Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

Background Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4–14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5–<25·0 kg/m2. Findings All-cause mortality was minimal at 20·0–25·0 kg/m2 (HR 1·00, 95% CI 0·98–1·02 for BMI 20·0–<22·5 kg/m2; 1·00, 0·99–1·01 for BMI 22·5–<25·0 kg/m2), and increased significantly both just below this range (1·13, 1·09–1·17 for BMI 18·5–<20·0 kg/m2; 1·51, 1·43–1·59 for BMI 15·0–<18·5) and throughout the overweight range (1·07, 1·07–1·08 for BMI 25·0–<27·5 kg/m2; 1·20, 1·18–1·22 for BMI 27·5–<30·0 kg/m2). The HR for obesity grade 1 (BMI 30·0–<35·0 kg/m2) was 1·45, 95% CI 1·41–1·48; the HR for obesity grade 2 (35·0–<40·0 kg/m2) was 1·94, 1·87–2·01; and the HR for obesity grade 3 (40·0–<60·0 kg/m2) was 2·76, 2·60–2·92. For BMI over 25·0 kg/m2, mortality increased approximately log-linearly with BMI; the HR per 5 kg/m2 units higher BMI was 1·39 (1·34–1·43) in Europe, 1·29 (1·26–1·32) in North America, 1·39 (1·34–1·44) in east Asia, and 1·31 (1·27–1·35) in Australia and New Zealand. This HR per 5 kg/m2 units higher BMI (for BMI over 25 kg/m2) was greater in younger than older people (1·52, 95% CI 1·47–1·56, for BMI measured at 35–49 years vs 1·21, 1·17–1·25, for BMI measured at 70–89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46–1·56, vs 1·30, 1·26–1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. Interpretation The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations

Healthcare professionals’ perceptions of alcoholintoxicated trauma patients: Implications for healthcare delivery at South Rand Hospital Emergency Department

Objectives: The objectives of this study were to explore healthcare professionals’ (HCPs) perceptions about patients who had been assaulted, who consult under the influence of alcohol, and to make them aware of their attitudes towards these patients, with a view to improving their care.Design: An explorative, descriptive study with 15 HCPs purposively  selected across professional categories, qualifications, work experience, gender and age. These HCPs participated in four focus group interviews on intoxicated patients who had been assaulted. The interviews were audio-taped and supplemented with field and observational notes. Themes were identified using the cut-and-paste method and grouped into categories. Findings were subjected to mental triangulation, peer review and member check, and were compared with those in the literature.Settings and subjects: HCPs who treat assault patients within the emergency department (ED) of South Rand Hospital, Rosettenville, comprised the study population. They expressed their perceptions and inner feeling about patients under the influence of alcohol who had been assaulted. Interviews were carried out in the boardroom of the hospital.Outcome measures: HCPs’ awareness of their attitudes towards assaulted patients under the influence of alcohol Results: Frustration, anger, a desire to punish intoxicated patients and concern about wastage of hospital resources were some of the stressors experienced by HCPs. Exposure to health hazards and a poor security system were concerns that arose following intimidation, aggression and verbal abuse from alcohol-intoxicated patients who had been assaulted.Conclusion: HCPs experience negative emotions and develop negative attitudes in response to alcohol-intoxicated patients who have been assaulted

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Medications are one of the most widely used therapeutic tools in the practice of medicine, since they improve or maintain the health and quality of life of the population. These benefits must be accompanied by rational use and proper disposal. If expired and/or obsolete drugs at home are not properly disposed of, there will be adverse effects on the environment such as bioaccumulation in living beings, contamination of drinking water and soil. On the other hand, they can cause damage to human health by generating resistance to pathogenic microorganisms, release of pollutants into the atmosphere, intoxication, loss of efficacy, counterfeiting or illicit trafficking. This constitutes a complex problem, which implies addressing health, educational, economic, social and environmental aspects. Objective: To survey social behaviors of the inhabitants of the city of Córdoba in the acquisition-consumption-disposal process of medicines; evaluate the degree of environmental awareness and measure the acceptance that the implementation of a differentiated collection system would have. Descriptive observational study, with a quantitative and cross-sectional approach. A specially designed survey was conducted on 606 people, in a synchronous, digital and self-administered manner. In 95% of the homes studied, medications are consumed; 62% accumulate drugs in disuse; 86.6% of the products that expire, or are left over from some treatment, are disposed of with household waste or in the toilet. Regarding environmental pollution, 88.9% are very concerned; 28.5% of those surveyed consider that it is dangerous for health to accumulate medicines and 49.5% think that disposing of them together with the garbage or down the drain contributes to environmental pollution. 98% of the population would be willing to participate in a drug safe disposal program. The level of medication consumption is high, there is an accumulation of drugs in disuse and the form of disposal is not adequate if the environmental impact is to be reduced. There is a lack of knowledge about drug contamination and the proper way to dispose of drugs. However, the high degree of environmental awareness of the Cordoba population would allow the implementation of a differentiated collection system for obsolete/expired medicines.Los medicamentos son una de las herramientas terapéuticas más utilizadas en la práctica de la medicina, ya que mejoran o mantienen la salud y la calidad de vida de la población. Estos beneficios deben estar acompañados de un uso racional y una correcta eliminación. Si los medicamentos vencidos, y/o en desuso domiciliario, no se descartan adecuadamente, se darán efectos adversos sobre el medio ambiente como bioacumulación en seres vivos, contaminación del agua potable y del suelo. Por otra parte, pueden generar daño sobre la salud humana generando resistencia a microorganismos patógenos, liberación de contaminantes a la atmósfera, intoxicación, pérdida de eficacia, falsificación o tráfico ilícito. Esto constituye un problema complejo, que implica abordar aspectos sanitarios, educativos, económicos, sociales y ambientales.&nbsp;Objetivo: Relevar conductas sociales de los habitantes de la ciudad de Córdoba en el proceso adquisición-consumo-descarte de medicamentos; evaluar el grado de conciencia ambiental y medir la aceptación que tendría la implementación de un sistema diferenciado de recolección. Estudio observacional descriptivo, de enfoque cuantitativo y transversal. Se realizó una encuesta, diseñada especialmente, a 606 personas, de manera sincrónica, digital y autoadministrada. En el 95% los hogares estudiados se consumen medicamentos; un 62% acumula fármacos en desuso; el 86.6% de los productos que expiran, o sobran de algún tratamiento, son eliminados con los desechos domésticos o al inodoro. Respecto a la contaminación ambiental, al 88.9% le preocupa mucho; el 28.5% de los encuestados considera que es peligroso para la salud acumular medicamentos y un 49.5% piensa que desecharlos junto con la basura o por el desagüe contribuye a la contaminación del ambiente. El 98% de la población estaría dispuesta a participar de un programa de descarte seguro de fármacos. El nivel de consumo de medicación es alto, hay acúmulo de fármacos en desuso y la forma de descarte no es la adecuada si se quiere disminuir el impacto ambiental. Existe desconocimiento sobre la farmacontaminación y la forma adecuada de eliminación de medicamentos. Sin embargo, el elevado grado de conciencia ambiental de la población cordobesa permitiría implementar un sistema de recolección diferenciado de medicamentos en desuso/vencidos.

The ‘state of exception’ and disaster education: a multilevel conceptual framework with implications for social justice

The term ‘state of exception’ has been used by Italian political theorist Giorgio Agamben to explain the ways in which emergencies, crises and disasters are used by governments to suspend legal processes. In this paper, we innovatively apply Agamben’s theory to the way in which countries prepare and educate the population for various types of emergencies. We focus on two main aspects of Agamben’s work: first, the paradoxical nature of the state of exception, as both a transient and a permanent part of governance. Second, it is a ‘liminal’ concept expressing the limits of law and where ‘law’ meets ‘not-law’. We consider the relationship between laws related to disasters and emergencies, and case studies of the ways in which three countries (England, Germany and Japan) educate their populations for crisis and disaster. In England, we consider how emergency powers have been orientated around the protection of the Critical National Infrastructure and how this has produced localised ‘states of exception’ and, relatedly, pedagogical anomalies. In Germany, we consider the way in which laws related to disaster and civil protection, and the nature of volunteering for civil protection, produce exceptional spaces for non-German bodies. In Japan, we consider the debate around the absence of emergency powers and relate this to Japanese non-exceptional disaster education for natural disasters. Applying Agamben’s work, we conclude by developing a new, multilevel empirical framework for analysing disaster education with implications for social justice

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Bronchial asthma is a chronic inflammatory disorder of the lower respiratory tract that causes symptoms such as wheezing, dyspnea, chest tightness and cough that vary over time in their appearance, frequency and intensity. It has been proposed that several genes with variable effects participate in its pathogenesis, as well as environmental factors, and the interaction between them modulates the clinical expression of asthma both at the beginning and in the course of the disease. Atopy is the most important identifiable predisposing factor for this disease. Environmental factors and lifestyle have been suggested as modulators in the development of atopy. Among the environmental factors, exposure to tobacco stands out, as well as exposure and sensitization to aeroallergens. There is currently no information available on how these factors influence the asthmatic pediatric population in the province of Córdoba. With the aim of analyzing the influence of exposure to tobacco and the place of residence in asthmatic patients, correlating them fundamentally with their levels of Immunoglobulin E (IgE), 65 patients with a diagnosis of allergic bronchial asthma of the Division of Allergy and Immunology of the Children\u27s Hospital of the Holy Trinity. The data was collected from the medical records compiled in the Division and analyzed statistically. No statistically significant relationship was observed between high levels of IgE (NV = 0 to 200 IU/ml) with exposure to tobacco smoke, or with the place of origin. The influence of these factors in the development and evolution of the disease is not ruled out. We propose that as it is a multifactorial disease, various genetic and environmental factors must be analyzed in order to reach conclusions that contribute to the epidemiology of this disease and that would help the treatment and follow-up of these patients.El asma bronquial es un trastorno inflamatorio crónico de las vías respiratorias inferiores que provoca síntomas tales como respiración sibilante, disnea, opresión torácica y tos que varían con el tiempo en su aparición, frecuencia e intensidad. Se ha propuesto que en su patogénesis participan varios genes con efectos variables al igual que factores ambientales, y la interacción entre los mismos modulan la expresión clínica del asma tanto en el comienzo como en la evolución de la enfermedad. La atopia es el factor predisponente identificable más importante de esta enfermedad. Los factores ambientales y el estilo de vida se han sugerido como moduladores en el desarrollo de atopia. Dentro de los factores ambientales se destacan la exposición al tabaco, tanto como la exposición y sensibilización a aeroalérgenos. Actualmente no se dispone de información de cómo estos factores influyen en la población pediátrica asmática de la provincia de Córdoba. Con el objetivo de analizar la influencia de la exposición al tabaco y el lugar de residencia en los pacientes asmáticos, correlacionándolos fundamentalmente con sus niveles de Inmunoglobulina E (IgE), se estudiaron 65 pacientes con diagnóstico de asma bronquial alérgico de la División de Alergia e inmunología del Hospital de Niños de la Santísima Trinidad. Los datos se recolectaron a partir de las historias clínicas confeccionadas en la División y se analizaron de manera estadística. No se observó una relación estadísticamente significativa entre niveles elevados de IgE (VN = 0 a 200 UI/ml) con la exposición al humo de tabaco, ni con el lugar de procedencia. No se descarta la influencia de estos factores en el desarrollo y evolución de la enfermedad. Proponemos que al ser una enfermedad multifactorial, deben de analizarse diversos factores tantos genéticos como ambientales para poder arribar a conclusiones que aporten a la epidemiologia de esta enfermedad y que ayudarían al tratamiento y seguimiento de estos pacientes.

The Show Must Go On: Navigating Rights for Broadway Productions

https://larc.cardozo.yu.edu/event-invitations-2018/1013/thumbnail.jp

Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions. Methods Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5–14 years, typically in school and cared for by child health services) and older adolescents (aged 15–24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990–2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage. Findings Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6–96·6) individuals aged 5–14 years and 80·6 million (78·2–83·3) aged 15–24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15–24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5–14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7–17·2) of those aged 5–14 years are forecasted to have obesity by 2050 (186 million [141–221]), compared with 14·2% (11·4–15·7) of those aged 15–24 years (175 million [136–203]). We forecasted that by 2050, there will be more young males (aged 5–14 years) living with obesity (16·5% [13·3–18·3]) than overweight (12·9% [12·2–13·6]); while for females (aged 5–24 years) and older males (aged 15–24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041–50: children and adolescents (males and females aged 5–24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5–14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5–14 years in Australasia; females aged 15–24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15–24 years in high-income North America. Interpretation Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis.publishedVersio

Gene-centric meta-analyses of 108,912 individuals confirm known body mass index loci and reveal three novel signals

Recent genetic association studies have made progress in uncovering components of the genetic architecture of body mass index (BMI). We used the ITMAT-Broad-CARe (IBC) array comprising up to 49,320 single nucleotide polymorphisms (SNPs) across ~2,100 metabolic and cardiovascular-related loci to genotype up to 108,912 individuals of European ancestry (EA), African Americans, Hispanics, and East Asians, from 46 studies, to provide additional insight into SNPs underpinning BMI. We used a five-phase study design: Phase I focused on meta-analysis of EA studies providing individual level genotype data; Phase II performed a replication of cohorts providing summary level EA data; Phase III meta-analyzed results from the first two phases; associated SNPs from Phase III were used for replication in Phase IV; finally in Phase V, a multi-ethnic meta-analysis of all samples from four ethnicities was performed. At an array-wide significance (P<2.40E-06), we identify novel BMI associations in loci TOMM40-APOE-APOC1 (rs2075650, P=2.95E-10), SREBF2 (a sterol regulatory element binding transcription factor gene, rs5996074, P=9.43E-07) and NTRK2 (a BDNF receptor, rs1211166, P=1.04E-06) in the Phase IV meta-analysis. Of ten loci with previous evidence for BMI association represented on IBC array, eight were replicated, with the remaining two showing nominal significance. Conditional analyses revealed two independent BMI associated signals in BDNF and MC4R regions. Of the 11 array-wide significant SNPs, three are associated with gene expression levels in both primary B-cells and monocytes; with rs4788099 in SH2B1 notably being associated with the expression of multiple genes in cis. These multi-ethnic meta-analyses expand our knowledge of BMI genetics

Men across a range of ethnicities have a higher prevalence of diabetes: findings from a cross-sectional study of 500000 UK Biobank participants

Aims: Studies show that white men have a higher prevalence of Type 2 diabetes mellitus than women at a given age and BMI, but equivalent standardized data for other ethnic groups in the UK are sparse. Methods: This cross-sectional study analysed UK Biobank data from 489 079 participants to compare the prevalence of diabetes mellitus across four major ethnic groups including: 471 700 (96.4%) white, 7871 (1.6%) South Asian, 7974 (1.6%) black and 1534 (0.3%) Chinese participants, before and after standardizing for age, socio-economic status (SES), BMI and lifestyle factors including physical activity, TV viewing, fruit and vegetable intake, processed meat, red meat, oily fish, alcohol intake and smoking. A subgroup analysis of South Asians was also undertaken. Results: Crude diabetes prevalence was higher in men across all four ethnicities. After standardizing for age, SES, BMI and lifestyle factors, a significant sex difference in diabetes prevalence persisted in white (men 6.0% vs. women 3.6%), South Asian (21.0% vs. 13.8%) and black individuals (13.3% vs. 9.7%) (P &#60; 0.0001); there was a non-significant difference between Chinese men and women (7.1% vs. 5.5%) (P = 0.211). Sex differences persisted across South Asian subgroups. Conclusions: Men across a range of major ethnic groups including white, South Asian and black, have a higher prevalence of diabetes compared with women of similar age, BMI, SES and lifestyle in the UK