Preventive Health Policies Research Articles

Not All Carcinogens Are Directly Mutagenic: A Holistic View of the Environmental Exposure–Cancer Connection

Cancers, a leading cause of morbidity and mortality worldwide, are undergoing notable shifts in incidence patterns. Cancer subtypes generally associated with advancing age are now increasingly being diagnosed in younger populations, while gender disparities in cancer susceptibility have fluctuated across various malignancies. Some cancer subtypes previously confined to specific geographical populations are now globally prevalent. Remarkably, these changing patterns of cancer incidence have occurred despite relatively stable mutational landscapes specific to each cancer type, highlighting the role of environmental exposures (exposomes) as potential drivers of these trends. Intriguingly, evidence suggests that the exposome may exert some of its influence through nonmutagenic mechanisms, although the precise ways in which environmental carcinogens trigger or promote cancer development remain poorly understood. This review summarizes the current understanding of the mutagenic and nonmutagenic mechanisms through which carcinogens, including tobacco smoke, air pollutants, metals, diet, and alcohol, impact cancer development, as this may help inform precision prevention and public health policy.

Social health gradient and risk factors among patients hospitalized for COVID-19 and pre-pandemic respiratory infections. A linked national individual case-control study in Belgium

IntroductionThe literature establishes a clear social gradient in health for transmissible respiratory diseases. However, this gradient’s extent remains largely unexplored in the context of COVID-19, and it is uncertain whether the pandemic has exacerbated this gradient. The study aims to compare the socio-economic profiles and comorbidities during the COVID-19 pandemic with a control population affected by viral pneumonia/respiratory disease in 2019.MethodsThis case-control study analyzed linked data from all patients hospitalized for COVID-19 in 2020 (n = 22,087) and for respiratory diseases in 2019 (n = 7,586). Socio-economic data from the social security database were linked to clinical data from the hospital registry. We analyzed the socio-demographic and clinical factors associated with COVID-19 hospitalization (control group, wave 1, and wave 2) using multinomial regressions and logistic regression models and the length of stay during hospitalization using binomial negative regressions.ResultsA social health gradient was observed in both the COVID-19 and control groups, with a significant increase across waves for COVID-19 (p-trend < 0.0001). Men, people over the age of 45, those with comorbidities, high population density, lower income, lower socio-economic status, and people living in Brussels capital were at higher risk of COVID-19 hospitalization and longer length of stay compared to the control group. Except for sub-Saharan Africans, all patients of foreign nationality had a significantly increased risk of hospitalization (p < 0.001), but a shorter length of stay compared to Belgians.ConclusionThe socio-health gradient for COVID-19 followed the same pattern as that observed in pre-pandemic respiratory diseases, intensifying in the second wave and among the most deprived groups. This study emphasizes the importance of collecting social data alongside clinical data for a better understanding of social health inequalities and for tailoring health prevention policies.

Eye Injury Incidence in Germany from 2008 to 2022: An Analysis of Hospital Quality Reports.

Eye injuries range from minor to severe and may lead to permanent visual impairment. There is still little in the way of epidemiological data on eye injuries in Germany. The aim of this study was to obtain an objective record of minor and severe eye injuries in Germany by evaluating hospital quality reports. We also investigated the relevance of injuries from fireworks in relation to the total number of eye injuries and the general population. This retrospective routine data study entailed analysing hospital quality reports from 2008 to 2022 in XML format. The R programming language was used for data processing and statistical analysis. The number of ICD-coded eye injuries was exported and analysed together with location data. We also included data from a prospective survey study on fireworks-related eye injuries from 2016 to 2023. Eyeball and/or orbital contusions are the most common eye injuries treated in Germany at up to 2,500 cases per year. The most severe injuries comprise traumatic globe rupture with loss of intraocular tissue at up to 990 cases per year. Numbers of eye injuries of any type have been declining since 2020. As a percentage of population, Mecklenburg-Western Pomerania treats the most eye injuries at up to 0.017%; in absolute numbers, North Rhine-Westphalia leads the country at up to 1,600 injuries. Private firework displays are probably responsible for 1.4% of annual globe ruptures and 8.3% of eyeball contusions. Our analysis of hospital quality reports has provided the first comprehensive epidemiological record on eye injuries in Germany. Firework-related injuries account for a relevant proportion of total injuries. These results could serve as a basis for preventive measures and health policy decisions.

Global, regional, and national burden of hearing loss in children and adolescents, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021

BackgroundHearing loss in children and adolescents is attracting increasing attention as a growing public health problem. This study aimed to analyze the burden of hearing loss in children and adolescents from 1990 to 2021 to provide a new basis for further epidemiological research, disease prevention, and public health policy development.MethodsThe prevalence and years lived with disability (YLDs) of hearing loss in children and adolescents from 1990 to 2021 at the global, regional, and national levels were extracted from the Global Burden of Disease 2021 database. The estimated annual percentage change (EAPC) was used to assess trends in prevalence and YLDs. Pearson correlation analysis was used to assess the relationships between sociodemographic index (SDI) and prevalence and YLDs.ResultsIn 2021, approximately 97.83 million children and adolescents under the age of 20 years were affected by hearing loss globally, resulting in approximately 3.91 million YLDs. From 1990 to 2021, the prevalence rate increased from 3537 per 100,000 to 3711 per 100,000, with an EAPC of 0.15% (95% CI: 0.12–0.17). The burden of hearing loss was greater in low-middle-SDI region and low-SDI region. Mild hearing loss accounted for 62.1% of the total cases and was the predominant type of hearing loss. Otitis media was the leading preventable cause of hearing loss, with 46.9% of hearing loss attributed to otitis media. Moreover, in children under 5 years of age, 68.7% of hearing loss was attributed to otitis media. Pearson correlation analysis revealed that the prevalence rates and YLDs rates of hearing loss were negatively correlated with the SDI (R = -0.57, P < 0.001; R = -0.64, P < 0.001).ConclusionsThe burden of hearing loss in children and adolescents has increased over the past three decades and remains high. The burden is greater in less economically developed countries or regions. Policymakers should pay attention to the increasing burden of hearing loss in children and adolescents and take targeted measures to control this burden.

Genomic insights into the antimicrobial resistance and virulence of Helicobacter pylori isolates from gastritis patients in Pereira, Colombia

BackgroundHelicobacter pylori infects the stomach and/or small intestines in more than half of the human population. Infection with H. pylori is the most common cause of chronic gastritis, which can lead to more severe gastroduodenal pathologies such as peptic ulcer, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. H. pylori infection is particularly concerning in Colombia in South America, where > 80% of the population is estimated to be infected with H. pylori and the rate of stomach cancer is one of the highest in the continent.ResultsWe compared the antimicrobial susceptibility profiles and short-read genome sequences of five H. pylori isolates obtained from patients diagnosed with gastritis of varying severity (chronic gastritis, antral erosive gastritis, superficial gastritis) in Pereira, Colombia sampled in 2015. Antimicrobial susceptibility tests revealed the isolates to be resistant to at least one of the five antimicrobials tested: four isolates were resistant to metronidazole, two to clarithromycin, two to levofloxacin, and one to rifampin. All isolates were susceptible to tetracycline and amoxicillin. Comparative genome analyses revealed the presence of genes associated with efflux pump, restriction modification systems, phages and insertion sequences, and virulence genes including the cytotoxin genes cagA and vacA. The five genomes represent three novel sequence types. In the context of the Colombian and global populations, the five H. pylori isolates from Pereira were phylogenetically distant to each other but were closely related to other lineages circulating in the country.ConclusionsH. pylori from gastritis of different severity varied in their antimicrobial susceptibility profiles and genome content. This knowledge will be useful in implementing appropriate eradication treatment regimens for specific types of gastritis. Understanding the genetic and phenotypic heterogeneity in H. pylori across the geographical landscape is critical in informing health policies for effective disease prevention and management that is most effective at local and country-wide scales. This is especially important in Colombia and other South American countries that are poorly represented in global genomic surveillance studies of bacterial pathogens.

A Survey of Lithuanian Pregnant Women's Knowledge about Periodontal Disease, Its Prevalence and Possible Influence on Pregnancy Outcomes.

Background: This study aimed to subjectively assess the changes in the oral health status of pregnant women, to find out their attitudes and knowledge about possible changes in the oral cavity that occurred during pregnancy, and their influence on the outcomes of pregnancy. Methods: 112 pregnant women who visited the Republican Siauliai Hospital during their pregnancy participated in the study. An anonymous self-administered questionnaire was used to conduct the research, surveying their demographic characteristics, oral health changes and habits during pregnancy, and awareness of possible negative pregnancy outcomes. Results: The study involved 112 pregnant women, with 35 in the first trimester, 28 in the second, and 48 in the third trimester. The findings revealed that pregnant women do not take sufficient care of their oral health: more than half of the respondents did not visit an oral care specialist during pregnancy; 22.3% of women reported brushing their teeth only once a day or less; and 35.7% did not clean interdental surfaces at all. Statistically, significantly more urban women believed there is a relationship between maternal oral health and adverse pregnancy outcomes than women living in rural areas (p = 0.013). While significant oral health changes were not observed in the first trimester, more women in the second and third trimesters reported issues such as bleeding gums, swelling, plaque accumulation, tartar, and caries (p < 0.001). Conclusions: The attitude of women towards oral health during pregnancy and their understanding of the possible risks for unfavorable pregnancy outcomes are insufficient. Notably, oral health issues become more prominent in the second and third trimesters, necessitating appropriate oral care to reduce the incidence of oral and dental diseases during pregnancy. This underscores the importance of educational and preventive public health policies focused on oral care for pregnant women, aimed at increasing awareness and promoting practices that safeguard both maternal and fetal health.

Level of implementation of digital transformation in dental radiology centers in Metropolitan Lima: A cross-sectional study.

Digital transformation (DT) involves introducing digital technologies into business models in all areas. This research aimed to evaluate the level of implementation of DT using the digital health indicator in private radiology centers in Lima, Perú. Forty-five randomly selected radiology centers included in a database of 50 registered centers were evaluated. The inclusion criteria were having a web domain and institutional email address. They were digitally surveyed using a digital survey (HIMSS DHI Rapid) measuring four dimensions: interoperability, governance and workforce, predictive analytics, and person-enabled health. These indicators allowed determination of the digital transformation level of a radiological company. The level of implementation was measured quantitatively on a scale from 0 to 400, and the Kruskal Wallis test (p>0.05) was used to compare DT according to the geographical location of the centers. The digital health indicator obtained was 60.24 ± 43.14 out of 400 achievable points. The dimensional analysis in terms of interoperability was 24 ± 18.09, followed by governance and workforce at 23.44 ± 18.58, person-enabled health at 18.73 ± 15.63, and finally, predictive analysis at 16.18 ± 13.51. No significant differences were found in health indicator dimensions according to the geographical location (p>0.05). DT in maxillofacial radiology centers in Lima is at an initial level. Radiology centers should take this situation into account to have relevant information for making diagnostic and treatment decisions and to provide better preventive health policies to benefit the population. Key words:Digital transformation, digital health indicator, dental radiology.

Peer Bullying and Psychiatric Diagnoses in Adolescents with Nonsuicidal Self-Injury

Objectives The aim of this study was to determine the comorbid psychiatric diagnoses, peer bullying rates and NSSI characteristics in adolescents who engage in self-injuring behavior. Materials and Methods This case-controlled cross-sectional study was conducted between 1 March 2020 and 1 May 2021 in the Child and Adolescent Psychiatry and Paediatrics outpatient clinic of a hospital in the Southeastern Anatolia region of Turkey. The data of 50 adolescents with NSSI and 60 adolescents without NSSI attending school were compared. The data in the study were obtained using sociodemographic form prepared by the researchers, the Affective Disorders and Schizophrenia Interview Schedule for School-Age Children—Present and Lifetime Version—Dsm–5, Peer Bullying Scale Adolescent Form and Self-Injurious Behaviour Assessment Inventory. Results Fifty adolescents (70% female) with a mean age of 15.4 years (S.D. = 1.4) with NSSI were included as case group and 60 adolescents (66.7% female) with a mean age of 15.5 years (S.D. = 1.3) without NSSI were included as control group. Banging/hitting self was the most common NSSI method, while affect regulation was the most common function. In the case group, verbal, isolation and damage to belongings among the victim subtypes in the last year were found to be significantly higher than in the control group. It was found that there was a positive correlation between the variety of self-injury methods and bullying exposure scores in adolescents with NSSI. Depression disorders, anxiety disorders, oppositional defiant disorder, attention deficit hyperactivity disorder, conduct disorder, and post-traumatic stress disorder diagnoses were found to be more prevalent in the group with NSSI. Conclusions Based on the finding, it was found that psychiatric diagnoses are more common in adolescents with NSSI, peer bullying subtypes are seen at a higher rate, and as bullying scores increase, the variety of NSSI methods also increases. It is thought that providing psychiatric evaluation and treatment for adolescents with NSSI, establishing cooperation with school and family for peer bullying, developing preventive mental health policies and effective intervention programmes may be beneficial.

Gastric cancer prevention by community eradication of Helicobacter pylori: a cluster-randomized controlled trial.

Gastric cancer is a leading cause of cancer-related deaths in China. Affecting more than 40% of the world's population, Helicobacter pylori is a major risk factor for gastric cancer. While previous clinical trials indicated that eradication of H. pylori could reduce gastric cancer risk, this remains to be shown using a population-based approach. We conducted a community-based, cluster-randomized, controlled, superiority intervention trial in Linqu County, China, with individuals who tested positive for H. pylori using a 13C-urea breath test randomly assigned to receiving either (1) a 10-day, quadruple anti-H. pylori treatment (comprising 20 mg of omeprazole, 750 mg of tetracycline, 400 mg of metronidazole and 300 mg of bismuth citrate) or (2) symptom alleviation treatment with a single daily dosage of omeprazole and bismuth citrate. H. pylori-negative individuals did not receive any treatment. We examined the incidence of gastric cancer as the primary outcome. A total of 180,284 eligible participants from 980 villages were enrolled over 11.8 years of follow-up, and a total of 1,035 cases of incident gastric cancer were documented. Individuals receiving anti-H. pylori therapy showed a modest reduction in gastric cancer incidence in intention-to-treat analyses (hazard ratio 0.86, 95% confidence interval 0.74-0.99), with a stronger effect observed for those having successful H. pylori eradication (hazard ratio 0.81, 95% confidence interval 0.69-0.96) than for those who failed treatment. Moderate adverse effects were reported in 1,345 participants during the 10-day treatment. We observed no severe intolerable adverse events during either treatment or follow-up. The findings suggest the potential for H. pylori mass screening and eradication as a public health policy for gastric cancer prevention. Chinese Clinical Trial Registry identifier: ChiCTR-TRC-10000979 .

Obesity in urban Indonesia: evidence from the 2007 and 2018 Basic Health Research

BACKGROUND The prevalence of obesity in urbanizing Indonesia is rising, where the double burden of malnutrition poses a significant challenge. This study aimed to examine the prevalence and increment of obesity-related noncommunicable diseases (NCDs) of diabetes and hypertension. METHODS Secondary data from the latest 2018 Basic Health Research (RISKESDAS) were used to analyze the obesity rate and its associations with lifestyle, sociodemographics, and certain comorbidities among urban Indonesians. This study included non-pregnant adults aged ≥18 years who lived in the urban area and whose blood pressure and glucose levels were measured in the survey. Results were compared to a similar study using data from 2007. RESULTS The proportion of obesity among Indonesia’s urban population was more than doubled from 23.0% in 2007 to 50.1% in 2018 for obesity and 28.0% to 57.2% for central obesity. Additionally, females, individuals with higher socioeconomic status, and higher education levels exhibited a higher obesity prevalence. CONCLUSIONS Urban Indonesia has witnessed a dramatic rise in obesity prevalence. Our findings highlighted the urgent need for policymakers to consider the escalating prevalence of NCDs associated with obesity. Strengthening and concretizing health promotion and prevention policies at the community level are crucial to combat this alarming public health challenge.

Assessment of Subsidies for Construction Businesses in Nigeria: Evolution from an Oil-Based Economy to an Infrastructural-Based Economy

Subsidies are financial or non-financial aids or support given to an economic sector, individual or organization by their government to promote the economy and achieve specific policy objectives. This study assessed the use of subsidies for construction businesses in Nigeria with a view to revolutionize the country from oil-based economy to infrastructural-based economy. A structured questionnaire was administered to four hundred and four (404) construction business stakeholders, and three hundred and four (304) representing 75.25% were retrieved from the respondents. Findings revealed that buying and selling of construction materials with Mean Score (MS) of 3.97 is the most successful construction businesses in Nigeria. The major factors considered in rating construction business performance are profitability to the investor (MS=3.70), resource management and control (MS=3.68), and cost performance (MS=3.63). The study concluded that the establishment of construction related institutions (MS=3.97), enforcement of health, safety, and hazards prevention policies (MS=3.91), exchange rate moderation for construction business (MS=3.86), and implementation of the National Building Code (NBC) (MS=3.85) will grow the infrastructural economy. The study recommended subsidies for construction businesses in Nigeria to boost the infrastructural sectors and the economy.

Development of a structured validated module to inculcate research skills in medical undergraduates.

Background Evidence-based research aids in decision-making in the health sector for developing health policies for prevention, diagnosis and treatment of diseases. Medical research is not taught in the undergraduate curriculum. Studies show that attributes of research knowledge, awareness and practical involvement in research are low among undergraduate students. We developed and validated a module and trained undergraduate students in research skills through an inter-ventional workshop using the structured module. Methods We did this participatory action research with a mixed-methods approach in the Department of Community Medicine at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab. A structured module was developed by the core committee and validated internally and externally. Pilot testing of the module was done by delivering it in the form of a workshop to 46 students. For statistical analysis, percentage agreements, validity indices, median (interquartile range), satisfaction percentages and Wilcoxon sign test were used. Results The structured and validated module was established to have high face validity (>90%) and content validity (CVI=0.975). The module was successfully pilot tested for delivery through both onsite and online modes. The satisfaction percentage with the workshop was 91% and 100% and overall rating of the module was 74% and 91% by interns and MBBS students, and 100% by faculty. The scores of knowledge and skills were found to be significantly higher on all variables post workshop with p<0.001. All students scored satisfactory grades for research skills. Conclusions Teaching research using a structured validated module improved the knowledge and skills related to research among students. Both students and faculty were satisfied with the use of the structured module.

Infección por Trypanosoma cruzi: estrategias para el desarrollo de una vacuna

Background: The Chagas-Mazza disease is an infection caused by the protozoan Trypanosoma cruzi and is considered one of the main public health problems in America. Because a large number of wild animals are T. cruzi reservoir, the lack of health policies for prevention and the lack of a vaccine, the infection cannot be eradicated. There are currently no vaccines against this Chagas disease, its development and application would be essential for the control of infection. Material and methods: A systematic review of study publications is carried out and metanalysis is carried out that integrates all available public information on the subject of study. Results: Over the years, a wide variety of vaccine platforms against Chagas-Mazza's disease have been investigated. The protection against the disease could be achieved by an mTS formulation plus a protein adjuvant. A recombinant protein derived from TS (TSr) together with the adjuvant CpG (TLR-9 agonist) was administered both intramuscular and intranasal with very good results. The glycosylated mutant trans-sialidase (TSm) formulation together with the adjuvant iscomatrix is highly effective, it reduces parasitemia by 50%. The nasal administration of Transpaine plus c-di-AMP is a highly immunogenic formulation that contributes to the control of the parasites, presenting less clinical evidence of infection and limited side effects. Conclusion: several research carried out so far and the progress made by immunization with vaccines using attenuated or inactivated live antigens or parasites or recombinant proteins in experimental models with promising results for the development of a vaccine in humans

A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol

BackgroundThe primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research.MethodsThis systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared.Discussion/conclusionThis will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners.Systematic review registrationPROSPERO CRD42022352333.

A Scoping Review on the Epidemiology of Orthobunyaviruses of Canadian Public and Animal Health Relevance in the Context of Vector Species.

Background: Mosquito-borne orthobunyaviruses are a growing priority for public and animal health in Canada. It is anticipated that disease incidence will increase due to a warming climate, given that habitats are expanding for reservoir hosts and vectors, particularly in Canada. Little is known about the ecology of primary vectors that perpetuate these orthobunyaviruses, including the viral transmission cycle and the impact of climatic and landscape factors. Methods: A scoping review was conducted to describe the current state of knowledge on the epidemiology of orthobunyaviruses relevant to Canada. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines was used to characterize studies focused on vector species. A literature search was conducted in six databases and gray literature. Eligible studies characterized orthobunyavirus epidemiology related to vector species, including viral competency, geospatial distributions, seasonal trends, and/or risk factors. Results: A total of 1734 unique citations were identified. Screening of these citations revealed 172 relevant studies, from which 87 studies presented primary data related to vectors. The orthobunyaviruses included Cache Valley virus (CVV), Jamestown Canyon virus (JCV), Snowshoe Hare virus (SHV), and La Crosse virus (LACV). Surveillance was the predominant study focus, with most citations representing the United States, specifically, LACV surveillance in Tennessee, followed by CVV and JCV in Connecticut. Orthobunyaviruses were detected in many mosquito species across multiple genera, with high vector specificity only being reported for LACV, which included Aedes triseriatus, Aedes albopictus, and Aedes japonicus. Peridomestic areas were positively associated with infected mosquitoes compared with dense forests. Orthobunyavirus infections, coinfections, and gut microbiota affected mosquito feeding and breeding behavior. Conclusion: Knowledge gaps included Canadian surveillance data, disease modeling, and risk projections. Further research in these areas, especially accounting for climate change, is needed to guide health policy for prevention of orthobunyaviral disease.

Association of diabetes mellitus with dementia- and non-dementia-related mortality amongst women: a secondary competing risks analysis of the California Teachers Study.

The prevalence of dementia is rapidly increasing. Attempts to further understand modifiable risk factors such as diabetes mellitus (DM) are urgently needed to inform public health policies for prevention. Thus, the objective of the current study was to assess the relationship between DM and risk of dementia and non-dementia mortality amongst women in the California Teachers Study prospective cohort. Women (n = 124,509) aged 22-104 years at baseline were included. DM was ascertained from self-reported questionnaires and hospital-linked records. Dementia-related deaths were ascertained from state and national records. Competing risk regression models were used to estimate cause-specific hazard ratios and 95% confidence intervals for the association of DM with dementia- and non-dementia-related mortality. There were 10,511 total DM cases and 3625 deaths due to dementia over a mean of 21.3 years of follow-up. Fully adjusted cause-specific hazard ratios of the association with DM were 2.26 (2.01, 2.55) for dementia-related and 1.97 (1.89, 2.05) for the competing risk of non-dementia-related mortality. This association was strongest amongst participants with incident DM, younger age at baseline and higher alcohol consumption or who were overweight. In the California Teachers Study, women with DM had increased risk of mortality due to both dementia and non-dementia causes; however, the risk of mortality due to dementia was elevated compared to non-dementia causes only amongst participants with incident DM.

A Contextualization of Transgender Women and Condom Use Using the HIV Syndemic Framework: Scoping Review

Objective: To contextualize condom use in the transgender women population utilizing the HIV syndemic framework. Methods: Studies reporting condom use frequency and syndemic factors associated with HIV risk in transgender women were systematically searched. We followed the Scoping Reviews (PRISMA-ScR) checklist. Results: Social factors have a proven relationship with using condoms and HIV among transgender women. Syndemic factors, defined as co-occurring adverse factors that interact to contribute to risk behaviors, deserve a specific analysis to develop strategies to face HIV among transgender women. Conclusions: A syndemic perspective allows to generate specific health intervention and prevention policies to protect transgender women.

Ethics of early detection of disease risk factors: A scoping review

BackgroundScientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture.MethodsTo identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers.ResultsAfter screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals.ConclusionsThe ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.

Heatwave 1987: the Piraeus versus Athens case.

Heatwaves represent the main indices of climate change, while mortality is one of the established markers of their human effects. For unknown reasons populations adapt to temperature variations/challenges differently. Thus, to allow better precision and prediction, heatwave evaluations should be enriched by historical context and local data. The mortality data for 1987 were collected from the Piraeus municipality registry, whereas data for Athens were obtained from literature retrieved from PUBMED. Ambient characteristics were extracted from the Geronikolou's 1991 BSc thesis and the reports of national organizations. From the death events, the odds ratio and relative risk in Piraeus compared to the Athens were calculated. Finally, a simple neural network proposed the dominant ambient parameter of the heatwave effects in the city residents of each location. The 1987 heatwave was more lethal (seven-fold) in Athens than in Piraeus and dependent on atmospheric nitric oxide (NO) concentration (with probability 0.999). In the case of Piraeus in 1987, ozone characterized the phenomenon (with probability 0.993). The odds of dying due to a heatwave are highly dependent on lifestyle, population sensitivity to preventive measures and public health policy, while the phenomenon was mainly moderated by ozone in Piraeus in 1987, and NO in Athens irrespective of year.

Morphometric Analysis of Coronary Arteries: An Autopsy Study from a Tertiary Hospital at Kolar, Karnataka, India

Introduction: The incidence and prevalence of Coronary Artery Disease (CAD) are rising worldwide, particularly in India. CAD can be asymptomatic in the general population. Aim: To analyse the significance of morphometric measurements of the coronary arteries in autopsy cases of unnatural deaths. Materials and Methods: This was a retrospective cross-sectional autopsy study conducted from January to December 2020 in the Department of Pathology in collaboration with the Department of Forensic Medicine at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Cases of deaths due to unnatural causes were considered. Morphometric parameters such as Luminal Area (LA), Internal Elastic Lamina Area (IELA), External Elastic Lamina Area (EELA), width of the intima at maximal thickness, width of the media at maximal thickness, intimal area, medial area, percentage of luminal narrowing, Intimal Thickness Index (ITI), and Intima to Media Ratio (IMR) were estimated using a Zeiss microscope on Verhoeff-Van-Gieson (VVG) stained tissue sections and analysed with ZEN software. All data were entered into a Microsoft Excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A total of 80 autopsy cases were considered for the current research, of which 62 were males and 18 were females. The mean age of the cases was 37.6 years. Two cases (11.1%) among females and nine cases (14.5%) among males had asymptomatic atherosclerotic lesions in their coronary arteries. With increasing age, the percentage of asymptomatic atherosclerotic cases also increased. The p-values for the width of the intima at maximal intimal thickness and IMR were 0.005 and 0.027, respectively, between the non atherosclerotic and atherosclerotic groups. Conclusion: The morphometric parameters, such as the width of the intima at maximal intimal thickness and IMR, predict the presence of atherosclerotic lesions/CAD in the asymptomatic general population. This information can be used to implement preventive measures and inform health policy by the medical community