Relationship of Body Mass Index to Cancer Incidence in Young and Middle Aged Men and Women followed over 24 years: The Tromsø Study

Background: Obesity remains a serious but preventable challenge of our time, and it has been linked to many comorbidities. This study uses body mass index (BMI) as a measure of obesity to investigate the relationship between low and high BMI and total cancer incidence, as well as some common specific cancers. These relationships were explored in relatively young subjects who may lose more life years to cancer. Method: A population-based cohort study was carried out using the third Tromsø survey of 1986-87 (Tromsø 3) with the Norwegian Cancer Registry (up to December 2010). The cohorts, which were year of birth based, were aged 20-61 years (men) and 20-56 years (women) in 1986. A total of 19,943 subjects (10,219 men and 9,724 women) were followed up for a mean period of 22.41 years. During the follow-up period, a total of 2,248 incident cancers were identified with 1,252 (55.7%) in men, and 996 (44.3%) in women. The relationship of the subjects’ BMI to the cancer incidence was explored using Cox proportional hazards regression to compute the hazard ratios (HR). In most of the analyses, subjects with BMI 20.0-24.9 kg/m2 were the reference category. Results: In men, a U-shaped relationship between BMI and total cancer incidence was observed, with men of BMI 20.0-24.9 kg/m2 having the lowest risk of cancer occurrence (BMI < 20.0 kg/m2: HR=1.41 [95% CI: 1.03-1.93]; BMI ≥ 30.0 kg/m2: HR=1.30 [95% CI: 1.03-1.63]). Unlike in men, there was essentially no relationship between BMI and the total cancer incidence observed in women. BMI appeared indifferent to prostate cancer risk, while BMI < 20.0 kg/m2 and ≥ 30.0 kg/m2 were associated with increased risk of lung cancer. In men, BMI may be a strong risk factor in colon cancer, with BMI < 25.0 kg/m2 having the lowest risk (BMI 25.0-29.9 kg/m2: HR=1.81 [95% CI: 1.19-2.74]; BMI ≥ 30.0 kg/m2: HR=1.83 [95% CI: 0.88-4.07]). In women, a null relationship was observed. However, when the women cohort were stratified into 2 by their mean age at baseline, 36 years, a relatively strong positive linear relationship was found between BMI and colon cancer risk in those younger than 36 years at the study baseline (BMI 25.0-29.9 kg/m2: HR=2.09 [95% CI=0.57-7.58]; BMI ≥ 30.0 kg/m2: HR=5.26 [95% CI: 1.15-24.06]). In men, a positive linear relationship was found between BMI and the risk of colorectal cancer. No marked fluctuation in the risk of colorectal cancer was observed in women. Conclusion: Low and high BMI have impacts on the total cancer risk in the relatively young and the middle aged population, as well as the risk of some of the other specific cancers studied. Therefore, any public health policies directed at reducing cancer incidents should address both ends of the BMI spectrum in the community

Lifestyle factors and colorectal cancer: The Norwegian Women and Cancer Study

Colorectal cancer (CRC) is a major global disease. The incidence rate among Norwegian women is currently the highest in the world. Lifestyle factors have a substantial influence on CRC susceptibility. However, it is not clear whether these factors are responsible for the high incidence in Norwegian women, or whether they play a role in CRC survival. This doctoral project investigated lifestyle factors in relation to CRC incidence and survival. We used self-reported information from the Norwegian Women and Cancer (NOWAC) Study, linked with Cancer Registry of Norway and Statistics Norway. We used Cox proportional hazards models to calculate hazard ratios for CRC risk by physical activity levels. We used the Karlson, Holm, and Breen method of decomposition to examine the extent to which the risk factors accounted for the observed geographical differences in CRC incidence. We performed competing mortality risks analyses to determine the associations between pre-diagnostic lifestyle factors and CRC survival. We found no association between physical activity level and the risk of CRC. Adult height, being a former smoker, or a current smoker, were associated with increased CRC risk; and a duration of education of >12 years, and a fruit and vegetable intake of >300 g/day were associated with reduced CRC risk. However, these factors combined, did not account for the geographical variations in CRC incidence. Finally, we found that a pre-diagnostic vitamin D intake of >10 μg/day was associated with 25% reduction in CRC death. Our data suggest that women may need to look further than physical activity in order to reduce their risk of CRC; and lifestyle factors did not explain geographical variations in CRC incidence in Norwegian women. A pre-diagnostic vitamin D intake could improve CRC survival

Covid-19-related misinformation on social media: a systematic review

Source at https://www.who.int/publications/journals/bulletin/. Objective - To review misinformation related to coronavirus disease 2019 (COVID-19) on social media during the first phase of the pandemic and to discuss ways of countering misinformation. Methods - We searched PubMed®, Scopus, Embase®, PsycInfo and Google Scholar databases on 5 May 2020 and 1 June 2020 for publications related to COVID-19 and social media which dealt with misinformation and which were primary empirical studies. We followed the preferred reporting items for systematic reviews and meta-analyses and the guidelines for using a measurement tool to assess systematic reviews. Evidence quality and the risk of bias of included studies were classified using the grading of recommendations assessment, development and evaluation approach. The review is registered in the international prospective register of systematic reviews (PROSPERO; CRD42020182154). Findings - We identified 22 studies for inclusion in the qualitative synthesis. The proportion of COVID-19 misinformation on social media ranged from 0.2% (413/212 846) to 28.8% (194/673) of posts. Of the 22 studies, 11 did not categorize the type of COVID-19-related misinformation, nine described specific misinformation myths and two reported sarcasm or humour related to COVID-19. Only four studies addressed the possible consequences of COVID-19-related misinformation: all reported that it led to fear or panic. Conclusion Social media play an increasingly important role in spreading both accurate information and misinformation. The findings of this review may help health-care organizations prepare their responses to subsequent phases in the COVID–19 infodemic and to future infodemics in general

Belief in COVID-19 Conspiracy Theories, Level of Trust in Government Information, and Willingness to Take COVID-19 Vaccines Among Health Care Workers in Nigeria: Survey Study

Background: The World Health Organization recently declared vaccine hesitancy or refusal as a threat to global health. COVID-19 vaccines have been proven efficacious and are central to combatting the pandemic. However, many—including skilled health care workers (HCWs)—have been hesitant in taking the vaccines. Conspiracy theories spread on social media may play a central role in fueling vaccine hesitancy. Objective: The objective of this study was to investigate HCWs’ belief in COVID-19 vaccine conspiracy theories (ie, that the vaccines can alter one’s DNA or genetic information and that the vaccines contain microchips) and trust in government information on COVID-19 vaccines. Methods: Health care workers in Ondo State, Nigeria, representing different health care professions were asked to participate anonymously in an online survey. The participants were asked about their beliefs in 2 viral conspiracy theories and their trust in government information on COVID-19 vaccines. We used multivariable logistic regressions to investigate the relationships between trust in government information on COVID-19 vaccines and (1) belief in DNA alteration, (2) belief in microchip implantation through the vaccine, and (3) willingness to accept the vaccine. Results: A total of 557 HCWs (n=156, 28% men and n=395, 70.9% women) were included in the study. A total of 26.4% (n=147) of the sampled HCWs believed COVID-19 vaccines contained digital microchips, while 30% (n=167) believed the vaccines could alter one’s DNA or genetic information. The beliefs varied according to professional group, with 45.8% (55/120) and 50% (5/10) of nurses and pharmacists, respectively, believing in the DNA alteration theory and 33.3% (40/120) and 37.5% (6/16) of the nurses and laboratory scientists, respectively, believing in the microchip theory. Social media was an important source of COVID-19 information for 45.4% (253/557) of HCWs. A total of 76.2% (419/550) of the participants expressed a willingness to take the vaccine. The odds of HCWs believing that COVID-19 vaccines contained digital microchips increased significantly with decreasing level of trust in government information on COVID-19 vaccines (odds ratio [OR] 4.6, 95% CI 2.6-8.0). We made a similar finding in those who believed COVID-19 vaccines could alter DNA and genetic information (OR 5.2, 95% CI 3.1-8.8). Conclusions: Misinformation regarding COVID-19 vaccines reaches and influences HCWs. A high proportion of the sampled HCWs believed that COVID-19 vaccines contained microchips or that the vaccines could alter recipients’ DNA and genetic information. This might have negative consequences in terms of the HCWs’ own COVID-19 vaccination and their influence on other people. Lack of trust in government and its institutions might explain the belief in both conspiracy theories and vaccine hesitancy. There is a need for health care stakeholders in Nigeria and around the world to actively counteract misinformation, especially on social media, and give HCWs necessary scientifically sound information.publishedVersio

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Lifestyle factors and colorectal cancer: The Norwegian Women and Cancer Study

Colorectal cancer (CRC) is a major global disease. The incidence rate among Norwegian women is currently the highest in the world. Lifestyle factors have a substantial influence on CRC susceptibility. However, it is not clear whether these factors are responsible for the high incidence in Norwegian women, or whether they play a role in CRC survival. This doctoral project investigated lifestyle factors in relation to CRC incidence and survival. We used self-reported information from the Norwegian Women and Cancer (NOWAC) Study, linked with Cancer Registry of Norway and Statistics Norway. We used Cox proportional hazards models to calculate hazard ratios for CRC risk by physical activity levels. We used the Karlson, Holm, and Breen method of decomposition to examine the extent to which the risk factors accounted for the observed geographical differences in CRC incidence. We performed competing mortality risks analyses to determine the associations between pre-diagnostic lifestyle factors and CRC survival. We found no association between physical activity level and the risk of CRC. Adult height, being a former smoker, or a current smoker, were associated with increased CRC risk; and a duration of education of >12 years, and a fruit and vegetable intake of >300 g/day were associated with reduced CRC risk. However, these factors combined, did not account for the geographical variations in CRC incidence. Finally, we found that a pre-diagnostic vitamin D intake of >10 μg/day was associated with 25% reduction in CRC death. Our data suggest that women may need to look further than physical activity in order to reduce their risk of CRC; and lifestyle factors did not explain geographical variations in CRC incidence in Norwegian women. A pre-diagnostic vitamin D intake could improve CRC survival

The use of cell phone for maternal health: the Abiye project

Background: Maternal health is a public health concern worldwide, especially in the sub-Saharan African countries, where the burden of maternal death is the highest in the world. A woman dies of pregnancy or childbirth related complications about every 90 seconds every day, and more than 95 per cent of these deaths occur in the sub-Saharan Africa and South Asia. The rapidly growing presence of cell phones in sub-Saharan Africa may offer a paradigm shift and a unique opportunity to make a significant difference in maternal health services. Set against this backdrop was the Abiye pilot project in the Ifedore Local Government Area (LGA) of Ondo-State of Nigeria, aimed at improving maternal health through the use of cell phones. This research work was designed to explore the project. Method: A quantitative case-control method was used in this study with retrospective data from January 1, 2011 to December 31, 2011 collated from the hospitals’ records and patients’ casefiles. Semi-structured questionnaires were also used to generate supplemental data. 2 LGAs (i.e. one LGA where cell phones were distributed and one without such distribution) were compared to detect any differences in the facility utilization of pregnant women and the odds ratios of causes of maternal death were calculated in the two areas. Findings: The primary healthcare and the total (primary and secondary) healthcare facility utilization rates were significantly higher in the LGA where cell phones were in use. The primary healthcare facility utilization in Ifedore LGA was 54.4 per cent while that of Idanre was 30.5 per cent (p < 0.001). Total facility utilization in Ifedore LGA was 43.4 per cent and Idanre was 36.7 per cent (p = 0.0001). The odds ratio of the occurrence of the measured causes of maternal death in the 2 LGAs was 1 (i.e. no difference). Conclusion: The study showed statistical indications that cell phone use increased the facility utilization of the pregnant women. The utilization was found to have increased mainly because of the raise in the primary healthcare utilization in the LGA where cell phones were in use. This means that cell phone usage may be a strengthening factor in the primary healthcare system. The odds of causes of maternal death were still the same in the 2 LGAs. This may be due to the relatively recent implementation of the programme. It is possible that changes in maternal death rates will occur as the programme develops, and this should be examined in further studies

Giving cell phones to pregnant women and improving services may increase primary health facility utilization: a case-control study of a Nigerian project

Background: Worldwide, about 287 000 women die each year from mostly preventable complications related to pregnancy and childbirth. A disproportionately high number of these deaths occur in sub-Saharan Africa. The Abiye (‘Safe Motherhood’) project in the Ifedore Local Government Area (LGA) of Ondo-State of Nigeria aimed at improving facility utilization and maternal health through the use of cell phones and generally improved health care services for pregnant women, including Health Rangers, renovated Health Centres, and improved means of transportation. Methods: A one-year sample of retrospective data was collected from hospital records and patients’ case files from Ifedore (the project area) and Idanre (control area) and was analyzed to determine healthcare facility utilization rates in each location. Semi-structured questionnaires were used to generate supplemental data. Results: The total facility utilization rate of pregnant women was significantly higher in Ifedore than in Idanre. The facility utilization rate of the primary health care centres was significantly higher in Ifedore than in Idanre. The number of recorded cases of the five major causes of maternal death in the two LGAs was not significantly different, possibly because the project was new. Conclusions: Giving cell phones to pregnant women and generally improving services could increase their utilization of the primary healthcare system

mHealth and obstetrics

In this lecture, dr. Oyeyemi presents his work evaluating the impact of the Abiye Project. A main outcome of the project was the increased use of primary level health facilities in the project area