Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Moments of realization: life-limiting illness in childhood—perspectives of children, young people and families

Changing patterns of childhood deaths and survival from once-fatal medical conditions mean that many children and their families face prolonged uncertainty combined with profound needs. Studies of children with life-limiting conditions tend to focus on the acute or terminal stage but rarely investigate the child’s experience of chronic life threat over long periods of time. This article describes qualitative research focused on the experiences of 11 children and young people affected by life-limiting conditions. Parents and siblings were also vital contributors (39 participants from 10 families). The aim was to understand the perceptions and experiences of the child, and to frame that understanding with family insights. This study identified several ‘moments of realization’, representing times in the child’s life when participants recognized the real threat to the child’s life, these included: questions of inheritance, diagnosis and prognosis, acute loss of abilities, slow deterioration and life-threatening surgery

P103 The daily experiences of life limited children and their families

Introduction This is a society in which children are expected to live into adulthood. Not much is known about the long-term needs of children, who will not reach adulthood, but who may live with their conditions for many years. Aims To hear directly from life limited children and their families about their day-to-day experiences. Methods Case study provided the overarching strategy combined with participant observation, interviews and an invitation for young participants to use their own artwork and photographs to help them explain their day-to-day experiences. Eleven children, parents and siblings from ten families took part (39 participants). Findings and discussion Children diagnosed early in babyhood seemed to have an identity within which the illness was integrated, perhaps because they were growing children hardly able to remember a time before their illness. The children who took part were going to lead short lives. Families tried to shut away this fact to get on with daily life and live life to the full for and with the child. Common elements (‘moments of realisation’) in the children’s life stories emerged: Questions of inheritance Diagnosis and prognosis Acute loss of abilities Slow deterioration Life threatening surgery The cycle of crisis and survival The child’s life and death. These elements followed similar patterns across cases despite the range of diagnosis; they ebbed and flowed throughout the child’s life generating fear and uncertainty for the child and their family. Care implications Families lived day-to-day in a society that expects children to live into adulthood. Participants felt alone with the knowledge that their child would die young, aware of the wider social context Professionals should be aware that ‘moments of realisation’ in the child’s unfolding life might highlight times when pressure on family communication is heightened

Reflections on the development of CHASE Children's Hospice Service

■ The tasks along the way to developing a children's hospice service are examined. ■ CHASE Children's Hospice Service aims to establish a network of care for life-limited and life- threatened children, young people and their families. ■ The services will be provided for families living mainly in SW London, Surrey and parts of West Sussex. ■ They will comprise a source of palliative and respite care for the children and their families in their own homes (community care), backed-up by a respite care service in the related hospice at Artington, near Guildford (Christopher's)

An exploration of the experiences of children affected by life limiting conditions and their families

This thesis provides an account of a qualitative study that set out to understand more about the needs and experiences of children affected by life limiting conditions and . their families. Participants included eleven children, their parents and siblings from ten families (39 participants in all). The theoretical approach is drawn towards interpretism and constructionism. Case study provided the overarching strategy and aspects of the design were drawn from Grounded Theory. The methods combined participant observation, interviews and an invitation for young participants, especially, to use their own artwork and photographs to help them explain their day-to-day experiences. Findings are presented initially through five conceptual cases (all based on the life stories of more than one child). The study identified recurring 'moments of realisation' in the children's life stories and revealed that these were the times when families recognised the threat to the child's life most clearly and needed to communicate with each other but struggled to do so. It is hoped that the conceptual cases and the concept of 'moments of realisation' will provide professionals with new ways to think about the needs and experiences of life limited children and their families. This concept challenges notions about 'one moment' to talk to the child about the life limiting nature of their illness and the somewhat linear notions of illness and dying trajectory. Participants in the research used a range of indirect topics to talk about the child's illness and dying through the research process. These are used to suggest new ideas for helping life limited children and their families to talk to each other about the child's illness and it's consequences. The findings suggest that children affected by life limiting conditions gradually integrate information about their illness and short life expectancy into their sense of self and their own life story. The children challenged concepts of biographical disruption because they demonstrated such capacity to incorporate the illness into their life stories and live life to the full.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Flora do Espírito Santo: Hypoxidaceae

Resumo A família Hypoxidaceae é cosmopolita, composta por nove gêneros e aproximadamente duzentas espécies. No Brasil encontra-se representada por três espécies pertencentes aos gêneros Curculigo e Hypoxis. O presente trabalho pretende contribuir para o conhecimento das espécies de Hypoxidaceae ocorrentes no estado do Espírito Santo. Está fundamentado no estudo das coleções depositadas nos herbários visitados, coletas de campo, além da consulta a dados bibliográficos. Para o estado foi registrado somente o gênero Hypoxis, com duas espécies, H. atlantica e H. decumbens. Descrita em 2016 para os estados da Bahia e Santa Catarina, H. atlantica é confirmada para o Espírito Santo. São apresentados descrições das espécies, comentários taxonômicos, dados sobre hábitat, ecologia e distribuição geográfica, além de fotografias. Adicionalmente, é apresentada uma chave de identificação para as espécies

New and reassessed species of griffinia (amaryllidaceae) from the brazilian atlantic forest

In the context of the revision of Amaryllidaceae tribe Griffinieae that we are preparing, we describe and illustrate a new species, Griffinia albolineata, known from a single fragment of the Atlantic Forest in the Brazilian State of Minas Gerais. It is distinguished by the foliar blade with a whitish longitudinal stripe and long-acuminate apex, unique features among the large-sized species of the genus. Additionally, we present a taxonomic reassessment of G. intermedia, described two centuries ago and historically of very uncertain identity. We provide a description and detailed distribution data, previously unpublished records, and photographs of the species in its natural habitat. We also compare the foliar anatomy and surface micromorphology of the two species. The conservation status of the two species is informally evaluated, and both are tentatively considered endangered. An identification key to the large-sized species of the genus is presented442310318CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESSem informação88881.132085/2016-0