Risk Reduction Research Articles

Modification of the association between coffee consumption and constipation by alcohol drinking: A cross-sectional analysis of NHANES 2007-2010.

The association between coffee consumption and constipation remains unclear. This study aimed to examine the relationship of coffee consumption with the risk of constipation, while also investigating potential effect modifiers. This cross-sectional study included 7844 participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2010. Coffee consumption was extracted from the 24-hour dietary recall. Constipation was assessed using the Bristol Stool Form Scale. The association between coffee consumption and constipation was assessed using multivariable restricted cubic spline and logistic regression with odds ratio (OR) and 95% confidence interval (CI). There was a J-shaped relationship between total coffee consumption and the risk of constipation in the whole population (p for nonlinearity = 0.049), with 1-2 cups/day of total coffee potentially reducing the risk of constipation by 39% (OR 0.61, 95% CI 0.35-1.06, p = 0.07). As for caffeinated coffee, a J-shaped association between its consumption and the risk of constipation was also observed in the whole population (p for nonlinearity = 0.008), with 1-2 cups/day being significantly associated with a reduced risk (OR 0.57, 95% CI 0.35-0.95, p = 0.03). When restricting to never drinkers of alcohol, the associations between total and caffeinated coffee consumption and constipation shifted to inverse linear trends, where at least 3 cups/day was significantly associated with an 88% reduction in constipation risk (total coffee: OR 0.12, 95% CI 0.02-0.68, p = 0.02; caffeinated coffee: OR 0.12, 95% CI 0.02-0.70, p = 0.02). Decaffeinated coffee showed no association with constipation. Consuming 1-2 cups of caffeinated coffee daily was associated with a reduced risk of constipation in the general population. Among never drinkers of alcohol, a linear protective effect was observed, with a notable 88% reduction in constipation risk for those consuming at least 3 cups per day. Moderate caffeinated coffee intake may therefore be a viable dietary strategy for managing constipation in the general population.

The impact of education level on all-cause mortality in patients with atrial fibrillation

The association of socioeconomic status with cardiovascular morbidity and mortality is well known, but data on the influence of education level on mortality in individuals with atrial fibrillation (AF) are scarce. We investigated education level as a predictor of all-cause mortality in patients diagnosed with AF. This retrospective cohort study used a database created from several Swedish nationwide registries to identify all patients hospitalized with a diagnosis of AF hospitalized from 1995 to 2008. Education level was categorized as primary, secondary, and academic. All-cause mortality risk was estimated in subpopulations defined by the Charlson Comorbidity Index and several comorbidities. A total of 272,182 patients (56% male; mean age 72 ± 10 years) were followed for five years. Cox regression models showed a reduction in all-cause mortality risk with increased education level. Hazard ratios (HR) relative to primary education remained significant after stratification and adjustment for several confounders: secondary education HR = 0.88; 95% CI: 0.86–0.89; P < 0.001; academic education HR = 0.70; 95% CI: 0.67–0.72; P < 0.001. Subpopulation analyses confirmed a significant reduction in relative risk with higher education level. Targeted screening and education programs could be effective in reducing mortality in AF patients with fewer years of formal education.

Real-world clinical and economic outcomes from rapid start antiretroviral therapy in HIV: systematic review and meta-analysis.

We aimed to synthesize clinical and economic outcomes of rapid start versus non-rapid antiretroviral therapy (ART) in people with HIV (PWH) in real-world settings. A search was conducted in PubMed, Embase, Web of Science, and ProQuest from January 2017 to January 2023, supplementing a previous search by Ford et.al, 2018. Observational studies investigating clinical or economic outcomes of rapid start ART versus non-rapid ART in PWH were included. Clinical outcomes were mortality, loss-to-follow-up (LTFU), and viral suppression. Economic outcomes were Incremental cost-effectiveness ratio (ICER) values and per patient per month (PPPM) costs. Meta-analyses using random-effects models were performed for clinical outcomes, while qualitative syntheses were conducted for economic outcomes. The quality of clinical and economic studies was assessed. Sixty-two studies were included. The pooled adjusted risk ratio (aRR) for mortality demonstrated a significant reduction in risk of mortality among participants who received rapid start ART compared to non-rapid ART (0.80, 95%CI, 0.65-0.98). For LTFU at 6 and 12 months, the pooled aRR showed increased LTFU for rapid start ART (1.33, 95%CI, 1.15-1.55 and 1.18, 95%CI, 0.74-1.89 respectively). All cost-effectiveness studies reported cost-saving or cost-effective findings. The PPPM costs of rapid start ART across the first 36 months of treatment were consistently lower than non-rapid ART. Rapid ART is associated with reduced mortality and is cost-effective compared to non-rapid ART in real-world settings. Clinicians and policymakers should consider these findings to facilitate rapid start of ART in PWH. Further research on LTFU in PWH is needed.

Polygenic risk, aspirin and primary prevention of coronary artery disease.

Recent aspirin primary prevention trials failed to identify a net benefit of aspirin for preventing cardiovascular disease versus the harms of bleeding. This study aimed to investigate whether a high-risk subgroup, individuals with elevated genetic predisposition to coronary artery disease (CAD), might derive more benefit than harm with aspirin, compared to those with lower genetic risk. We performed genetic risk stratification of the Aspirin in Reducing Events in the Elderly (ASPREE) randomized controlled trial using a CAD polygenic risk score (GPSMult). For 12,031 genotyped participants (5,974 aspirin, 6,057 placebo) overall, we stratified them by GPSMult quintiles (q1-5), then examined risk of CAD (composite of myocardial infarction and coronary heart disease death) and bleeding events using Cox models. During a median 4.6 years of follow-up with randomization to 100 mg/day aspirin versus placebo, 234 (1.9%) participants had CAD and 373 (3.1%) had bleeding events. In the overall cohort, aspirin resulted in higher bleeding risk (adjusted Hazard Ratio [aHR]=1.30 [1.06-1.61], P=0.01) but no significant CAD reduction (aHR=0.84 [0.64-1.09], P=0.19). However, among the highest quintile of polygenic risk (q5, top 20% of the GPSMult distribution), there was a 47% reduction in risk of CAD events with aspirin (aHR=0.53 [0.31-0.90], P=0.02) without increased bleeding risk (aHR=1.05 [0.60-1.82], P=0.88). Interaction between the GPSMult and aspirin was significant for CAD (q5 versus q1, P=0.02) but not bleeding (P=0.80). The balance between net benefit and harm on aspirin in the primary prevention setting shifts favourably in individuals with an elevated genetic predisposition.

Without Risk Reduction: How Black Men’s Well-being and Humanity Are Compromised in Mobile Public Spaces

Much of the urban research on the daily experiences of Black men in American society has focused on Black men as perpetrators, as victims of street and gang violence, or with some carceral connection. These earlier studies highlight how racist tropes of Black men as dangerous and thus to be feared situate Black men for continuous, targeted, and aggressive actions by the state and other social actors. This places a social tax on Black men who are then bound to exercises of embodied negotiations in public social spaces where they navigate both being shunned and “disappeared” while also hyper-visible. Drawing on ethnographic data collected across several years, this article examines how Black men are targeted for aggression in mobile public spaces in Chicago, Illinois. We use public transportation as a space of interrogation because of the uniqueness of mobile places where riders and transit personnel are temporarily confined while mobile and with limited options to escape the dangers of racism and racial aggression. In these spaces, we find that (1) Black men are threatened with harm, (2) their bodies are treated as sites of fear, and (3) their well-being is risked through an institutional breach of duty to provide safety for them as passengers and transit personnel.

Racing toward attaining sustainable development in India: Probing the asymmetric effect of country risk and coal energy

AbstractThe pursuit of a sustainable environment is a common goal for many nations; however, achieving this has become increasingly difficult due to country‐specific risks, often referred to as country risk. Despite its importance, the relationship between country risk and environmental outcomes is still in its early stages of exploration. This study aims to bridge this gap by examining the influence of country risk on India's ecological footprint within an asymmetric empirical framework, while accounting for economic growth and coal energy consumption. Utilizing the nonlinear autoregressive distributed lag (NARDL) estimator, the analysis covers data from 1984 to 2018. The findings reveal that positive changes in economic and financial risk contribute to environmental improvement by significantly reducing the ecological footprint, whereas negative changes in these risks lead to an increase in ecological footprint. Additionally, positive changes in political risk, economic growth, and coal energy usage exacerbate the ecological footprint, while reductions in coal energy use and political risk lead to environmental benefits. Based on these outcomes, policymakers are encouraged to establish a clear risk benchmark and reduce the ecological footprint by fostering economic growth in a sustainable manner. Governments should also prioritize strong support for green technology investments and ensure stability across political, economic, and financial sectors to promote long‐term environmental sustainability.

Using Precious Metals to Reduce the Downside Risk of FinTech Stocks

FinTech stocks are an important new asset class that reflects the rapidly growing FinTech sector. This paper studies the practical implications of using gold, silver, and basket-of-precious-metals (gold, silver, platinum, palladium) ETFs to diversify risk in FinTech stocks. Downside risk reduction is estimated using relative risk ratios based on CVaR. The analysis shows that gold provides the most downside risk protection. For a 5% CVaR, a 30% portfolio weight for gold reduces the downside risk by about 25%. The minimum variance and minimum correlation three-asset (FinTech, gold, and silver) portfolios (with portfolio weights estimated using a TVP-VAR model) have the highest risk-adjusted returns (Sharpe ratio, Omega ratio) followed by the fixed-weight FinTech and gold portfolio. These results show the benefits of diversifying an investment in FinTech stocks with precious metals. These results are robust to weekly or monthly portfolio rebalancing and reasonable transaction costs.

Characteristics, Predictors, and Clinical Outcomes in Heart Failure With Reduced Ejection Fraction According to a 1-Year Left Ventricular Ejection Fraction Following Sacubitril/Valsartan Treatment.

Optimal medical treatment can lead to improvement in left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF). We investigated the characteristics, predictors, and outcomes of HFrEF according to the 1-year LVEF following angiotensin receptor-neprilysin inhibitors therapy (ARNI). Using the STRATS-HF-ARNI (Strain for Risk Assessment and Therapeutic Strategies in Patients With Heart Failure Treated With Angiotensin Receptor-Neprilysin Inhibitor) registry, we identified 1074 patients with HFrEF who took ARNI and underwent baseline and 1-year echocardiography. Patients were classified as HF with improved ejection fraction (HFimpEF) and persistent HFrEF (perHFrEF) (1-year LVEF >40% and ≤40%). The primary and secondary outcomes were all-cause and cardiac mortality from the 1-year follow-up. Among 1074 included patients, 498 (46.4%) had HFimpEF, and 576 (53.6%) had perHFrEF. Older age, male sex, and large LV end-diastolic volumes were positive predictors of perHFrEF, whereas atrial fibrillation and high systolic blood pressure were identified as inverse predictors. Patients with HFimpEF showed lower all-cause and cardiac mortality rates (both log-rank P<0.001). In the multivariable analysis, perHFrEF (hazard ratio, 2.402 [95% CI, 1.251-4.610]; P=0.008) was an independent predictor of poor outcomes. The risk of all-cause mortality decreased as the 1-year LVEF increased up to 40%; however, no additional risk reduction was observed beyond 40%. Compared with patients taking renin-angiotensin-aldosterone system inhibitors in the STRATS-AHF (Strain for Risk Assessment and Therapeutic Strategies in Patients With Acute Heart Failure) registry, those in the STRATS-HF-ARNI registry demonstrated better outcomes in both HFimpEF and perHFrEF. Patients with HFimpEF had better prognosis than those with perHFrEF, and ARNI treatment in HFrEF could be more beneficial than renin-angiotensin-aldosterone system inhibitors for both HFimpEF and perHFrEF. URL: https://www.who.int/clinical-trials-registry-platform; Unique identifier: KCT0008098.

Human papillomavirus vaccine to prevent CIN3 or worse (CIN3+): A nationwide case-control study in Japan.

An increase in cervical cancer incidence has been reported in Japan. The Ministry of Health, Labor, and Welfare of Japan has resumed the active recommendation of regular HPV vaccines in 2022. In Japan, the preventive effect of CIN3+ in the real world has not yet been demonstrated in age-adjusted cohort or case-control studies. This study aimed to estimate the effect of the HPV vaccine against CIN3+ in Japanese women. This nationwide case-control study from April 2013 to March 2020 targeted women aged 20-26 years old at the time of cervical screening. We compared HPV vaccination exposure between those with abnormal and those with normal cytology. Abnormal cytology was classified into cervical intraepithelial neoplasia (CIN)1+, CIN2+, and CIN3+. We calculated the odds ratio (OR) and 95% confidence interval (CI) of the above endpoints and vaccination exposure using the conditional logistic regression model and estimated vaccine effectiveness using the formula (1 -OR) × 100. A total of 2790 cases and 13,990 controls (one-to-five matching) were eligible in 37 municipalities in Japan. In this study, 61 CIN3 (2.2%) and 10 squamous cell carcinomas (SCC) (0.4%) were found. The OR for CIN3+ versus controls was 0.14 (95% CI, 0.03-0.75), equating to a vaccine effectiveness of 86%. Of the 10 patients who had SCC none were vaccinated. This nationwide case-control study in Japan demonstrated a substantial risk reduction in CIN3+ among women who did versus those who did not receive HPV vaccination.

Exposure to e-cigarette and heated tobacco product advertisements via digital, traditional media, and points-of-sale: An examination of associations with use intentions and perceived risk among adults in Armenia and Georgia.

E-cigarette and heated tobacco product (HTP) marketing often leverages digital media and points-of-sale (POS) and advertises risk reduction, including in Armenia and Georgia where male cigarette use rates are high. Using 2022 survey data from Armenian and Georgian adults (n=1468, mean age=42.92 years, 51.4% female; and past-month use of e-cigarettes 3.2%, HTPs 2.7%, and cigarettes 31.6%), multivariable linear regression examined 4 outcomes - e-cigarette and HTP use intentions and perceived risk (1=not at all, to 7=extremely) - in relation to past-month e-cigarette or HTP advertisement exposure via digital media, traditional media, and POS, controlling for covariates (country, age, gender, education level, relationship status, children, past-month cigarette and e-cigarette/HTP use). E-cigarette and HTP use intentions were low (mean score=1.47, SD=1.39 each), while perceived risk was high (mean score=5.83, SD=1.6, and mean score=5.87, SD=1.56, respectively). Past-month exposure to e-cigarette and HTP advertisements, respectively, were 12.9% and 11.2% via digital media, 6.1% and 4.8% traditional media, and 22.5% and 21.1% POS. For e-cigarettes, ad exposure via digital media was associated with greater use intentions (β=0.24; 95% CI: 0.03-0.44), ad exposure via traditional media (β= -0.32; 95% CI: -0.55 - -0.09) and POS (β= -0.30; 95% CI: -0.60 - -0.004) was associated with lower risk perceptions. For HTPs, ad exposure via digital media (β=0.35; 95% CI: 0.14-0.56) and POS (β=0.21; 95% CI: 0.04-3.63) was associated with greater use intentions, and ad exposure at POS was associated with lower risk perceptions (β= -0.23; 95% CI: -0.42 - -0.03). Tobacco control efforts should monitor and regulate e-cigarette and HTP marketing, particularly via digital media which may effectively promote use, and via POS which may target and influence risk perceptions.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 1: Patient presentation through revascularization.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical initial phases of care are reviewed. Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes. Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.

Machine learning-based assessment of regional-scale variation of landslide susceptibility in central Vietnam.

Recurrent landslide events triggered by typhoons and tropical storms over Vietnam pose a longstanding threat to the nation's population and infrastructure. Changes in hydroclimatic conditions, especially the growing intensity and frequency of storms, have elevated landslide susceptibility in many parts of the country. This research examines the spatio-temporal variations in landslide susceptibility across central Vietnam over several years, using multi-temporal landslide inventories from Typhoon Ketsana (2009), Tropical Storm Podul (2013), and Typhoon Molave (2020). Additionally, the research explores the impact of individual landslide causative factors on the probabilistic occurrences of landslides. The post-event landslide susceptibility models of these three climate extreme events were developed using nine causative factors and a Random Forest machine learning algorithm. The results indicate a notable areal expansion of high to very high landslide susceptibility in the northern and eastern regions and a moderate reduction in the central and southern areas during the post-Molave period compared to the post-Ketsana period. These changes may be early indicators of increasing landslide susceptibility in response to changing hydro-climatic conditions. The research found that annual average rainfall and topographic elevation are the two most important variables influencing landslide prediction, showing a nonlinear relationship with landslide probability. The landslide susceptibility models achieved high Area Under the Receiver Operating Characteristic Curve (AUC) (>95%), accuracy (>89%), and sensitivity (>90%) scores, signifying the robustness of the models. Additionally, the uncertainty of the models was quantified and spatially mapped. This multi-temporal analysis of landslide susceptibility is crucial for understanding the regional susceptibility trends and identifying areas with increasing, decreasing, and consistently high susceptibility to landslides. These insights are invaluable for prioritizing mitigation and risk reduction strategies in landslide-prone regions and guiding appropriate land use planning.

Cost-Effectiveness of Empagliflozin (JARDIANCE®) in the Treatment of Patients with Chronic Kidney Disease in France, Based on the EMPA-KIDNEY Clinical Trial.

The efficacy and safety of empagliflozin in the treatment of chronic kidney disease (CKD) were demonstrated in the EMPA-KIDNEY trial, which showed a 28% reduction in combined risks of kidney disease or death from cardiovascular causes (hazard ratio, 0.72; 95% confidence interval, 0.64-0.82; p < 0.001) compared with placebo. Based on these results, the present study aimed to assess the cost-effectiveness of empagliflozin + standard of care (SoC) compared with SoC alone in the treatment of CKD in France. A Markov state microsimulation model was adapted to compare the health and economic outcomes in France, considering a healthcare system perspective, in patients treated with empagliflozin in addition to SoC versus patients treated with SoC alone. The model simulated the intention-to-treat population of the trial, transitioning between 18 mutually exclusive and collectively exhaustive health states defined based on the Kidney Disease: Improving Global Outcomes classification. For each arm, the model estimated (over a 25-year time horizon) the number of events and deaths, and the costs associated with these events, to calculate the incremental cost-effectiveness ratio. The resources used were derived using French authorities reports, literature, and French CKD guidelines. Both economic and health outcomes were discounted at a 2.5% annual rate according to French guidelines. The model predicted that using empagliflozin + SoC to treat patients with CKD would prevent CKD-related complications and deaths associated with a cardiovascular event or all-cause deaths while in kidney replacement therapy, resulting on average in a discounted gain of 1.29 years in overall survival (9.48 years vs. 8.19 with SoC alone). Empagliflozin costs (treatment, events, and disease management) were completely offset by the cost savings from avoided kidney failure events. Overall, empagliflozin + SoC would be more effective and less costly than SoC alone and would therefore be the dominant treatment strategy. The sensitivity analyses conducted support the results' robustness in showing the dominance of empagliflozin + SoC over SoC alone. The base-case results indicate that empagliflozin + SoC is a dominant strategy compared with the current SoC for the management of CKD in France. Empagliflozin + SoC would have a positive impact on patients with CKD by slowing CKD progression and leading to the prevention of kidney failure events on top of all-stages CKD complications.

Transforming public health and economic outcomes by reducing risky behaviors: the potential for South Korea

South Korea faces a diminishing workforce driven by the world's lowest fertility rate, restrictive immigration, and low female labor participation. This paper explores reducing non-communicable diseases from risky behaviors as a solution. We investigate how many cases could be prevented if South Koreans changed risky consumption patterns, and the associated economic healthcare burden impact. Utilizing the Preventable Risk Integrated Model (PRIME), we model hypothetical 2022 reductions in tobacco, alcohol, and unhealthy diet risks to estimate disease case and economic cost impacts. We contrast actual 2022 consumption against a moderate harm reduction scenario. Findings reveal potentially preventing approximately 73,400 new non-communicable disease cases, 69% among working-age Koreans, benefiting the workforce. This reduction could save $13 billion from avoided treatment costs, absenteeism, and premature deaths, including $3.7 billion in 2022 and $9.3 billion in future economic losses. The study emphasizes needing a harm reduction regulatory approach balancing public health and societal realities. We advocate risk-proportionate taxation policies incentivizing consumers toward less harmful alternatives. Given government responsibilities preserving both public health and productivity, smart regulation of risky consumption is critical. This timely research quantifies the significant potential gains from strategic interventions on key risk factors, informing policymakers navigating health promotion and economic objectives.

Association of immunoglobulin E levels with glioma risk and survival.

Previous epidemiologic studies have reported an association of serum immunoglobulin E (IgE) levels with reduced glioma risk, but the association between IgE and glioma prognosis has not been characterized. This study aimed to examine how sex, tumor subtype, and IgE class modulate the association of serum IgE levels with glioma risk and survival. We conducted a case-control study using participants from the University of California, San Francisco Adult Glioma Study (1997-2010). Serum IgE levels for total, respiratory and food allergy were measured in adults diagnosed with glioma (n = 1319) and cancer-free controls (n = 1139) matched based on age, sex, and race and ethnicity. Logistic regression was adjusted for patient demographics to assess the association between IgE levels and glioma risk. Multivariable Cox regression adjusted for patient-specific and tumor-specific factors compared survival between the elevated and normal IgE groups. All statistical tests were 2-sided. Elevated total IgE was associated with reduced risk of IDH-wildtype (RR = 0.78, 95% CI: 0.71-0.86) and IDH-mutant glioma (RR = 0.73, 95% CI: 0.63-0.85). In multivariable Cox regression, positive respiratory IgE was associated with improved survival for IDH-wildtype glioma (RR = 0.79, 95% CI: 0.67-0.93). The reduction in mortality risk was significant in females only (RR = 0.75, 95% CI: 0.57-0.98) with an improvement in median survival of 6.9 months (P<.001). Elevated serum IgE was associated with improved prognosis for IDH-wildtype glioma, with a more pronounced protective effect in females than males, which has implications for the future study of IgE-based immunotherapies for glioma.

Towards the fair regulation of all coca leaf derivatives in Colombia

Purpose The purpose of this study is to envision the possible path to regulation of the coca leaf and its derivatives. There are a range of possible coca derivatives that could be considered for the broader market and which could be conceived of as risk and harm reduction interventions, as well as have other nutritional and industrial uses. Design/methodology/approach The methodology consists of a historical analysis of the advances in alternative uses of the coca leaf within a commercial market in Colombia as a means of providing greater economic capacity to communities that cultivate the plant, while exploring the nutritional and industrial benefits of the plant. Findings Low-risk products, such as coca leaf and coca tea, could be regulated under the same criteria as coffee or other caffeinated beverages. With a more diverse range of products on the market, consumers can make more informed decisions about their consumption, particularly regarding the associated risks and the effects they desire. Practical implications The legal regulation of coca leaf products implies the creation of a regulatory government agency specialized in the subject, as well as monitor and evaluate the cultivation and processing of products. The production of the coca leaf would still be in the hands of the cultivating communities but would fall under the control and monitoring of the government. Social implications The legal regulation of the coca leaf could have strong impacts on cultivating communities to guarantee their human rights and provide greater protection. Various industries have expressed an interest in using coca leaf derivatives and could represent economic opportunities for communities that cultivate. Originality/value Minimal work has been done on the regulation of coca leaf although there are some international examples that could be relevant in Bolivia and Perú. There is a need to continue exploring the multiple uses of the leaf to reach greater international consensus on its rescheduling.

Discussion of HIV and Other Sexually Transmitted Infections with Sex Partners of Nigerian Men who have Sex with Men and Transgender Women: Implications for Interventions to Promote Safer Sex Practices.

Discussion of HIV and other sexually transmitted infections (STIs) among sex partners facilitates risk reduction. We evaluated HIV/STI-related communications, including broad assessment of any self-reported discussion of the topic and specific discussion of each partners' HIV status, among a historically marginalized and presently criminalized community of sexual and gender minorities (SGM) in Nigeria. From 2013-2018, we enrolled SGM aged 18+ in Lagos or 16+ in Abuja who reported anal sex with men. At enrollment and 3-, 9-, and 15-month follow-up visits, participants were asked about their sexual behaviors and communications with main sexual partners (MSP) and casual sexual partners (CSP). Questions included "have you talked with your [MSP/CSP] about sexually transmitted infections and HIV?" Multivariable robust Poisson regression with generalized estimating equations was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV/STI-related communications with some or all of each type of sexual partner. Among 2795 SGM enrolled with median age 23 years (interquartile range 20-27), questions about HIV/STI-related communications with MSP were answered by 2436 (87.2%) and with CSP by 2398 (85.9%). Communication with MSP was reported by 68.1% (1659/2436), of whom 897 (54.1%) discussed their own HIV status and 925 (55.8%) discussed their partner's status. Communication with CSP was reported by 43.9% (1052/2398), of whom 389 (37.0%) discussed their own HIV status and 385 (36.6%) discussed their partner's status. Among participants with both MSP and CSP, HIV/STI-related communication with MSP was more common among participants with higher than secondary education (aRR 1.40 [95%CI 1.24-1.58)], who were divorced/separated/widowed (aRR 1.19 [95% CI 1.06-1.33]), who discussed their HIV status with CSP (aRR 1.18 [95%CI 1.10-1.25]), discussed CSP's HIV status (aRR 1.20 [95%CI 1.13-1.27]), and used a condom at last sex with CSP (aRR 1.16 [95%CI 1.08-1.25]). HIV/STI-related communication with CSP was more common among participants with higher than secondary education (aRR 1.36 [95%CI 1.12-1.66]); who were divorced/separated/widowed (aRR 1.38 [95%CI 1.13-1.69]), who discussed their HIV status with MSP (aRR 1.47 [95%CI 1.27-1.69]), who discussed CSP's HIV status (aRR 1.22 [95%CI 1.06-1.40]) and used a condom at last sex with CSP (aRR 1.22 (95%CI 1.08-1.38]). HIV/STI-related communications with main and casual sex partners were both associated with safer sex with CSP. HIV prevention and treatment programs for SGM should promote open communications in sexual relationships and consider deployment of modern strategies to facilitate disclosure, especially in settings with criminalizing legislation.

A Systematic Review and Narrative Synthesis of Strategies for Disaster Risk Reduction Education for People With Disabilities.

To identify the components and characteristics of disaster risk reduction education for people with disabilities and to explore the contents and results of disaster risk reduction education. A systematic review and narrative synthesis. The review was conducted in accordance with Tawfik's guidelines and followed the reporting standards outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality appraisal was guided by the mixed methods appraisal tool. The contents of each type of education were narratively synthesised. The literature search was conducted in December 2023 using several electronic databases, including PubMed, EMBASE, CINAHL, Cochrane library and PsycINFO. Eight quantitative studies were selected for this study. Disaster risk reduction education for people with disabilities has focused mainly on fires and earthquakes, and drills were the most used teaching method. Some of the education was conducted by designating a 1:1 ratio of educators and participants or modifying the ratio according to the type of disability. The staff mainly conducted the education, and after education, the effect of disaster risk reduction education was confirmed in terms of the knowledge and response of people with disabilities during drills. This review provides insights for developing disaster risk reduction education for people with disabilities. However, only a few randomised controlled trial (RCT) studies and quasi-experimental studies have been conducted, and several studies have bias risks. Thus, practical, continuous, quality interventions are needed for effective disaster risk reduction education for people with disabilities. This systematic review analysed the research trends of disaster risk reduction education for people with disabilities. The results provide the basis for quality evaluations of the operation, methods and achievements of educational programmes. Efforts are needed to promote collaboration between researcher and the practitioners to conduct further quality research. No Patient or Public Contribution: Systematic review.

Perceived Susceptibility to and Severity of Cardiovascular Disease Is Associated With Intent to Change Behavior Among Women 25-55 Years Old.

Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased, whereas CVD knowledge and awareness remain low. The objective of this study was to describe the relationship between the stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify predictors of the stage of behavior change. A cross-sectional online survey of women ages 25-55 years living in the United States was conducted. Awareness was measured with the question "What is the leading cause of death for women in the United States?" Knowledge, perceptions, and the stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and Precaution Adoption Process Model instruments, respectively. Chi-square and t tests were used to determine differences between awareness, knowledge, and perceptions based on the stage of behavior change. Multiple logistic regression was used to evaluate the relationship between the stage of behavior change and awareness, knowledge, and perceptions. A total of 149 primarily minority women (n = 105) were included (mean age = 37.15 ± 7.86 years). The perception of CVD susceptibility was associated with increased intention to change behavior (odds ratio, 1.247; 95% confidence interval, 1.101-1.414; P < .001). The perception of CVD severity was associated with reduced intention to change behavior (odds ratio, 0.809; P = .004). Women who believed they were susceptible to CVD and did not perceive CVD as severe were more likely to report intent to change behavior, suggesting perception of CVD risk is more important than awareness or knowledge. Addressing misperceptions may be a strategy for primary risk reduction.

A Case for Improved Global Coordination of Volcano Observatories

The distribution of volcano monitoring networks and volcano expertise does not correlate well with the global distribution of volcanic risk. All countries have cultural, financial, bureaucratic, political, and logistical barriers to effective risk reduction. The lack of parity amongst volcano observatories jeopardizes public safety and curtails scientific research and understanding. Having global data compiled daily to retain a full record of volcanic unrest would lead to large and meaningful improvements in future eruption forecasts. To make progress on these issues, the volcanological community needs greater collaboration, standardization, and support..