Prevention Of Premature Death Research Articles

Preventable Premature Deaths from the Five Leading Causes of Death in Nonmetropolitan and Metropolitan Counties, United States, 2010-2022.

A 2019 report quantified the higher percentage of potentially excess (preventable) deaths in U.S. nonmetropolitan areas compared with metropolitan areas during 2010-2017. In that report, CDC compared national, regional, and state estimates of preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties during 2010-2017. This report provides estimates of preventable premature deaths for additional years (2010-2022). 2010-2022. Mortality data for U.S. residents from the National Vital Statistics System were used to calculate preventable premature deaths from the five leading causes of death among persons aged <80 years. CDC's National Center for Health Statistics urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Preventable premature deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Preventable premature deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and the District of Columbia. During 2010-2022, the percentage of preventable premature deaths among persons aged <80 years in the United States increased for unintentional injury (e.g., unintentional poisoning including drug overdose, unintentional motor vehicle traffic crash, unintentional drowning, and unintentional fall) and stroke, decreased for cancer and chronic lower respiratory disease (CLRD), and remained stable for heart disease. The percentages of preventable premature deaths from the five leading causes of death were higher in rural counties in all years during 2010-2022. When assessed by the six urban-rural county classifications, percentages of preventable premature deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan and fringe metropolitan) for the five leading causes of death during the study period.During 2010-2022, preventable premature deaths from heart disease increased most in noncore (+9.5%) and micropolitan counties (+9.1%) and decreased most in large central metropolitan counties (-10.2%). Preventable premature deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan and large fringe metropolitan counties (-100.0%; benchmark achieved in both county categories in 2019). In all county categories, preventable premature deaths from unintentional injury increased, with the largest increases occurring in large central metropolitan (+147.5%) and large fringe metropolitan (+97.5%) counties. Preventable premature deaths from CLRD decreased most in large central metropolitan counties where the benchmark was achieved in 2019 and increased slightly in noncore counties (+0.8%). In all county categories, preventable premature deaths from stroke decreased from 2010 to 2013, remained constant from 2013 to 2019, and then increased in 2020 at the start of the COVID-19 pandemic. Percentages of preventable premature deaths varied across states by urban-rural county classification during 2010-2022. During 2010-2022, nonmetropolitan counties had higher percentages of preventable premature deaths from the five leading causes of death than did metropolitan counties nationwide, across public health regions, and in most states. The gap between the most rural and most urban counties for preventable premature deaths increased during 2010-2022 for four causes of death (cancer, heart disease, CLRD, and stroke) and decreased for unintentional injury. Urban and suburban counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in preventable premature deaths from unintentional injury during 2010-2022, leading to a narrower gap between the already high (approximately 69% in 2022) percentage of preventable premature deaths in noncore and micropolitan counties. Sharp increases in preventable premature deaths from unintentional injury, heart disease, and stroke were observed in 2020, whereas preventable premature deaths from CLRD and cancer continued to decline. CLRD deaths decreased during 2017-2020 but increased in 2022. An increase in the percentage of preventable premature deaths for multiple leading causes of death was observed in 2020 and was likely associated with COVID-19-related conditions that contributed to increased mortality from heart disease and stroke. Routine tracking of preventable premature deaths based on urban-rural county classification might enable public health departments to identify and monitor geographic disparities in health outcomes. These disparities might be related to different levels of access to health care, social determinants of health, and other risk factors. Identifying areas with a high prevalence of potentially preventable mortality might be informative for interventions.

Abstract P454: Health Insurance Increases Access to Hypertension Treatment Among Venezuelan Migrants and Refugees: A Population-Based Survey in Peru

Introduction: Over 6 million migrants and refugees have left Venezuela because of an ongoing political instability and socioeconomic crisis. This unprecedented migration has led to an increase of over 1 million Venezuelan migrants and refugees in Peru. Migrants are considered a vulnerable population and are often faced with discrimination, financial distress, and restricted access to health services. According to the literature, chronic diseases, such as hypertension, are the leading cause of preventable morbidity and premature death. In Peru, according to a 2018 survey, only 10.8% of Venezuelan migrants receive regular treatment for chronic diseases. Hypothesis: We assessed the hypothesis that having health insurance is associated with access to hypertension treatment. Methods: Cross-sectional study based on a secondary analysis from the 2022 survey of Venezuelan Population Living in Peru (ENPOVE 2022). The survey included 12,487 participants. Our population included Venezuelan migrants and refugees over 18 years old with self-reported hypertension. The outcome variable was to receive regular treatment, while the independent variable was having health insurance. Complex samplings characteristics and sampling weights of ENPOVE 2022, as well as the subpop command were used. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (CIs) were obtained using Poisson log generalized linear regression models. Results: A total of 419 Venezuelan adults with self-reported hypertension were included in our study, of whom only 26.5% (95% CI 20.1-33.0) received regular treatment. Mean age was 50.3 ±12.9 (standard deviation) years old. Moreover, 30% perceived discrimination (95% CI 24.5-36.0), 39.1% (95% CI 32.4-46.2) were undocumented and 69% (95% CI 62.1- 75.1) did not have health insurance. In the multivariate analysis, after controlling by sex, age, socio-economic status, perceived discrimination, immigration status and disability, having health insurance was associated with receiving regular treatment (aPR 2.33; 95% CI 1.47-3.70). Neither perceived discrimination (aPR 0.62; 95% CI 0.37-1.05) nor disability (aPR 1.46; 95% CI 0.08-2.55) were associated with receiving regular treatment. Conclusions: In conclusion, less than 1/3 of migrants and refugees with hypertension have access to regular treatment. Having health insurance was associated with receiving regular treatment for hypertension. There is a need to improve health insurance coverage among migrants and refugees regardless of the immigration status.

Exploring the Enigmatic Link: Unraveling the Relationship Between Obesity and Cigarette Smoking Among Diverse College Students at Imam Mohammed Ibn Saud Islamic University in Riyadh, Saudi Arabia.

Obesity is defined as an excess of body fat. This medical condition frequently results in a high BMI and an increased risk of a variety of health problems, including diabetes, cardiovascular disease, and certain types of cancer. Cigarette smoking includes inhaling smoke created by the combustion of tobacco. It is linked to a variety of health issues, including lung cancer, heart disease, and respiratory ailments, and is a primary cause of preventable disease and premature death worldwide. The association between obesity and cigarette smoking is complex and incompletely understood. This study aims to investigate the intriguing association between obesity and cigarette smoking among diverse college students at Imam Mohammed Ibn Saud Islamic University in Riyadh, Saudi Arabia. The study was conducted as an observational study, specifically an analytical cross-sectional study, to measure the prevalence of cigarette smoking and obesity and their association. This type of study is chosen because of its advantages including targeting a large sample in a short time and inexpensive way, with no loss to follow-up, unlike some other study designs. In this study, we were able to collect data from 603 participants, of which 57.4% were male and 67.8% of them aged between 20 and 24 years old. Moreover, we found that 39.6% had normal weight; however, the prevalence of obesity, overweight, and underweight were 24%, 28.1%, and 8.3%, respectively. Considering the prevalence of smoking, we found that 22.6% of the participants reported being current smokers, while 5.3% were former smokers. There is a significant difference between participants with different BMIs (P=0.001). The prevalence of smoking was significantly higher in obese and overweighted participants (35.1% and 31.3%, respectively) compared with 28.4% in normal-weighted participants. The prevalence of smoking and obesity in this study was significantly higher than reported in different studies. Moreover, we found a significant relationship between smoking and obesity; however, further investigation should be conducted to determine the cause of this relationship.

ACHIEVE conference proceedings: implementing action plans to reduce and control hypertension burden in Africa.

The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.

Long- and short-term health benefits attributable to PM2.5 constituents reductions from 2013 to 2021: A spatiotemporal analysis in China

Long- and short-term exposure to constituents of fine particulate matter (PM2.5) substantially affects human health. However, assessments of the health and economic benefits of reducing PM2.5 constituents are scarce. This study estimates the number of premature deaths from all-cause, cardiovascular (CVD), and respiratory diseases avoided due to reductions in daily and annual average concentrations of PM2.5 constituents. The Environmental Benefits Mapping and Analysis Program was used for two scenarios: we used yearly concentrations of PM2.5 constituents from 2013 to 2020 as the baseline concentration surface (Scenario I), and 2021 as the baseline year (Scenario II). With reductions in daily and annual average concentrations of PM2.5 constituents, 309,099 (95 % confidence interval [CI]: 37,265–571,485) and 195,297 (95 % CI: 178,192–211,914) premature deaths were avoided in Scenario I, respectively; meanwhile, 347,296 (95 % CI: 79,258–604,758) and 201,567 (95 % CI: 185,038–217,530) premature deaths were avoided in Scenario II, respectively. Moreover, economic benefits associated with the prevention of premature deaths were estimated using the willingness to pay (WTP) and modified human capital (AHC) methods. The total estimated economic benefits amounted to 563.32 billion RMB (WTP) and 322.03 billion RMB (AHC) in Scenario I. In Scenario II, the associated economic benefits were 751.48 billion RMB (WTP) and 427.56 billion RMB (AHC), accounting for 0.657 and 0.374 % of China's gross domestic product in 2021, respectively. Additionally, we analyzed the sensitivity of CVD-related premature deaths to the concentrations of PM2.5 constituents, and found that CVD-related premature deaths were more sensitive to black carbon.

Associations of Nut Consumption with All-Cause Mortality among Individuals with Type 2 Diabetes

BackgroundNuts are energy-dense, high-fat foods, and whether nut consumption influences mortality risk among individuals with type 2 diabetes (T2D) remains unclear. ObjectivesThis study aimed to investigate the associations of nut consumption with all-cause mortality among adults with T2D and to further explore the potential mediation effects of cardiometabolic biomarkers. MethodsThe current analysis included 5090 US participants with T2D from the National Health and Nutrition Examination Survey (1999–2014). Cox proportional hazards models were conducted to estimate hazard ratio (HR) and 95% confidence interval (CI). ResultsAfter 35,632 person-y of follow-up, 1174 deaths were documented. Higher nut consumption was significantly associated with a lower risk of all-cause mortality among individuals with T2D. After multivariable adjustment including lifestyles and dietary factors, diabetes duration, and glycated hemoglobin, compared with participants who did not consume nuts, the HR (95% CI) for those who consumed nuts over 3.5 ounce equivalent (oz.eq)/wk was 0.64 (0.50, 0.82; P-trend < 0.001) for all-cause mortality. A linear dose–response relationship was observed between nut consumption and all-cause mortality among individuals with T2D (Poverall=0.004, Pnonlinearity=0.35). In substitution analyses, replacing one serving of red and processed meat, refined grains, eggs, and dairy foods with one serving of nuts was associated with a 18% to 22% lower risk of all-cause mortality. In addition, mediation analysis suggested that C-reactive protein and γ-glutamine transaminase explained 6.7% and 9.1% of the relationship between nut consumption with all-cause mortality, respectively. ConclusionsHigher nut consumption was significantly associated with lower all-cause mortality among individuals with T2D. These findings indicate a potential benefit of nut consumption in the prevention of premature death among individuals with T2D.

Serum Glutathione Peroxidase and Superoxide Dismutase Levels in Young Adult Active Smokers and Non-Smokers in a Southwest Based Tertiary Institution

Cigarette smoking is still a major public health issue, as it is the primary cause of various preventable diseases and premature deaths around the world. Previous studies have shown that tobacco components aggravate respiratory burst thus increasing the generation of reactive oxygen species (ROS). This case-control study is to examine glutathione peroxidase and superoxide dismutase levels among young adult active and non-active cigarette smokers at a tertiary institution in South West, Nigeria. This descriptive comparative study was carried out to compare the levels of serum glutathione peroxidase by Paglia and Valentine method and Nebot method of superoxide dismutase estimation in young adult active smokers and non-smokers in Ogun state based tertiary institution, between February and June, 2021. There was a significantly higher level (p = 0.000) of glutathione peroxidase in the case (55.39 ± 2.87) compared to the control (42.59 ± 2.41). There was no significant difference in the level of the measured antioxidants at different categories of years of smoking among the group of smokers. There was no significant difference in the level of the measured antioxidants at different quantities of cigarettes smoked by the participants. This study revealed that there was no significant difference in the level of the measured antioxidants at different categories of years amd quantity of cigarette smoked among the group of smakers. Prolonged exposure and quantity of cigarette smooke by smokers did not cause depletion of antioxidants among active smokers. However, smoking was associated with a higher level of oxidative stress marker.

Physiological State Evaluation in Working Environment Using Expert System and Random Forest Machine Learning Algorithm.

Healthy lifestyle is one of the most important factors in the prevention of premature deaths, chronic diseases, productivity loss, obesity, and other economic and social aspects. The workplace plays an important role in promoting the physical activity and wellbeing of employees. Previous studies are mostly focused on individual interviews, various questionnaires that are a conceptual information about individual health state and might change according to question formulation, specialist competence, and other aspects. In this paper the work ability was mostly related to the employee's physiological state, which consists of three separate systems: cardiovascular, muscular, and neural. Each state consists of several exercises or tests that need to be performed one after another. The proposed data transformation uses fuzzy logic and different membership functions with three or five thresholds, according to the analyzed physiological feature. The transformed datasets are then classified into three stages that correspond to good, moderate, and poor health condition using machine learning techniques. A three-part Random Forest method was applied, where each part corresponds to a separate system. The obtained testing accuracies were 93%, 87%, and 73% for cardiovascular, muscular, and neural human body systems, respectively. The results indicate that the proposed work ability evaluation process may become a good tool for the prevention of possible accidents at work, chronic fatigue, or other health problems.

The Impact of Smokers' Information-Seeking Behavior on Smoking Cessation.

Smoking has a harmful effect on human body and is rated to be the primary cause of preventable premature disease and death worldwide, while it is responsible for at least 25 life-threatening diseases. An empirical investigation has been carried out through the development and distribution of a structured questionnaire. The sample of empirical investigation consisted of 150 smokers aged over 18years (response rate 85.7%). Descriptive analysis and correlation control of questionnaire variables are used to report the findings of the study. Information about passive smoking, smoking consequences, and current therapies in quitting smoking were rated highest among smoke-related information needs. The main sources of information were family/relatives/friends/colleagues and Internet and less important factors were formal sources like medical staff, health professionals, and primary health care services. Ε-health literacy is correlated with higher self-efficacy, positive intention to quit smoking, and better educational level while is negatively correlated with increasing age. The creation of specialized programs and upgraded information services is fundamental for successful smoking cessation. These programs and services should be addressed to all socioeconomic groups and combined with the improvement in smokers' e-health literacy will contribute to a higher self-efficacy and finally drive them to quit smoking.

Ambiente e Salute News n.20 - marzo-aprile 2023

The European Environment Agency (EEA) has recently developed the European Environment and Health Atlas: an online platform [1] to reveal the air quality where we live, noise levels, green areas, and the quality of bathing sites. It is one of the tools set up by EEA to monitor the quality of the environment in Europe as part of policies to achieve zero pollution. It will be updated regularly and is open to user feedback. It is possible to obtain information on the air quality in our environment by clicking on a map or entering our address, thus obtaining indications of annual averages for PM2.5 , NO2 and Ozone and displaying the concentration of the pollutants as well as the number of people exposed to them, the number of preventable premature deaths and the number of life years lost. There is also the measure of noise monitoring level (not available for Italian locations), bathing water quality and the green area closest to your residence. In this issue of Environment and Health news there are various articles of the effects of air pollution on the vulnerable population (pregnant women and children), so the atlas is an excellent way to learn about the quality of the air we breathe every day in the places where we live and work. In this journal we continue to summarize the main articles published in the monitored journals, all articles and editorials deemed worthy of attention are listed divided by topic, with a brief commentary. This issue is based on the systematic monitoring of publications in March and April 2023.

Respiratory mechanics following chronic cigarette smoke exposure in the Apoe[Formula: see text] mouse model.

Even though cigarette smoking (CS) has been on the decline over the past 50 years, it is still the leading cause of preventable premature death in the United States. Preclinical models have investigated the cardiopulmonary effects of CS exposure (CSE), but the structure-function relationship in the respiratory system has not yet been fully explored. To evaluate these relationships, we exposed female apolipoprotein E-deficient (Apoe[Formula: see text]) mice to mainstream CS ([Formula: see text]) for 5 days/week over 24 weeks with room air as a control (AE, [Formula: see text]). To contextualize the impact of CSE, we also assessed the natural aging effects over 24 weeks of air exposure (baseline, [Formula: see text]). Functional assessments were performed on a small animal mechanical ventilator (flexiVent, SCIREQ), where pressure-volume curves and impedance data at four levels of positive end-expiratory pressure ([Formula: see text]) and with increasing doses of methacholine were collected. Constant phase model parameters ([Formula: see text]: Newtonian resistance, H: coefficient of tissue elastance, and G: coefficient of tissue resistance) were calculated from the impedance data. Perfusion fixed-left lung tissue was utilized for quantification of parenchyma airspace size and tissue thickness, airway wall thickness, and measurements of elastin, cytoplasm + nucleus, fibrin, and collagen content for the parenchyma and airways. Aging caused the lung to become more compliant, with an upward-leftward shift of the pressure-volume curve and a reduction in all constant phase model parameters. This was supported by larger parenchyma airspace sizes, with a reduction in cell cytoplasm + nucleus area. Airway walls became thinner, even though low-density collagen content increased. In contrast, CSE caused a downward-rightward shift of the pressure-volume curve along with an increase in H, G, and hysteresivity ([Formula: see text]). Organ stiffening was accompanied by enhanced airway hyper-responsiveness following methacholine challenge. Structurally, parenchyma airspaces enlarged, as indicated by an increase in equivalent airspace diameter ([Formula: see text]), and the septum thickened with significant deposition of low-density collagen along with an influx of cells. Airway walls thickened due to deposition of both high and low-density collagen, infiltration of cells, and epithelial cell elongation. In all, our data suggest that CSE in female Apoe[Formula: see text] mice reduces respiratory functionality and causes morphological alterations in both central and peripheral airways that results in lung stiffening, compared to AE controls.

Caregiver factors influencing nutritional status of preschool children in Mwingi West, Kitui County Kenya

Children are at an increased risk of malnutrition, with many undernourished children being highly susceptible to preventable premature death and morbidity. Insufficient dietary intake, infections, food insecurity, and inadequate care are the main causes of child malnutrition. These factors are sequentially influenced by caregivers’ characteristics. Despite this, the effect of a caregiver’s characteristics on a child's nutrition status has not been exhaustively studied in rural areas of Kenya. It is important to continuously examine the trends in the prevalence of malnutrition for effective interventions. Regular updates on the prevalence of malnutrition are crucial for appropriate interventions. In this study, the nutritional status of children was evaluated alongside their association with caregivers’ characteristics. The study was based in Migwani ward, Mwingi West Sub-County in Kitui County. The study was conducted between October and December 2020 and involved 106 caregivers with their 106 children aged 36–42 months. The characteristics of the caregivers were determined by the use of a pretested study questionnaire. To evaluate the nutritional status of children, the height and weight measures, age, and sex of the child were taken and transferred into the WHO Anthro software, and z-scores were derived. The Statistical Package for the Social Sciences (SPSS) was used to carry out additional data analysis. Children's nutritional status and caregivers’ characteristics were bivariate tested to determine the association.&#x0D; In the present study, the prevalence of stunting was 33.0%, wasting was 15.1%, and underweight was 20.8%. In this study, the caregivers that had lower income had more children that were underweight (χ2 = 9.2 p = 0.02), stunted (χ2 = 10.4 p = 0.015) and wasted (χ2 = 16.9, p&lt;0.001) compared to those with higher incomes. More so, the caregivers that were younger had more children that were wasted (χ2 = 20.04, p&lt;0.001), stunted (χ2 = 9.65, p = 0.032) and underweight (χ2 = 8.26, p = 0.041). Households that were headed by women had more children that were stunted (p = 0.022), wasted (p = 0.041) and underweight (p = 0.003). Similarly, respondents with lower education levels had more children that were stunted (χ2 = 14.02, p = 0.003), wasted (χ2 = 4.85, p = 0.037) and underweight (χ2 = 4.76, p = 0.045). In this study, the caregiver’s occupation was significantly associated with children's stunting (χ2 = 12.23, p = 0.007) and underweight levels (χ2 = 6.12, p = 0.034). The caregiver’s occupation had no influence on the children's wasting levels. The present study found that the marital status of a caregiver did not influence a child's nutritional status. These study results affirm that nutritional problems of stunting, wasting, and underweight among preschool children in Kitui County require public health actions. That caregivers’ characteristics play a role in the nutritional status of preschool children in Kitui County. Based on these study findings, priority should be given to children's nutrition programs that incorporate the dynamics of caregivers' characteristics. By doing this, such programs will be more effective.

Modern Approaches for the Treatment of Heart Failure: Recent Advances and Future Perspectives.

Heart failure (HF) is a progressively deteriorating medical condition that significantly reduces both the patients’ life expectancy and quality of life. Even though real progress was made in the past decades in the discovery of novel pharmacological treatments for HF, the prevention of premature deaths has only been marginally alleviated. Despite the availability of a plethora of pharmaceutical approaches, proper management of HF is still challenging. Thus, a myriad of experimental and clinical studies focusing on the discovery of new and provocative underlying mechanisms of HF physiopathology pave the way for the development of novel HF therapeutic approaches. Furthermore, recent technological advances made possible the development of various interventional techniques and device-based approaches for the treatment of HF. Since many of these modern approaches interfere with various well-known pathological mechanisms in HF, they have a real ability to complement and or increase the efficiency of existing medications and thus improve the prognosis and survival rate of HF patients. Their promising and encouraging results reported to date compel the extension of heart failure treatment beyond the classical view. The aim of this review was to summarize modern approaches, new perspectives, and future directions for the treatment of HF.

Türkiye’de Hava Kirliliği ve Sağlık Harcamaları

Hava kirliliği sebebiyle Türkiye’de her yıl yaklaşık 45 bin önlenebilir erken ölüm gerçekleşmektedir. Hava kirliliği sebebiyle yaşanan rahatsızlıklar ve ölümlerin hem ekonomiye hem de sağlık harcamalarına etkisi olmaktadır. Dolayısıyla bu çalışmada hava kirliliğinden kaynaklı rahatsızlıklar sebebiyle sağlık harcamalarındaki maliyetlerin incelenmesi amaçlanmaktadır. Çalışma verileri OECD İstatistik tarafından sağlanan 2009-2019 yılları arasındaki hava kirliliğine etki eden faktörlerin değişiminden ve HEAL 2021 yılı hava kirliliği kaynaklı sağlık harcamaları maliyetlerinden oluşmaktadır. Araştırmada veriler grafik ve tablo haline getirilerek yorumlanmaktadır. Yapılan incelemeler sonucunda Türkiye’de hava kirliliği sonucu asgari 25,845 milyon TL, azami 52,492 milyon TL sağlık maliyetinin ortaya çıktığı görülmüştür. Hava kirliliği insanları, hayvanları, bitki ve hatta nesneleri etkilemektedir. Bir ülkede ortaya çıkan hava kirliliği atmosferde taşınarak başka bir yerde hava kirliliğine etkide bulunabilir. Hava kirliliği sadece tek bir alanı değil tüm dünyayı etkilemektedir. Bu yüzden küresel işbirliği ile kirletici faktör limitlerinin sıkı önlemlerle gerçekleştirilmesi gerekmektedir. Küresel işbirliği ile yenilenebilir, temiz enerji kaynaklarının kullanımı için teşvik politikalarının oluşturulması daha sağlıklı bir toplum ve güçlü bir ekonominin oluşmasını sağlayacaktır.

Genetic Susceptibility to Insulin Resistance and Its Association with Estimated Longevity in the Hungarian General and Roma Populations.

Diabetes mellitus is a major public health problem with a wide range of prevalence among different ethnic groups. Early recognition of pre-diabetes is important to prevent the development of the disease, its complications, co-morbidities, and consequently early death. Insulin resistance (IR) is considered a condition that precedes type 2 diabetes; thus, understanding its underlying causes (genetic and non-genetic factors) will bring us closer to preventing it. The present study aimed to investigate the genetic susceptibility to IR and its impact on estimated longevity in populations with different ethnic origins using randomly selected samples of 372 Hungarian general (HG, as a reference with Caucasian origin) and 334 Roma participants (largest ethnic minority in Europe, with a northern India origin). In the present study, we used the Homeostasis Model Assessment—Insulin Resistance (HOMA—IR) to identify people with IR (>3.63) at the population level. To investigate the genetic predisposition to IR, 29 single nucleotide polymorphisms (SNPs) identified in a systematic literature search were selected and genotyped in sample populations. In the analyses, the adjusted p < 0.0033 was considered significant. Of these 29 SNPs, the commutative effects of 15 SNPs showing the strongest association with HOMA—IR were used to calculate an optimized genetic risk score (oGRS). The oGRS was found nominally significantly (p = 0.019) higher in the Roma population compared to HG one, and it was more strongly correlated with HOMA—IR. Therefore, it can be considered as a stronger predictor of the presence of IR among the Roma (AUCRoma = 0.673 vs. AUCHG = 0.528). Furthermore, oGRS also showed a significant correlation with reduced estimated longevity in the Roma population (β = −0.724, 95% CI: −1.230–−0.218; p = 0.005), but not in the HG one (β = 0.065, 95% CI: −0.388–0.518; p = 0.779). Overall, IR shows a strong correlation with a genetic predisposition among Roma, but not in the HG population. Furthermore, the increased genetic risk of Roma is associated with shorter estimated longevity, whereas this association is not observed in the HG one. Increased genetic susceptibility of Roma to IR should be considered in preventive programs targeting the development of type 2 diabetes, which may also reduce the risk of preventable premature death among them.

Associations of exposure to lead and cadmium with risk of all-cause and cardiovascular disease mortality among patients with type 2 diabetes.

The aim of this paper is to investigate the associations of lead and cadmium exposure with all-cause and cardiovascular disease (CVD) mortality among adults with type 2 diabetes (T2D). The prospective cohort study included participants with T2D (n = 7420 for blood lead; n = 5113 for blood cadmium) from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999-2014. Death outcomes were ascertained through linkage with the National Death Index records. The geometric mean (interquartile range) concentrations of blood lead and cadmium were 19.6 (11.8, 35.0) μg/L and 0.39 (0.21, 0.60) μg/L, respectively. During 72,279 and 37,017 person-years of followup, 2818 all-cause deaths (including 832 CVD deaths) for blood lead and 1237 all-cause deaths (including 319 CVD deaths) for blood cadmium were documented, respectively. Comparing extreme quartiles, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality were 1.51 (1.25, 1.82) for blood lead (Ptrend < 0.001) and 1.58 (1.22, 2.03) for blood cadmium (Ptrend < 0.001); and the HRs (95% CIs) of CVD mortality were 2.27 (1.54, 3.34) for blood lead (Ptrend < 0.001) and 1.78 (1.04, 3.03) for blood cadmium (Ptrend = 0.07). In the joint analysis, compared with participants in the lowest tertiles of blood lead and cadmium, participants in the highest tertiles had a HR (95% CI) of 2.09 (1.35, 3.24) for all-cause mortality. Exposure to lead and cadmium alone or in combination was significantly associated with higher risk of mortality among patients with T2D. These findings imply that minimizing exposure to lead and cadmium may aid in the prevention of premature death among individuals with diabetes.

Predictors of Waterpipe Smoking among Male Students of Jazan University, Jazan, Saudi Arabia

Background: Smoking is the leading cause of preventable premature death worldwide. Therefore, tobacco consumption is labeled as one of the major threats to public health. Aim of Study: To identify predictors of waterpipe smoking among male students of Jazan university. Subjects and Methods: A cross-sectional study was conducted to evaluate characteristics and factors associated with tobacco use among 409 undergraduate male students in Jazan University, Jazan, Saudi Arabia. A self-administrated questionnaire was used for data collection. It consists of 26 questions in 3 domains, covering demographic and socioeconomic characteristics of participants, tobacco use history, and factors associated with waterpipe use. Results: A total of 409 university students took part in this study. About three-quarters of students (73.8%) reported having a friend who smokes waterpipe and 37.7% had a sibling who smokes waterpipe, while 15.2% and 2.4% of participants had fathers and mothers who smoke waterpipe, respectively. Moreover, 22.1% of waterpipe smoker students reported that they smoke waterpipe once a day, 12.6% smoke twice a week, 9.1% smoke once a week, 14.7% smoke once a month and 16.9% smoke once a year. For students who smoke waterpipe, the average number of smoking times was 16 times during the last month, 5 times during the last week and twice during the last day. Regardless of waterpipe smoking, 48.4% of students try to smoke cigarettes at least once. Conclusions: The main factors associated with waterpipe smoking are age, monthly income, and having a father, siblings or friends who smoke waterpipe. Furthermore, students who smoke cigarettes or tobacco or have many friends who smoke waterpipe are significantly more likely to engage in waterpipe smoking. Key Words: Smoking, waterpipe, cigarette, nicotine, university students, Jazan, Saudi Arabia.

Method Development and Applications for Reduced-Risk Products

Cigarette smoking remains the leading cause of preventable premature death and disease in the U [...]

Association of Lifestyle Factors and Antihypertensive Medication Use With Risk of All-Cause and Cause-Specific Mortality Among Adults With Hypertension in China

The joint association of antihypertensive medication use and healthy lifestyle with mortality among individuals with hypertension is unclear. To examine the association of lifestyle factors combined with antihypertensive medication use, as well as changes in lifestyle, with all-cause and cause-specific mortality among individuals with hypertension. This cohort study used data from the Dongfeng-Tongji cohort, a long-term, prospective cohort including employees at a manufacturer in China, with baseline from 2008 to 2010. Participants with hypertension were followed up for a median (IQR) of 7.3 (5.7-10.3) years, ending in 2018. Data were analyzed from February to April 2021. Lifestyle factors, including body mass index, smoking status, diet, physical activity, and sleep duration, were coded on a 3-point scale (range, 0-2, with higher score indicating a healthier lifestyle). Lifestyle was evaluated according to the total score of all 5 factors, and categorized into 3 groups: unfavorable (scores 0-4), intermediate (scores 5-7), and favorable (scores 8-10). Antihypertensive medication use was defined as use within the last 2 weeks. All-cause, cardiovascular, and cancer mortality were identified by linking the cohort database with the health care system through December 31, 2018. A total of 14 392 participants (mean [SD] age, 65.6 [7.4] years; 7277 [50.6%] men and 7115 [49.4%] women) with hypertension were included, and 2015 deaths were documented, including 761 cardiovascular deaths and 525 cancer deaths. Compared with individuals not using antihypertensive medication and with a lifestyle score of 0 to 4, the combination of using antihypertensive medication and having a lifestyle score of 8 to 10 was associated with the lowest risk of all-cause mortality (hazard ratio [HR], 0.32; 95% CI, 0.25-0.42), cardiovascular mortality (HR, 0.33; 95% CI, 0.21-0.53), and cancer mortality (HR, 0.30; 95% CI, 0.19-0.47). In addition, improvement in lifestyle score after hypertension diagnosis was associated with lower risk of all-cause mortality (HR, 0.52; 95% CI, 0.36-0.76) and cardiovascular mortality (HR, 0.53; 95% CI, 0.30-0.94). These findings suggest that adherence to healthy lifestyle and antihypertensive medication treatment were associated with lower risk of mortality among adults with hypertension. These findings further support that, in addition to antihypertensive medication use, adopting a healthy lifestyle is associated with benefits in the prevention of premature death among individuals with hypertension.

Prevalence of tobacco smoking among dental practitioners: A hospital-based study.

ABSTRACTBackground:Consumption of tobacco is a prevalent public health problem in Saudi Arabia and worldwide. It remains one of the world’s leading causes of preventable premature death and a public health concern. We aim to Estimation the prevalence of tobacco smoking among dental practitioners working at the Security Forces Hospital in Riyadh, Saudi Arabia.Methods:A cross-sectional study was conducted in one of the largest government hospitals in Riyadh using a self-administered questionnaire. The study targeted dental practitioners including; oral and maxillofacial surgeons, orthodontists, periodontists, prosthodontists, endodontists, pediatric dentists, restorative dentists, general dentists, dental hygienists, dental assistants, and dental lab technicians. The study data were analyzed using the SPSS statistical software package.Results:Overall, 74 dental practitioners completed the study questionnaire; 54.1% were females. The age of study participants ranged between 24 to 56 years, while their mean age was 33.84 years. The prevalence of current smokers among the respondents in was 25.67%. Of the participants, 9.45% were ex-smokers. Stress relief was the main reason for smoking (52.6%), followed by relaxation (31.6%). Most respondents agreed that dental practitioners should serve as role models (73%), and that health care practitioners should give advice or information about smoking cessation to patients (79.7%). Most participants had insufficient training about tobacco hazards (56.8%).Conclusion:The prevalence of tobacco smoking among dental practitioners included in this study was closer to that in previous studies. Furthermore, study participants lacked sufficient training about tobacco hazards and control.