Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Main Outcomes and Measures Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 95.9 million (95% UI, 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. Conclusions and Relevance: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher

Urban Policies and Health In Developing Countries: The Case of Maputo (Mozambique) and Cochabamba (Bolivia)

Urban planning and related policies can contribute to improvement in health. Recent epidemiological and quantitative Health Impact Assessment (HIA) studies in Europe and North America suggest that a change from passive (car) to active transportation (cycling, walking) and public transport in daily life could improve health. HIA studies are still largely lacking in low and middle-income countries. We conducted a scoping study to evaluate the availability of data to conduct quantitative HIA in two cities from two low-income countries. We collected information through interviews with different local agents, from the National Institute of Statistics and by conducting field work to identify the built environment and mobility characteristics in the respective cities. Conducting a quantitative HIA in Maputo (Mozambique) is currently not possible, mainly because there is no appropriate data on mortality, road traffic accidents and physical activity of the general population. However, in Cochabamba (Bolivia) it might be possible when the mobility plan will be available (currently under development), in which data on traffic flows, mobility surveys and transport modal shares will become available. The current paper describes two examples of the opportunities and difficulties to conduct quantitative HIA in low- and middle-income countries, highlighting the limited availability of data (quantitatively and qualitatively) on transport and urban planning and health outcomes

Toxoplasma gondii Infection and Threatened Abortion in Women from Northern Peru

Introduction. Toxoplasma gondii infection can cause important complications during pregnancy. Threatened abortion may be a late indicator for infection in settings with high prevalence of toxoplasmosis. We aimed to determine the association between T. gondii infection and threatened abortion in women from northern Peru. Methods. We conducted a secondary analysis of a cross-sectional study in pregnant women from a hospital and a rural community in Lambayeque, Peru. Exposure variable was serological diagnosis of toxoplasmosis, defined as the demonstration of either IgM or IgG antibodies against T. gondii. Outcome variable was threatened abortion, defined as the diagnosis of bloody vaginal discharge or bleeding during the first half of pregnancy. Prevalence ratios were estimated in simple and multiple regression analyses. Results. Of 218 pregnant women, 35.8% presented positive serology for T. gondii and 14.7% had threatened abortion in their current pregnancy. Pregnant women with positive T. gondii infection had 2.45-fold higher frequency of threatened abortion (PR: 2.45, 95% CI: 1.15-5.21). In addition, the frequency of threatened abortion decreased by 9% for each additional year of age (PR: 0.91, 95% CI: 0.86-0.97). A previous history of threatened abortion also showed a higher frequency of threatened abortion (PR: 5.22, 95% CI: 2.45-11.12). Conclusions. T. gondii infection is associated with threatened abortion. An early age of pregnancy and a previous history of abortion are also associated with this condition

Integrated Impact Assessment of Active Travel: Expanding the Scope of the Health Economic Assessment Tool (HEAT) for Walking and Cycling.

The World Health Organization's Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess the health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies at both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. The health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits derived from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, the impacts on carbon emissions from mode shifts to active travel modes can now be assessed. The monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behavior or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling

Urban and Transport Planning Related Exposures and Mortality: A Health Impact Assessment for Cities

BACKGROUND: By 2050, almost 70% of people globally are projected to live in urban areas. As the environments we inhabit affect our health, urban and transport designs that promote healthy living are needed. OBJECTIVE: We estimated the number of premature deaths preventable under compliance with international exposure recommendations for physical activity (PA), air pollution, noise, heat, and access to green spaces. METHODS: We developed and applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) tool to Barcelona. Exposure estimates and mortality data were available for 1357361 residents. We compared recommended with current exposure levels. We quantified the associations between exposures and mortality and calculated population attributable fractions to estimate the number of premature deaths preventable. We also modeled life-expectancy and economic impacts. RESULTS: We estimated that annually almost 20% of mortality could be prevented if international recommendations for performance of PA, exposure to air pollution, noise, heat, and access to green space were complied with. Estimations showed that the biggest share in preventable deaths was attributable to increases in PA, followed by exposure reductions in air pollution, traffic noise and heat. Access to green spaces had smaller effects on mortality. Compliance was estimated to increase the average life expectancy by 360 (95% CI: 219, 493) days and result in economic savings of 9.3 (95% CI: 4.9; 13.2) billion euro per year. CONCLUSIONS: PA factors and environmental exposures can be modified by changes in urban and transport planning. We emphasize the need for (1) the reduction of motorized traffic through the promotion of active and public transport and (2) the provision of green infrastructure, which are both suggested to provide PA opportunities and mitigation of air pollution, noise, and heat

Large-scale citizen science provides high-resolution nitrogen dioxide values and health impact while enhancing community knowledge and collective action

We present outcomes from a large-scale air quality citizen science campaign (xAire, 725 measurements) to demonstrate its positive contribution in the interplay between advances in exposure assessment and developments in policy or collective action. A broad partnership with 1,650 people from communities around 18 primary schools across Barcelona provided the capacity to obtain unprecedented high-resolution NO2 levels and an updated asthma Health Impact Assessment. It is shown that NO2 levels vary considerably with at some cases very high levels. More than a 1,000 new cases of childhood asthma could be prevented each year by lowering NO2 levels. Representativity of site selection and the minimal number of samplers for land use regression modelling are considered. Enhancement of community knowledge and attitudes towards collective response were observed and identified as key drivers for successful large-scale monitoring campaigns. The results encourage strengthening collaboration with local communities when exploring environmental health issues

Operatividad Industrial en el Mercado Bursátil colombiano.

En los estudios de inversión, se han encontrado algunas variables macro y microeconómicas con correlaciones significativas. Estas correlaciones son una manera de predecir el comportamiento de una variable frente a otra variable económica. Crear modelos de predicción, estudiar el comportamiento y la correlación de dichas variables a través del estudio estadístico y el desarrollo de modelos de predicción, es el objetivo de muchas compañías para repotenciar sus utilidades; o incluso mitigar posibles pérdidas. El objetivo principal de esta investigación es documentar un proceso de estudio económico por medio del análisis estadístico, para que las pequeñas y medianas empresas puedan repotenciar sus utilidades implementando los mismos planes de desarrollo de las grandes compañías; las cuales incrementan sus utilidades invirtiendo a través del mercado bursátil

Operatividad Industrial en el Mercado Bursátil colombiano.

En los estudios de inversión, se han encontrado algunas variables macro y microeconómicas con correlaciones significativas. Estas correlaciones son una manera de predecir el comportamiento de una variable frente a otra variable económica. Crear modelos de predicción, estudiar el comportamiento y la correlación de dichas variables a través del estudio estadístico y el desarrollo de modelos de predicción, es el objetivo de muchas compañías para repotenciar sus utilidades; o incluso mitigar posibles pérdidas. El objetivo principal de esta investigación es documentar un proceso de estudio económico por medio del análisis estadístico, para que las pequeñas y medianas empresas puedan repotenciar sus utilidades implementando los mismos planes de desarrollo de las grandes compañías; las cuales incrementan sus utilidades invirtiendo a través del mercado bursátil

Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project

Introduction: Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. Methods and analysis: PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14 000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHO's online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The study's wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice. Ethics and dissemination: Ethics approval has been obtained by the local ethics committees in the countries where the work is being conducted, and sent to the European Commission before the start of the survey. The PASTA website (http://www.pastaproject.eu) is at the core of all communication and dissemination activities. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL. Document type: Articl