Risk Factor For Premature Death Research Articles

Pathophysiological mechanisms of major mental disorders related to cardiovascular disease

Although the relationship of mental health with cardiovascular dysfunction is not a recent finding, scientific data has appeared approximately at the middle of the last century. Firstly, depression was studied as a risk factor for premature death in cases of cardiovascular disease (CVD). Much later, the mechanism of psychosis and schizophrenia in the development of CVD were studied, as it was observed that most premature deaths in schizophrenia were related to cardiovascular disease. This interaction is supported both by epidemiological data and by the associated mechanisms. Inflammation, oxidative and biologic stress, and hormonal and neurotransmitter disorders in coagulation, tissue perfusion, vascular dysfunction and genetic factors get involved in these mental disorders. The combination of these pathophysiological mechanisms and the general risk factors for CVD (sex, age, smoking, systolic blood pressure, body weight, glucose levels) leads, to some extent, to increased rates of comorbidity and mortality. Patients with severe mental disorders are often not monitored and do not receive appropriate treatment for cardiovascular risk factors. In studies of patients with comorbid coronary heart disease and depression, there were signs of cardiovascular dysfunction, including increased heart rate, mainly in stress, QT prolongation and ventricular arrhythmia. At the same time, there is a dose-response relationship between the severity of depression and cardiovascular risk, with the presence of even mild symptoms of untreated depression involving some cardiovascular risk. In addition, improving the symptoms of depression through medication has been associated with increased survival. Moreover, the causes of increased mortality in patients with schizophrenia are similar to those of the general population with metabolic syndrome and diabetes mellitus, while failure to receive antipsychotic medication could lead to obesity, insulin resistance, dyslipidemia and hypertension. These data could be used as a source for future anti-inflammatory therapeutic approaches, but also for the appropriate selection of therapeutic agents, by taking a more holistic view of the patient's comorbidity. The interdisciplinary collaboration and liaison - consultation psychiatry are important factors for the timely prevention, recognition and treatment of potent complications of the cardiovascular system in mentally ill patients. The aim of this review was to present the pathophysiological mechanisms of serious mental disorders, such as depression, bipolar disorder, and schizophrenia that may be related to the development of CVD.

Sodium intake, life expectancy, and all-cause mortality.

Since dietary sodium intake has been identified as a risk factor for cardiovascular disease and premature death, a high sodium intake can be expected to curtail life span. We tested this hypothesis by analysing the relationship between sodium intake and life expectancy as well as survival in 181 countries worldwide. We correlated age-standardized estimates of country-specific average sodium consumption with healthy life expectancy at birth and at age of 60 years, death due to non-communicable diseases and all-cause mortality for the year of 2010, after adjusting for potential confounders such as gross domestic product per capita and body mass index. We considered global health estimates as provided by World Health Organization. Among the 181 countries included in this analysis, we found a positive correlation between sodium intake and healthy life expectancy at birth (β = 2.6 years/g of daily sodium intake, R2 = 0.66, P < 0.001), as well as healthy life expectancy at age 60 (β = 0.3 years/g of daily sodium intake, R2 = 0.60, P = 0.048) but not for death due to non-communicable diseases (β = 17 events/g of daily sodium intake, R2 = 0.43, P = 0.100). Conversely, all-cause mortality correlated inversely with sodium intake (β = -131 events/g of daily sodium intake, R2 = 0.60, P < 0.001). In a sensitivity analysis restricted to 46 countries in the highest income class, sodium intake continued to correlate positively with healthy life expectancy at birth (β = 3.4 years/g of daily sodium intake, R2 = 0.53, P < 0.001) and inversely with all-cause mortality (β = -168 events/g of daily sodium intake, R2 = 0.50, P < 0.001). Our observation of sodium intake correlating positively with life expectancy and inversely with all-cause mortality worldwide and in high-income countries argues against dietary sodium intake being a culprit of curtailing life span or a risk factor for premature death. These data are observational and should not be used as a base for nutritional interventions.

On- and off-licensed premises drinking behaviour among adults in the city of Tshwane, South Africa: An analysis of data from the International Alcohol Control study.

Alcohol use is among the leading risk factors for premature death and morbidity in South Africa. This study sought to identify factors associated with drinking behaviour in on- and off-licensed premises (typical occasion quantity and frequency) among adults in the City of Tshwane, South Africa. A household survey was conducted in 2014, using a multi-stage stratified cluster random sampling design. Participants comprised 982 adults (65% males) aged 18-65 years. Factors explored included socio-demographic variables and situational variables at on- and off-licensed premises. Multiple logistic regression analysis was performed to predict drinking behaviour at on- and off-licensed premises. The majority of the participants consumed alcohol in off-licensed premises (64% vs. 36%). However, participants who consumed alcohol at on-licensed premises were more likely to drink more alcohol and more frequently (weekly). Additionally, participants who consumed alcohol in above-average sized containers were more likely to consume six or more drinks and drink weekly. Being of high socio-economic status was associated with drinking weekly at off-licensed premises, while being less educated was associated with a significantly higher frequency of drinking at on-licensed premises. Interventions to reduce alcohol use should target specific drinking behaviour at on- and off-licensed premises, for example, regulating the availability of alcohol in big-sized containers and the need for cutting down on quantity of alcohol and frequency of drinking for South African males who drink at on- and off-licensed premises.

Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study

BackgroundExposure to household air pollution from solid fuel combustion for cooking and heating is an important risk factor for premature death and disability worldwide. Current evidence supports an association of ambient air pollution with cardiovascular disease but is limited for household air pollution and for cardiac function. Controlled exposure studies can complement evidence provided by field studies. ObjectivesTo investigate effects of short-term, controlled exposures to emissions from five cookstoves on measures of cardiac function. MethodsForty-eight healthy adults (46% female; 20–36 years) participated in six, 2-h exposures (‘treatments’), including emissions from five cookstoves and a filtered-air control. Target fine particulate matter (PM2.5) exposure-concentrations per treatment were: control, 0 µg/m3; liquefied petroleum gas, 10 µg/m3; gasifier, 35 µg/m3; fan rocket, 100 µg/m3; rocket elbow, 250 µg/m3; and three stone fire, 500 µg/m3. Participants were treated in a set (pre-randomized) sequence as groups of 4 to minimize order bias and time-varying confounders. Heart rate variability (HRV) and cardiac repolarization metrics were calculated as 5-min means immediately and at 3 h following treatment, for analysis in linear mixed-effects models comparing cookstove to control. ResultsShort-term differences in SDNN (standard deviation of duration of all NN intervals) and VLF (very-low frequency power) existed for several cookstoves compared to control. While all cookstoves compared to control followed a similar trend for SDNN, the greatest effect was seen immediately following three stone fire (β = −0.13 ms {%}; 95% confidence interval = −0.22, −0.03%), which reversed in direction at 3 h (0.03%; −0.06, 0.13%). VLF results were similar in direction and timing to SDNN; however, other HRV or cardiac repolarization results were not similar to those for SDNN. DiscussionWe observed some evidence of short-term, effects on HRV immediately following cookstove treatments compared to control. Our results suggest that cookstoves with lower PM2.5 emissions are potentially capable of affecting cardiac function, similar to stoves emitting higher PM2.5 emissions.

Long-term exposure to moderate fine particulate matter concentrations and cause-specific mortality in an aging society

Background: Long-term exposure to particulate matter less than 2.5 μm (PM2.5) is considered a risk factor for premature death. However, only a few studies have been conducted in areas with moderate PM2.5 concentrations. Moreover, an aging society may be more susceptible to environmental exposure and future health impacts of PM2.5. Methods: This study estimates hazard ratios (HRs) for all-cause and cause-specific mortality from long-term exposure to moderate PM2.5 concentrations in the elderly populations of seven cities in South Korea. We also projected nationwide elderly mortality caused by long-term exposure to PM2.5, accounting for population aging until 2045. Mortality in 1,720,230 elderly adults aged 65 years and older in 2008 was monitored across 2009-2016 and linked to modeled PM2.5 concentrations. Results: A total of 421,100 deaths occurred in 2009-2016, and the mean of annual PM2.5 concentration ranged between 21.1 μg/m3 and 31.9 μg/m3 in most regions. The overall HR for a 10 μg/m3 increase in a 36-month PM2.5 moving average was 1.024 (95% confidence intervals: 1.009, 1.039). We estimated that 11,833 all-cause nationwide elderly deaths were attributable to PM2.5 exposure. Annual death tolls may increase to 17,948 by 2045. However, if PM2.5 is reduced to 5 μg/m3 by 2045, the tolls may decrease to 3,646. Conclusions: The long-term exposure to moderately high levels of PM2.5 was associated with increased mortality risk among the elderly. Thus, PM2.5 reduction in response to the projected aging-associated mortality in South Korea is critical.

Long-term exposure to moderate fine particulate matter concentrations and cause-specific mortality in an ageing society.

Long-term exposure to particulate matter <2.5 μm in size (PM2.5) is considered a risk factor for premature death. However, only a few studies have been conducted in areas with moderate PM2.5 concentrations. Moreover, an ageing society may be more susceptible to environmental exposure and future burden of mortality due to PM2.5. This study estimates hazard ratios (HRs) for all-cause and cause-specific mortality from long-term exposure to moderate PM2.5 concentrations in the elderly populations of seven cities in South Korea. We also projected nationwide elderly mortality caused by long-term exposure to PM2.5, accounting for population ageing until 2045. Mortality in 1 720 230 elderly adults aged ≥65 years in 2008 was monitored across 2009-16 and linked to modelled PM2.5 concentrations. A total of 421 100 deaths occurred in 2009-16, and the mean of annual PM2.5 concentration ranged between 21.1 and 31.9 μg/m3 in most regions. The overall HR for a 10 μg/m3 increase in a 36-month PM2.5 moving average was 1.024 (95% confidence intervals: 1.009, 1.039). We estimated that 11 833 all-cause nationwide elderly deaths were attributable to PM2.5 exposure. Annual death tolls may increase to 17 948 by 2045. However, if PM2.5 is reduced to 5 μg/m3 by 2045, the tolls may show a lower increase to 3646. Long-term exposure to moderately high levels of PM2.5 was associated with increased mortality risk among the elderly. Thus, PM2.5 reduction in response to the projected ageing-associated mortality in South Korea is critical.

Analysis of Quality of Life Parameters in a Health-Promoting Program for a Population with Cardiovascular Risk Factors: a Preliminary Study

One of the main risk factors of premature death in non-communicable diseases is physical inactivity, being as significant as hypertension, diabetes mellitus, and even smoking. It has been observed that interventions for carrying out physical activity (PA) in a communal environment have been very effective in terms of participation and adherence. The aim of this study is to prove the changes that occur on a physical level in a group of 46 patients on a regulated promotion plan for PA for health. The study consisted of a total of 15 weeks, during which a series of measurements were taken on the patients prior and post carrying out the program. There were significant changes in the undertaking of body mass index (p = 0.006), systolic and diastolic arterial pressure (p = 0.03 and p = 0.01, respectively), changes in attitude [degree of PA (METs, p ≤= 0.001)], changes in perceived quality of life (EuroQoL-VAS, p ≤= 0.001), as well as in the total number of risk factors (RFT, p = 0.03). These data confirm that a regulated program of PA is effective improving cardiovascular risk factors; improving all parameters of functional fitness studied; increasing the degree of PA; and increasing the subjective perception of patients’ health. Furthermore, it is verified that carrying out these types of programs is awarded a high degree of satisfaction by the participants.

Synthetic oversampling based decision support framework to solve class imbalance problem in smoking cessation program

ABSTRACT Smoking is one of the significant avoidable risk factors for premature death. Most smokers make multiple quit attempts during their lifetime but smoking dependence is not easy and many people eventually failed quit attempts. Predicting the likelihood of success in smoking cessation program is necessary for public health. In recent years, a few numbers of decision support systems have been developed for dealing with smoking cessation based on machine learning techniques. However, the class imbalance problem is increasingly recognized as serious in real-world applications. Therefore, this paper presents a synthetic minority over-sampling technique (SMOTE) based decision support framework in order to predict the success of smoking cessation program using Korea National Health and Nutrition Examination Survey (KNHANES) dataset. We carried out experiments as follows: I) the unnecessary instances and variables have been eliminated, II) then we employed three variations of SMOTE, III) also the prediction models have been constructed. Finally, compare the prediction models to obtain the best model. Our experimental results showed that SMOTE improved the prediction performance of machine learning classifiers among evaluation metrics. Moreover, SMOTE regular based Random Forest (RF) and Naive Bayes (NB) classifiers were determined the best prediction models in real-world smoking cessation dataset. Consequently, our decision support framework can interpret the important risk factors of smoking cessation using multivariate regression analysis.

Electronic cigarettes and health with special focus on cardiovascular effects: position paper of the European Association of Preventive Cardiology (EAPC).

Tobacco use is the single largest preventable risk factor for premature death of non-communicable diseases and the second leading cause of cardiovascular disease. In response to the harmful effects of tobacco smoking, the use of electronic cigarettes (e-cigarettes) has emerged and gained significant popularity over the past 15 years. E-cigarettes are promoted as safe alternatives for traditional tobacco smoking and are often suggested as a way to reduce or quit smoking. However, evidence suggests they are not harmless. The rapid evolution of the e-cigarette market has outpaced the legislator's regulatory capacity, leading to mixed regulations. The increasing use of e-cigarettes in adolescents and young individuals is of concern. While the long-term direct cardiovascular effects of e-cigarettes remain largely unknown, the existing evidence suggests that the e-cigarette should not be regarded as a cardiovascular safe product. The contribution of e-cigarette use to reducing conventional cigarette use and smoking cessation is complex, and the impact of e-cigarette use on long-term cessation lacks sufficient evidence. This position paper describes the evidence regarding the prevalence of e-cigarette smoking, uptake of e-cigarettes in the young, related legislations, cardiovascular effects of e-cigarettes and the impact of e-cigarettes on smoking cessation. Knowledge gaps in the field are also highlighted. The recommendations from the population science and public health section of the European Association of Preventive Cardiology are presented.

A deep learning approach to identify smoke plumes in satellite imagery in near-real time for health risk communication.

Background:Wildland fire (wildfire; bushfire) pollution contributes to poor air quality, a risk factor for premature death. The frequency and intensity of wildfires are expected to increase; improved tools for estimating exposure to fire smoke are vital. New generation satellite-based sensors produce high-resolution spectral images, providing real-time information of surface features during wildfire episodes. Because of the vast size of such data, new automated methods for processing information are required.Objective:We present a deep fully convolutional neural network (FCN) for predicting fire smoke in satellite imagery in near real time (NRT).Method:The FCN identifies fire smoke using output from operational smoke identification methods as training data, leveraging validated smoke products in a framework that can be operationalized in NRT. We demonstrate this for a fire episode in Australia; the algorithm is applicable to any geographic region.Results:The algorithm has high classification accuracy (99.5% of pixels correctly classified on average) and precision (average intersection over union = 57.6%).Significance:The FCN algorithm has high potential as an exposure assessment tool, capable of providing critical information to fire managers, health and environmental agencies and the general public to prevent the health risks associated with exposure to hazardous smoke from wildland fires in NRT.

Target levels of blood pressure in patients with arterial hypertension and coronary heart disease

High blood pressure (BP) is a leading risk factor for premature death and one of the important risk factors for coronary heart disease (CHD). A significant increase in risk is observed starting from the level of systolic BP of about 140 mm Hg. Tactics of antihypertensive therapy in patients with co-existent hypertension (HTN) and CHD are reviewed in the European and Russian recommendations for HTN. In spite of this, some uncertainty remains regarding the optimal target BP level in patients with HTN and clinically manifest CHD mainly due to the lack of convincing evidence arising from large and specially designed randomized clinical trials (RCTs) dedicated to this issue. Some observational studies, meta-analysis, special analysis of subgroups of patients with HTN and CHD from the large RCTs, showed a J-shaped relation between the achieved BP and an increased cardiovascular risk. Our paper reviews up-to-date literature in relation to the target BP level in patients with HTN and CHD, including patients with high cardiovascular risk and patients undergoing revascularization. We review data from large studies and meta-analysis, evaluating the impact of more intensive vs. less intensive control of BP on the risk of major cardiovascular events or mortality. The analysis of the literature confirmed a lack of evidence of benefits of lower target BP values in senile patients with co-existent HTN and CHD, thus indicating the need for well-planned RCTs.

Prevalence and associated factors of hypertension among adults in Gadarif in eastern Sudan: a community-based study

BackgroundHypertension is becoming an increasingly common health issue worldwide, especially in countries in Sub-Saharan Africa. Hypertension is the leading risk factor for premature death and disability worldwide, and it is the leading risk factor for mortality from cardiovascular diseases worldwide. The data on hypertension in Sudan that has been published is limited. We conducted this study to assess the prevalence of hypertension and its associated risk factors.MethodsA multistage sampling survey was conducted in Gadarif, Eastern Sudan, from January to May 2018 to investigate the prevalence of hypertension and associated factors in adults in Eastern Sudan. The World Health Organization (WHO) three-level stepwise approach questionnaire was used to gather sociodemographic characteristics (age, sex, height, weight marital status, education level, smoking habit, alcohol consumption habit, and family history of hypertension). Hypertension was defined as the presence of an average blood pressure of ≥140/90 mmHg or the reported use of anti-hypertensive medications for high blood pressure.ResultsA total of 600 participants (mean age: 44.9 years) were enrolled in this study. Four hundred twenty-two (70.3%) participants were women, and 196 (32.7%) participants were obese. Of the 600 enrolled participants, 245 (40.8%) individuals had hypertension, 44 (7.3%) had been previously diagnosed with hypertension, and 201 (33.5%) were newly diagnosed with hypertension. A logistic regression analysis showed no significant associations across the education level, marital status, overweight and hypertension factors. However, an older age (adjusted OR = 3.20, 95% CI = 2.28–4.51, P < 0.001) and obesity (adjusted OR = 2.41, 95% CI = 1.57–3.69, P < 0.001) were associated with the presence of hypertension.ConclusionThere is a high rate of hypertension in Eastern Sudan, especially among older and obese individuals. Preventive measures, such as dietary measures, should be implemented.

Abstract 17: Comparative Effectiveness of Implementation Strategies on Cardiovascular Risk Factor Control in Patients With Diabetes: The D4C Cluster Randomized Trial

Objectives: Uncontrolled blood glucose, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) are major risk factors for premature death and cardiovascular disease (CVD) in patients with diabetes. We compared the effectiveness of team-based care (TBC) with clinical decision support systems (CDSS) versus TBC alone on CVD risk factor control among patients with diabetes in China. Methods: In the Diabetes Complication Control in Community Clinics (D4C) cluster randomized trial, 38 community health centers were randomly assigned to TBC-CDSS (primary care physician-health educator-diabetes specialist collaborative care plus guideline-based treatment protocol implemented in CDSS) or TBC alone in Xiamen City, China. A total of 11,132 patients (5378 in TBC-CDSS and 5754 in TBC) aged ≥50 years with uncontrolled diabetes and additional risk factors (dyslipidemia, hypertension, or clinical CVD) were recruited. The intervention lasted for 18 months, and study data were collected at 6, 12, and 18 months after baseline. Results: Mean baseline age (62.6 vs. 63.1 years), body mass index (24.9 vs. 24.9 kg/m 2 ), HbA1c (8.8 vs. 8.7%), LDL-C (121.2 vs. 121.1 mg/dL), systolic BP (136.6 vs. 136.9 mm Hg) and diastolic BP (79.7 vs. 79.8 mmHg) were comparable between TBC-CDSS and TBC alone groups. About 87.1% of participants in the TBC-CDSS group and 84.1% in the TBC alone group completed the 18-month intervention. Both TBC-CDSS and TBC alone significantly reduced HbA1c, LDL-C, and BP over the 18-month follow-up (all P&lt;0.0001). Furthermore, the proportions of controlled HbA1c, LDL-C, and BP, as well as all 3 risk factors, were significantly higher in the TBC-CDSS group compared to the TBC alone group (Table). Conclusions: As compared with team-based care alone, team-based care plus a guideline-based treatment protocol implemented in clinical decision support systems further reduces CVD risk factors in patients with diabetes. (ClinicalTrials.gov number, NCT02835287)

Development of a practical evaluation approach of a typical biomass cookstove

Abstract Exposure to air pollutant emissions from household combustion of solid fuels is leading risk factor for premature deaths in the developing countries. A natural draft Improved Cook Stove (ICS) was designed for household combustion of solid fuels. The objectives of the design included multi fuel usage, user friendliness, lower emissions and better efficiency. Comparisons of newly designed cookstove (ND) with Traditional cookstove (TCS) and three other ICS have been discussed. The performance of the ND when loaded with five different solid fuels has also been discussed. Modified Water Boiling Test (WBT) and Bureau of Indian Standards (BIS, 2013) methodology was used for performance evaluation of the designed ICS. The cookstove was designed for 2kW energy output and fuel consumption rate of 1.5 kg/hr. Turn down ratio of 3.23, fire power of 7kW and specific fuel consumption of 85 g/liter was estimated from the WBT. The ND performed better than TCS and other commercial ICS with 75% reduction in PM2.5 and 63% reduction in CO concentrations respectively. The thermal efficiency of ND indicated a significant increase of 106% from TCS. Outcomes from this study can be used for designing a multi fuel biomass stove with enhanced efficiency and lowered emissions.

Long-Distance Skiing and Incidence of Hypertension: A Cohort Study of 206 889 Participants in a Long-Distance Cross-Country Skiing Event.

Hypertension is the leading risk factor for death worldwide, and high levels of physical activity are associated with a lower incidence of hypertension. The associations of excessive levels of exercise and incidence of hypertension are less well known. We aim to compare the incidence of hypertension among 206 889 participants in a long-distance cross-country skiing event and 505 542 people randomly sampled from the general population (matched to the skiers on age, sex, and place of residence). Skiers' best performance (in percent of winning time) and number of completed races during the study period were associated with incidence of hypertension after participation in Vasaloppet. Hypertension was defined as prescription of blood pressure-lowering drugs as obtained from the national drug registry. Models were adjusted for sex, age, education, and income (total effect). During a median time of risk of 8.3 years, skiers had a lower incidence of hypertension compared with nonskiers (hazard ratio [HR], 0.59 [95% CI, 0.58-0.60]). Among the skiers, better performance (in percent of winning time) in Vasaloppet was strongly associated with a lower incidence of hypertension (fastest fifth: HR, 0.41 [95% CI, 0.39-0.42]; slowest fifth: HR, 0.78 [95% CI, 0.75-0.81]). The association was nearly linear and did not differ between sexes. Among the skiers, a weaker association was seen between the number of completed races during the study period and the incidence of hypertension (1 race: HR, 0.63 [95% CI, 0.62-0.65]; >5 races: HR, 0.51 [95% CI, 0.50-0.53]). A subanalysis of 10 804 participants including adjustment for lifestyle factors showed similar results. Participation in a long-distance skiing event was associated with a 41% lower incidence of hypertension over the next 8 years compared with nonparticipation. A near linear association between performance and incidence of hypertension was observed. This adds to the list of beneficial effects of intensive training, because hypertension is the leading risk factor of premature death globally.

Sodium-hydrogen exchanger regulatory factor-1 (NHERF1) confers salt sensitivity in both male and female models of hypertension in aging

Hypertension is a risk factor for premature death and roughly 50% of hypertensive patients are salt-sensitive. The incidence of salt-sensitive hypertension increases with age. However, the mechanisms of salt-sensitive hypertension are not well understood. We had demonstrated decreased renal sodium‑hydrogen exchanger regulatory factor 1 (NHERF1) expression in old salt-resistant F344 rats. Based on those studies we hypothesized that NHERF1 expression is required for the development of some forms of salt-sensitive hypertension. To address this hypothesis, we measured blood pressure in NHERF1 expressing salt-sensitive 4-mo and 24-mo-old male and female Fischer Brown Norway (FBN) rats male and female 18-mo-old NHERF1 knock-out (NHERF1−/−) mice and wild-type (WT) littermates on C57BL/6J background after feeding high salt (8% NaCl) diet for 7 days. Our data demonstrate that 8% salt diet increased blood pressure in both male and female 24-mo-old FBN rats but not in 4-mo-old FBN rats and in 18-mo-old male and female WT mice but not in NHERF1−/− mice. Renal dopamine 1 receptor (D1R) expression was decreased in 24-mo-old rats, compared with 4-mo-old FBN rats. However, sodium chloride cotransporter (NCC) expression increased in 24-mo-old FBN rats. In FBN rats, age had no effect on NaK ATPase α1 and NKCC2 expression. By contrast, high salt diet increased the renal expressions of NKCC2, and NCC in 24-mo-old FBN rats. High salt diet also increased NKCC2 and NCC expression in WT mice but not NHERF1−/− mice. Our data suggest that renal NHERF1 expression confers salt sensitivity with aging, associated with increased expression of sodium transporters.

Knowledge and Determinants of Mother Kangaroo Care (MKC) at the Hospital Environment of Lubumbashi in DR Congo: About a Survey Carried out at Jason Sendwe Hospital

The poor heat chain observed in developing countries remains an important risk factor for premature death. Mother Kangaroo care (MKC) presents itself as an efficient alternative for the improvement of the conditions for raising premature babies to a poorly equipped area. The objective of this study was to determine the level of knowledge of the MKC and to identify the factors influencing said knowledge. This was a qualitative survey-type study that involved 50 people met in the pediatrics department of Jason Sendwe Hospital from March 1st to 31st, 2018. At the end of our analyzes, it comes out that 96% of people met had already been informed about the MKC method; only 42% of our respondents have a global knowledge of the MKC method; the age above 40 years old, the quality of a medical Doctor and the affectation to neonatology are the factors that are positively associated in an independent way with good knowledge of the method of MKC. The popularization of the MKC method must remain a priority in our under-equipped environments in order to considerably reduce neonatal mortality in general and the lethality of prematurity in particular.

Role of sodium-glucose cotransporter 2 inhibition to mitigate diabetic kidney disease risk in type 1 diabetes.

Diabetic kidney disease (DKD) is a common complication of type 1 diabetes (T1D) and a major risk factor for premature death from cardiovascular disease (CVD). Current treatments, such as control of hyperglycaemia and hypertension, are beneficial, but only partially protect against DKD. Finding new, safe and effective therapies to halt nephropathy progression has proven to be challenging. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated, in addition to glycaemic lowering, impressive protection against DKD and CVD progression in people with type 2 diabetes. Although these beneficial cardiorenal effects may also apply to people with T1D, supporting data are lacking. Furthermore, the increased rates of euglycaemic diabetic ketoacidosis may limit the use of this class in people with T1D. In this review we highlight the pathophysiology of DKD in T1D and the unmet need that exists. We further detail the beneficial and adverse effects of SGLT2 inhibitors based on their mechanism of action. Finally, we balance the effects in people with T1D and indicate future lines of research.

Estimated Aerosol Health and Radiative Effects of the Residential Coal Ban in the Beijing-Tianjin-Hebei Region of China

ABSTRACT Particle-phase air pollution is a leading risk factor for premature death globally and impacts climate by scattering or absorbing radiation and changing cloud properties. Within the Beijing-Tianjin-Hebei region of China, where there are severe air quality problems, several municipalities have begun implementing a coal-to-electricity program that bans residential coal and provides subsidies for electricity and electric-powered heat pumps. We used GEOS-Chem to evaluate two complete residential coal-to-electricity transitions—a Beijing-off scenario and Beijing-Tianjin-Hebei-off scenario—each relative to a base case. We estimate that within China, the ambient fine particulate matter (PM2.5) reductions in the Beijing-off scenario could lead to 1,900 (95% CI: 1,200–2,700) premature deaths avoided annually, while the Beijing-Tianjin-Hebei-off scenario could lead to 13,700 (95% CI: 8,900–19,600) premature deaths avoided annually. Additionally, we estimate that the residential-coal-ban scenarios will result in a positive top-of-the-atmosphere aerosol direct radiative effect (DRE) (model domain average: Beijing-off: 0.023 W m–2; Beijing-Tianjin-Hebei-off: 0.30 W m–2) and a negligible cloud-albedo aerosol indirect effect (AIE) (Beijing-off: 0.0001 W m–2; Beijing-Tianjin-Hebei-off: 0.0027 W m–2). To evaluate the uncertainty of the radiative effects, we calculated the DRE under four black-carbon mixing-state assumptions and both the DRE and AIE assuming three different black-carbon-to-organic-aerosol (BC:OA) ratios for residential-coal emissions. Although the magnitude of our radiative forcing estimates varied across sensitivity cases, the domain average remained positive. When only considering the aerosol-related effects of the aforementioned coal-ban scenarios, we predict substantial health benefits, but do not anticipate a climate “co-benefit”, because removing aerosol emissions leads to a warming tendency. However, if the coal-to-electricity program results in less net greenhouse gas emissions due to the replacement heaters, the policy may be able to achieve health and climate “co-benefits”.

A study on the scope of homoeopathy in the management of suicidal ideation in depressive episodes

Background: Suicidal ideation in depressive patient is one of the risk factors for premature death due to their hopelessness, worthlessness, to escape or solve the problem, or to take revenge. Objective: The objective of the study is to study the effectiveness of homeopathic medicine in the management of suicidal ideation in depressive episodes. Materials and Methods: Thirty patients were selected for this study based on purposive sampling. The diagnosis was made on international classification of diseases-10 and DSM-V criteria, and grading of severity of depressive episodes and suicidal ideations were assessed before and after treatment by Hamilton depression rating scale and scale of suicidal ideation. This study was carried out for a period of 24 months. The remedy selection was based on the individualization of each case. Potencies ranging 30-10 M were used on the demand of the cases. Patients were reviewed on weekly basis initially and fortnightly on considerable improvement or on demand of the case. Each case was followed up for a minimum period of 6 months. The descriptive statistics such as mean, standard deviation, and percentage were used, and statistical inference was obtained by paired t-test with the scores of before and after treatment P