Association of ambient particulate matter with heart failure incidence and all-cause readmissions in Tasmania: an observational study

Objectives: We sought to investigate the relationship between air quality and heart failure (HF) incidence and rehospitalisation to elucidate whether there is a threshold in this relationship and whether this relationship differs for HF incidence and rehospitalisation.Methods: This retrospective observational study was performed in an Australian state-wide setting, where air pollution is mainly associated with wood-burning for winter heating. Data included all 1246 patients with a first-ever HF hospitalisation and their 3011 subsequent all-cause readmissions during 2009-2012. Daily particulate matter 2.5), temperature, relative humidity and influenza infection were recorded. Poisson regression was used, with adjustment for time trend, public and school holiday and day of week.Results: Tasmania has excellent air quality (median PM2.5=2.9 µg/m3 (IQR: 1.8-6.0)). Greater HF incidences and readmissions occurred in winter than in other seasons (p2.5 was detrimentally associated with HF incidence (risk ratio (RR)=1.29 (1.15-1.42)) and weakly so with readmission (RR=1.07 (1.02-1.17)), with 1 day time lag. In multivariable analyses, PM2.5 significantly predicted HF incidence (RR=1.12 (1.01-1.24)) but not readmission (RR=0.96 (0.89-1.04)). HF incidence was similarly low when PM 3 and only started to rise when PM2.5≥4 µg/m3. Stratified analyses showed that PM2.5 was associated with readmissions among patients not taking beta-blockers but not among those taking beta-blockers (pinteraction=0.011).Conclusions: PM2.5 predicted HF incidence, independent of other environmental factors. A possible threshold of PM2.5=4 µg/m3 is far below the daily Australian national standard of 25 µg/m3. Our data suggest that beta-blockers might play a role in preventing adverse association between air pollution and patients with HF

Risk factors for left ventricular dysfunction in adulthood: role of low birth weight

Aims: This study aimed to determine the relationship of low birth weight (LBW) with adult cardiac structure and function andinvestigate potential causal pathways.Methods and results: A population-based sample of 925 Australians (41.3% male) were followed from childhood (aged7–15 years) to young adulthood (aged 26–36 years) and mid-adulthood (aged 36–50 years). Left ventricular (LV) globallongitudinal strain (GLS, %), LV mass index (LVMi, g/m2.7), LV filling pressure (E/e╯), and left atrial volume index (g/m2) weremeasured by transthoracic echocardiography in mid-adulthood. Birth weight category was self-reported in young adulthoodand classified as low (≤5 lb or ≤2270 g), normal (5–8 lb or 2271–3630 g), and high (>8 lb or >3630 g). Of the 925participants, 7.5% (n = 69) were classified as LBW. Compared with participants with normal birth weight, those with LBWhad 2.01-fold (95% confidence interval: 1.19, 3.41, P = 0.009) higher risks of impaired GLS (GLS > 18%) and 2.63-fold(95% confidence interval: 0.89, 7.81, P = 0.08) higher risks of LV hypertrophy (LVMi > 48 g/m2.7 in men or >44 g/m2.7 inwomen) in adulthood, independent of age, sex, and any socio-economic factors. Participants with LBW significantlyincreased body fat from childhood to adulthood relative to their peers and had greater levels of triglycerides, fastingglucose, and arterial stiffness in adulthood. These risk factors were the strongest mediators and explained 54% of the LBWeffect size on adult GLS and 33% of the LBW effect size on LVMi. The remaining of these associations was independent ofany of the measured risk factors.Conclusions: Low birth weight was associated with impaired cardiac structure and function in mid-adulthood. This association was only partially explained by known risk factors

Sexually dimorphic gene expression emerges with embryonic genome activation and is dynamic throughout development

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public DomainVKR is supported by grants from the Biotechnology and Biological Sciences Research Council, UK (BB/M012494/1), VKR and CG by (BB/G00711/X/1). MLH is supported by a Research Council UK Academic Fellowship. RL is supported by EU-FP7 BLUEPRINT

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015:a systematic analysis for the Global Burden of Disease Study 2015

Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores.Findings We generated 9.3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17.2 billion, 95% uncertainty interval [UI] 15.4-19.2 billion) and diarrhoeal diseases (2.39 billion, 2.30-2.50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2.36 billion (2.35-2.37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo.Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Copyright (C) The Author(s). Published by Elsevier Ltd.</p

Exploring attachment to the "homeland" and its association with heritage culture identification

Conceptualisations of attachment to one’s nation of origin reflecting a symbolic caregiver can be found cross-culturally in literature, art, and language. Despite its prevalence, the relationship with one’s nation has not been investigated empirically in terms of an attachment theory framework. Two studies employed an attachment theory approach to investigate the construct validity of symbolic attachment to one’s nation of origin, and its association with acculturation (operationalized as heritage and mainstream culture identification). Results for Study 1 indicated a three-factor structure of nation attachment; the factors were labelled secure-preoccupied, fearful, and dismissive nation attachment. Hierarchical linear modelling was employed to control for differing cultures across participants. Secure-preoccupied nation attachment was a significant predictor of increased heritage culture identification for participants residing in their country of birth, whilst dismissive nation attachment was a significant predictor of decreased heritage culture identification for international migrants. Securepreoccupied nation attachment was also associated with higher levels of subjective-wellbeing. Study 2 further confirmed the validity of the nation attachment construct through confirmatory factor analysis; the three-factor model adequately fit the data. Similar to the results of Study 1, secure-preoccupied nation attachment was associated with increased levels of heritage culture identification and psychological well-being. Implications of the tripartite model of nation attachment for identity and well-being will be discussed

Global, regional, and national levels of maternal mortality, 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.Peer reviewe

Associations of childhood and adult obesity with left ventricular structure and function

Background: Overweight and obesity are associated with left ventricular (LV) dysfunction. We sought whether echocardiographic evidence of abnormal adult cardiac structure and function was related to childhood or adult adiposity.Methods: This study included 159 healthy individuals aged 7-15 years and followed until age 36-45 years. Anthropometric measurements were performed both at baseline and follow-up. Cardiac structure (indexed left atrial volume (LAVi), left ventricular mass (LVMi)) and LV function (global longitudinal strain (GLS), mitral e') were assessed using standard echocardiography at follow-up. Conventional cutoffs were used to define abnormal LAVi, LVMi, GLS and mitral annular e'.Results: Childhood body mass index (BMI) was correlated with LVMi (r = 0.25, P = 0.002), and child waist circumference was correlated with LVMi (r = 0.18, P = 0.03) and LAVi (r = 0.20, P = 0.01), but neither were correlated with GLS. One s.d. (by age and sex) increase in childhood BMI was associated with LV hypertrophy (relative risk: 2.04 (95% confidence interval (CI): 1.09, 3.78)) and LA enlargement (relative risk: 1.81 (95% CI: 1.02, 3.21)) independent of adult BMI, but the association was not observed with impaired GLS or mitral e'. Cardiac functional measures were more impaired in those who had normal BMI as child, but had high BMI in adulthood (P P > 0.33).Conclusions: Childhood adiposity is independently associated with structural cardiac disturbances (LVMi and LAVi). However, functional alterations (GLS and mitral e') were more frequently associated with adult overweight or obesity, independent of childhood adiposity

Associations of childhood and adult obesity with left ventricular structure and function.

Background Overweight and obesity are associated with left ventricular (LV) dysfunction. We sought whether echocardiographic evidence of abnormal adult cardiac structure and function was related to childhood or adult adiposity. Methods This study included 159 healthy individuals aged 7-15 years and followed until age 36-45 years. Anthropometric measurements were performed both at baseline and follow-up. Cardiac structure (indexed left atrial volume [LAVi], left ventricular mass [LVMi]) and LV function (global longitudinal strain [GLS], mitral e’) were assessed using standard echocardiography at follow up. Conventional cut-offs were used to define abnormal LAVi, LVMi, GLS and mitral annular e’. Results Childhood body mass index (BMI) was correlated with LVMi (r=0.25, p=0.002), and child waist circumference was correlated with LVMi (r=0.18, p=0.03) and LAVi (r=0.20, p=0.01), but neither were correlated with GLS. One standard deviation (by age and sex) increase in childhood BMI was associated with LV hypertrophy (RR: 2.04 [95% CI: 1.09, 3.78]) and LA enlargement (RR: 1.81 [95% CI: 1.02, 3.21]) independent of adult BMI, but the association was not observed with impaired GLS or mitral e’. Cardiac functional measures were more impaired in those who had normal BMI as child but had high BMI in adulthood (p&lt;0.03), and not different in those who were overweight or obese as a child and remained so in adulthood (p&gt;0.33). Conclusions Childhood adiposity is independently associated with structural cardiac disturbances (LVMi and LAVi). However, functional alterations (GLS and mitral e’) were more frequently associated with adult overweight or obesity, independent of childhood adiposity.</p