The Association between Chronic Arsenic Exposure and Hypertension: A Meta-Analysis

Background. There is inconclusive evidence from cross-sectional and cohort studies that arsenic exposure is a risk factor involved in the development of hypertension. Methods. A database search, using several keywords, was conducted to identify relevant studies. Separate odds ratio estimates for arsenic exposure with concentration only and arsenic exposure with duration, including biomarker, were extracted from studies that met all inclusion criteria. The extracted odds ratios (OR) comparing the highest exposure categories with the lowest in each study were pooled using the random effects methods of meta-analysis. Heterogeneity of odds ratios in the included studies were analyzed using I2 statistics. Results. Eight studies were analyzed. Using the exposure as arsenic concentration in the drinking water, the OR estimate was 1.9 (95% CI: 1.2–3.0), with the I2 = 92%, while using the exposure as concentration and duration, the OR estimate was 1.4 (95% CI: 0.95–2.0) with the I2 = 80%. Meta-regression was done and the quality of exposure measurement was found to be significantly associated with the effect measure. For a one unit increase in the score from exposure assessment, the odds ratio decreased by 6%. No publication bias was evident. The only major weaknesses of this study were heterogeneity across studies and small sample size. Conclusions. The study findings provide limited evidence for a relationship between arsenic and hypertension. In summary, the relationship between arsenic exposure and hypertension is still inconclusive and needs further validation through prospective cohort studies

Systematic review and meta-analysis of residential radon and lung cancer in never-smokers

Background: Globally, radon is the leading risk factor for lung cancer in never-smokers (LCINS). In this study, we systematically reviewed and meta-analysed the evidence of the risk of LCINS associated with residential radon exposure. Methods: Medline and Embase databases were searched using predefined inclusion and exclusion criteria to identify relevant studies published from 1 January 1990 to 5 March 2020 focused on never-smokers. We identified four pooled collaborative studies (incorporating data from 24 case–control studies), one case–control study and one cohort study for systematic review. Meta-analysis was performed on the results of the four pooled studies due to different measures of effect and outcome reported in the cohort study and insufficient information reported for the case–control study. In a post hoc analysis, the corresponding risk for ever-smokers was also examined. Results: Risk estimates of lung cancer from residential radon exposure were pooled in the meta-analysis for 2341 never-smoker cases, 8967 never-smoker controls, 9937 ever-smoker cases and 12 463 ever-smoker controls. Adjusted excess relative risks (aERRs) per 100 Bq·m−3 of radon level were 0.15 (95% CI 0.06–0.25) for never-smokers and 0.09 (95% CI 0.03–0.16) for ever-smokers, and the difference between them was statistically insignificant (p=0.32). The aERR per 100 Bq·m−3was higher for men (0.46; 95% CI 0.15–0.76) than for women (0.09; 95% CI −0.02–0.20) among never-smokers (p=0.027). Conclusion: This study provided quantified risk estimates for lung cancer from residential radon exposure among both never-smokers and ever-smokers. Among never-smokers in radon-prone areas, men were at higher risk of lung cancer than womenS

Annual Incidence of Snake Bite in Rural Bangladesh

Snake bite is one of the major causes of morbidity and mortality in many rural tropical areas. As a neglected public health problem, estimate of the risk is largely unknown. However, the associated personal and economic impact of snake bite is substantial across developing countries. This national survey investigated the risk and consequences of snake bite among the rural Bangladeshi population. We surveyed 18857 individuals from 24 out of 64 districts in Bangladesh where 98 snake bites including one death were reported. The estimated incidence density of snake bite is 623.4/ 100,000 person years (95% CI: 513.4–789.2/100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) received snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of them went directly to either a medical doctor or a hospital. The observed rate of snake bite in rural Bangladesh is substantially higher than anticipated. This coupled with poor access to health services led to an increase in related morbidity and mortality. An improvement in public health actions is therefore warranted

The effect of access to water, sanitation and handwashing facilities on child growth indicators: Evidence from the Ethiopia Demographic and Health Survey 2016.

IntroductionPoor access to water, sanitation, and handwashing (WASH) facilities frequently contribute to child growth failure. The role of access to WASH facilities on child growth outcomes in Ethiopia is largely unknown. The aim of this study was to determine individual and combined effects of access to WASH facilities on child growth outcomes.MethodsData for this analysis was sourced from the recent Ethiopia Demographic and Health Survey (EDHS) 2016. A multivariable logistic regression model was applied to identify the separate and combined association of access to WASH facilities with child growth outcomes. Odds ratio (OR) and 95% confidence interval (CI) were estimated. Statistical significance was declared at p ResultsIncluded in the analyses were data for children 0-59 months of age, which amounted to valid data for 9588 children with a height-for-age z-score (HAZ), 9752 children with a weight-for-age z-score (WAZ) and 9607 children with a weight-for-height z-score (WHZ). Children with access to improved combined sanitation with handwashing facilities had 29% lower odds of linear growth failure (stunting) (adjusted odds ratio (AOR) = 0.71; 95% CI: 0.51-0.99) compared with those with unimproved. Children with access to combined improved WASH facilities were 33% less likely to have linear growth failure (AOR = 0.67; 95% CI: 0.45-0.98). Access to improved handwashing alone reduced the odds of being underweight by 17% (AOR = 0.83; 95% CI: 0.71-0.98) compared with unimproved. Improved water and sanitation separately as well as combined WASH were not associated with decreased odds of underweight and wasting.ConclusionsCombined access to improved water, sanitation and handwashing was associated with reduced child linear growth failure. Further research with robust methods is needed to examine whether combined WASH practices have synergistic effect on child growth outcomes

Short-term predictive ability of selected cardiovascular risk prediction models in a rural Bangladeshi population: A case-cohort study

Background: Prediction of absolute risk of cardiovascular diseases (CVDs) has important clinical and public health significance, but the predictive ability of the available tools has not yet been tested in the rural Bangladeshi population. The present study was undertaken to test the hypothesis that both laboratory-based (Framingham equation and WHO/ISH laboratory-based charts) and non-laboratory-based tools may be used to predict CVDs on a short-term basis. Methods: Data from a case-cohort study (52989 cohort and 439 sub-cohort participants), conducted on a rural Bangladeshi population, were analysed using modified Cox PH model with a maximum follow-up of 2.5 years. The outcome variable, coronary heart diseases (CHDs), was assessed in 2014 using electrocardiography, and it was used as a surrogate marker for CVDs in Bangladesh. The predictive power of the models was assessed by calculating C-statistics and generating ROC curves with other measures of diagnostic tests. Results: All the models showed high negative prediction values (NPVs, 84 % to 92 %) and these did not differ between models or gender. The sensitivity of the models substantially changed based on the risk prediction thresholds (between 5-30 %); however, the NPVs and PPVs were relatively stable at various threshold levels. Hypertension and dyslipidaemia were significantly associated with CHD outcome in males and ABSI (a body shape index) in females. All models showed similar C-statistics (0.611-0.685, in both genders). Overall, the non-laboratory-based model showed better performance (0.685) in women but equal performance in men. Conclusions: Existing CVD risk prediction tools may identify future CHD cases with fairly good confidence on a short-term basis. The non-laboratory-based tool, using ABSI as a predictor, may provide better predictive accuracy among women

Prevalence of risk factors for cardiovascular diseases in Bangladesh: A systematic review and meta-analysis

Background: Given the rising incidence of cardiovascular diseases (CVDs) in Bangladesh, an improved understanding of the epidemiology of CVD risk factors is needed. Therefore, we reviewed published studies on CVD modifiable risk factors e.g., Type 2 Diabetes Mellitus (T2DM), hypertension (HTN), dyslipidemia and smoking as well as studies on CVDs and conducted a meta-analysis of risk factors and disease prevalence. Methods: We searched the GLOBAL HEALTH, MEDLINE, EMBASE \u27BanglaJol\u27 databases for all studies in English on CVDs and its associated modifiable risk factors. Random effects meta-analysis methods were used to estimate pooled prevalence. Results: There were 74 eligible studies (outcome: T2DM = 32, HTN = 24, dyslipidaemia = 8 and smoking = 25; CVDs = 10). Due to high between study heterogeneity (p\u3c0.001, I2\u3e 95%) in the prevalence of CVD risk factors, we presented median and interquartile range (IQR) instead of the pooled estimates as the summary measures. Median (IQR) prevalence of T2DM, HTN, dyslipidemia and smoking were 5.9% (1.97%-8.25%); 15.1% (10.52%-17.60%); 34.35% (10.66%-48.50%) and 40.56% (0.80%-55.95%), respectively. The prevalence of T2DM and dyslipidemia were significantly higher in urban compared to rural populations (13.5 vs 6%, p\u3c0.001; 41.5 vs 30%, p = 0.007, respectively). Conclusions: The prevalence of risk factors for CVDs is high in Bangladesh, more so in urban areas. Ageing of the population may be a factor but urbanization seems to have an influence, possibly related to changes in dietary and physical activity patterns. Further research, in particular longitudinal studies, is needed to explore the complex interaction of these factors and to inform policies and programs for the prevention and management of CVDs in Bangladesh

Health literacy and health-promoting behaviours among Australian-Singaporean communities living in Sydney metropolitan area

Background: Health literacy affects how individuals navigate and make decisions within the healthcare system and has been recognized to influence health behaviours. However, less is known about its associations with health-promoting behaviours amongst Australian migrant populations. This study is an attempt to fill this gap by investigating the level of health literacy and its associations with physical activity, healthy diet, smoking and health services utilization among Australian-Singaporean communities. Methods: A total of 157 participants were recruited from Singaporean communities living in Sydney metropolitan areas, New South Wales, Australia. Data was collected through a cross-sectional online survey from January 2016 to August 2016. Results: Most of the respondents were female (56.1%), employed (70.7%) and had lived in Sydney for >5 years (80.3%). About 60% of the participants were inadequately health-literate (Brief Health Literacy Screening Tool score ≤ 16). The level of health literacy varied significantly based on participants’ socioeconomic status. Regression analysis indicated that health literacy was a reliable predictor of health-promoting behaviours including diet, body mass index, smoking and alcohol consumption, physical activity and having a medical check-up. Conclusions: This study’s findings have significant implications for health policy makers and suggest that health literacy should be encouraged and included in any health-promoting behaviour interventions amongst migrant populations

Chronic arsenic exposure and type 2 diabetes : a meta-analysis

Chronic exposure to inorganic arsenic in drinking water has been associated with Type 2 Diabetes (T2D). However, the association is still inconclusive. We incorporated 33 studies in the analysis including 13 cross-sectional, 6 case-control and 4 cohort studies reporting Odds Ratio (OR), 6 cross-sectional and cohort studies reporting Relative Risk (RR) and 3 mortality studies reporting Standardized Mortality Ratio (SMR). The pooled OR estimate was 1.76 (95% CI: 1.43, 2.17), pooled RR was 1.17 (95% CI: 0.95, 1.45) and pooled SMR was 0.79 (95% CI: 0.59, 1.06), and the overall pooled estimate was 1.55 (95% CI: 1.27, 1.88). The study heterogeneity was very high (I2 = 97% for case-control studies, 47% for cohort studies, and overall 98%). Because of the very high heterogeneity and non-significant results from cohort studies, this analysis provides a limited evidence for an association between arsenic and Type 2 Diabetes (T2D) that needs further validation

Smokeless tobacco consumption in the South Asian population of Sydney, Australia: prevalence, correlates and availability

Aim.: The aim of this study was to estimate the prevalence and identify correlates of smokeless tobacco consumption among the South Asian residents of Sydney, Australia. Methods.: A cross-sectional survey was conducted using a pretested, self-administered mailed questionnaire among members of Indian, Pakistani and Bangladeshi community associations in Sydney. Results.: Of 1600 individuals invited to participate, 419 responded (26%). Prevalence rates of ever consumption, more than 100 times consumption and current consumption were 72.1%, 65.9% and 17.1%, respectively. Men (74.3%) were more likely to ever consume than women (67.6%). Over 96% of consumers reported buying smokeless tobacco products from ethnic shops in Sydney. Current consumption of smokeless tobacco products was associated with country of birth: Indians (odds ratio 5.7, 95% confidence interval 2.3-14.5) and Pakistanis (odds ratio 3.1, 95% confidence interval 1.5-6.5) were more likely to be current consumers than Bangladeshis after adjusting for sociodemographic variables. For ever consumption, there was a positive association with age (P for trend=0.013) and male gender (odds ratio 2.1, 95% confidence interval 1.5-3.1). Conclusions.: Given the availability of smokeless tobacco and the high prevalence and potential adverse health consequences of consumption, smokeless tobacco consumption may produce a considerable burden of non-communicable disease in Australia. Effective control measures are needed, in particular enforcement of existing laws prohibiting the sale of these products