Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

Hip fractures: nutrition, lifestyle factors and socio-economic factors

Hip fractures constitute a major and growing public health problem in the western world and an emerging problem in the developing countries. They are associated with considerable disability, loss of independence and diminished quality of life, as well as with a 20% reduction in expected survival. The importance of preventing at least part of these fractures cannot be overemphasized. Recognizing and better understanding the factors affecting the risk of hip fracture is a major step towards reducing its burden. This thesis was conducted in the Department of Hygiene, Epidemiology and Medical Statistics of the University of Athens Medical School. It aimed to explore the associations of hip fractures with life-style factors, such as nutrition and physical activity, as well as socio-economic status. The thesis was based on data collected in the context of the Greek component of the European Prospective Investigation into Cancer and nutrition (EPIC) study. EPIC is a multicenter prospective cohort study set up to investigate the role of nutrition and other lifestyle factors in the development of cancer and other chronic diseases. The original Greek EPIC population comprised 28.572 healthy volunteers, 11.954 men and 16.618 women, aged 30 to 82 years. This thesis used data from 8.521 participants, 3.461 men and 5.060 women, 60 years or older (mean age: 67.2, SD.4.5 years, age ranges: 60 to 86 years) at recruitment. For the purposes of this study, the following variables were examined: age, sex, body height, body mass index, educational level, physical activity, nutrition, smoking, history of diabetes mellitus, past fractures and gynaecological history. During a median follow-up time of 8 years and the total accumulation of 60.118 person-years, 105 hip fractures of low impact (20 men and 85 women) were ascertained. The factors that were found to be inversely associated with hip fracture risk were: increased body mass index, consumption of fish and consumption of unsaturated lipids. Increased physical activity appeared also to provide a protective effect, albeit to non-statistically significant level. High educational level did not appear to provide a statistically significant protective effect in this population. The factors that were found to be positively associated with hip fracture risk were: age, female gender, diabetes mellitus, menopause at a younger age and consumption of sweets. In conclusion, populations at high risk for suffering hip fractures comprised women, and particularly those with early menopause, individuals older than 70 years of age and those suffering from diabetes mellitus. Prevention strategies should aim at emphasising optimal body weight, promotion of physical activity and preference of dietary patterns rich in fish and seafood, as well as, unsaturated lipids with avoidance of excess consumption of saturated lipids and sweets.Στόχος της διατριβής ήταν η διερεύνηση των σχέσεων μεταξύ των καταγμάτων του ισχίου και παραγόντων του τρόπου ζωής, όπως η διατροφή και η φυσική δραστηριότητα, καθώς και κοινωνικο-οικονομικών παραγόντων, όπως το επίπεδο εκπαίδευσης. Τα δεδομένα προέρχονται από το Ελληνικό τμήμα του Ευρωπαϊκού Προγράμματος συνεργασίας Ιατρικής και Κοινωνίας με το ακρωνύμιο ΕΠΙΚ. Το πρόγραμμα ΕΠΙΚ αποτελεί πολυκεντρική επιδημιολογική μελέτη, προοπτικού τύπου, σχεδιασμένη με στόχο τη διερεύνηση του ρόλου της διατροφής, του τρόπου ζωής καθώς και άλλων γενετικών και μη χαρακτηριστικών στην αιτιολογία των κακοήθων νεοπλασιών και άλλων χρόνιων νοσημάτων. Τον πληθυσμό αναφοράς αποτέλεσαν 28.572 άτομα, 16.618 γυναίκες και 11.954 άνδρες, ηλικίας 30-82 ετών, κατά τεκμήριο υγιείς, μόνιμοι κάτοικοι της Ελλάδας που συμμετείχαν εθελοντικά στο πρόγραμμα ΕΠΙΚ. Από τον πληθυσμό αναφοράς για τη διατριβή αυτή χρησιμοποιήθηκε δείγμα 8.521 ατόμων, 3.461 άνδρες και 5.060 γυναίκες, ηλικίας 60 ετών και άνω κατά την ένταξη τους στην έρευνα (μέση ηλικία 67,2 έτη με σταθερή απόκλιση 4,5 έτη και εύρος τιμών: 60 ως 86 ετών) με πλήρη στοιχεία σε όλες τις μεταβλητές. Στο δείγμα αυτό εξετάσθηκαν οι παρακάτω μεταβλητές: ηλικία, φύλο, ανάστημα, δείκτης μάζας σώματος, επίπεδο εκπαίδευσης, φυσική δραστηριότητα, διατροφή, καπνισματικές συνήθειες, ιστορικό σακχαρώδους διαβήτη, ιστορικό προηγηθέντος κατάγματος και για τις γυναίκες γυναικολογικό ιστορικό. Κατά τη διάρκεια διαχρονικής παρακολούθησης διάμεσης διάρκειας 8 ετών και τη σταδιακή άθροιση 60.118 ανθρωπο-ετών καταγράφηκαν 105 επιβεβαιωμένα περιστατικά κατάγματος του ισχίου (20 άνδρες, 85 γυναίκες) χαμηλής ισχύος. Τα κυριότερα ευρήματα ήταν τα εξής: Παράγοντες που σχετίζονται αρνητικά με το κάταγμα του ισχίου και φαίνεται να δρουν προστατευτικά, σε στατιστικά σημαντικό βαθμό, ήταν: ο αυξημένος δείκτης μάζας σώματος, η κατανάλωση ψαριών και θαλασσινών και η κατανάλωση ακόρεστων λιπιδίων. Η αυξημένη φυσική δραστηριότητα εκτός εργασίας επίσης φαίνεται να επιδρά προστατευτικά στην εμφάνιση κατάγματος του ισχίου παρά το γεγονός ότι η συσχέτιση αυτή δεν ήταν στατιστικά σημαντική. Παράγοντες που βρέθηκαν να σχετίζονται θετικά, σε στατιστικά σημαντικό βαθμό με το κάταγμα του ισχίου και επομένως αυξάνουν τον κίνδυνο εμφάνισής του ήταν: το γυναικείο φύλο, η μεγαλύτερη ηλικία (άνω των 70 ετών), το ιστορικό σακχαρώδους διαβήτη, η εμμηνόπαυση σε νεαρή ηλικία και η κατανάλωση προϊόντων ζάχαρης. Το επίπεδο εκπαίδευσης δε βρέθηκε να αποτελεί σημαντικό παράγοντα κινδύνου στα δεδομένα μας. Συμπερασματικά, πληθυσμοί υψηλού κινδύνου για την εμφάνιση κατάγματος του ισχίου είναι οι γυναίκες και ιδιαίτερα αυτές με πρώιμη εμμηνόπαυση, τα άτομα ηλικίας μεγαλύτερης των 70 ετών και οι πάσχοντες από σακχαρώδη διαβήτη. Οι στρατηγικές πρόληψης θα πρέπει να επικεντρώνονται στη αποφυγή εκτροπών από το φυσιολογικό βάρος, στην προαγωγή της φυσικής δραστηριότητας και στη προτίμηση διατροφικών προτύπων πλούσιων σε ψάρια και θαλασσινά καθώς και σε ακόρεστα λιπίδια με αποφυγή υπερκατανάλωσης κορεσμένων λιπιδίων και προϊόντων ζάχαρης

Atrioventricular Conduction Disturbances in Hyperthyroidism

A 73-year-old man was referred from another hospital to our department for permanent pacemaker implantation due to persistent (more than 3 days) complete atrioventricular (AV) block. His past medical history included history of hyperthyroidism under treatment with carbimazol 2.5 mg once daily. On admission, serum thyroxin stimulating hormone concentration was <0.01 μIU/ml (normal 0.35-4.95 μIU/ml). Antithyroid drug treatment was intensified. Five days after admission complete heart block persisted on ECG, but 1 week later the ECG revealed a junctional rhythm, which resolved to first degree AV block on the tenth day of hospitalization and the patient was discharged. Subsequent follow up at 3 months after discharge with 24-hour holter recording, revealed normal sinus rhythm without any conduction disturbances

A neural network approach to audio-assisted movie dialogue detection

Abstract A novel framework for audio-assisted dialogue detection based on indicator functions and neural networks is investigated. An indicator function defines that an actor is present at a particular time instant. The cross-correlation function of a pair of indicator functions and the magnitude of the corresponding cross-power spectral density are fed as input to neural networks for dialogue detection. Several types of artificial neural networks, including multilayer perceptrons (MLPs), voted perceptrons, radial basis function networks, support vector machines, and particle swarm optimization-based MLPs are tested. Experiments are carried out to validate the feasibility of the aforementioned approach by using ground-truth indicator functions determined by human observers on six different movies. A total of 41 dialogue instances and another 20 non-dialogue instances are employed. The average detection accuracy achieved is high, ranging between 84:78% AE 5:499% and 91:43% AE 4:239%.

A neural network approach to audio-assisted movie dialogue detection

A novel framework for audio-assisted dialogue detection based on indicator functions and neural networks is investigated. An indicator function defines that an actor is present at a particular time instant. The cross-correlation function of a pair of indicator functions and the magnitude of the corresponding cross-power spectral density are fed as input to neural networks for dialogue detection. Several types of artificial neural networks, including multilayer perceptrons, voted perceptrons, radial basis function networks, support vector machines, and particle swarm optimization-based multilayer perceptrons are tested. Experiments are carried out to validate the feasibility of the aforementioned approach by using ground-truth indicator functions determined by human observers on 6 different movies. A total of 41 dialogue instances and another 20 non-dialogue instances is employed. The average detection accuracy achieved is high, ranging between 84.78%±5.499% and 91.43%±4.239%