Lifetime Risk Of Death Research Articles

Characterization of radiation risk associated with computed tomography for the Russian patients using disability-adjusted life years measure

adiation risks assessment in medical exposure of patients is one of the mandatory steps in justifying the medical radiological examinations. The main objectives of such assessment are the need for benefit-harm analysis, when prescribing a study, and informing patients or their legal representatives about the radiation risk associated with the recommended examination. The traditional approach to radiation risk assessment is the use of measures based on lifetime morbidity and/or mortality due to radiation exposure in risk characterization. However, the development of the methodology of population health assessment and the need to harmonize the methodology of radiation risk assessment with risks from exposure to factors of other nature imply the use of more informative generalized health indicators in the assessment of exposure to harmful environmental factors. The aim of actual work was to apply the developed methodology of radiation detriment assessment to characterize the risk by calculating DALY (number of years of healthy full life lost due to exposure to ionizing radiation) values for different sex and age groups of Russian patients undergoing computed tomography. To achieve this goal, the previously developed method of estimating the number of years of healthy life lost due to exposure to ionizing radiation was used. Calculations were performed with the use of a specially developed computer program based on the models of the International Commission on Radiological Protection using medical and demographic data of Russian population. The article presents the results of DALY calculation for six types of computed tomographic examinations. The use of DALY to characterize risk instead of the most widely used value of radiation detriment (or lifetime risk of death, relating the harm from the reduction in the quality of life in the case of non-fatal oncological disease) is an attempt to harmonize the methodology of radiation risk assessment with the methodologies of other kind of health risks. One of the directions of calculation results usage is the development of sexand age-dependent risk coefficients associated with medical exposure of patients. The analysis of the obtained results showed that the age distribution of risks agrees well with the data presented in the methodological recommendations MR 2.6.1.0215-20 “Assessment of radiation risk to patients in radiology examinations”. It is also shown that the DALY indicator can serve as a basis for comparative assessment of obtainable and avoidable risks in the field of medical radiation exposure of patients.

25, 50 & 75 years ago.

25, 50 & 75 years ago.

Addressing hepatic metastases in ovarian cancer: Recent advances in treatment algorithms and the need for a multidisciplinary approach.

The lifetime risk for ovarian cancer incidence is 1.39% and the lifetime risk of death is 1.04%. Most ovarian cancer patients are diagnosed at advanced stages (III, IV) because there were no specific symptoms or existing screening tests. Liver metastases have been found in up to 50% of patients dying of advanced ovarian cancer. Recent studies indicate the need for a multidisciplinary approach from initial diagnosis to oncologic surgery and chemotherapy treatment, mandating the involvement of gynecologic oncologists, surgical oncologist, medical oncologists, hepatobiliary surgeons, and interventional radiologists.

КАЛИБРОВОЧНЫЕ АЛГОРИТМЫ ОПРЕДЕЛЕНИЯ ЧИСЛА РАДИОГЕННЫХ СМЕРТЕЙ В КОГОРТЕ

Background: Development of algorithms for estimating the number of radiogenic deaths in a cohort that happened or may happen before an arbitrary moment in time. Algorithms should be based on continuous lifelong risk models and minimize the errors of estimates based on deformable non-radiation models ("seed" models) reflecting the general patterns of Russian mortality, but with the possibility of calibrating according to selected data.
 Materials and methods: For the study, the databases of the register of liquidators of the consequences of the Chernobyl accident – employees of the enterprises of the Ministry of Atomic Energy of Russia were used. Persons with a non-zero dose of ionizing radiation received as a result of the accident and who were registered in the register until 2018 were selected from the register. There are 7324 men and 655 women in this sample. The number of deaths from the beginning of the observation period until 1996, 2006, 2016 from all causes, as well as from solid cancers and leukemias, was used as a reference data for the calibration. Radiation risk was calculated using UNSCEAR 2006 models. Calibration was performed using the Levenberg – Marquardt method.
 Results: A general formula was obtained for assessing the excess lifetime risk of death, which is the basis of the developed algorithms. The "seed" models of the risk of death from all causes and from solid cancers and leukemia’s were obtained. In accordance with the purpose of the work, two algorithms have been developed. The first algorithm is intended for direct (without using radiation risk models) estimation of the number of radiation-induced deaths in a cohort. The second uses radiation risk models. The performance of the algorithms was tested using the industry register of liquidators of the consequences of the Chernobyl accident. In particular, a 30 % calculated increase in the estimated number of deaths from radiation-induced solid cancers was recorded using calibrated models.
 Conclusions: The proposed calculation algorithms for calibrated models provide reliable (if the radiation risk models are considered sufficiently adequate) estimates of the number of Chernobyl deaths for points in time preceding the current one and, presumably, more accurate predictive estimates compared to the calculation algorithm for uncalibrated models. The low sensitivity of the lifelong risk model to variations in the parameters of the background models and the total mortality model makes it possible to apply models calibrated according to the liquidator register to other closely related populations (NPP workers, etc.).

Специфика риска радиогенного рака для профессиональных работников

Purpose: Analysis of the dependence of the probability of death due to radiogenic cancer on the dose level, on the nature of exposure to ionizing radiation (IR), on age when exposed to IR and on the age of its effect, etc., to support decisions on medical and social measures to protect workers in hazardous industries.
 Material and methods: Calculation formulas for risk assessment are given using the multiplicative and additive risk models for one-time and extended exposure to IR. Medical and demographic data for the urban population of the Chelyabinsk region for 1989 were taken as necessary baseline data for risk assessment. The risk was calculated using the combined BEIR VII and EPA models.
 Results: The risk is calculated in terms of annual or lifetime risk of death from spontaneous and radiogenic solid cancer for two scenarios of occupational exposure to IR (single and extended), for a set dose of 0.5; 1; 2 Sv and different ages of survival of a person who started work in production at the age of 20.
 Conclusions: 1. For small and moderate doses (D ≤ 1 Sv), prolonged exposure in the age range of 20–30 years leads to less risk than with short-term exposure at the age of 20 years with the same dose. This effect is absent for irradiation after 30 years. 2. The risk of death from spontaneous solid cancer is somewhat less for exposed people than for non-exposed people. Reason: radiogenic cancer begins to compete with spontaneous one. 3. With relatively small integral doses (< 1 Sv), the radiogenic risk linearly depends on the dose. At moderate and high doses (≥ 1 Sv), for continuous extended exposure the dose dependence becomes nonlinear. 4. The probability of causation of death from radiogenic solid cancer for older people and for doses of D ≥ 1 Sv becomes significant, especially for women (30 % and more in relation to spontaneous solid cancer). 5. The lifetime risk of radiogenic cancer from the dose received at working age decreases significantly with age when it reaches 60 years of age.

An updated mortality risk analysis of the post-pubertal undescended testis.

The undescended testicle (UDT) presents a problem in post-pubertal (PP) men, as it carries an increased risk of developing a germ cell tumour (GCT). Management of the PP patient with an UDT must weigh the relative risk (RR) of perioperative mortality (POM) from orchiectomy against the lifetime risk of death from a GCT. The most recent data on GCT mortality were obtained from the National Centre for Health Statistics. Standard life tables were used to calculate the cumulative risk over a man's lifetime based on age. The increased RR of GCT in men with UDT was determined by weighing the observed and expected rates from literature review. Life table data was then multiplied by the RR to define the risk of GCT in men with UDT. Data from patients undergoing similar risk surgical procedures stratified by American Society of Anesthesiologists (ASA) class was used to determine POM. Lifetime risk of dying from GCT decreases with increasing age. POM exceeded risks of death from GCT for men after age 50.2 for ASA class 1 and age 35.4 for ASA class 2. Men with an ASA class higher than 2 have a higher risk of POM compared to GCT for all ages. We found different ages from previous reports at which observation is advised. We consider prophylactic orchiectomy only in men who are under 50.2 years if ASA class 1 and under 35.4 years if ASA class 2. Men with an ASA class 3 or higher should always undergo observation.

English

In Nigeria, the lifetime risk of death from pregnancy or childbirth complications is 1 in 30. Maternal healthcare utilisation addresses the risk of maternal mortality and morbidity but its utilisation is influenced by varying factors of which autonomy has been neglected especially for young married women. Therefore, this study examined the relationship between young married women’s level of autonomy and maternal health care utilisation in Nigeria. Secondary data from the 2013 Nigeria Demographic and Health Survey was analysed (n=4996) with consideration of young ever married women (age 15 to 24), who had at least one live birth in the last five years preceding the survey. The binary logistic regression models were fitted into the data. Findings revealed that only 30% of women aged 15 to 24 delivered at a health facility while 44% of the total pregnant women had four or more antenatal care visits before delivery. Also, young women with low autonomy were less likely to meet the minimum requirement of four antenatal visits (OR=0.35: CI: 0.29-0.43) and less likely to deliver at a health facility (OR=0.32: CI: 0.27-0.39). The study underscores the need to empower young women to achieve higher levels of autonomy due to its obvious implication on their health and to encourage integrated interventions that considers engaging household and community structures on the benefits of women autonomy and its importance for mother and child’s health. Policy and program considerations that would enable the removal of socio-cultural/demographic barriers towards women autonomy in Nigeria should be encouraged. Key words: Maternal healthcare utilization, antenatal, postnatal, place of delivery, women autonomy

F6. PSYCHOLOGICAL RESILIENCE TO SUICIDAL THOUGHTS AND BEHAVIOURS: A QUALITATIVE EXAMINATION OF THE EXPERIENCES OF PEOPLE WITH MENTAL HEALTH PROBLEMS ON THE SCHIZOPHRENIA SPECTRUM

BackgroundSuicide is one of the leading causes of premature death in schizophrenia. The lifetime risk of death by suicide in people with schizophrenia is around 10 per 100 people. Some people can counter the impact of suicide risk (e.g., life stressors) by incorporating personal skills and experiences. Although exposure to life stressors can have a detrimental effect on mental health, this does not apply to everyone, as some individuals appear protected from the impact of stress. The notion of resilience in mental health has recently gained research attention. Resilience has been defined as an individual’s skills or resources that help them manage suicidal thoughts and feelings. Consistent with this definition, it is important to understand the psychological factors that contribute to resilience to the frequency and severity of suicidal thoughts and behaviours. We aimed to examine the experiences of psychological resilience to suicidal thoughts and behaviours of people with schizophrenia-spectrum mental health problems.MethodsWe conducted face-to-face interviews with 20 individuals with experiences on the schizophrenia spectrum and lifetime experiences of suicidal thoughts, plans, and behaviours. Participants were recruited from community mental health services in the North-West of England, UK. A topic guide for semi-structured interviews was used to facilitate participants’ descriptions of their experiences in their own words. All interviews were audio-recorded, with participants’ consent, and transcribed verbatim. Thematic analysis was used to examine the themes and patterns within the data which were important in addressing the research aim.ResultsThe majority of the participants were white British, single, and living alone. The average age of the sample was 48 years (SD = 14.4; range: 23–75 years) and 50% were female. Several factors were involved in promoting psychological resilience. Participants described strategies that indicated they were being active in maintaining and developing their resilience. These included cognitive reasoning (e.g., rationalising and validating experiences) and active coping strategies (e.g., acceptance of experiences, perseverance). Perceived social support from significant others and mental health professionals (e.g., care coordinators, psychiatrists) also played an important role in bolstering individual resilience.DiscussionThis is the first study to showcase the experiences of resilience to suicidal thoughts and behaviours from the unique perspective of individuals with mental health problems on the schizophrenia spectrum and a range of suicidal experiences (e.g., ideation, attempts, plans). The data indicated that resilience to suicidal thoughts and behaviours developed over time, through the experience of managing psychotic symptoms and their deleterious impact on individual wellbeing. People employed different types of coping strategies, depending on the severity of their psychotic symptoms and suicidal feelings. However, if their symptoms became severe, they usually sought support from mental health services. Efforts to develop psychological resilience to suicidal thoughts and behaviours in individuals with schizophrenia are of paramount importance to clinical research and practice. It is important to consider the impact of psychotic symptoms, which were the main precipitating factors of suicidal thoughts and behaviours for most participants, in the development of psychological resilience. Of note, only individuals under the care of mental health services were recruited into the study. Future research should explore the resilience experiences of people not accessing mental health services.

Knowledge Towards Antenatal Care and Service Utilization Among Women in Fiche Town, North Shewa, Ethiopia

Maternal mortality is the highest in sub- Saharan Africa, where the life time risk of death from pregnancy related conditions is 1 in 16, compared with 1 in 2800 in developed countries, In Ethiopia, like other sub Saharan Africa countries, maternal and infant mortality remains to be a problem of public health importance. There are 350 maternal deaths for every 100000 live births. Antenatal care, the care that the women receive during pregnancy, helps to ensure healthy outcome for women and new born. A community based cross sectional study design was conducted. Systematic random sampling technique was used. A total of 345 women who delivered in the 5 years before the date of survey were interviewed. Two hundred twenty three (64.6%) women were reported to have received antenatal care at least once during their last pregnancy. Of these, 89 (39.9%) had four or more antenatal care follow ups during their last pregnancy. This is low coverage compared to other developing country. The government sector and health worker need to give great attention for antenatal care.

Dialectical behaviour therapy with skills training seems to be more effective in reducing non-suicidal self-injury

Patients with borderline personality disorder (BPD) have a 10% lifetime risk of death by suicide.1 Therefore, prevention of self-harm is an important target for treatment in this population. A recent...

European Public Health News

This European public health news is looking at the future, and foremost at putting the health of our citizens first. Public health needs to move forward and the way forward includes support, collaboration, integration and an investment in the future public health professionals. Ricciardi emphasizes both the need for collaboration and the need for science, but especially the need for a change in the culture of the public health professionals. Our EUPHAnxt coordinators emphasize this change of culture and aim to prepare the next generations of public health professionals to be committed and engaged. Jakab reaffirms the need for participatory and intersectoral health systems and Borg commits to continuous support to European Union (EU) member states to invest in our future by investing in the health of our citizens. If we all work in the same direction, the future of public health is indeed looking bright. # President's Column {#article-title-2} Twentieth century health systems were dominated by clinicians, effectiveness and efficiency. The two revolutions, the control of infectious disease and the battle against non-communicable disease, are both still ongoing, but the results of these revolutions are very different if we compare the situation in the developed world and in the developing countries. The infant mortality rate is 5.1 in Canada and 97.1 in Haiti, the rate of maternal deaths is 35 times higher in Latin America than in North America and the lifetime risk of death is 1 in 7.700 deliveries in Canada and 1 in 17 in Haiti. In Western industrialized countries, the success of public health has in many cases changed the nature of these societies, making them ‘health societies’, putting health as a main theme in social and political life, and as a major individual goal with a high life expectancy and ageing populations and an expansive health and medical care …

Population-based study to determine mortality in spina bifida: New York State Congenital Malformations Registry, 1983 to 2006.

The lifetime risk of death among individuals with spina bifida is 10-times higher compared with the general population. A population-based analysis on cause-specific mortality among individuals spina bifida is lacking. Using statewide, population-based New York Congenital Malformations Registry, we examined all births between years 1983 and 2006, and identified 1988 births with spina bifida and 10,951 births with congenital hypertrophic pyloric stenosis (CHPS). We linked registry records to birth and death files from vital records, and determined age- and cause-specific mortality for isolated and multiple spina bifida, and compared the findings with the less fatal CHPS. Mortality in spina bifida is significantly high compared with CHPS (16.9% vs. 0.96%, respectively). The probability of survival in spina bifida was lower compared with CHPS. A majority of the deaths in spina bifida occurred in infants within the first year of birth; however, an increased risk of death persisted in young adulthood for both isolated and multiple cases of spina bifida. The common causes of death in children with spina bifida were hydrocephalus, infections, cardiac anomalies, pneumonia, and pulmonary embolism; while infections, heart or kidney failure, injuries and neoplasms contributed to deaths in adults. We conclude that mortality in spina bifida is a large concern, and individuals living with the defect require improved clinical care for lethal medical complications. Primary prevention of spina bifida through mandatory folic acid fortification remains as the best strategy to reduce both disability and mortality associated with this defect across the world.

Abstract ED06-02: Circulating ovarian cancer biomarkers and early detection

Abstract Ovarian cancer is considered a rare disease (affecting fewer than 200,000 people) but at the same time it is the ninth most common cancer in the United States and the fifth leading cause of cancer-related deaths in women. The American Cancer Society estimates that in 2013, about 22,240 new cases of ovarian cancer will be diagnosed and 14,030 women will die of ovarian cancer in the U.S. The mortality rates for ovarian cancer have not improved in forty years since the “War on Cancer” was declared. However, other cancers have shown a marked reduction in mortality, due to the availability of early detection tests and improved treatments. Unfortunately, this is not the case with ovarian cancer, which is still the most lethal gynecological malignancy accounting for more deaths than endometrial and cervical cancer combined. The lifetime incidence for ovarian malignancies is one in 72 (1.39%) and the lifetime risk of death from ovarian cancer is one in 96 (1.04%) for US women. The symptoms of ovarian cancer can be vague and are not always gynecologic. They often mimic those of many other more common conditions, including digestive problems and thus women continue to be diagnosed with advanced-stage disease when survival rates are unacceptable (5-year survival is less than 45%). Therefore, preventive strategies, including improvements in early detection of disease as well as in preventing disease recurrence, are crucial to improving prognosis. Ovarian cancer prevention can be defined by two main strategies: 1) early detection of cancer in at-risk patients and 2) prevention of recurrent disease in patients with an established diagnosis of cancer. If one could detect early-stage disease, women would require a less morbid operation, may not require adjuvant chemotherapy and have a 5-year survival approaching 90%. However, only 20% of ovarian cancer cases are caught before the cancer has spread. More importantly, despite herculean efforts, there are still no highly sensitive or specific screening assays for detection of early-stage disease. Therefore, new tools such as serum biomarkers and medical imaging are required to affect a paradigm shift from the detection of late- to early-stage ovarian cancer. An ideal screening test for ovarian cancer must have a high sensitivity in order to correctly diagnose all women with the disease and a high specificity to avoid too many false-positive results. A blood test with 75% sensitivity and 98% specificity when combined with an imaging modality such as transvaginal ultrasonography (TVU) achieves a specificity of 99.6% resulting in an acceptable positive predictive value for surgery. Such a screening test would greatly improve care if the test detected most ovarian cancers in early stage disease. Current screening methods include pelvic examination, CA-125 levels, TVU, or a combination of modalities and allow for the detection of only 30 to 45% of cases in early-stage disease. Recent developments in the biology of ovarian cancer and “omics”-based research have identified a number of potential biomarkers. This talk will examine the current status of a potentially promising circulating biomarkers and detection approaches with the goal towards improving early detection of ovarian cancer. Citation Format: Andrew K. Godwin. Circulating ovarian cancer biomarkers and early detection. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr ED06-02.

Melanoma epidemiology of Austria reveals gender-related differences

Cutaneous melanoma shows gender-specific trends worldwide, with highest rates in older men. In Austria, women show greater knowledge about the early detection of skin cancer by screening. Our aim was to analyse national melanoma incidence and mortality rates with regard to gender to improve our prevention efforts. Population-based incidence (1983-2008) and mortality (1970-2010) data were retrieved from the Austrian cancer registry. ICD 9/10 Codes (172/C43) were used for melanoma. Stages were defined by the TNM classification. Age-standardized rates were calculated using the direct method (2000 WHO standard population) and linear regression models were used to estimate trends. Age-standardized incidence rates of melanoma increased for both genders from 4.9 in 1983 to 10.5 in 2008 (P<0.001), for men more than women (P<0.005). In 2006-2008 the lifetime risk of developing a melanoma was 1:123 (women: 1:128, men 1:117). In-situ and local stages were more common in women, men presented with regional and distant disease. In 2008-2010 male mortality was 1.7 times higher than female (P<0.005) and the lifetime risk of death from melanoma amounted to 1:570 (women 1:705, men 1:434; P<0.05). Comparatively, men over 75 faced the highest risk of presenting with or dying from melanoma. In Austria, melanoma epidemiology showed gender-specific differences. Efforts in early detection need to be increased in elderly men. As shown in the female population, a change in the melanoma-related epidemiology is feasible, most likely by means of secondary prevention.

Massive Paraesophageal Hernia Mimicking Pulmonary Embolus

An 87-year-old woman presented with a traumatic fracture of her right femoral neck. After admission she became tachypneic, tachycardic, and had increased oxygen requirements. Computed tomography showed no pulmonary embolism, but revealed a 17 × 10-cm type-IV paraesophageal hernia (Figs. 1 and ​and2).2). The hernia included the entirety of her stomach, majority of the pancreas, portions of the duodenum, the splenic flexure of the colon, and associated vasculature. Fewer than 5% of paraesophageal hernias involve viscera beyond the stomach,1 and pancreatic involvement is especially rare.2,3 Her acute dyspnea was attributed to immobility, atelectasis, and the massive hernia. She ultimately had a right hip hemiarthroplasty with successful postoperative extubation. She was weaned off oxygen and was asymptomatic at discharge. Figure 1. Massive paraesophageal hernia—coronal view. Black arrow: pancreas. The pancreatic head is adjacent to the right diaphragm, and the associated pancreatic vasculature can be seen inferior to the pancreas. White arrow: stomach. The stomach is adjacent ... Figure 2. Massive paraesophageal hernia—axial view. White arrow: pancreas. The majority of the pancreatic outline can be seen in this view. Elective surgery of asymptomatic paraesophageal hernias was historically thought to be required to prevent the development of life-threatening complications.4 However, the mortality rate from elective laparoscopic repair is approximately 1.4%, while the lifetime risk of death from watchful waiting is estimated to be approximately 1%.4 The lifetime risk of developing acute symptoms requiring emergency surgery also decreases exponentially after 65 years of age.4 Thus, watchful waiting appears to be a reasonable strategy for some minimally symptomatic or asymptomatic paraesophageal hernias.

The dangers of the day of birth

BackgroundPerinatal and maternal mortality have fallen over the last century and now appear minor compared with many other risks. However, the risks of childbirth are concentrated around the day of...

Hip Fracture

In the Clinic6 December 2011Hip FractureFernanda Porto Carriero, MD, Colleen Christmas, MD, Deborah Cotton, MD, MPH, Darren Taichman, MD, PhD, and Sankey Williams, MDFernanda Porto Carriero, MDSearch for more papers by this author, Colleen Christmas, MDSearch for more papers by this author, Deborah Cotton, MD, MPHSearch for more papers by this author, Darren Taichman, MD, PhDSearch for more papers by this author, and Sankey Williams, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-11-201112060-01006 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hip fracture is the most serious consequence of osteoporosis. About 1% of all falls in the elderly residing in the community result in hip fracture, often with life-changing consequences. Acute mortality from hip fracture is 3%–5%; the lifetime risk for death from hip fracture is similar to that from breast cancer. Far fewer than half of patients with hip fracture fully recover their ability to perform all of their basic activities of daily living. Outcomes are even more grim for those who have postoperative complications. Timely diagnosis and highly attentive perioperative care of the complex patient with a hip fracture ...

European Public Health News * EUPHA President's Column * EUPHA office news * Message from the Who Regional Director for Europe: Non-Communicable Diseases, Inequalities and Development * Health at a Glance: Europe 2010 * Public Health and Welfare - Welfare Development and Health, 10-12 November 2011, the Bella Centre, Copenhagen, Denmark

In this section of the EJPH , we provide you with updates from EUPHA, WHO/EURO and DG Sanco. All three contributions look at the state-of-the-art of European public health as well as presenting thoughts on future public health issues. News from EUPHA office looks at our objectives of capacity, knowledge and policy building and EUPHApedia. Of course, we are providing you with the latest information on the fourth European Public Health Conference, Copenhagen 2011. # EUPHA President's Column {#article-title-2} Twentieth century health systems were dominated by clinicians, effectiveness and efficiency. The two revolutions: the control of infectious disease and the battle against non-communicable disease are both still ongoing but the results of these revolutions are very different if we compare the situation in the developed world and in the developing countries. The infant mortality rate is 5.1 in Canada and 97.1 in Haiti, the rate of maternal deaths is 35 times higher in Latin America than in North America, the life time risk of death is 1 in 7.700 deliveries in Canada and 1 in 17 in Haiti. In Western industrialized countries, the success of public health has in many cases changed the nature of these societies making them ‘health societies’, putting health as a main theme in social and political life and as a major individual goal with a high life expectancy and ageing populations and an expansive health and medical care system. This situation is in contrast with the reality of the poorest countries where health is a matter of survival, neglected in the development policies and there is still a lack of access to even the most basic services and a falling life expectancy. To face these challenges the developed world is still too lazy and ineffective. We cannot continue to do public health as we used to but we need a …

Prostate-Specific Antigen, Risk Factors, and Prostate Cancer: Confounders Nestled in an Enigma

Prostate-Specific Antigen, Risk Factors, and Prostate Cancer: Confounders Nestled in an Enigma

Adverse cardiovascular effects of air pollution

Air pollution is increasingly recognized as an important and modifiable determinant of cardiovascular disease in urban communities. Acute exposure has been linked to a range of adverse cardiovascular events including hospital admissions with angina, myocardial infarction, and heart failure. Long-term exposure increases an individual's lifetime risk of death from coronary heart disease. The main arbiter of these adverse health effects seems to be combustion-derived nanoparticles that incorporate reactive organic and transition metal components. Inhalation of this particulate matter leads to pulmonary inflammation with secondary systemic effects or, after translocation from the lung into the circulation, to direct toxic cardiovascular effects. Through the induction of cellular oxidative stress and proinflammatory pathways, particulate matter augments the development and progression of atherosclerosis via detrimental effects on platelets, vascular tissue, and the myocardium. These effects seem to underpin the atherothrombotic consequences of acute and chronic exposure to air pollution. An increased understanding of the mediators and mechanisms of these processes is necessary if we are to develop strategies to protect individuals at risk and reduce the effect of air pollution on cardiovascular disease.