Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records.

BACKGROUND: Cross-sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD. METHODS: We estimated the effect of 2-y weight change interventions on 7-y risk of CVD (CVD death, myocardial infarction, stroke, hospitalization from coronary heart disease, and heart failure) by emulating hypothetical interventions using electronic health records. We identified 138,567 individuals with 45-69 years of age without chronic disease in England from 1998 to 2016. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying confounders. We categorized each individual into a weight loss, maintenance, or gain group. RESULTS: Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for CVD compared with weight maintenance. Among overweight individuals, we observed moderately higher risk of CVD in both the weight loss [RD = 0.7% (-0.2% to 1.7%)] and the weight gain group [RD = 0.7% (-0.1% to 1.7%)], compared with maintenance. In the obese, those losing weight showed lower risk of coronary heart disease [RD = -1.4% (-2.4% to -0.6%)] but not of stroke. When we assumed that chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals. CONCLUSION: Among individuals with obesity, the weight-loss group had a lower risk of coronary heart disease but not of stroke. Weight gain was associated with increased risk of CVD across BMI groups. See video abstract at, http://links.lww.com/EDE/B838

Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records.

Funder: Department of HealthFunder: Medical Research CouncilBackgroundTargeted obesity prevention policies would benefit from the identification of population groups with the highest risk of weight gain. The relative importance of adult age, sex, ethnicity, geographical region, and degree of social deprivation on weight gain is not known. We aimed to identify high-risk groups for changes in weight and BMI using electronic health records (EHR).MethodsIn this longitudinal, population-based cohort study we used linked EHR data from 400 primary care practices (via the Clinical Practice Research Datalink) in England, accessed via the CALIBER programme. Eligible participants were aged 18-74 years, were registered at a general practice clinic, and had BMI and weight measurements recorded between Jan 1, 1998, and June 30, 2016, during the period when they had eligible linked data with at least 1 year of follow-up time. We calculated longitudinal changes in BMI over 1, 5, and 10 years, and investigated the absolute risk and odds ratios (ORs) of transitioning between BMI categories (underweight, normal weight, overweight, obesity class 1 and 2, and severe obesity [class 3]), as defined by WHO. The associations of demographic factors with BMI transitions were estimated by use of logistic regression analysis, adjusting for baseline BMI, family history of cardiovascular disease, use of diuretics, and prevalent chronic conditions.FindingsWe included 2 092 260 eligible individuals with more than 9 million BMI measurements in our study. Young adult age was the strongest risk factor for weight gain at 1, 5, and 10 years of follow-up. Compared with the oldest age group (65-74 years), adults in the youngest age group (18-24 years) had the highest OR (4·22 [95% CI 3·86-4·62]) and greatest absolute risk (37% vs 24%) of transitioning from normal weight to overweight or obesity at 10 years. Likewise, adults in the youngest age group with overweight or obesity at baseline were also at highest risk to transition to a higher BMI category; OR 4·60 (4·06-5·22) and absolute risk (42% vs 18%) of transitioning from overweight to class 1 and 2 obesity, and OR 5·87 (5·23-6·59) and absolute risk (22% vs 5%) of transitioning from class 1 and 2 obesity to class 3 obesity. Other demographic factors were consistently less strongly associated with these transitions; for example, the OR of transitioning from normal weight to overweight or obesity in people living in the most socially deprived versus least deprived areas was 1·23 (1·18-1·27), for men versus women was 1·12 (1·08-1·16), and for Black individuals versus White individuals was 1·13 (1·04-1·24). We provide an open access online risk calculator, and present high-resolution obesity risk charts over a 1-year, 5-year, and 10-year follow-up period.InterpretationA radical shift in policy is required to focus on individuals at the highest risk of weight gain (ie, young adults aged 18-24 years) for individual-level and population-level prevention of obesity and its long-term consequences for health and health care.FundingThe British Hearth Foundation, Health Data Research UK, the UK Medical Research Council, and the National Institute for Health Research

Classical BSE dismissed as the cause of CWD in Norwegian red deer despite strain similarities between both prion agents

The first case of CWD in a Norwegian red deer was detected by a routine ELISA test and confirmed by western blotting and immunohistochemistry in the brain stem of the animal. Two different western blotting tests were conducted independently in two different laboratories, showing that the red deer glycoprofile was different from the Norwegian CWD reindeer and CWD moose and from North American CWD. The isolate showed nevertheless features similar to the classical BSE (BSE-C) strain. Furthermore, BSE-C could not be excluded based on the PrPSc immunohistochemistry staining in the brainstem and the absence of detectable PrPSc in the lymphoid tissues. Because of the known ability of BSE-C to cross species barriers as well as its zoonotic potential, the CWD red deer isolate was submitted to the EURL Strain Typing Expert Group (STEG) as a BSE-C suspect for further investigation. In addition, different strain typing in vivo and in vitro strategies aiming at identifying the BSE-C strain in the red deer isolate were performed independently in three research groups and BSE-C was not found in it. These results suggest that the Norwegian CWD red deer case was infected with a previously unknown CWD type and further investigation is needed to determine the characteristics of this potential new CWD strain

Pengaruh gugus metoksi pada senyawa 4-metoksibenzaldehida dalam sintesis senyawa n-((2-hidroksinaftalen-1-il)4-metoksibenzil)etanamida melalui metode sintesis bebas pelarut dengan katalis asam borat

Pada penelitian sebelumnya, telah dilaporkan bahwa turunan 1-amidoalkil-2-naftol memiliki efek antihipertensi. Pada penelitian ini akan disintesis senyawa N-((2-hidroksinaftalen-1-il)4-metoksibenzil)etanamida yang merupakan senyawa turunan 1-amidoalkil-2-naftol dengan menggunakan metode yang mengacu pada konsep green chemistry. Tujuan dari penelitian ini yaitu untuk mengetahui pengaruh substituen metoksi pada posisi para pada benzaldehida terhadap reaksi sintesis senyawa N-((2-hidroksinaftalen-1-il)4-metoksibenzil)etanamida. Tahap awal penelitian ini yaitu mereaksikan 4-metoksibenzaldehid dan benzaldehid yang masing-masing direaksikan dengan 2-naftol, asetamida, dan asam borat sebagai katalis dengan menggunakkan radiasi gelombang mikro selama 20 menit. Kemurnian senyawa hasil sintesis dianalisis dengan pengujian titik leleh dan kromatografi lapis tipis, sedangkan identifikasi struktur dianalisis dengan spektrofotometri infra merah dan spektrometri Resonansi Magnet Inti-1H. Penelitian ini menunjukkan bahwa persentase hasil sintesis senyawa N-((2-hidroksinaftalen-1-il)4-metoksibenzil)etanamida sebesar 25,95±2,36% dan senyawa N-((2-hidroksinaftalen-1-il)benzil)etanamida sebesar 31,38±0,14% Dari data tersebut dapat disimpulkan bahwa substituen metoksi pada posisi para akan mempersulit reaksi sintesis daripada sintesis senyawa tanpa substituen

Peranan pelatihan, keselamatan dan kesehatan kerja, dan Total Quality Control dalam meningkatkan kualitas produk di di PT. X

Pada era globalisasi ini, karyawan merupakan sumberdaya utama perusahaan dituntut untuk memberikan pelayanan terbaik kepada konsumen dan memberikan kinerja yang optimal agar tidak kalah bersaing dengan perusahaan lain dan dapat menarik minat konsumen. Oleh karena itu, pengelolaan sumber daya manusia harus dilakukan dengan baik sehingga dapat meningkatkan kualitas produk. PT. X merupakan salah satu perusahaan yang bergerak di bidang farmasi. Industri farmasi membutuhkan sumber daya manusia yang ahli dalam bidangnya dan juga sarana penunjang kesehatan dan keselamatan kerja. Tujuan dari penelitian ini yaitu untuk mendeskripsikan program pelatihan, penerapan Keselamatan dan Kesehatan Kerja, pelaksanaan Total Quality Control, serta menganalisis peran pelatihan, Keselamatan dan Kesehatan Kerja, dan Total Quality Control dalam meningkatkan kualitas produk di PT. X. Penelitian ini menggunakan pendekatan kualitatif yang bersifat deskriptif. Metode penelitian yang dipilih adalah observasi dan wawancara. Hasil yang diperoleh dari penelitian ini adalah PT. X memiliki program pelatihan yang harus diikuti oleh seluruh karyawan baru namun masih belum maksimal karena tidak adanya evaluasi pelatihan, memiliki program Keselamatan dan Kesehatan Kerja yang jelas dan mudah dimengerti akan tetapi komite Keselamatan dan Kesehatan Kerja perlu ditambah agar dapat mengawasi jalannya proses produksi, serta penerapan Total Quality Control perlu diperketat untuk mengurangi produk reject

Peranan pelatihan, keselamatan dan kesehatan kerja, dan Total Quality Control dalam meningkatkan kualitas produk di di PT. X

Pada era globalisasi ini, karyawan merupakan sumberdaya utama perusahaan dituntut untuk memberikan pelayanan terbaik kepada konsumen dan memberikan kinerja yang optimal agar tidak kalah bersaing dengan perusahaan lain dan dapat menarik minat konsumen. Oleh karena itu, pengelolaan sumber daya manusia harus dilakukan dengan baik sehingga dapat meningkatkan kualitas produk. PT. X merupakan salah satu perusahaan yang bergerak di bidang farmasi. Industri farmasi membutuhkan sumber daya manusia yang ahli dalam bidangnya dan juga sarana penunjang kesehatan dan keselamatan kerja. Tujuan dari penelitian ini yaitu untuk mendeskripsikan program pelatihan, penerapan Keselamatan dan Kesehatan Kerja, pelaksanaan Total Quality Control, serta menganalisis peran pelatihan, Keselamatan dan Kesehatan Kerja, dan Total Quality Control dalam meningkatkan kualitas produk di PT. X. Penelitian ini menggunakan pendekatan kualitatif yang bersifat deskriptif. Metode penelitian yang dipilih adalah observasi dan wawancara. Hasil yang diperoleh dari penelitian ini adalah PT. X memiliki program pelatihan yang harus diikuti oleh seluruh karyawan baru namun masih belum maksimal karena tidak adanya evaluasi pelatihan, memiliki program Keselamatan dan Kesehatan Kerja yang jelas dan mudah dimengerti akan tetapi komite Keselamatan dan Kesehatan Kerja perlu ditambah agar dapat mengawasi jalannya proses produksi, serta penerapan Total Quality Control perlu diperketat untuk mengurangi produk reject