The influence of early-life conditions on cardiovascular disease later in life among ethnic minority populations: a systematic review

Ethnic minority groups are disproportionately affected by cardiovascular diseases (CVDs). The reasons for the high prevalence of CVD in ethnic minority groups are not fully understood. Recently, the importance of early-life developmental factors and their impact on CVDs in adulthood is increasingly being recognised, but little is known about this among ethnic minority groups. Therefore, the current paper aimed to fill this knowledge gap by reviewing the available literature to assess the influence of early-life conditions on CVDs and its risk factors in ethnic minority populations residing in Western countries. A systematic search was performed in PubMed and EMBASE between 1989 and 2014. In total, 1418 studies were identified of which 19 met the inclusion criteria. Six studies investigated the relationship between early-life anthropometrics and CVD risk factors of which all except one found significant associations between the assessed anthropometric measures and CVD risk factors. Seven studies evaluated the influence of childhood socio-economic status (SES) on CVD and risk factors of which five found significant associations between childhood SES measures and CVD risk factors. Five studies investigated the relationship between other early-life conditions including early-life nutrition, physical development, and childhood psychosocial conditions, and CVD risk factors. Four of these studies found significant associations between the assessed childhood conditions and CVD risk factors. This review reinforces the importance of early-life conditions on adult CVD in ethnic minority groups. Improvement of early-life conditions among ethnic minority groups may contribute to reducing CVD risk in these population

Non-communicable disease outcomes among adults living with HIV in Asia

The introduction of effective antiretroviral therapy (ART) has dramatically increased life expectancy of people living with HIV (PLHIV). However, due to lifestyle factors, side effects of ART, ongoing inflammation and immune activation, and ageing, non-communicable diseases (NCDs) are becoming more apparent in this population. This will prove challenging in some countries in the Asian region, where health systems are already strained by a high HIV burden and limited resources are available to provide optimal care for all PLHIV. The aim of this thesis was to investigate NCDs – primarily cardiovascular disease (CVD), diabetes and kidney disease – and related outcomes in PLHIV in the Asian region. All analyses were based on routinely collected data from the TREAT Asia cohorts, two large adult observational cohorts of PLHIV in 12 countries across the Asia-Pacific region. Similar to what is happening at the global level, ART uptake across this region has increased over time. Among those on ART in the TREAT Asia cohorts, there was a considerable burden of comorbid CVD, diabetes and kidney disease. Risk factors for CVD were primarily of modifiable nature, such as hypertension, unfavourable lipid levels and overweight. It was estimated that the CVD incidence might double in the next decade, although this could be largely addressed by implementing interventions that target CVD risk factors. Diabetes and prediabetes were strongly associated with mortality. When assessing risk factors of mortality after long-term exposure to ART, the findings showed that diabetes, kidney disease, and hepatitis were associated with increased mortality, while treatment continuity remained important to improve survival. Overall, the findings indicate that there was suboptimal monitoring for NCDs in the TREAT Asia cohorts.With the growing population of PLHIV who are on life-long ART, there is an urgent need for integrated NCD and HIV care. Timely interventions are key to reducing the unnecessary morbidity and mortality. Future efforts to improve NCD-related outcomes in PLHIV in the Asian region should thus have a clear focus on screening and monitoring for NCDs with appropriate diagnostic tools and access to affordable treatment options

Global prevalence of help-seeking for problem gambling: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Multiple studies have examined barriers and facilitators to help-seeking, but the prevalence of help-seeking for problem gambling (PG) is not well established. We aimed to estimate the international prevalence of help-seeking for PG among the general population and among subgroups of people at risk for PG (i.e. low-risk, moderate-risk and PG). METHODS: Systematic search of grey literature (through gambling repositories, gambling research institutes and Google) and peer-reviewed literature (through ProQuest, PsycINFO, PubMed and Scopus) for gambling prevalence studies that reported on help-seeking for PG. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses. Studies used representative sampling methods to determine the prevalence of gambling participation and data collection 2010 onward. Twenty-four studies met the inclusion criteria. The main outcome was population prevalence of help-seeking for PG. Help-seeking was defined as any intentional action to change gambling behaviours, including professional services (inclusive of in-person or distance help), non-professional help (e.g. from family and friends) and self-help. Subgroup analyses were conducted to explain variability in help-seeking prevalence estimates. RESULTS: Measurement of help-seeking was inconsistent across included studies and, overall, there was high risk of bias. We estimated a general population help-seeking prevalence for PG of 0.23%. Prevalence estimates were significantly higher in studies assessing lifetime compared with current help-seeking, but there was no evidence of difference in prevalence estimates by gambling participation, region, type of help-seeking, or year of data collection. Compared with people with low-risk gambling, prevalence estimates were significantly higher in those with moderate-risk and problem gambling. CONCLUSIONS: One in 25 moderate-risk gamblers and 1 in 5 people with problem gambling have sought help for problems related to their gambling

Functionele capaciteiten en werkgerelateerde uitkomsten na borstkanker: Een systematische review

Diagnose en behandeling van borstkanker hebben vaak een nadelig effect op arbeidsparticipatie.1-3 Onderzoek wijst uit dat werkhervatting samenhangt met factoren zoals leeftijd, sociaal-economische status, stadium van de kanker, en behandeling of daaruit voortvloeiende klachten.4,5 Daarnaast wordt gesuggereerd dat het niet aansluiten van functionele mogelijkheden na borstkanker op de functie-eisen van werk, succesvolle arbeidsre-integratie kan belemmeren.6 Bedrijfsartsen kunnen hulp bieden bij arbeidsre-integratie door de brug te slaan tussen functionele mogelijkheden van de cliënt en functie-eisen van het werk. Dit literatuuronderzoek geeft een overzicht van de relatie tussen functionele mogelijkheden en werkgerelateerde uitkomsten bij mensen die borstkanker hebben gehad

Functional Impairments and Work-Related Outcomes in Breast Cancer Survivors: A Systematic Review

Purpose Work participation after breast cancer treatment is generally negatively affected. Occupational health professionals might improve work-related outcomes by bridging the gap between sick-listed employees’ levels of functioning and work demands. To aid them in this task, this review explored the association between functional impairments and work-related outcomes in breast cancer survivors. Methods Publications from January 2000–March 2016 were identified through five online databases (i.e. Pubmed, EMBASE, PsycINFO, CINAHL and the Cochrane Library). Quantitative and qualitative studies were included if they focused on functional impairments and work-related outcomes in breast cancer survivors. Two reviewers independently selected studies, extracted data and performed quality assessment. Results The search identified 998 studies, of which 20 studies met eligibility criteria. Impairments in physical functioning negatively affected return to work (RTW) and work ability in quantitative and qualitative studies. Studies measuring cognitive functioning with tests found no association with work-related outcomes, whereas the results of studies using self-reported measures were ambiguous. Social functioning was less commonly investigated and findings differed across work-related outcomes. Emotional functioning was not associated with work-related outcomes in quantitative studies, while in qualitative studies feelings such as insecurity were described as influencing RTW. Conclusions Functional impairments can severely hamper work participation in breast cancer survivors. This provides important opportunities for occupational health professionals to enhance RTW in breast cancer survivors, such as adequately addressing illness perceptions and work expectations. Ongoing research is warranted to aid occupational health professionals in providing effective vocational guidance and improve work-related outcomes in breast cancer survivors

Adherence to antiretroviral therapy for HIV in sub-Saharan Africa and Asia: a comparative analysis of two regional cohorts

Our understanding of how to achieve optimal long-term adherence to antiretroviral therapy (ART) in settings where the burden of HIV disease is highest remains limited. We compared levels and determinants of adherence over time between HIV-positive persons receiving ART who were enrolled in a bi-regional cohort in sub-Saharan Africa and Asia. This multicentre prospective study of adults starting first-line ART assessed patient-reported adherence at follow-up clinic visits using a 30-day visual analogue scale. Determinants of suboptimal adherence ( <95%) were assessed for six-month intervals, using generalized estimating equations multivariable logistic regression with multiple imputations. Region of residence (Africa vs. Asia) was assessed as a potential effect modifier. Of 13,001 adherence assessments in 3934 participants during the first 24 months of ART, 6.4% (837) were suboptimal, with 7.3% (619/8484) in the African cohort versus 4.8% (218/4517) in the Asian cohort (p < 0.001). In the African cohort, determinants of suboptimal adherence were male sex (odds ratio (OR) 1.27, 95% confidence interval (CI) 1.06-1.53; p = 0.009), younger age (OR 0.8 per 10 year increase; 0.8-0.9; p = 0.003), use of concomitant medication (OR 1.8, 1.0-3.2; p = 0.044) and attending a public facility (OR 1.3, 95% CI 1.1-1.7; p = 0.004). In the Asian cohort, adherence was higher in men who have sex with men (OR for suboptimal adherence 0.6, 95% CI 0.4-0.9; p = 0.029) and lower in injecting drug users (OR for suboptimal adherence 1.6, 95% CI 0.9-2.6; p = 0.075), compared to heterosexuals. Risk of suboptimal adherence decreased with longer ART duration in both regions. Participants in low- and lower-middle-income countries had a higher risk of suboptimal adherence (OR 1.6, 1.3-2.0; p < 0.001), compared to those in upper-middle or high-income countries. Suboptimal adherence was strongly associated with virological failure, in Africa (OR 5.8, 95% CI 4.3-7.7; p < 0.001) and Asia (OR 9.0, 95% CI 5.0-16.2; p < 0.001). Patient-reported adherence barriers among African participants included scheduling demands, drug stockouts, forgetfulness, sickness or adverse events, stigma or depression, regimen complexity and pill burden. Psychosocial factors and health system resources may explain regional differences. Adherence-enhancing interventions should address patient-reported barriers tailored to local settings, prioritizing the first years of AR