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 populationbased health surveys. We obtained relative risks for the eff ects of risk factors on cause-specifi c mortality from metaanalyses 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 eff ects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specifi c population attributable fractions by the number of disease-specifi c deaths. We obtained cause-specifi c mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the fi nal 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\ub78 million deaths, 95% CI 10\ub71\u201311\ub75) of deaths from these diseases in 2010 were attributable to the combined eff ect of these four metabolic risk factors, compared with 67% (7\ub71 million deaths, 6\ub76\u20137\ub76) 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 eff ects 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 eff ect 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 globalresponse to non-communicable diseases

does participating in national and ethnic associations promote migrant integration a study with young first and second generation migrants

On arrival to a new country, migrants usually face language barriers, cultural barriers, discrimination, and other sources of unjust contextual conditions that lower their chances of a successful life (Handy and Greenspan, Nonprofit Volunt Sect Q 38:956–982, 2009). This scenario compromises their levels of well-being and supports a tendency toward social fragmentation in places of settlement (Garcia-Ramirez et al., Am J Community Psychol 47(1–2), 86–97, 2011). In response to this situation, migrants' engagement in civic life has been identified as an important element for developing both individual well-being and cohesive communities (Gilster, J Community Psychol 40(7), 769–784, 2012) (Stoll and Wong, Int Migr Rev 41(4), 880–908, 2007). Using a qualitative study, the present work explores the effects of activism on youth of sub-Saharan African origin, of the first and second generations, who are active in national and ethnic associations. The work aims to explore (1) through narratives the meaning that integration has for young migrants; (2) how integrated they feel; and (3) the role of the association, both national and ethnic, in the perception of integration of these young people

Liposomal encapsulation improves the duration of soft tissue anesthesia but does not induce pulpal anesthesia

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Study Objective: To compare the topical and the pulpal anesthesia efficacy of liposomal and plain benzocaine formulations Design: Double-blinded, randomized crossover study. Setting: University ambulatory dental center Patients: 30 ASA physical status 1 volunteers Interventions: Volunteers received, in three different sessions, topical application of liposome-encapsulated 10% benzocaine (LB10), 10% benzocaine gel (B10), and 20% benzocaine gel (B20) in the right maxillary canine mucobuccal fold Measurements: Pain associated with the needle insertion was rated by visual analog scale (VAS) and the duration of topical anesthesia was recorded Pulpal anesthesia was evaluated using an electric pulp tester Main Results: VAS values (median. 1st - 3rd quartiles) were 17 cm (11 - 25), 14 cm (3 - 22), and 21 cm (9 21) for B10, LB10, and 1320, respectively No differences were noted among the groups (Friedman test, P = 0 58) Soft tissue anesthesia was also not different The LB10 [10 (8 - 12) min] showed longer soft tissue anesthesia (Friedman test, P < 0 01) than the other agents [1310 = 8 (5 - 10) min, and B20 = 7 (6 - 9) min] None of the topical benzocaine formulations tested induced pulpal anesthesia Conclusions: The encapsulation of benzocaine into liposome increased the duration of soft tissue anesthesia However, it did not induce pulpal anesthesia (C) 2010 Elsevier Inc All rights reserved225313317DFL Ind Corn Ltda, Rio de Janeiro, BrazilConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Automedicação na adolescência: um desafio para a educação em saúde Self-medication in adolescence: a challenge to health education

O estudo visa analisar o conhecimento dos estudantes de escolas públicas e privadas do município de Fortaleza (CE) sobre o uso de medicamentos e suas implicações para a saúde. Trata-se de um estudo descritivo, com 722 adolescentes matriculados em dez escolas do município de Fortaleza. Levantou-se, por meio de um questionário, aspectos relativos ao consumo, indicação e orientação de medicamentos e a influência da mídia. Relataram uso de medicamentos, nos últimos sessenta dias, 72,0% dos participantes, sendo os analgésicos os mais citados (65,4%). Os responsáveis pelas indicações foram familiares (51,2%) e médicos (33,1%), sendo a automedicação relatada por 20,8% dos estudantes. Não receberam orientações sobre o uso correto de medicamentos 70,9% dos alunos. Do total, 34,1% revelaram já terem sido influenciados por meios de comunicação na compra de medicamentos. É possível concluir que o conhecimento dos adolescentes sobre medicamentos e suas implicações na saúde é bastante incipiente e desprovido de qualquer noção básica sobre o uso racional deles. Além disso, os estudantes da rede pública são mais orientados sobre o uso correto de medicamentos, por parte dos profissionais do sistema público de saúde, o que demonstra a eficiência do sistema como promotor de saúde da população matriculada em escolas públicas de Fortaleza.<br>The study aims to examine the knowledge of students of public and private schools in the city of Fortaleza, Ceará State, Brazil on the use of medicine and their health implications. It is a descriptive study of 722 adolescents enrolled in ten schools in the city of Fortaleza. He got up aspects of consumption, indication and guidance medicine and influence of the media using a questionnaire. Seventy two percent of the participants reported use of medicine the last 60 days, and painkillers were the most cited (65.4%). The indications were responsible for the family (51.2%) and physicians (33.1%), and the self-medication by 20.8% of the students. Regarding the use of medicine 70.9% of the students were not instructed on the proper use of the medicine. Of the total, 34.1% had already been influenced by media in the purchase of medicine. It's possible to conclude that teenagers' knowledge about medicine and its implications on health is very weak and devoid of any basic notion of the rational use of medicine. In addition, public school students are more oriented on the proper use of medicines by professionals in the public health system, which demonstrates the efficiency of the promoter of health of the population enrolled in public schools in Fortaleza