Cause Of Premature Death Research Articles

Alcohol and cause-specific mortality among 150,000 participants in the Mexico City Prospective Study

Abstract Background The Global Burden of Disease and Risk Factor models assess alcohol to be a leading cause of premature death both globally and in Mexico, but direct epidemiological evidence from Mexico is limited. We investigated the relevance of alcohol to mortality at ages 35-74 in a large prospective study of Mexican adults followed for nearly two decades. Methods Between 1998 and 2004, 150,000 adults aged ≥35 years were recruited into the Mexico City Prospective Study, and followed for median 19 years. Cox regression was used to relate baseline-reported alcohol consumption (never, former, ‘occasional’ [defined as less than monthly], and ‘regular’ [defined as at least monthly, and split into <70, ≥70 to <140, ≥140 to <210 and ≥210g/week]) to mortality at ages 35-74 from all causes, and from underlying causes selected a priori as being potentially ‘alcohol-related’. Analyses were adjusted for age at risk, sex, residential district, education, smoking, physical activity and diabetes. They excluded those who at recruitment were aged ≥75 years, had incomplete data, or had vascular disease or any other chronic condition (except diabetes) recorded. Results Among 45,262 men and 93,607 women aged 35-74 years, 6% of men and 26% of women reported being never drinkers, 45% of men and 56% of women reported being occasional drinkers, and 33% of men and 7% of women reported being regular drinkers. There were 12,597 deaths from any cause before age 75, including 3,433 deaths from the selected underlying causes. Compared with occasional drinkers, never drinkers had 16% higher all-cause mortality (RR 1.16, 95% CI 1.10-1.22) but similar mortality from the subset of deaths considered potentially alcohol-related (RR 1.06, 95% CI 0.96-1.17). Among regular drinkers, all-cause mortality increased progressively across the four studied categories. Compared with occasional drinkers, regular drinkers of ≥140 to <210g/week had 20% higher mortality (RR 1.20, 95% CI 1.08-1.34) while regular drinkers of >210g/week had 46% higher mortality (RR 1.46, 95% CI 1.33-1.61). For the subset of deaths considered to be alcohol-related these RRs were 1.61 (1.35-1.93) and 2.42 (2.10-2.79) respectively. Liver disease was especially strongly related to alcohol consumption: the RR comparing regular drinkers of >210g/week with occasional drinkers was 5.89 (95% CI 4.75-7.29). Associations were similar in those with and without diabetes, so the absolute relevance of alcohol to mortality was larger in those with diabetes. Conclusions In this Mexican cohort, higher alcohol consumption was associated with higher mortality.

Years of life lost and long-term outcomes due to glomerular disease in a Southeast Asian Cohort

Death and end-stage kidney disease (ESKD) are major outcomes of glomerular disease. (GD) The years of potential life lost (YLL) may provide additional insight into the disease burden beyond death rates. There is limited data on premature mortality in GD. In this retrospective observational cohort study, we evaluated the mortality, ESKD rates, and YLL in Thais with biopsy-proven GD. The mortality and combined outcome rates were determined by log-rank test and ESKD by using a competing risk model. YLL and premature life lost before age 60 were calculated for different GD based on the life expectancy of the Thai population. Patients with GD (n = 949) were followed for 5237 patient years. The death rate and ESKD rates (95%CI) were 4.2 (3.7–4.9) and 3.3 (2.9–3.9) per 100 patient-years, respectively. Paraprotein-related kidney disease had the highest death rate, and diabetic nephropathy had the highest ESKD rate. Despite not having the highest death rate, lupus nephritis (LN) had the highest YLL (41% of all GD) and premature loss of life before age 60. In conclusion, YLL provided a different disease burden assessment compared to mortality rates and identified LN as the major cause of premature death due to GD in a Southeast Asian cohort.

Correlation between chronic disease management program (prolanis) activities and health status of hypertension patients at Muara Satu community health center, Lhokseumawe city

The Chronic Disease Management Program (Prolanis) is a program intended for people with chronic diseases such as hypertension which is quite effective but there are still many hypertensive patients who have not used the program. Hypertension is one of the causes of premature death due to the high rate of complications, the incidence of hypertension in the world continues to increase, especially in Indonesia. An increase in the incidence of hypertension will determine a person's health status. The purpose of this study was to identify the Chronic Disease Management Program (Prolanis), to identify the health status of Prolanis participants with hypertension, and to determine the relationship between Prolanis activities and the health status of hypertensive patients at the Muara Satu Subdistrict Health Center, Lhokseumawe City. The research method used a cross sectional research design, to analyze the relationship between Prolanis and the health status of hypertensive patients using the Chi Square test. The results showed the characteristics of the majority of Prolanis participants with hypertension were early elderly (46-55 years), female gender, not working, elementary school education, and marital status, as well as long suffering from hypertension with short duration occupying the highest position. The description of the degree of hypertension is more in the category of first-degree hypertension, most of the elderly who participate in Prolanis are in the good category (65.7%) and have the most health status in the good category (74.3%). The elderly who participate in Prolanis in the sufficient category will have sufficient health status (100%). Likewise, the elderly who participate in Prolanis in the good category will have a good health status (88.5). The conclusion of this study shows that there is a significant relationship between participating in Prolanis activities and the health status of the elderly.

Cardiometabolic effect of sodium and glucosa cotransporter inhibitors type 2

Introduction: Type 2 diabetes mellitus has emerged as a leading cause of premature death and a growing threat to the healthcare system due to the high costs of medical care in the context of cardiovascular complications. Methods: We conducted a systematic electronic search of clinical trials published from 2015 to January 2023 in PubMed, Scopus, Web of Science and ScieLO databases, which evaluated the efficacy and safety of the use of type 2 sodium-glucose cotransporter inhibitors in patients with type 2 diabetes mellitus and established cardiovascular disease on routine treatment and their cost-effectiveness.Results: Significantly lower rates of acute myocardial infarction, stroke, cardiovascular death and hospitalization due to heart failure were observed when the study drugs were added to standard therapy. In addition, it was evidenced that the reduction in cardiovascular clinical events manages to offset the cost of type 2 sodium-glucose cotransporter inhibitors resulting in a cost-effective use of resources at the health care level.Conclusions: As the transition to a new evidence-based era of managing patients with type 2 diabetes mellitus and cardiovascular disease progresses, it is imperative that new therapies are developed that not only improve glycemic control, but also improve cardiovascular outcomes, because these events represent the major cause of mortality in this population.

The Burden of Premature Mortality in Southern Iran during 2004-2019 Using Standard Expected Years of Life Lost: A Population-Based Study.

Traditionally, mortality rates are used to estimate public health problems and determine the relative significance of different causes of mortality, but they cannot necessarily determine the burden of premature death. We aimed to investigate the 16-year trend of burden of premature mortality in Southern Iran. In this cross-sectional study, all deaths due to various causes of death in Fars Province from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, Years of Life Lost (YLL) and YLL rate data were calculated and to examine the trend, joinpoint regression was used. During the study period, 281,903 deaths occurred, of which, 59.85% (n=168,735) occurred in men. Also, 42.18% of these deaths (n=118,610) occurred due to cardiovascular diseases (CVDs). The total number of YLLs due to premature death was 4,154,828 years. Of these, 2,591,564 years (62.37%) were in men. The highest number of YLL was due to CVDs, external causes of death and cancer. Trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -2.1% (95% CI -2.6 to -1.6, P<0.001) for males, -0.9% (95% CI -1.4 to -0.4, P=0.002) (P=0.002) for females. Although the trend of premature death has been decreasing during the years of study, but the seven major causes of premature death in 2004 to 2019 were non-communicable diseases, especially ischemic heart diseases, stroke, external cause of morbidity, and cancer. Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.

Early life exposure to cigarette smoking and adult and old-age male mortality: Evidence from linked US full-count census and mortality data.

Smoking is a leading cause of premature death across contemporary developed nations, but few longitudinal individual-level studies have examined the long-term health consequences of exposure to smoking. We examine the effect of fetal and infant exposure to exogenous variation in smoking, brought about by state-level cigarette taxation, on adulthood and old-age mortality (ages 55-73) among cohorts of boys born in the United States during the 1920s and 1930s. We use state-of-the-art methods of record linkage to match 1930 and 1940 US full-count census records to death records, identifying early life exposure to the implementation of state-level cigarette taxes through contemporary sources. We examine a population of 2.4 million boys, estimating age at death by means of OLS regression, with post-stratification weights to account for linking selectivity. Fetal or infant exposure to the implementation of state cigarette taxation delayed mortality by about two months. Analyses further indicate heterogenous effects that are consistent with theoretical expectations; the largest benefits are enjoyed by individuals with parents who would have been affected most by the tax implementation. Despite living in an era of continuously increasing cigarette consumption, cohorts exposed to a reduction in cigarette smoking during early life enjoyed a later age at death. While it is not possible to comprehensively assess the treatment effect on the treated, the magnitude of the effect should not be underestimated, as it is larger than the difference between having parents belonging to the highest and lowest socioeconomic groups. The study provides the first estimates of long-run health effects from early life exposure to cigarette smoking.

MEMAHAMI PERILAKU KETIDAKPATUHAN PENGGUNAAN OBAT DI KALANGAN PENDERITA PENYAKIT HIPERTENSI: APLIKASI TEORI HEALTH BELIEF MODEL

Hypertension disease is one of the risk factors for cardiovascular and blood vessel disease which is increasing constantly through the world and it is the main cause of premature death. Currently, the therapy that used for hypertension is antihypertensive treatment and applying the healthy lifestyle. Adherence in using antihypertensive medications is very important to achieve controlled hypertension. However, there are many nonadherence behaviors in the use of drugs that can cause a decrease in the patient’s quality of life. This study aimed to explore factors related to patient’s adherence in antihypertensive medications using Health Belief Model theory. This research is a qualitative study through deep interviews with open-ended questions. Respondents were all hypertension patients with minimum 3 months treatment of antihypertensive medications. Interviews were conducted using an interview guide compiled based on HBM constructs. Data were analyzed with content analysis. Result: 34 respondents were interviewed. Most respondents have high adherence in antihypertensive treatment 62% and 38% respondents have low adherence. This behavior is influenced by the low perception of susceptibility and severity to hypertension, which is caused by a lack patient knowledge. In addition, the high perception of barrier and the lack of perceived benefits when taking medication regularly also affects the level of patient nonadherence. Conclusion: Nonadherence behavior to antihypertensive medications was noticed in 38% of the respondents studied. Interventions strategies aiming to improve adherence can be done through patient education and using the electronic reminders.

Altered Peripheral Blood Gene Expression in Childhood Cancer Survivors With Anthracycline-Induced Cardiomyopathy - A COG-ALTE03N1 Report.

Background Anthracycline-induced cardiomyopathy is a leading cause of premature death in childhood cancer survivors, presenting a need to understand the underlying pathogenesis. We sought to examine differential blood-based mRNA expression profiles in anthracycline-exposed childhood cancer survivors with and without cardiomyopathy. Methods and Results We designed a matched case-control study (Children's Oncology Group-ALTE03N1) with mRNA sequencing on total RNA from peripheral blood in 40 anthracycline-exposed survivors with cardiomyopathy (cases) and 64 matched survivors without (controls). DESeq2 identified differentially expressed genes. Ingenuity Pathway Analyses (IPA) and Gene Set Enrichment Analyses determined the potential roles of altered genes in biological pathways. Functional validation was performed by gene knockout in human-induced pluripotent stem cell-derived cardiomyocytes using CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9) technology. Median age at primary cancer diagnosis for cases and controls was 8.2 and 9.7 years, respectively. Thirty-six differentially expressed genes with fold change ≥±2 were identified; 35 were upregulated. IPA identified "hepatic fibrosis" and "iron homeostasis" pathways to be significantly modulated by differentially expressed genes, including toxicology functions of myocardial infarction, cardiac damage, and cardiac dilation. Leading edge analysis from Gene Set Enrichment Analyses identified lactate dehydrogenase A (LDHA) and cluster of differentiation 36 (CD36) genes to be significantly upregulated in cases. Interleukin 1 receptor type 1, 2 (IL1R1, IL1R2), and matrix metalloproteinase 8, 9 (MMP8, MMP9) appeared in multiple canonical pathways. LDHA-knockout human-induced pluripotent stem cell-derived cardiomyocytes showed increased sensitivity to doxorubicin. Conclusions We identified differential mRNA expression profiles in peripheral blood of anthracycline-exposed childhood cancer survivors with and without cardiomyopathy. Upregulation of LDHA and CD36 genes suggests metabolic perturbations in a failing heart. Dysregulation of proinflammatory cytokine receptors IL1R1 and IL1R2 and matrix metalloproteinases, MMP8 and MMP9 indicates structural remodeling that accompanies the clinical manifestation of symptomatic cardiotoxicity.

Suicidal thoughts and attempts among married women who experience intimate partner violence in Türkiye.

Suicide is one of the main causes of premature death and an important health concern globally because of its current rising prevalence. To investigate suicidal thoughts and attempts among married women who have experienced intimate partner violence in Sivas, Türkiye. This cross-sectional, population-based survey was conducted between January and December 2019 among 2243 currently married women aged 15-49 years, who had been residing in the centre of Sivas Province, Türkiye, for ≥ 6 months. Multistage clustered random sampling was used in the survey. The 12-item General Health Questionnaire was used for the measure of mental health, while the violence items were measured using the Conflict Tactic Scales-2. The data were analysed using SPSS version 16.0. Prevalence of suicidal thoughts and attempts was 9.5% and 4.8%, respectively. Multivariate logistic regression analysis showed that age < 25 years, mental health problems, being a victim of violence during childhood or marriage, and insufficient income were associated with suicidal thoughts. Age < 25 years, mental health problems, being a victim of violence during childhood or marriage were associated with suicidal attempts. Intimate partner violence is a risk factor for poor health among women, including mental health, and it could result in suicidal thoughts and attempts. Intimate partner violence against women should be addressed by the relevant authorities to reduce suicidal thoughts and attempts, especially among younger women.

Cardiovascular Disease and Stroke in Immune TTP-Challenges and Opportunities.

Advances in the management of immune thrombotic thrombocytopenic purpura (iTTP) have dramatically improved outcomes of acute TTP episodes, and TTP is now treated as a chronic, relapsing disorder. It is now recognized that iTTP survivors are at high risk for vascular disease, with stroke and myocardial infarction occurring at younger ages than in the general population, and cardiovascular disease is the leading cause of premature death in this population. iTTP appears to have a phenotype of accelerated vascular aging with a particular predilection for cerebral circulation, and stroke is much more common than myocardial infarction. In addition to traditional cardiovascular risk factors, low ADAMTS13 activity during clinical remission may be a risk factor for some of these outcomes, such as stroke. Recent studies also suggest that Black patients, who are disproportionately affected by iTTP in the United States, are at higher risk of adverse cardiovascular outcomes, likely due to multifactorial reasons. Additional research is required to establish the risk factors and mechanisms underlying these complications in order to institute optimal screening strategies and identify interventions to improve outcomes.

Myocardial Infarction Within 30 Days of Discharge From an Emergency Department: A Descriptive Study of Albertan Women

BackgroundCardiovascular diseases (CVDs) are the leading cause of premature death for Canadian women, which may be due partly to a lack of awareness of the presentation of acute coronary events in emergency departments (EDs). To address an identified gap in women’s cardiovascular care, we sought to describe the clinical and comorbid factors of women who, following discharge from an ED, suffered a myocardial infarction (MI). MethodsDescriptive analyses were completed on a cohort of women who presented to an ED in Alberta, Canada, between January 1, 2010 and December 31, 2020, were discharged, and within 30 days of their index ED visit, were admitted to the hospital with an MI. The cohort was explored for clinical and comorbid data, ED visits pre-MI, type of MI, and presenting complaint/ primary diagnosis for the index ED visit. Results1380 women were included in this analysis with a mean age of 67 (standard deviation ±13) years. The frequencies of hypertension, diabetes, and dyslipidemia among the youngest women, aged 18-45 years, were 47.5%, 31.3%, and 48.8%, respectively. Women across all ages demonstrated a high prevalence of traditional CVD risk factors, and 22% of women presented to an ED 2 or more times within the 30 days pre-MI. ConclusionsRegardless of their age, the women in this cohort had notable CVD risk factors. Future research is required to better understand the phenomenon of women presenting multiple times to an ED pre-MI. Research is needed on life-stage–specific factors of women presenting to EDs pre-MI, to help reduce MI incidence.

7-Hydroxy Frullanolide Ameliorates Isoproterenol-Induced Myocardial Injury through Modification of iNOS and Nrf2 Genes.

Myocardial infarction (MI) is the principal cause of premature death. Protecting myocardium from ischemia is the main focus of intense research. 7-hydroxy frullanolide (7-HF) is a potent anti-inflammatory agent, showing its efficacy in different acute and chronic inflammatory disorders such as atherosclerosis, suggesting it can be a potential cardioprotective agent. For the induction of MI, Sprague-Dawley rats (n = 5) were administered isoproterenol (ISO) 85 mg/kg s.c at 24 h intervals for two days. The potential cardioprotective effect of 7-HF and its mechanisms were explored by in vivo and in vitro methods. 7-HF significantly prevented the extent of myocardial injury by decreasing the infarct size, preserving the histology of myocardial tissue, and reducing the release of cardiac biomarkers. Further, 7-HF increased the mRNA expression of cardioprotective gene Nrf2 and reduced the mRNA expression of iNOS. 7-HF also improved cardiac function by decreasing the cardiac workload through its negative chronotropic and negative ionotropic effect, as well as by reducing peripheral vascular resistance due to the inhibition of voltage-dependent calcium channels and the release of calcium from intracellular calcium stores. In conclusion, 7-HF showed cardioprotective effects in the MI model, which might be due to modulating the expression of iNOS and Nrf2 genes as well as improving cardiac functions.

Clustering and trajectories of key noncommunicable disease risk factors in Norway: the NCDNOR project

Noncommunicable diseases (NCDs) are a leading cause of premature death globally and have common preventable risk factors. In Norway, the NCDNOR-project aims at establishing new knowledge in the prevention of NCDs by combining information from national registries with data from population-based health studies. In the present study, we aimed to harmonize data on key NCD risk factors from the health studies, describe clustering of risk factors using intersection diagrams and latent class analysis, and identify long-term risk factor trajectories using latent class mixed models. The harmonized study sample consisted of 808,732 individuals (1,197,158 participations). Two-thirds were exposed to ≥ 1 NCD risk factor (daily smoking, physical inactivity, obesity, hypertension, hypercholesterolaemia or hypertriglyceridaemia). In individuals exposed to ≥ 2 risk factors (24%), we identified five distinct clusters, all characterized by fewer years of education and lower income compared to individuals exposed to < 2 risk factors. We identified distinct long-term trajectories of smoking intensity, leisure-time physical activity, body mass index, blood pressure, and blood lipids. Individuals in the trajectories tended to differ across sex, education, and body mass index. This provides important insights into the mechanisms by which NCD risk factors can occur and may help the development of interventions aimed at preventing NCDs.

Penyuluhan Edukasi Bahaya Merokok Di SMP Negeri 11 Sigi

Tobacco use is a global problem that causes death in the world. Tobacco smoking is a risk factor for six out of eight causes of premature death, namely ischemic heart disease, cerebrovascular disease, lower respiratory tract infections, chronic obstructive pulmonary disease, tuberculosis and cancer of the trachea, bronchi and lungs. Individuals who develop smoking behaviors in their early teens also have an increased risk of cardiovascular disease, respiratory disease, and cancer, and they are more likely to experiment with alcohol and other drugs. The Education Counseling on the Dangers of Smoking includes an explanation of the Dangers of Smoking and the effects that smokers can have. The education also provides knowledge on how to prevent smokers. With the existence of health education given to adolescents, it will add to the knowledge of adolescents about the dangers of smoking.

The Importance of Nontraditional and Sex-Specific Risk Factors in Young Women With Vasomotor Nonobstructive vs Obstructive Coronary Syndromes

BackgroundHeart disease is the leading cause of premature death for women in Canada. Ischemic heart disease is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI-CAD). This study aims to study the prevalence of traditional and nontraditional ischemic heart disease risk factors and their relationships with (M)INOCA, compared to MI-CAD and non-MI-CAD in young women. MethodsThis study investigated women who presented with premature (at age ≤ 55 years) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women’s Heart Health Clinic Registry (WHC) or the Study to Avoid Cardiovascular Events in British Columbia (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD, and non-MI-CAD. ResultsA total of 254 women enrolled between 2015 and 2022 were analyzed, as follows: 77 with INOCA and 37 with MINOCA from the registry, and 66 with non-MI-CAD and 74 with MI-CAD from the study. Regression analyses demonstrated that migraines and preeclampsia or gestational hypertension were the most significant risk factors, with a higher likelihood of being associated with premature (M)INOCA, relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood of being associated with premature CAD. ConclusionsThe risk factor profiles of patients with premature (M)INOCA, compared to obstructive CAD, have significant differences.

Synergistic effects of GABA and hypoglycemic drugs

Diabetes mellitus (DM) is the leading cause of premature death and disability. Despite a significant number of drugs, the effectiveness of therapy aimed at normalizing the level of glycemia and preventing complications does not fully satisfy doctors and patients. Therefore, the search for new approaches for the prevention and treatment of DM and its complications continues. Significant resources are used to develop new drugs, but recently the possibility of using «old» widely available drugs with newly discovered pleiotropic properties has been substantiated. These may include preparations of gammaaminobutyric acid (GABA) and agents that directly or indirectly activate GABAergic transmission, which have a pronounced pancreatic protective effect, which has been widely discussed in foreign literature over the past 10-15 years. However, there are few such publications in the domestic literature.It has been established that the content of GABA in β-cells in patients with type 1 and type 2 diabetes is reduced and this correlates with the severity of the disease. Genetic suppression of GABA receptors causes a significant decrease in the mass of β-cells and glucose-stimulated insulin secretion, which confirms the importance of GABA in ensuring glucose homeostasis and the advisability of replenishing the GABA deficiency in DM with its additional administration. It has been established that in animals with DM, GABA suppresses apoptosis and stimulates the regeneration of β-cells, increases β-cell mass and insulin production.Experimental data have been obtained indicating a synergistic effect of GABA when combined with glucagon-like peptide-1 (GLP-1) receptor agonists, DPP-4 inhibitors and sodium-glucose cotransporter 2 (SGLT-2) inhibitors, when a more pronounced pancreoprotective effect is observed, due to decrease in oxidative and nitrosative stress, inflammation, increase in the level of Klotho protein, Nrf-2 activity and antioxidant defense enzymes, suppression of NF-kB activity and expression of pro-inflammatory cytokines. As a result, all this leads to a decrease in apoptosis and death of β-cells, an increase in β-cell mass, insulin production and, at the same time, a decrease in glucagon levels and insulin resistance.The review substantiates the feasibility of using GABA and drugs with a positive GABAeric effect in combination with new generation antidiabetic agents: GLP-1 receptor agonists, DPP-4 inhibitors and SGLT-2 inhibitors in order to increase their antidiabetic potential.The search was carried out in the databases Pubmed, eLibrary, Medline. Keywords: diabetes mellitus, gamma-aminobutyric acid, glucagon-like peptide-1, GLP-1 receptor agonists, glucose-dependent insulinotropic peptide, dipeptidyl peptidase inhibitors, sodium-glucose cotransporter 2 inhibitors. The search was carried out from 2000 to 2022, but the review presents the results studies published mainly in the last 3 years, due to the requirements of the journal for the maximum amount of work and the number of sources.

New Developments and Challenges in Liver Transplantation.

Liver disease is increasing in incidence and is the third most common cause of premature death in the United Kingdom and fourth in the United States. Liver disease accounts for 2 million deaths globally each year. Three-quarters of patients with liver disease are diagnosed at a late stage, with liver transplantation as the only definitive treatment. Thomas E. Starzl performed the first human liver transplant 60 years ago. It has since become an established treatment for end-stage liver disease, both acute and chronic, including metabolic diseases and primary and, at present piloting, secondary liver cancer. Advances in surgical and anaesthetic techniques, refined indications and contra-indications to transplantation, improved donor selection, immunosuppression and prognostic scoring have allowed the outcomes of liver transplantation to improve year on year. However, there are many limitations to liver transplantation. This review describes the milestones that have occurred in the development of liver transplantation, the current limitations and the ongoing research aimed at overcoming these challenges.

BODY MASS INDEX STATUS WITH HYPERTENSION

Hypertension is the leading cause of premature death in the world. It does not only attack the productive age but also attacks the elderly. Hypertension is known as "The Silent Killer" because it is often without complaints and there are complications. Body Mass Index (BMI) is very influential on blood pressure. Abnormal BMI has twice the chance of experiencing hypertension and triggers higher risk factors for hypertension than normal people. This research aims to determine the relationship between BMI and the incidence of hypertension in Ngablak Hamlet, Sitimulyo Piyungan Village, Bantul, Yogyakarta. This research was an analytic observational study with a cross-sectional research design. Sampling used the Accidental Sampling technique with 30 respondents based on the inclusion and exclusion criteria. Measuring instruments used to collect BMI data were weight scales and height measuring devices (cm) and measuring instruments used to measure blood pressure are stethoscopes and sphygmomannometers. Measurements consisted of systolic and diastolic blood pressure, weight, and height. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 16.0 program. The results of this research showed a significance value of 0.044 (p &lt;0.05). thus, there was a significant relationship between BMI and the incidence of hypertension in Ngablak Hamlet, Sitimulyo Piyungan Village, Bantul Yogyakarta.

Diabetes in childhood cancer survivors: emerging concepts in pathophysiology and future directions.

With advancements in cancer treatment and supportive care, there is a growing population of childhood cancer survivors who experience a substantial burden of comorbidities related to having received cancer treatment at a young age. Despite an overall reduction in the incidence of most chronic health conditions in childhood cancer survivors over the past several decades, the cumulative incidence of certain late effects, in particular diabetes mellitus (DM), has increased. The implications are significant, because DM is a key risk factor for cardiovascular disease, a leading cause of premature death in childhood cancer survivors. The underlying pathophysiology of DM in cancer survivors is multifactorial. DM develops at younger ages in survivors compared to controls, which may reflect an "accelerated aging" phenotype in these individuals. The treatment-related exposures (i.e., chemotherapy, radiation) that increase risk for DM in childhood cancer survivors may be more than additive with established DM risk factors (e.g., older age, obesity, race, and ethnicity). Emerging research also points to parallels in cellular processes implicated in aging- and cancer treatment-related DM. Still, there remains marked inter-individual variability regarding risk of DM that is not explained by demographic and therapeutic risk factors alone. Recent studies have highlighted the role of germline genetic risk factors and epigenetic modifications that are associated with risk of DM in both the general and oncology populations. This review summarizes our current understanding of recognized risk factors for DM in childhood cancer survivors to help inform targeted approaches for disease screening, prevention, and treatment. Furthermore, it highlights the existing scientific gaps in understanding the relative contributions of individual therapeutic exposures and the mechanisms by which they exert their effects that uniquely predispose this population to DM following cancer treatment.

Upaya Mengenali Sindrom Kardiometabolik melalui Pengabdian kepada Masyarakat

Introduction: The Healthy Adjusted Life Expectancy Index (HALE) for 2019 for the Indonesian population is 62.8 years lower than the 71.3 years for standard life expectancy; this is due to the lack of quality of life in Indonesia. The profile of the population in Central Java for the elderly category every year is similar to the increase on a national scale. The fact that the elderly are still working to earn a living indicates that their welfare level is still low. Non-communicable diseases (NCDs) are often the cause of premature death before the age of 70. Cardiovascular disease is the number-one killer in the world. Cardiometabolic syndrome is characterized by at least three things: abdominal obesity, increased plasma glucose, increased blood pressure, increased triglycerides, and decreased HDL cholesterol. A study on five members found an average total cholesterol level of 168.9 mg/dl and an average blood pressure of 125.4/80.9 mmHg. Objective: The aim of this community service is to increase awareness and the health status of members of the hypertension care group in Mersi Purwokerto. Methods: This community service method involves coordination with the chief of the hypertension care group, making leaflets, and preparing tools and materials for cholesterol examination. Results: This community service received good active participation from members of the hypertension care group in Mersi, Purwokerto. Overview of the risk of metabolic syndrome in community service participants, namely 32 DM sufferers (55.2%), 25 hypertension sufferers (43.1%), and 45 with high total cholesterol levels (77.6%). Conclusion: The results of this community service are expected to be a screening for participants who have a high risk of cardiometabolic syndrome and a desire to continue to make active and healthy lifestyle changes.