt of treatment among those who were aware of their hypertension status was above 70% in all provinces except for Tibet (37.7%) and Guizhou (54.5%). Control of hypertension among those receiving treatment (SBP < 140 and DBP < 90 mmHg) was generally low, especially in northeastern and southwestern provinces. Adjustment for demographic, socioeconomic and behavioral factors, weight status, healthcare use and urbanization of residence accounted for 57.7% of variation between provinces in hypertension status, 48.5% in awareness, 47.6% in treatment and 18.0% in control. Hypertension is spatially patterned in China and there is an unmet need at each step from diagnosis to receiving treatment and achieving controlled hypertension. Geographically targeted strategies are required to enhance hypertension prevention and management in China.

Identification of the Therapeutic Effects of Gamma-Irradiated Chamomile Aqueous Extract Against Alcohol Induced Hepato-nephrotoxicity in Rats

Alcohol consumption represents the third largest risk factor for disease burden in most countries of the world and can damage several organs and systems in the body such as liver and kidney. Medicinal herb plants may act as an effective remedy for the enormous health burden posed by alcohol consumption. The aim of this study was to investigate the therapeutic effects of an aqueous extract of gamma-irradiated chamomile (GCE) (10 kGy) on alcohol-induced hepato-nephrotoxicity in rats. In this study, results of rats that received alcohol alone (1 ml of 70 % ethanol daily for 56 days) showed hepato-nephrotoxicity as indicated by significant increases in the activity of hepatic enzyme markers. These changes include: increased levels of serum creatinine, urea and uric acid with significant decreased levels of total protein, albumin and globulin. Ethanol administration also resulted in elevation in malondialdehyde (MDA) concentration and the activity of xanthine oxidase (XO) and alcohol dehydrogenase (ADH) with reduction in glutathione level (GSH) and the activities of aldehyde dehydrogenase (ALDH) , xanthine dehydrogenase(XDH),superoxide dismutase(SOD) and catalase (CAT) in both liver and kidney tissues compared to control rats. Post-treatment of ethanol-administered rats with aqueous gamma-irradiated chamomile extract significantly ameliorates the deleterious effects of ethanol on all biochemical parameters and enhances the hepato-renal antioxidant status and improved alterations in hepatic alcohol metabolizing enzymes. Conclusion: Thus, gamma-irradiated chamomile can be suggested to offer distinct treatment against ethanol induced organ damage.