Population-wide Prevention Research Articles

Coronary heart disease mortality is decreasing in Argentina, and Colombia, but keeps increasing in Mexico: a time trend study

BackgroundMortality rates due to coronary heart disease (CHD) have decreased in most countries, but increased in low and middle-income countries. Few studies have analyzed the trends of coronary heart disease mortality in Latin America, specifically the trends in young-adults and the effect of correcting these comparisons for nonspecific causes of death (garbage codes). The objective of this study was to describe and compare standardized, age-specific, and garbage-code corrected mortality trends for coronary heart disease from 1985 to 2015 in Argentina, Colombia, and Mexico.MethodsDeaths from coronary heart disease were grouped by country, year of registration, sex, and 10-year age bands to calculate age-adjusted and age and sex-specific rates for adults aged ≥25. We corrected for garbage-codes using the methodology proposed by the Global Burden of Disease. Finally, we fitted Joinpoint regression models.ResultsIn 1985, age-standardized mortality rates per 100,000 population were 136.6 in Argentina, 160.6 in Colombia, and 87.51 in Mexico; by 2015 rates decreased 51% in Argentina and 6.5% in Colombia, yet increased by 61% in Mexico, where an upward trend in mortality was observed in young adults. Garbage-code corrections produced increases in mortality rates, particularly in Argentina with approximately 80 additional deaths per 100,000, 14 in Colombia and 13 in Mexico.ConclusionsLatin American countries are at different stages of the cardiovascular disease epidemic. Garbage code correction produce large changes in the mortality rates in Argentina, yet smaller in Mexico and Colombia, suggesting garbage code corrections may be needed for specific countries. While coronary heart disease (CHD) mortality is falling in Argentina, modest falls in Colombia and substantial increases in Mexico highlight the need for the region to propose and implement population-wide prevention policies.

Suicidal ideation prediction in twitter data using machine learning techniques

People prefer new technology by using online social media as a communication channels to express their suicidal thoughts. Primary identification and detection are viewed as an effective approach to avoid suicidal attempt and suicidal ideation-two basic hazards causing effective suicide. This paper exhibits different techniques to comprehend suicidal ideation through online user contents in particularly by considering twitter data for past last two years as an objective of early detection by means of sentiment analysis and supervised leaning methods. Analysing the text descriptions and users language exposes rich knowledge that can be utilized as a primary cautioning system for suicidal detection. To identify tweets exhibiting suicidal ideation, several features are extracted and a set of features are proposed for training the model over the dataset by using ensemble and baseline classifiers. Based on the outcome of baseline classifier; improved ensemble random forest (RF) algorithm achieved an accuracy of 0.99% compared to other classification methods for suicidal prediction with tweets containing suicidal thought is better when compared to the existing system. Such experimentation and monitoring may help individual and population-wide prevention by counseling and informing to suicidal research and policy. The experimental analysis expresses the feasibility of the methodology used by providing a benchmark for suicidal detection on online social network: Twitter.

Does sleep grow on trees? A longitudinal study to investigate potential prevention of insufficient sleep with different types of urban green space.

IntroductionTo investigate association between urban green space and prevalent and incident cases of insufficient sleep (<6 h sleep per day).MethodsThis longitudinal study examined the odds of prevalent and incident insufficient sleep in relation to indicators of total green space, tree canopy, open grass and other low-lying vegetation in the Sax Institute's 45 and Up Study (baseline 2006–2009; follow-up 2012–2015). Association between green space within 1.6 km road distances and insufficient sleep among 38,982 participants living in Sydney, Wollongong or Newcastle were analysed using multilevel logistic regressions adjusted for confounding.ResultsParticipants with more total green space had lower odds of prevalent insufficient sleep (e.g. ≥30% compared with 0-4% total green space odds ratio (OR) = 0.68, 95% credible interval (95%CI) = 0.53, 0.85). The odds of prevalent insufficient sleep were lower among participants with more tree canopy (e.g. ≥30% compared with 0-9% tree canopy OR = 0.78, 95%CI 0.69, 0.88). The odds of incident insufficient sleep were also lower with more tree canopy (e.g. ≥30% compared with 0-9% tree canopy OR = 0.87, 95%CI = 0.75, 0.99). There were no statistically significant associations between prevalent or incident insufficient sleep with open grass or other low-lying vegetation, nor incident sufficient sleep with total green space.ConclusionsPrioritising restoration and protection of urban tree canopy may help to promote population-wide prevention of insufficient sleep in middle-to-older aged adults.

Post Stroke Depression: the Mechanisms, Prevention and Therapy Through Holistic Treatment Approach

Background/ObjectivesStroke is the third most common cause of disability and second most common cause of death worldwide. At least one‐third of stroke survivors suffer from depression.Depression is a common complication of stroke, leading to increased morbidity and mortality, and is defined as depressed mood on a daily basis for a minimum duration of two weeks.Objective is to investigate the causal associations between post stroke depression and its outcomes. To evaluate the associations between stroke and depression in Nigerians adults living American and in NigeriaMethodInvestigation of post stroke depression in American adults and Nigerian‐American adult living in America and Nigeria.Holistic clinical approach interventions when treating PSD for better outcome than pharmacological only approach. These includes: Adult day care, dietitian, speech therapy, social services, PT, OT, yoga, psycho‐therapy, primary care clinicians, family and friends.Results/discussionStudy participants living with other people did better than those living alone P‐value 0.05.ConclusionStroke has been identified as one of the prioritized non‐communicable diseases the hope is that the promotion and endorsement of new, more‐effective approaches for the prevention of stroke and CVD, in combination with prevention strategies, will change current practice worldwide, thereby saving millions of lives. By complementing cost‐effective individual health‐care interventions with population‐wide prevention strategies, to make a substantial impact on the global non‐communicable diseases. There are many factors that have effects on PSD. The severity of stroke is an important factor in the occurrence of PSD. Mental history is a possible predictor of PSD. Prevention of PSD requires social and family participation, and holistic therapy approach.RECOMMENDATIONSThe recommendations listed below must be considered. For any successful outcome in treating PSD, nursing, social worker, family members, and power of attorney or guardians should team up for better living arrangement, because this study showed that patients living with others have better outcomes than those living alone. Social determinant factors cannot be ignored in this patient population. Considering social determinant factors such as level of poverty, less than high school education, median house income, employment, transportation factors all play a role for successful outcome in managing PSD. Support or Funding InformationEinstein Institute ‐ USATThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Challenges in policy reforms for non-communicable diseases: the case of diabetes in Kenya

ABSTRACTBackground: The 2011 UN declaration on non-communicable diseases (NCDs) recognized their importance as a global health issue, particularly for low- and middle-income countries. The extent to which these countries address policy implementation gaps in the face of resource limitations and competing priorities remains largely unexplored.Objective: This qualitative study presents Kenya’s experience of translating the UN declaration to national policies for diabetes prevention and control.Methods: Policy documents published between 2006 and 2016 were analyzed. Thirty-two documents were included in the analysis. Interviews with six purposively selected policy stakeholders at multiple levels of decision-making were conducted. Emerging themes were deconstructed into a policy analysis triangle.Results: Diabetes-specific policies already existed in Kenya before 2011, suggesting successful advocacy work by diabetes interest groups. The 2011 UN declaration subsequently coincided with a period of political transition in Kenya, opening policy windows that the diabetes community leveraged to trigger political drive against prevailing challenges. The post-declaration period reflected a transition from diabetes-specific policies to a wider NCD agenda. Most of the documents and national strategies aligned strongly with international documents, however, were based on scant local evidence. The implementation process was largely health-sector driven. The non-health sector remained largely uninvolved, contrary to global recommendations. This, in addition to fragmented health governance and weak monitoring systems, continues to undermine existing gains and efforts to fight diabetes and NCDs on a wider scale.Conclusions: In Kenya, a major gap remains between how diabetes is addressed within the NCD policy agenda and tackling diabetes in reality, with respect to local implementation processes. More emphasis on population-wide prevention and inclusion of the non-health sector could help to cascade national efforts to the grassroots level. A concerted effort from the highest political level is needed to address overarching NCD drivers while maintaining health system improvement strategies.

Effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery: a systematic review.

The objective of this review was to investigate the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on patients' health-related quality of life and hospital readmission. Coronary heart disease is a major cause of death and disability worldwide, putting a great strain on healthcare resources. For the past two decades, population-wide primary prevention and individual healthcare approaches have resulted in a dramatic decline in overall cardiac mortality. Over the intervening years, surgical techniques in cardiology have also improved substantially. As a result, long-term outcomes in patients treated with coronary artery bypass graft surgery have established the treatment's effectiveness and survival benefit. Furthermore, participating in cardiac rehabilitation following coronary artery bypass graft surgery has also demonstrated a significant decrease in all-cause cardiac mortality in these patients. This review included studies with participants aged 18 years and over, post coronary artery bypass graft surgery that evaluated nurse-led cardiac rehabilitation (CR) programs compared with usual care or other forms of CR. The outcomes of interest were the health-related quality of life and hospital readmissions following coronary artery bypass graft surgery and measured using validated scales. Randomized controlled trials reported in English between 2000 to June 2017 were considered for inclusion. The search strategy aimed to find both published and unpublished studies using a three-step search strategy. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies including Dissertation Abstracts International, ProQuest Dissertations and Theses, Google Scholar, MedNar and ClinicalTrials.gov. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal tools from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Quantitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-SUMARI. No meta-analysis was undertaken due to heterogeneity of the outcome measures. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Three trials involving 329 patients were included in the final review. The trials that investigated the effect of home based cardiac rehabilitation programs compared to usual care at six weeks, three months and six months follow-up demonstrated no statistically significant difference in health-related quality of life at any of the follow-up periods. However, one study demonstrated significantly higher scores related to health-related quality of life among those who received nurse-led home based cardiac rehabilitation (154.93 ± 4.6) compared to those who received usual care (134.20 ± 8.2) at two months follow-up. No trials were identified that compared the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on readmissions to hospital. There is not enough evidence to support or discourage nurse-led cardiac rehabilitation programs on health-related quality of life in patients following coronary artery bypass graft surgery. However, the sparse data available suggests improvements in health-related quality of life at two months follow-up among those who received a nurse-led program. Further large-scale multicenter trials with standardized methodology are needed to determine the effect of nurse-led cardiac rehabilitation programs on health-related quality of life and rates of readmission to hospital following coronary artery bypass graft surgery.

Update on the epidemiology, risk factors and disease outcomes of osteoarthritis.

Osteoarthritis (OA) is the most frequent form of arthritis and a leading cause of pain and disability worldwide. OA can affect any synovial joint, although the hip, knee, hand, foot and spine are the most commonly affected sites. Knowledge about the occurrence and risk factors for OA is important to define the clinical and public health burden of the disease to understand mechanisms of disease occurrence and may also help to inform the development of population-wide prevention strategies. In this article, we review the occurrence and risk factors for OA and also consider patient-reported outcome measures that have been used for the assessment of the disease.

Sources of Cardiovascular Health Information and Channels of Health Communication among Urban Population in Nigeria

&lt;p&gt;This study employed mixed methods to investigate the preferred sources of health information and later explored the views of community healthcare workers on the enablers, barriers and ways of overcoming barriers to health communication. The study found that majority of the participants preferred their source of CV (cardiovascular) health information from the healthcare workers including the medical doctors, nurses, and pharmacists. On the other hand, the least preferred source of health information was from friends, family members, and community leaders. Some of the identified enablers to community health communication include awareness programme via Non-Governmental Organisations (NGOs), community-based organisations such as faith-based organisations and healthcare facilities. Others are traditional media and social media. The identified barriers to community-based health communication include lack of knowledge and poverty, language barriers, and other miscellaneous issues including misuse of internet, lack of basic amenities and religious beliefs. The community-based healthcare providers articulated ways to overcome the identified barriers, including enlightenment programmes, using the language of the target audience, funding health awareness programmes, and monitoring of health education interventions. This study concludes that dissemination of health information using numerous channels is essential in ensuring population-wide primary prevention of diseases.&lt;/p&gt;

Online suicide prevention through optimised text classification

Online communication platforms are increasingly used to express suicidal thoughts. There is considerable interest in monitoring such messages, both for population-wide and individual prevention purposes, and to inform suicide research and policy. Online information overload prohibits manual detection, which is why keyword search methods are typically used. However, these are imprecise and unable to handle implicit references or linguistic noise. As an alternative, this study investigates supervised text classification to model and detect suicidality in Dutch-language forum posts. Genetic algorithms were used to optimise models through feature selection and hyperparameter optimisation. A variety of features was found to be informative, including token and character ngram bags-of-words, presence of salient suicide-related terms and features based on LSA topic models and polarity lexicons. The results indicate that text classification is a viable and promising strategy for detecting suicide-related and alarming messages, with F-scores comparable to human annotators (93% for relevant messages, 70% for severe messages). Both types of messages can be detected with high precision and minimal noise, even on large high-skew corpora. This suggests that they would be fit for use in a real-world prevention setting.

Explaining the decline in coronary heart disease mortality rates in the Slovak Republic between 1993-2008.

ObjectiveBetween the years 1993 and 2008, mortality rates from coronary heart disease (CHD) in the Slovak Republic have decreased by almost one quarter. However, this was a smaller decline than in neighbouring countries. The aim of this modelling study was therefore to quantify the contributions of risk factor changes and the use of evidence-based medical therapies to the CHD mortality decline between 1993 and 2008.MethodsWe identified, obtained and scrutinised the data required for the model. These data detailed trends in the major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics (National Health Information Centre and Statistical Office of the Slovak Republic) and national representative studies (AUDIT, SLOVAKS, SLOVASeZ, CINDI, EHES, EHIS). The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence-based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs) attributable to risk factor changes or treatments. Uncertainties were explored using sensitivity analyses.ResultsBetween 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic (SR) decreased by 23% in men and 26% in women aged 25–74 years. This represented some 1820 fewer CHD deaths in 2008 than expected if mortality rates had not fallen. The IMPACT model explained 91% of this mortality decline. Approximately 50% of the decline was attributable to changes in acute phase and secondary prevention treatments, particularly acute and chronic treatments for heart failure (≈12%), acute coronary syndrome treatments (≈9%) and secondary prevention following AMI and revascularisation (≈8%). Changes in CHD risk factors explained approximately 41% of the total mortality decrease, mainly reflecting reductions in total serum cholesterol. However, other risk factors demonstrated adverse trends and thus generated approximately 740 additional deaths.ConclusionOur analysis suggests that approximately half the CHD mortality fall recently observed in the SR may be attributable to the increased use of evidence-based treatments. However, the adverse trends observed in all the major cardiovascular risk factors (apart from total cholesterol) are deeply worrying. They highlight the need for more energetic population-wide prevention policies such as tobacco control, reducing salt and industrial trans fats content in processed food, clearer food labelling and regulated marketing of processed foods and sugary drinks.

Patterns of objectively assessed physical activity and sedentary time: Are Nigerian health professional students complying with public health guidelines?

BackgroundUnderstanding patterns of physical activity and sedentary time is important to effective population-wide primary prevention and control of non-communicable diseases. This study examined the patterns of objectively assessed physical activity and sedentary time, and the prevalence of compliance with physical activity guidelines according to different public health recommendations in a sub-population of health professional students in Nigeria.MethodsA cross-sectional study was conducted among 102 health professional students (age = 19–34 years old, 43.1% women) of the University of Maiduguri, Nigeria. Participants wore Actigraph accelerometers on their waist for minimum of 5 days/week to objectively measure intensity and duration of physical activity and sedentary time. Prevalence and demographic patterns of physical activity and sedentary time were examined using descriptive and inferential statistics.ResultsThe students spent most time in sedentary activity (458.6 ± minutes/day, about 61% of daily time) and the least in vigorous-intensity activity (2.1 ± 4.4 minutes/day, about 0.3% of daily time). Sedentary time was higher among older than younger students (P<0.038) and among medical laboratory science students than physiotherapy and nursing students (P = 0.046). Total physical activity was higher among nursing and medical students than medical laboratory science students (P = 0.041). Although, 85.3% of the students engaged in 150 minutes/week of moderate-to-vigorous physical activity, only 2.9% met the guideline of 75 minutes/week of vigorous intensity activity.ConclusionsPrevalence of sedentary time was high while that of vigorous-intensity activity was very low among health professional students in Nigeria. Compliance with physical activity guidelines was mainly through accumulation of moderate intensity activity. The results suggest that age and academic programme may influence physical activity level and sedentary behaviour of health professional students in Nigeria. These findings provide preliminary evidence that could be used to inform the needs to develop interventions to improve and support active lifestyle behaviour among students in Nigerian universities.

Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005-2015.

Anterior cruciate ligament (ACL) injuries in children and adolescents have been the focus of recent media attention and parental concern, given their potential for adverse long-term health outcomes and healthcare costs. However, there is limited formal evidence on trends in the incidence of ACL injuries in children. This study utilizes the Victorian Admitted Episodes Dataset (VAED) to characterize epidemiologic trends of hospital-admitted ACL injuries in those aged 5 to 14 years over a period of 10 years from 2005 to 2015. There was a total of 320 cases and the overall annual rate of ACL injuries increased by 147.8% from 2.74 per 100,000 population in 2005/2006 to 6.79 per 100,000 in 2014/2015. The majority (96.9%) of these injuries were in 10- to 14-year-olds. The main in-hospital procedure provided to over 80% of the hospitalized cases involved ACL reconstruction. Sporting activities accounted for 56.6% of ACL injuries. For females, over half (52.4%) of ACL injuries occurred whilst playing ball sports, compared to 35.4% of males. The large increase in ACL injuries in 5- to 14-year-olds in the state of Victoria, Australia over a 10-year period indicates they are a significant and emerging health burden. Population-wide ACL prevention policies are required to halt these trends. Cost effective prevention programs that involve neuromuscular training must be implemented in schools and junior sports teams.

Primary prevention of cardiovascular disease through population-wide motivational strategies: insights from using smartphones in stroke prevention

The fast increasing stroke burden across all countries of the world suggests that currently used primary stroke and cardiovascular disease (CVD) prevention strategies are not sufficiently effective. In this article,...

Abstract P115: Better Methodologies to Compare Coronary Heart Disease Mortality Trends in Latin American Countries: Argentina, Colombia and Mexico From 1985 to 2012

Introduction: Coronary heart disease (CHD) is the leading cause of death worldwide. CHD mortality rates have decreased in most high-income countries, but increased in some Latin-American countries. CHD mortality rates have plateaued among young adults (&lt;55 years) in the US, UK and Australia, but trends in Latin-America are largely unknown. Few studies have analyzed trends in age and sex-specific CHD mortality rates in this region, and almost none has assured data quality by correcting for garbage codes (ICD codes for nonspecific causes of death) as recommended by WHO. Objective: To describe and compare standardized, age-specific and garbage-code corrected mortality trends for coronary heart disease (CHD) from 1985 to 2012 in three contrasting Latin American countries. Methods: CHD deaths (1985-2012) in Argentina, Colombia and Mexico were grouped by calendar year, sex and 10-year age bands to calculate the overall age-adjusted and age and sex specific mortality rates for adults aged ≥25 years. We corrected for garbage-codes for the three countries (1997-2012) using the Global Burden of Disease (GBD) methodology. We then fitted Joinpoint regression models, using the original and garbage code corrected rates, to estimate the annual percent change (APC) and detect points in time when significant changes in the trends occurred. Results: In 2012, age-standardised mortality rates per 100,000 were 65.3 in Argentina, 132.4 in Colombia and 130.3 in Mexico. Compared to 1985, by 2012 mortality fell by 17.5% in Colombia and 52.5% in Argentina. The largest annual decreases in mortality rates were observed in Argentina from 1988-1994 (APC=-5.7 p-value&lt;0.01). The declines in Colombia were constant and smaller for the full period (APC=-0.4 p-value&lt;0.01). CHD mortality rose by 48.9% in Mexico, particularly after 2000. Mortality rates increased in both men and women, particularly in younger men (&lt;39 years) and older women (&gt;60 years). Application of the garbage code corrections produced dramatic increases in mortality rates, more in women than men, and particularly in Argentina: approximately 80 additional deaths per 100,000 (compared with just 14 additional deaths per 10 5 in Colombia and 13 per 10 5 in Mexico). Conclusions: Different Latin American countries demonstrate dramatically different CHD epidemiology. Mortality rates increased after correcting for garbage code misclassification. Although CHD mortality is falling in Argentina, the modest falls in Colombia and substantial rises in Mexico highlight the region’s urgent need for effective, population-wide prevention policies.

The relationship between dietary intake and other cardiovascular risk factors with blood pressure in individuals without a history of a cardiovascular event: Evidence based study with 5670 subjects

Background and aimRaised blood pressure is a leading cause of morbidity and mortality worldwide; improved nutritional approaches to population-wide prevention are required.We aimed to investigate the relationship between dietary intake and other cardiovascular risk factors with blood pressure in individuals without a history of a cardiovascular event in an Iranian cohort. Material and methodA cross-sectional study of 5670 healthy subjects [approximately 40% (n=2179) males and 60% (n=3491) females] was undertaken in a sample from northeastern Iran. Subjects were recruited from an urban population, using a stratified-cluster method and derived from the Mashhad Stroke Heart Atherosclerosis Disorder (MASHAD) study, Mashhad, Iran. The age of the subjects was between 35 and 64 years. None of the subjects had a past history of major disease. ResultsThe mean ages for the male and female subgroups were 50.1± 8.1years and 48.2 ±7.8 y respectively. Not unexpectedly, subjects without hypertension (HTN) were younger than those with established HTN. Individuals with HTN were significantly more adipose than those without (p<0.01). We found no significant differences in crude or total energy adjusted intake of nutrients between the three groups (p>0.05), except for crude and energy adjusted phosphorus intake (p<0.05) and crude intake of the cholesterol (p<0.05). There was a significant correlation between the dietary intake of total fatty acids, phosphorus and vitamin E with both systolic blood pressure (SBP) and diastolic blood pressure (DBP). PUFA (odds ratio [OR] [95% confidence interval (CI)], 1.56 [1.05–1.06]; P<0.01), sodium (OR [95% CI], 1.00 [(1.00–1.01)]; P<0.01) and phosphorus (OR [95% CI], 1.00 [(1.00–1.01)]; P<0.01)were significant independent predictors of HTN after adjustment for energy intake. ConclusionIn our representative population from North-Eastern Iran, it appears that in adults without a history of cardiovascular disease, crude or energy adjusted intake of phosphorus and total fatty acid intake were significant determinants of BP, however we found no association between sodium and potassium intake with BP.

Changes in Cardiovascular Health Status and the Risk of New-Onset Hypertension in Kailuan Cohort Study.

American Heart Association cardiovascular health metrics are intimately related to cardiovascular diseases. Acting as a key independent risk factor for high morbidity and mortality of cardiovascular diseases, hypertension and its relationship between health status get urgent attention. While the influence of individual health status changes and the future risk of new-onset hypertension is rarely understood, the present study applied this construct to assess the changes of cardiovascular health status and the morbidity of hypertension in Kailuan cohort study in north China. The Cardiovascular Health Score (CHS) was evaluated by the follow-ups of 2006–2007, 2008–2009, 2010–2011 and 2012–2013. The study population (n = 19381) was divided into 5 groups based on the changes in their CHS score between the first two follow-ups (△CHS) of 2006–2007 and 2008–2009 (≤-2, -1, 0, 1, ≥2). The morbidity of hypertension was collected during 2010–2011 and 2012–2013 follow-ups. Data analysis showed that during a median follow-up of 3.79±0.96 years, morbidity of hypertension had a graded relationship with △CHS. As △CHS scored from low to high, the standardized morbidity of hypertension for all participants were 81.40, 75.47, 68.37, 71.43 and 83.13 per 1000 person-year, respectively. An increased △CHS score of 1 was associated with a 10% decrease in the future risk of new-onset hypertension(HR: 0.90, 95% CI: 0.88–0.92). In conclusion, there was a strong inverse relationship between the incidence of new-onset hypertension and elevation of cardiovascular health metrics. Population-wide prevention, especially the promotion of lifestyle improvements, is critical to reducing the morbidity of new-onset hypertension.

The molecular spectrum and distribution of haemoglobinopathies in Cyprus: a 20-year retrospective study.

Haemoglobinopathies are the most common monogenic diseases, posing a major public health challenge worldwide. Cyprus has one the highest prevalences of thalassaemia in the world and has been the first country to introduce a successful population-wide prevention programme, based on premarital screening. In this study, we report the most significant and comprehensive update on the status of haemoglobinopathies in Cyprus for at least two decades. First, we identified and analysed all known 592 β-thalassaemia patients and 595 Hb H disease patients in Cyprus. Moreover, we report the molecular spectrum of α-, β- and δ-globin gene mutations in the population and their geographic distribution, using a set of 13824 carriers genotyped from 1995 to 2015, and estimate relative allele frequencies in carriers of β- and δ-globin gene mutations. Notably, several mutations are reported for the first time in the Cypriot population, whereas important differences are observed in the distribution of mutations across different districts of the island.

Increased Antiretroviral Therapy Use and Virologic Suppression in the Bronx in the Context of Multiple HIV Prevention Strategies.

Multiple population-based HIV prevention strategies from national, state, local, and institutional levels have been implemented in the Bronx, which has one of the highest HIV prevalences in the U.S. We examined changes in antiretroviral therapy (ART) use and associated outcomes between 2007 and 2014 among patients seen at one of >20 outpatient clinics affiliated with the largest Bronx HIV care provider. Among eligible HIV-infected patients age ≥13 years, we examined annual trends in ART use, mean HIV RNA level, and virologic suppression (<200 copies/ml) overall and among prespecified subgroups. In a subset with suppressed HIV RNA at the end of each year, we determined the percentage whose levels remained suppressed within the next year. Regression models assessed disparities in outcomes. Among 7,196 patients (median age 50, 47% Hispanic, 45% black), we identified consistent increases over time in the percent prescribed ART (78% in 2007 to 93% in 2014) and with virologic suppression (58% to 80%), as mean HIV RNA decreased (351 to 73 copies/ml) (all p < .001). Sustained virologic suppression improved markedly beginning in 2011, coinciding with local test-and-treat initiatives and adoption of expanded treatment guidelines. While disparities among population groups were most pronounced for sustained virologic suppression, those aged 13-24 fared relatively poorly for all outcomes examined (e.g., rate ratio 0.57 for virologic suppression, 95% confidence interval 0.52-0.62, vs. age 65+). Population-wide HIV prevention strategies coincided with improvements in virologic suppression among most population groups. However, more attention is needed to address continued disparities in the HIV care continuum among young people.

Prevalence of the risk factors of cerebrovascular disorders in the capital city residents aged 40–59: a clinical and epidemiological study

Introduction. Circulatory system diseases and cerebrovascular disorders are among the principal causes of morbidity and mortality in the Russian Federation. Updated information on prevalence and structure of the risk factors is needed to elaborate populationwide prevention measures. The aim is to assess the prevalence of the risk factors for cerebrovascular disorders in the working-age population of capital city residents and stratification of subjects into the risk groups using clinical scales for comprehensive evaluation. Materials and methods. Thorough screening of the open population aged 40–59 was carried out at one outpatient medical service facility in Moscow in 2011–2012: 376 subjects (156 men, 220 women). The analysis took into account gender and agerelated differences (in the age groups of 49–49 and 50–59-yearold adults). Results. We obtained the data on prevalence of the major risk factors of cerebrovascular disorders, men/women (%): family history – 38.5/55.9, smoking 40.4/25.9, low physical activity – 48.4/49.5, class 1 obesity – 21.8/21.4, class 2 and 3 obesity – 6.4/12.7, elevated serum cholesterol levels – 32.7/43.2, elevated serum triglyceride levels – 23.1/15.0, hypertension – 48.1/45.0, type 2 diabetes – 3.8/2.7, increased intima-media thickness in the carotid and femoral arteries – 44.9/65.9, atherosclerotic plaques of any localization (carotid and/or femoral arteries) 62.8/40.5, and >30% atherosclerotic stenosis of any localization – 12.2/7.7. Prevalence of the risk factors in the population and, in some cases, their severity increased with age (before and after age 50) up to 1.5–2 fold. When using SCORE and Stroke Riskometer ™ tools for stratification, 8.6% and 39.3% subjects fell into the high-risk groups, respectively. Conclusion. Working-age capital city residents in the 40–59 years cohort show high prevalence of risk factors for cardiovascular and cerebrovascular disorders with the first significant rise of prevalence after reaching a 50-year age border; hypertension, low physical activity and increased intima-media thickness hold leading positions. The newest Stroke Riskometer™ appears to be the most relevant tool for the risk assessing as it has a variety of undoubted advantages compared to other clinical instruments.

Abstract P057: Cardiovascular Diseases and Cancer Incidences Associated With Cardiovascular Risk Profile: Results from MATISS Italian Cohort

Background: Individuals with low levels of cardiovascular risk factors experience low incidence of subsequent cardiovascular diseases (CVD). The aims of this study were to assess cancer incidence in people with favorable (low) CVD risk profile and its association with educational level (EL). Methods: The MATISS longitudinal cohort comprised 3609 men and 4146 women aged 20-70 years, free of CVD and cancer at baseline with validated non-fatal and fatal CVD and cancer events during a median 17.7 years of follow-up. People at baseline were classified as ‘low risk’ with total cholesterol &lt;240 mg/dl and blood pressure &lt;140/90 mmHg and BMI &lt;30.0 kg/m 2 and no hypertension treatment and no diabetes and no smoking habit and ‘high risk’ (total cholesterol &gt;=240mg/dl or blood pressure &gt;=140/90 mmHg or BMI &gt;=30.0 kg/m 2 or hypertension treatment, diabetes, smoking). EL was classified as low (LEL=elementary school) and middle-high (MHEL=middle/high school/university). Results: 724 cancer and 571 CVD events occurred; 22.7% of participants were ‘low risk’; 77.3% were ‘high risk; 61.5% had LEL. Cancer and CVD incidences increased with age; age-adjusted cancer and CVD incidence were higher in men compared to women (cancer: 68.92 versus 48.95 x 10,000 person-years; CVD: 64.18 versus 29.5 x 10,000 person-years). Incidences of cancer and CVD were higher in LEL (cancer: 83.22 versus 50.35 x 10,000 person-years in men and 51.67 versus 33.59 x 10,000 person-years in women; CVD: 70.07 versus 64.84 x 10,000 person-years in men and 30.72 versus 17.89 x 10,000 person-years in women). Persons with ‘low risk’ profile experienced less cancers and CVD than persons with ‘high risk (cancer: 37.66 versus 72.3 x 10,000 person-years in men and 39.57 versus 50.07 x 10,000 person-years in women; CVD: 18.49 versus 69.75 per 10,000 person-years in men and 20.34 versus 30.7 x 10,000 person-years in women). In analysis by risk profile and EL considered together for both genders rates of both CVD and cancer were highest in those with less education classified as high risk (cancer: 85.2 versus 56.13 x 10,000 person-years in men and 50.97 versus 35.12 x 10,000 person-years in women; CVD: 74.58 versus 69.06 per 10,000 person-years in men and 30.87 versus 22.69 x 10,000 person-years in women). Conclusions: Increasing educational levels and prevalence of low CVD risk profile in the general population may be effective strategies for population-wide CVD and cancer prevention.