Quantifying the Socio-Economic Benefits of Reducing Industrial Dietary Trans Fats: Modelling Study.

BACKGROUND: Coronary Heart Disease (CHD) remains a leading cause of UK mortality, generating a large and unequal burden of disease. Dietary trans fatty acids (TFA) represent a powerful CHD risk factor, yet to be addressed in the UK (approximately 1% daily energy) as successfully as in other nations. Potential outcomes of such measures, including effects upon health inequalities, have not been well quantified. We modelled the potential effects of specific reductions in TFA intake on CHD mortality, CHD related admissions, and effects upon socioeconomic inequalities. METHODS & RESULTS: We extended the previously validated IMPACTsec model, to estimate the potential effects of reductions (0.5% & 1% reductions in daily energy) in TFA intake in England and Wales, stratified by age, sex and socioeconomic circumstances. We estimated reductions in expected CHD deaths in 2030 attributable to these two specific reductions. Output measures were deaths prevented or postponed, life years gained and hospital admissions. A 1% reduction in TFA intake energy intake would generate approximately 3,900 (95% confidence interval (CI) 3,300-4,500) fewer deaths, 10,000 (8,800-10,300) (7% total) fewer hospital admissions and 37,000 (30,100-44,700) life years gained. This would also reduce health inequalities, preventing five times as many deaths and gaining six times as many life years in the most deprived quintile compared with the most affluent. A more modest reduction (0.5%) would still yield substantial health gains. CONCLUSIONS: Reducing intake of industrial TFA could substantially decrease CHD mortality and hospital admissions, and gain tens of thousands of life years. Crucially, this policy could also reduce health inequalities. UK strategies should therefore aim to minimise industrial TFA intake

Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm.

Background. Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption. Methods. We developed and validated a Markov model for the Tunisian population aged 35–94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling). Results. The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (−30240 [−30580 to −29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death. Conclusions. The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations

Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study

Objective This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass index (BMI) levels, diabetes prevalence and fruit and vegetable (F&V) consumption on future coronary heart disease (CHD) mortality in Turkey for year 2025. Design A CHD mortality model previously developed and validated in Turkey was extended to predict potential trends in CHD mortality from 2008 to 2025. Setting Using risk factor trends data from recent surveys as a baseline, we modelled alternative evidence-based future risk factor scenarios (modest/ideal scenarios). Probabilistic sensitivity analyses were conducted to account for uncertainties. Subject Projected populations in 2025 (aged 25–84) of 54 million in Turkey. Results Assuming lower mortality, modest policy changes in risk factors would result in ∼25 635 (range: 20 290–31 125) fewer CHD deaths in the year 2025; 35.6% attributed to reductions in salt consumption, 20.9% to falls in diabetes, 14.6% to declines in saturated fat intake and 13.6% to increase in F&V intake. In the ideal scenario, 45 950 (range: 36 780–55 450) CHD deaths could be prevented in 2025. Again, 33.2% of this would be attributed to reductions in salt reduction, 19.8% to increases in F&V intake, 16.7% to reductions in saturated fat intake and 14.0% to the fall in diabetes prevalence. Conclusions Only modest risk factor changes in salt, saturated/unsaturated fats and F&V intake could prevent around 16 000 CHD deaths in the year 2025 in Turkey, even assuming mortality continues to decline. Implementation of population-based, multisectoral interventions to reduce salt and saturated fat consumption and increase F&V consumption should be scaled up in Turkey

A simplified design approach to prevent shrinkage cracking in patch repairs

This paper outlines two procedures for determining the interfacial shrinkage stresses in a repair patch. The first is an analytical approach based on the analogy of a bimetallic strip undergoing contraction (shrinkage). The second is a semi-empirical procedure based on strain monitoring of in situ repairs to in-service bridges. The procedures determine conversion factors to relate the specified properties of the repair materials to their in situ properties in a field repair patch. For example, the shrinkage of a repair patch is influenced by the volume–surface effect, site temperature and relative humidity which are not considered in repair material specification. Creep is initiated in situ by differential shrinkage stresses in the repair material and is determined by adopting an effective elastic modulus approach. Both procedures require the basic material properties (elastic modulus, shrinkage, creep) and geometrical details (width, depth) of the repair patch. The analytical approach incorporates the repair material creep coefficient to predict the interfacial tensile stresses. Alternatively, it uses a less rigorous, elastic approach that omits creep. The creep approach provides higher accuracy whereas the elastic approach overestimates stresses since relaxation by creep is neglected. The elastic approach is recommended for design due to its simplicity and the in-built factor of safety provided by the overestimation of tensile stress. The semi-empirical approach uses an expression derived from long-term field data to determine the strain (and consequently stresses) at the interface of the repair patch and the substrate concrete. The procedures predict the maximum interfacial tensile stress during the service life of a repair patch. They can be used to design crack-free repair patches and optimise repair material selection through a better understanding of the interaction between the repair patch and substrate concrete.</p

XMM-Newton observations of GB B1428+4217: confirmation of intrinsic soft X-ray absorption

We report the results of XMM-Newton observations of the X-ray bright, radio-loud blazar GB B1428+4217 at a redshift of z=4.72. We confirm the presence of soft X-ray spectral flattening at energies <0.7 keV as reported in previous ROSAT and BeppoSAX observations. At hard X-ray energies the spectrum is consistent with a power-law although we find the spectral slope varied between both XMM-Newton observations and is also significantly different from that reported previously. Whilst we cannot rule-out intrinsic cold absorption to explain the spectral depression, we favour a dust-free warm absorber. Cold absorption requires a column density ~1.4-1.6 x 10^22 cm^-2 whilst a warm absorber could have up to ~10^23 cm^-2 and an ionization parameter ~10^2. The spectrum of GB B1428+4217 shows remarkable parallels with that of the z=4.4 blazar PMN J0525-3343, in which the available evidence is also most consistent with a warm absorber model.Comment: 5 pages, 5 figures, MNRAS accepted. Minor changes to sections 3.1 and

Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling study

Background Reliable estimation of future trends in life expectancy and the burden of disability is crucial for ageing societies. Previous forecasts have not considered the potential impact of trends in disease incidence. The present prediction model combines population trends in cardiovascular disease, dementia, disability, and mortality to forecast trends in life expectancy and the burden of disability in England and Wales up to 2025. Methods We developed and validated the IMPACT-Better Ageing Model—a probabilistic model that tracks the population aged 35–100 years through ten health states characterised by the presence or absence of cardiovascular disease, dementia, disability (difficulty with one or more activities of daily living) or death up to 2025, by use of evidence-based age-specific, sex-specific, and year-specific transition probabilities. As shown in the English Longitudinal Study of Ageing, we projected continuing declines in dementia incidence (2·7% per annum), cardiovascular incidence, and mortality. The model estimates disability prevalence and disabled and disability-free life expectancy by year. Findings Between 2015 and 2025, the number of people aged 65 years and older will increase by 19·4% (95% uncertainty interval [UI] 17·7–20·9), from 10·4 million (10·37–10·41 million) to 12·4 million (12·23–12·57 million). The number living with disability will increase by 25·0% (95% UI 21·3–28·2), from 2·25 million (2·24–2·27 million) to 2·81 million (2·72–2·89 million). The age-standardised prevalence of disability among this population will remain constant, at 21·7% (95% UI 21·5–21·8) in 2015 and 21·6% (21·3–21·8) in 2025. Total life expectancy at age 65 years will increase by 1·7 years (95% UI 0·1–3·6), from 20·1 years (19·9–20·3) to 21·8 years (20·2–23·6). Disability-free life expectancy at age 65 years will increase by 1·0 years (95% UI 0·1–1·9), from 15·4 years (15·3–15·5) to 16·4 years (15·5–17·3). However, life expectancy with disability will increase more in relative terms, with an increase of roughly 15% from 2015 (4·7 years, 95% UI 4·6–4·8) to 2025 (5·4 years, 4·7–6·4). Interpretation The number of older people with care needs will expand by 25% by 2025, mainly reflecting population ageing rather than an increase in prevalence of disability. Lifespans will increase further in the next decade, but a quarter of life expectancy at age 65 years will involve disability. Funding British Heart Foundation

Analysis of interfacial shrinkage stresses in patch repairs

This paper presents simple analytical expressions that predict the interfacial shrinkage stresses in a repair patch over time. Four repair materials (L2, L3, L4 and G1) were applied by spraying (gunite) to unpropped compression members of two highway structures, and their performance was monitored to approximately six months' age. The elastic moduli of all the repair materials, E rm , were greater than the elastic moduli of the substrate concrete, E sub . The mechanics of patch repair interaction with the substrate were established, and analytical models, based on an analogy of the bimetallic strip undergoing a drop in temperature, were developed. Basic properties of the repair material (elastic modulus, shrinkage and tensile creep) and substrate concrete (elastic modulus), and geometrical details of the repair patch, are required to analyse the interfacial stresses in the repair patch. Verification of the analytical procedures is based on the field data, and the results show a satisfactory correlation between the actual and predicted stress redistribution.</p