Risk Factor For Premature Death Research Articles

Corn Silk Flavonoids Ameliorate Hyperuricemia via PI3K/AKT/NF-κB Pathway.

Hyperuricemia (HUA) is a widespread metabolic disease marked by an elevated level of uric acid, and is a risk factor for premature death. The protective effect of corn silk flavonoids (CSF) against HUA and its potential mechanisms were explored. Five important apoptosis and inflammation-related signaling pathways were identified by network pharmacological analysis. The CSF exhibited significant uric acid (UA)-lowering activity in vitro by decreasing xanthine oxidase (XOD) and increasing hypoxanthine-guanine phosphoribosyl transferase levels. In a potassium oxonate-induced HUA in vivo, CSF treatment effectively inhibited XOD activity and promoted UA excretion. Furthermore, it decreased the levels of TNF-α and IL-6 and restored pathological damage. In summary, CSF is a functional food component to improve HUA by reducing inflammation and apoptosis through the down-regulating PI3K/AKT/NF-κB pathway.

High quality diet attenuated the positive association between polychlorinated biphenyls and premature mortality among middle-aged and older adults

ObjectivePolychlorinated biphenyls (PCBs) have been reported to be a risk factor for premature death, while a high diet quality is thought to lower mortality risk. We aimed to examine whether PCBs were associated with higher all-cause and cause-specific mortality risk and whether such associations could be modified by the diet quality among US middle-aged and older adults. MethodsIncluded were 1259 participants aged 40 years or older from the 1999–2004 National Health and Nutrition Examination surveys. Exposure to PCBs was assessed in non-fasting serum samples, and mortality status was ascertained through December 31, 2019 using the public-use, linked mortality files. Diet quality was assessed using the Healthy Eating Index-2015 based on 24-h dietary recalls. Cox proportional hazard regression was applied to assess the associations of different PCB congener groups with mortality and the modifying effect by the diet quality. ResultsDuring a median follow-up of 17.75 years, 419 deaths occurred, including 131 from cardiovascular disease (CVD) and 102 from cancer. Serum concentrations of dioxin-like PCBs and non-dioxin-like PCBs were significantly associated with all-cause mortality, with hazard ratios (HRs) of 1.84 (95% confidence interval [CI], 1.10, 2.99) and 1.82 (1.09, 3.03) for extreme-tertile comparisons. A significant interaction was noted between dioxin-like PCBs and diet quality (P for interaction: 0.012), with a substantially more pronounced association among participants with a low diet quality (HR, 3.47; 95% CI: 1.29, 9.32), compared to those with a high diet quality (HR, 0.98; 95% CI: 0.40, 2.43). A similar weaker association was observed for total PCBs in participants with a high diet quality (P for interaction: 0.032). However, effect modifications by diet quality were not noted for the associations between different PCB groups and CVD mortality. ConclusionsWhile our findings need to be validated in other populations and mechanistic studies, they may suggest that a high quality diet could potentially attenuate the harmful effects of chronic PCB exposure.

Double or triple combination therapy in systemic arterial hypertension: to whom, when and with what?

La hipertensión arterial sistémica (HAS) es el principal factor de riesgo para muerte prematura en el mundo y en México.1 Se estima que existen 15.2 millones de mexicanos con diagnóstico de HAS, de los cuales 7.48 millones son derechohabientes del IMSS (evaluación de los riesgos financieros considerados en el Programa de Administración de Riesgos Institucionales, ENSANUT, 2018).2

Age, Period, and Cohort Analysis of Smoking Intensity Among Current Smokers in Malaysia, 1996-2015.

Tobacco use is one of the major preventable risk factors for premature death and disability worldwide. Understanding the trend of tobacco use over time is important for informed policy making. The present study aimed to examine the changes in mean daily cigarette consumption among random samples of the Malaysian current smoker population over 20 years using an age-period-cohort (APC) approach. We conducted APC analysis using a multilevel hierarchical age-period-cohort model and data from four nationally representative, repeated cross-sectional surveys (National Health and Morbidity Survey) conducted in 1996, 2006, 2011, and 2015 among individuals aged 18 to 80 years. Analyses were also stratified by gender and ethnicity. Overall, mean daily cigarette consumption (smoking intensity) among current smokers increased with age until 60, after which a drop was observed. There were increases in daily cigarette consumption across birth cohorts. Age and cohort trends did not vary by gender but by ethnicity. The decreasing cigarette consumption after age 60 among the current smoker population was consistent with those observed among the Chinese and Indians, a trend that was not observed in Malays and other aborigines. In contrast, the increasing cohort trend was consistent with those observed among the Malays and other bumiputras. The present study highlighted important ethnic-specific trends for mean daily cigarette consumption among the current smoker population in Malaysia. These findings are essential in guiding the formulation of interventional strategies or implementation of national tobacco control policies and help achieve the Ministry of Health Malaysia's 2025 and 2045 targets for smoking prevalence. This is the first APC study on smoking intensity among current smokers in a multiracial, middle-income nation. Very few studies had performed gender- and ethnic-stratified APC analyses. The ethnic-stratified APC analyses provide useful insights into the overall age and cohort trends observed among the current smoker population in Malaysia. Therefore, the present study could add evidence to the existing literature on the APC trends of smoking intensity. The APC trends are also important in guiding the government to develop, implement, and evaluate antismoking strategies.

Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study

BackgroundFine particulate matter (PM2.5) is a well-recognized risk factor for premature death. However, evidence on which PM2.5 components are most relevant is unclear. MethodsWe evaluated the associations between mortality and long-term exposure to eight PM2.5 elemental components [copper (Cu), iron (Fe), zinc (Zn), sulfur (S), nickel (Ni), vanadium (V), silicon (Si), and potassium (K)]. Studied outcomes included death from diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders as well as all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), and lung cancer. We followed all residents in Denmark (aged ≥30 years) from January 1, 2000 to December 31, 2017. We used European-wide land-use regression models at a 100 × 100 m scale to estimate the residential annual mean levels of exposure to PM2.5 components. The models were developed with supervised linear regression (SLR) and random forest (RF). The associations were evaluated by Cox proportional hazard models adjusting for individual- and area-level socioeconomic factors and total PM2.5 mass. ResultsOf 3,081,244 individuals, we observed 803,373 death from natural causes during follow-up. We found significant positive associations between all-natural mortality with Si and K from both exposure modeling approaches (hazard ratios; 95% confidence intervals per interquartile range increase): SLR-Si (1.04; 1.03–1.05), RF-Si (1.01; 1.00–1.02), SLR-K (1.03; 1.02–1.04), and RF-K (1.06; 1.05–1.07). Strong associations of K and Si were detected with most causes of mortality except CKD and K, and diabetes and Si (the strongest associations for psychiatric disorders mortality). In addition, Fe was relevant for mortality from RD, lung cancer, CKD, and psychiatric disorders; Zn with mortality from CKD, RD, and lung cancer, and; Ni and V with lung cancer mortality. ConclusionsWe present novel results of the relevance of different PM2.5 components for different causes of death, with K and Si seeming to be most consistently associated with mortality in Denmark.

The Effects of Trash, Residential Biofuel, and Open Biomass Burning Emissions on Local and Transported PM2.5 and Its Attributed Mortality in Africa.

Long-term exposure to ambient fine particulate matter (PM2.5) is the second leading risk factor of premature death in Sub-Saharan Africa. We use GEOS-Chem to quantify the effects of (a) trash burning, (b) residential solid-fuel burning, and (c) open biomass burning (BB) (i.e., landscape fires) on ambient PM2.5 and PM2.5-attributable mortality in Africa. Using a series of sensitivity simulations, we excluded each of the three combustion sources in each of five African regions. We estimate that in 2017 emissions from these three combustion sources within Africa increased global ambient PM2.5 by 2%, leading to 203,000 (95% confidence interval: 133,000-259,000) premature mortalities yr-1 globally and 167,000 premature mortalities yr-1 in Africa. BB contributes more ambient PM2.5-related premature mortalities per year (63%) than residential solid-fuel burning (29%) and trash burning (8%). Open BB in Central Africa leads to the largest number of PM2.5-attributed mortalities inside the region, while trash burning in North Africa and residential solid-fuel burning in West Africa contribute the most regional mortalities for each source. Overall, Africa has a unique ambient air pollution profile because natural sources, such as windblown dust and BB, contribute strongly to ambient PM2.5 levels and PM2.5-related mortality. Air pollution policies may need to focus on taking preventative measures to avoid exposure to ambient PM2.5 from these less-controllable sources.

Time in therapeutic range: timely in hypertension therapeutics?

Elevated blood pressure ranks among the most important modifiable risk factors for premature death, and disability from hypertension mediated organ damage in the world. Many studies attest to the value of lifestyle adjustments and pharmacologic therapy in improving outcomes in patients with hypertension. Since blood pressure is a dynamic vitals sign, variability in visit-to-visit measurements is expected. While guidelines recommend a goal blood pressure, increasing attention is centered on how often a patient's blood pressure is found to be not only below the recommended goal value, but also how much of the time the blood pressure is below what is considered a safe lower goal threshold for blood pressure. In this Perspective we review a relatively new technique in addressing adequacy of blood pressure treatment, the time in therapeutic range, and provide examples supporting the clinical relevance of this novel metric.

A Source Apportionment and Emission Scenario Assessment of PM2.5- and O3-Related Health Impacts in G20 Countries.

Exposure to air pollution is a leading risk factor for premature death globally; however, the complexity of its formation and the diversity of its sources can make it difficult to address. The Group of Twenty (G20) countries are a collection of the world's largest and most influential economies and are uniquely poised to take action to reduce the global health burden associated with air pollution. We present a framework capable of simultaneously identifying regional and sectoral sources of the health impacts associated with two air pollutants, fine particulate matter (PM2.5) and ozone (O3) in G20 countries; this framework is also used to assess the health impacts associated with emission reductions. This approach combines GEOS-Chem adjoint sensitivities, satellite-derived data, and a new framework designed to better characterize the non-linear relationship between O3 exposures and nitrogen oxides emissions. From this approach, we estimate that a 50% reduction of land transportation emissions by 2040 would result in 251 thousand premature deaths avoided in G20 countries. These premature deaths would be attributable equally to reductions in PM2.5 and O3 exposure which make up 51% and 49% of the potential benefits, respectively. In our second application, we estimate that the energy generation related co-benefits associated with G20 countries staying on pace with their net-zero carbon dioxide targets would be 290 thousand premature deaths avoided in 2040; action by India (47%) would result in the most benefits of any country and a majority of these avoided deaths would be attributable to reductions in PM2.5 exposure (68%).

PS-BPB06-5: URINARY CELL TRANSCRIPTOMICS: A NON-INVASIVE EXPRESSION READOUT OF KIDNEY GENES OF RELEVANCE TO HYPERTENSION

Objective: Hypertension affects 35% of the global adult population and is the leading preventable risk factor for premature death globally. The kidney is the key organ of blood pressure regulation in the body. Here, we compare the gene expression profile from renal cells shed naturally into the urine and kidney tissue to determine if urine can provide a non-invasive readout of kidney gene expression and whether hypertension-associated genes can be quantified in urine. Design and Method: Urinary cell and kidney tissue samples were collected from 33 human participants and were both profiled by poly-A RNA-sequencing, generating an average of 30 million paired reads per sample. These were quantified using the standard Genotype Tissue Expression (GTEx) project pipeline and were compared against 43 different human tissues and other bodily fluids using transcriptomic correlation. RNA-sequencing quality metrics were calculated by RNA-SeQC software. Gene set overrepresentation analysis for Gene Ontology (GO) terms and Kyoto Encyclopaedia of Genes and Genomes (KEGG) employed Fishers exact test. Enriched and enhanced kidney genes were collected from the Human Protein Atlas (HPA). Results: Our RNA-sequencing metric analysis revealed that urinary cells can generate robust data of comparable or superior quality to that of saliva at similar read coverage. The top one hundred most highly expressed urinary cell genes show an enrichment for biological themes shared with the renal transcriptome, including immunity (P = 1.2x10–7), glucose metabolism (P = 1.3x10–5) and renal mineral reabsorption (P = 9.8x10–4). In an analysis all protein-coding genes across 43 human tissues/cell-types, urinary cells showed the highest level of transcriptomic correlation with kidney cortex (r2 = 0.65) and kidney medulla (r2 = 0.64). This correlation between urinary cells and kidney tissue was particularly strong (r2 = 0.72) in an analysis restricted to highly specific kidney genes (including uromodulin and the Na-K-Cl cotransporter NKCC2 [loop diuretic target]). 98% (176 out of 179) of kidney genes with a known causal association to blood pressure were expressed in urinary cells. Their urinary expression demonstrated strong correlation with their abundance in kidney cortex (r2 = 0.68) and medulla (r2 = 0.64). Conclusions: Standard poly-A RNA-sequencing of cells harvested from urinary sediments produces robust gene expression profiles. These profiles provide a non-invasive insight into transcriptome of the kidney and permit measuring expression of kidney genes of relevance to BP regulation and hypertension.

S-50-3: MICROSAMPLING BASED MASS SPECTROMETRY FOR QUANTIFICATION OF ANGIOTENSIN PEPTIDES IN THE RENIN ANGIOTENSIN ALDOSTERONE SYSTEM

Objective: Hypertension is the leading risk factor of premature death globally, affecting around 1.3 billion people. The canonical renin angiotensin aldosterone system (RAAS) has been extensively studied and methods are available for use clinically to assess hypertension. The non-canonical axis of the RAAS (consists of angiotensin 1Ξ7, angiotensin 1Ξ9, angiotensin converting enzyme 2 and alamandine) counteract the effects of the canonical pathway. This reveals their role as potential therapeutic targets for cardiovascular disease, but it has not been studied in detail in the clinical or research setting due to the difficulty in measuring its components owing to instability. Furthermore, the functional balance between the two arms of RAAS has not been fully understood. These limitations can be overcome by using dried microsampling, which provides better sample stability. Microsampling requires just a micro blood volume (<30 μL) from a finger prick collected on a card. It is minimally invasive, cheap, and easy to collect by patients. Design: A microsampling based liquid chromatography coupled with triple quadrupole mass spectrometry (LCMS/MS assay) was developed and optimised to simultaneously quantify 10 peptides (angiotensin II, Ang III, Ang IV, ACE2, Ang 1Ξ5, Ang 1Ξ7, Ang 1Ξ9, Ang 1Ξ12, Alamandine and Ang A) in the RAAS pathway. Methods: For the preparation of calibration samples, 30 μL of bovine serum albumin (BSA) was spiked with the 10 peptides standards, spotted on a card, dried and extracted by solid phase extraction using their respective internal standards. Chromatographic analyses were performed on an Acquity C18 Premier peptide column using gradient elution with a run time of 8 min. Identification was carried out using electrospray ionisation (positive) on a Waters Xevo TQXS triple quadrupole mass spectrometer. The developed assay is currently undergoing validation in line with international guidelines. Results: The method shows good linearity. The accuracy (relative error) and precision (coefficient of variation) values were within the pre-defined limits of ≧15% at all tested concentrations for the peptides. The assay sensitivity was sufficient to detect the peptides in dried blood spot samples. Conclusion: The microsampling based LCMS/MS assay development was successful and following completion of validation has the potential to quantify the circulating levels of these vasoactive peptides in patients with hypertension. This has been achieved, for the first time to the best of our knowledge on the entire RAAS pathway. This microsampling based proteomics assay could be used to study patients with hypertension in both research and clinical settings.

The use of modern digital technologies in predictive analysis of risk factors for premature death due to socially significant non-communicable diseases (literature review)

The effectiveness of the implementation of the Concept of predictive, preventive and personalized medicine is directly related to the development and scaling of the process of digitalization of healthcare with the leading position occupied by artificial intelligence technologies (AI technologies). This fully applies to the problem of predictive analysis of risk factors for premature death from socially significant non-communicable diseases (NCDs). The purpose of the work was to summarize the current domestic and foreign experience of using AI technologies and machine learning (ML) in predictive analysis of risk factors for premature death from socially significant non-communicable diseases. The search for publications was carried out in the RSCI, CyberLeninka, eLibrary, and PubMed databases containing domestic and foreign sources of scientific information. The search depth covered period from 2011 to 2021. More than 50 sources of scientific information were analyzed. The article briefly reports on the global risk factors (RF) of premature death due to NCDs, the main place among which is occupied by diseases of the circulatory system. The disadvantages of calculators used in mass examinations to determine the total risk of fatal cardiovascular events (CVE) are considered ¾ Framingham scale and SCORE scale. It is shown that the individual predictive efficiency of calculators can be increased due to ML technologies that use big data on the health status of the population in certain regions, digitalization of medical images, and expansion of structured databases of the RF spectrum, which makes it possible to recognize and take into account complex relationships between multiple, correlated, and nonlinear RF and CVE outcomes. Examples of the predictive effectiveness of ML models are given. Special attention is paid to AI technologies and deep ML in the stratification of CVE risk and outcomes based on the analysis of imagesof the fundus the eye. Conclusion. The introduction of AI technologies and ML in clinical practice opens up the prospect of achieving an effective individualized stratification of the risk of premature death due to chronic NCDs and their factor of personalized prevention through timely optimization of socially significant diseases modifiable by the F.

Reduced renal elimination of larger molecules is a strong predictor for mortality

Renal dysfunction is a major risk factor for premature death and has been studied extensively. A new renal syndrome, shrunken pore syndrome (SPS), confers higher mortality in all studied populations. SPS is a condition in which cystatin C-based estimation of glomerular filtration rate (eGFRcystatin C) is ≥ 60% than creatinine-based estimation of glomerular filtration rate (eGFRcreatinine). We aimed to study the impact of SPS on mortality in a cohort of patients with follow up of up to 10 years. This was a retrospective single centre cohort study. We enrolled 3993 consecutive patients undergoing elective cardiac surgery. Outcome was evaluated using Kaplan Meier analysis and multivariable Cox regression. 1-, 5- and 10-year survival for patients with SPS was 90%, 59% and 45%, and without SPS 98%, 88% and 80% (p < 0.001). SPS was found to be an independent predictor for mortality with an HR of 1.96 (95% CI 1.63–2.36). SPS negatively affected survival regardless of pre-operative renal function. SPS is an independent predictor for mortality after elective cardiac surgery, equal to or greater than risk factors such as diabetes, impaired left ventricular function or renal dysfunction. SPS affected mortality even in patients with normal eGFR.Clinical registration number: ClinicalTrials.gov, ID NCT04141072.

Pattern and correlates of physical activity and sedentary behaviours of pregnant women in Ibadan, Nigeria: Findings from Ibadan pregnancy cohort study.

Globally, physical inactivity is the fourth leading risk factor for premature death. Pregnancy is associated with reduced physical activity because of physiological and anatomical changes and socio-cultural barriers. Even though physical activity provides many benefits, such as improved insulin sensitivity and reduced cardiometabolic risk, it is not emphasized among pregnant women in Nigeria. This study described the pattern of physical activity and sedentary behaviours of pregnant women from the Ibadan Pregnancy Cohort Study in Ibadan, Nigeria. The Ibadan Pregnancy Cohort Study (IbPCS) is a prospective cohort study investigating the associations between maternal obesity, lifestyle factors on glycaemia control, gestational weight gain, pregnancy and postpartum outcomes among pregnant women in Ibadan. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess physical activity and sedentary behaviour. Sedentary time was estimated from the time spent watching television, sitting at work and the computer. Bivariate and multivariate logistic regression analyses were done to investigate associations at a 5% level of statistical significance. None of the pregnant women met the WHO recommendation of 150mins of moderate-intensity activity per week. The average time spent engaged in moderate-intensity activity was 26.3 ± 22.9 mins. The mean daily sedentary time was 6.5 ± 4.2 hours. High parity para ≥ 4: [AOR 0.57 95% CI: (0.36-0.89) p = 0.014] and being employed [AOR 0.23 95% CI: (0.15-0.33) p <0.001] reduced the odds of having inadequate physical activity. Correlates of sedentary behavior after adjusting for confounders were high parity: para 1-3 AOR 0.73, 95% CI: (0.58-0.91) p = 0.004], tertiary education: AOR 2.39 95% CI: (1.16-4.91) p = 0.018] and earning a higher income: AOR 1.40: 95% CI: (1.11-1.78) p = 0.005]. Pregnant women's physical activity and sedentary behaviours are emerging public health issues, especially in Nigeria. The level of physical activity was inadequate among pregnant women, while the sedentary time was high. There is a need to implement programmes that promote physical activity and discourage sedentary behaviour among pregnant women in Nigeria.

Blood pressure telemonitoring and telemedicine for hypertension management—positions, expectations and feasibility of Latin–American practitioners. SURVEY carried out by several cardiology and hypertension societies of the Americas

Purpose To assess the opinion of Latin–American physicians on remote blood pressure monitoring and telehealth for hypertension management. Material and methods Cross-sectional survey of physicians residing in Latin–America. The study was conducted by the Mexico Hypertension Experts Group, Interamerican Society of Hypertension, Interamerican Society of Cardiology Epidemiology and Cardiovascular Prevention Council, and National Cardiologist Association of Mexico. An online survey composed of 40 questions using Google Forms was distributed from 7 December 2021, to 3 February 2022. The survey was approved by the GREHTA Ethics Committee and participation was voluntary and anonymous. Multiple logistic regression models were constructed to identify the challenges of telehealth. Results 1753 physicians’ responses were gathered. The responses came from physicians from different Latin–American countries, as follows: 24% from Mexico, 20.6% from Argentina, 14.7% from Colombia, 10.9% from Brazil, 8.7% from Venezuela, 8.2% from Guatemala and 3.2% from Paraguay. Responders with a high interest in carrying out their assistance task through remote telemonitoring reached 48.9% (821), while 43.6% are already currently conducting telemonitoring. A high number, 62%, claimed to need telemonitoring training. There is a direct relation between higher interest in telemonitoring and age, medical specialty, team working, residence in the biggest cities, expectations regarding telemedicine and reimbursement. Conclusions Remote monitoring is feasible in Latin–America. General practitioners and specialists from bigger cities seem eager and are self-perceived as well-trained and experienced. Facilities and resources do not seem to be a challenge but training reinforcement and telemedicine promotion is necessary for those physicians less motivated. PLAIN LANGUAGE SUMMARY What is the context? Hypertension is one of the leading worldwide modifiable risk factors for premature death. Strong evidence supports that effective treatment of this condition results in a significant reduction of hard outcomes. Only 20%–30% of hypertensive patients are within the blood pressure targets recommended by guidelines in Latin–America. There is an urgent need to implement innovative strategies to reverse this alarming health situation. What is new? Latin–American physicians were highly predisposed to telemonitoring practice. This high motivation was not influenced by hardware or software availability, technological knowledge or experience, by volume of monthly consultations, or by area (private–public) where the care activity is carried out. This high motivation may be supported by the conviction that this practice could be very useful as a complement to face–to–face assistance and a highly effective tool to improve adherence even though respondents considered that just 10% of the patients would prefer telemonitoring over office consultation. What is the impact? Facilities and resources do not seem to be a challenge but training reinforcement and telemedicine promotion is necessary for those physicians less motivated. The general perception is that it is necessary to move forward to resolve legal gaps and financial aspects. Physicians must adapt to changes and develop new communication strategies in a world where the unrestricted access to teleinformation makes patients self-perceived as experts.

Socioeconomic Determinants of Household Stove Use-Choice and Stove Stacking Patterns in Ghana Using Multinomial Logit Models

Background and Aim: Air pollution is the fourth-highest risk factor for premature deaths globally and the second-highest risk factor for premature deaths in Ghana. Understanding the socioeconomic correlates of cooking stove/fuel choices and stove stacking patterns is a precursor to designing effective household air pollution interventions. Methods: The study used a quantitative cross-sectional design to collect data from sampled districts in all 16 regions of Ghana, covering about 7,400 household-level respondents in 370 enumeration areas (EAs); across 177 urban EAs and 193 rural EAs. Face-to-face interviews were conducted at home. The questionnaire was designed to elicit information on primary, secondary, and tertiary cooking stoves and fuels. Results: Use of LPG correlates positively with education (Primary education-RRR:2.377, p&amp;#x3c;0.01, CI: 95), (Middle/JHS education-RRR:3.019, p&amp;#x3c;0.0, CI:95), (Technical/SHS education-RRR:6.491, p&amp;#x3c;0.01, CI: 95), (Post-secondary/University education-RRR:14.41, p&amp;#x3c;0.01, CI:95). Similarly, use of an LPG-charcoal stove mix compared to Charcoal stove-open fire mix correlates positively with education. All else equal, households with more than one cookstove (RRR:1.185, p&amp;#x3c;0.05, CI:95), and urban households (RRR:6.488, p&amp;#x3c;0.01, CI:95) reported using LPG stoves as their primary cookstove more frequently than did households using a single stove or living in rural areas. The age of the primary cook (RRR:1.44, p&amp;#x3c;0.1, CI:95), household income (RRR: 1.052, p&amp;#x3c;0.1, CI:95), and urbanicity (RRR:4.134, p&amp;#x3c;0.01, CI:95) were statistically significant in predicting use of an LPG-Charcoal mix compared to Charcoal stove-open fire mix. LPG, charcoal and 3-stone (open fire) stoves refer to cooking devices that are fueled by combustible gas, charcoal and wood respectively. Conclusion: Most households in Ghana use multiple cookstoves and fuels. Biomass fuel use is concentrated in poorer, less educated, and rural households. Equitable household energy transitions will require particular attention to encouraging sustained exclusive use of clean fuels in these communities to improve health. Keywords: socioeconomic factors, cookstove, choice, stove stacking,

Long-term exposure to elemental components of fine particulate matter and natural and cause-specific mortality in a Danish nationwide administrative cohort

BACKGROUND AND AIM: Fine particulate matter (PM₂.₅) is an established risk factor for premature death, but it remains unclear which components and sources are most responsible. We investigated the associations between long-term exposure to PM₂.₅ components and mortality from all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), lung cancer, diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders in a Danish nationwide administrative cohort. METHODS: We followed all Danish residents aged &amp;#x2265;30 at January 1, 2000 (3,081,244) until December 31, 2017. Residential annual mean exposure PM₂.₅ components levels (copper, iron, zinc, sulfur, nickel, vanadium, silicon, and potassium) were estimated by Europe-wide land-use regression models at a 100×100m scale, developed within the &amp;#x22;Effects of Low-Level Air Pollution: A Study in Europe” project, with two modeling approaches: supervised linear regression (SLR) and random forest (RF). We used Cox proportional hazard models to evaluate the associations between each component and mortality, adjusting for demographic, socioeconomic factors, and PM₂.₅ mass. RESULTS: The cohort accumulated 46,992,890 person-years, and 803,373 died from natural causes. For natural mortality, we observed significant positive associations [hazard ratios (HRs); 95% confidence intervals per interquartile range increase] with SLR-silicon (1.04; 1.03-1.05) and SLR-potassium (1.03; 1.02-1.04) and with RF- iron (1.02; 1.01-1.02), RF-zinc (1.02; 1.01-1.03), RF-nickel (1.01; 1.00-1.02), RF-vanadium (1.02; 1.01-103), RF-silicon (1.01; 1.00-1.02), and RF-potassium (1.06; 1.05-1.07). Potassium and silicon were most strongly associated with all causes of death except CKD and diabetes, respectively, with the highest HRs observed for psychiatric disorders. Furthermore, iron was associated with RD, lung cancer, CKD, and psychiatric disorders, zinc with RD, CKD, and lung cancer, and nickel and vanadium with lung cancer. CONCLUSIONS: We present novel findings that different PM₂.₅ components were relevant to different causes of death. Potassium and silicon seemed most consistently associated with mortality in Denmark. KEYWORDS: Long-term exposure, PM₂.₅ components, mortality

Do alcohol policies affect everyone equally? An assessment of the effects of state policies on education-related patterns of alcohol use, 2011–2019

BackgroundPublic policies are a powerful tool to change behaviors that may harm population health, but little is known about how state alcohol policies affect different population groups. This study assesses the effects of a comprehensive measure of the state alcohol regulatory environment (the State Alcohol Policy Score or SAPS) on heavy drinking—a risk factor for premature death—on different population groups, defined by levels of educational attainment, then by race/ethnicity, and sex. MethodsWe pool each state’s Behavioral Risk Factor Surveillance Survey (BRFSS) 2011–2019 and use robust Poisson regression analyses that control for individual-level factors, state-level factors (1 year lagged SAPS score for each state, state fixed effects), and year fixed effects to assess the relationship between SAPS and heavy drinking behaviors by education group. Interaction terms test whether education moderates the relationship by race/ethnicity and gender. ResultsSAPS scores increased 2010–2018, but substantial gaps persist between states. A 10 % increase in a state’s alcohol policy score is associated with a 2 % lower prevalence in current drinking (APR=0.97, 95 % CI=0.97–0.97, p < 0.0011) although not for those with a high school education or less. A 10 % increase in the SAPS was associated with a 3 % lower prevalence of heavy drinking; interaction terms in models reveal that a 10 % increase in the SAPS was associated with a lower prevalence of heavy drinking among those with less than a college education. ConclusionNarrowing gaps in alcohol policies between states may reduce heavy drinking among those with lower educational attainment.

γ-Glutamylcysteine alleviates ethanol-induced hepatotoxicity via suppressing oxidative stress, apoptosis, and inflammation.

Alcohol abuse is a major cause of alcoholic liver disease (ALD) and can result in fibrosis and cirrhosis. γ-glutamylcysteine (γ-GC) is a precursor of glutathione (GSH) with antioxidant and anti-inflammatory properties. Our research aimed to explore the protective impact of γ-GC on ALD and its potential mechanisms of efficiency in vitro and in vivo. L02 cells were pretreated with γ-GC (20, 40, and 80 μM) for 2h and exposed to ethanol for 24 h. Cell viability, apoptosis, oxidative stress, and inflammatory levels were measured. The expression of protein cleaved caspase-3 and cleaved PARP and flow cytometry results indicated that γ-GC decreases apoptosis on L02 cells after ethanol treatment. Moreover, γ-GC also attenuated oxidative stress and mitochondrial damage in hepatocytes caused by ethanol via increasing cellular GSH, SOD activity, and mitochondrial membrane potential. In vivo experiments, γ-GC effectively reduced the AST, ALT, and TG levels in mice. The inflammation of ALD was alleviated by γ-GC both in vivo and in vitro. Additionally, histopathological examination demonstrated that γ-GC treatment lessened lipid droplet formation and inflammatory damage. In conclusion, these results showed that γ-GC has anti-inflammatory and anti-apoptotic effects on ALD because it could help hepatocytes maintain sufficient GSH levels to combat the excess reactive oxygen species (ROS) generated during ethanol metabolism. PRACTICAL APPLICATIONS: Alcohol intake is the fifth highest risk factor for premature death and disability among all risk variables. However, few medicines are both safe and effective for the treatment of ALD. As a direct precursor of GSH, γ-GC has a broad variety of potential antioxidant and anti-inflammatory applications for the treatment of numerous medical conditions. In conclusion, these results showed that γ-GC could protect cells from ALD via suppressing oxidative stress, alleviating inflammation, and preventing apoptosis.

Exploring Health and Premature Mortality of Wheelchair Users from a Medical and a Greek-Orthodox Perspective

Wheelchair users have a lower life expectancy compared to the general population. This project aims to provide a deeper understanding of the interaction between physical, psychological, social, and spiritual factors that affect the mortality and health of this target group. The methods used were qualitative. Data from phenomenological interviews, questionnaires, medical reports, and existing literature were composed to develop a grounded theory depicting the overall health of wheelchair users. The research team explored death causes, risk factors of premature death, and contributors that affect risk factors. In the discussion, we explored and analyzed specific patterns of interaction of the factors in the data and other research projects. Moreover, we attempted to analyze these patterns through the viewpoint of the Greek-Orthodox tradition. In general, the project confirmed previous research findings. The most common death causes seemed to be heart attacks and cancer. These seemed to be affected mainly by obesity, physical inactivity, unhealthy lifestyle, and inadequate preventive healthcare. Spiritual practices based on the Greek-Orthodox tradition are suggested as ways of management. The conclusions can be useful not only to health and social care professionals and clerics, but also wheelchair users themselves.

Fixed drug combinations as a way of complex antihypertensive therapy optimization: focus on the combination of amlodipine, indapamide, perindopril

This article is an analysis of current data on arterial hypertension (HTN) as a leading risk factor for premature death. We discuss the reasons of the failure to achieve target levels of blood pressure, and the available approaches to HTN pharmacological treatment by the main classes of antihypertensive drugs in accordance with current clinical guidelines. We show the advantages of fixed combinations (FC) of antihypertensive drugs and the ways to optimize antihypertensive treatment by administration of a triple FC, containing amlodipine, indapamide and perindopril.