Long-term residential exposure to PM2.5 constituents and mortality in a Danish cohort

Studies on health effects of long-term exposure to specific PM2.5 constituents are few. Previous studies have reported an association between black carbon (BC) exposure and cardiovascular diseases (CVD) and a few studies have found an association between sulfate exposure and mortality. These studies, however, relied mainly on exposure data from centrally located air-monitoring stations, which is a crude approximation of personal exposure. We focused on specific chemical constituents of PM2.5, i.e. elemental and primary organic carbonaceous particles (BC/OC), sea salt, secondary inorganic aerosols (SIA, i.e. NO3–, NH4+, and SO42-), and secondary organic aerosols (SOA), in relation to all-cause, CVD and respiratory disease mortality. We followed a Danish cohort of 49,564 individuals from enrollment in 1993–1997 through 2015. We combined residential address history from 1979 onwards with mean annual air pollution concentrations obtained by the AirGIS air pollution modelling system, lifestyle information from baseline questionnaires and socio-demography obtained by register linkage. During 895,897 person-years of follow-up, 10,193 deaths from all causes occurred – of which 2319 were CVD-related and 870 were related to respiratory disease. The 15-year time-weighted average concentrations of PM2.5, BC/OC, sea salt, SIA and SOA were 13.8, 2.8, 3.4, 4.9, and 0.3 µg/m3, respectively. For all-cause mortality, a higher risk was observed with higher exposure to PM2.5, BC/OC and SOA with adjusted hazard ratios of 1.03 (95% confidence intervals: 1.01, 1.05), 1.06 (1.03, 1.09), and 1.08 (1.03, 1.13) per interquartile range, respectively. The associations for BC/OC and SOA remained after adjustment for PM2.5 in two-pollutant models. For CVD mortality, we observed elevated risks with higher exposure to PM2.5, BC/OC and SIA. The results showed no clear relationship between sea salt and mortality. In this study, we observed a relationship between long-term exposure to PM2.5, BC/OC, and SOA and all-cause mortality and between PM2.5, BC/OC, and SIA and CVD mortality.</p

Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: A cross-sectional study

Background and purpose: Long obstructive sleep apnoeas (LOSAs) can cause brain ischaemia through paradoxical embolism since they can lead to right to left shunting (RLSh) but this has never been assessed as a risk factor for stroke. We investigated whether the combination of LOSA and RLSh is associated with ischaemic stroke or transient ischaemic attack (TIA) on waking (wake-up stroke). Methods: We prospectively considered patients aged over 18 years, admitted to 13 stroke units for acute ischaemic stroke or TIA. Patients had to be able to give consent, to specify whether the event occurred on waking, and to cooperate sufficiently to undergo contrast transcranial Doppler examination and cardiorespiratory sleep study within 10 days of the onset of symptoms. Single LOSA events, lasting 20 s or more, were considered a possible harbinger of RLSh. Results: Between April 2008 and March 2010, 335 patients (109 women; 61 TIA, mean age 64 years) were enrolled; 202 (60%) had at least one LOSA and 116 (35%) a RLSh; 69 (21%) had both. There were significantly more wake-up strokes/TIAs in subjects with RLSh plus LOSA than those without this association (27/69 vs 70/266; OR 1.91, controlled for age, sex, hypertension, diabetes, atrial fibrillation, antithrombotic therapy; 95% CI 1.08 to 3.38; p=0.03). No other risk factor was associated with an increase in the incidence of events on waking. Conclusions: The study suggests that the combination of LOSA and RLSh could be a new major, potentially treatable risk factor for cerebrovascular ischaemic events

Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: a cross-sectional study.

BACKGROUND AND PURPOSE: Long obstructive sleep apnoeas (LOSAs) can cause brain ischaemia through paradoxical embolism since they can lead to right to left shunting (RLSh) but this has never been assessed as a risk factor for stroke. We investigated whether the combination of LOSA and RLSh is associated with ischaemic stroke or transient ischaemic attack (TIA) on waking (wake-up stroke). METHODS: We prospectively considered patients aged over 18 years, admitted to 13 stroke units for acute ischaemic stroke or TIA. Patients had to be able to give consent, to specify whether the event occurred on waking, and to cooperate sufficiently to undergo contrast transcranial Doppler examination and cardiorespiratory sleep study within 10 days of the onset of symptoms. Single LOSA events, lasting 20 s or more, were considered a possible harbinger of RLSh. RESULTS: Between April 2008 and March 2010, 335 patients (109 women; 61 TIA, mean age 64 years) were enrolled; 202 (60%) had at least one LOSA and 116 (35%) a RLSh; 69 (21%) had both. There were significantly more wake-up strokes/TIAs in subjects with RLSh plus LOSA than those without this association (27/69 vs 70/266; OR 1.91, controlled for age, sex, hypertension, diabetes, atrial fibrillation, antithrombotic therapy; 95% CI 1.08 to 3.38; p=0.03). No other risk factor was associated with an increase in the incidence of events on waking. CONCLUSIONS: The study suggests that the combination of LOSA and RLSh could be a new major, potentially treatable risk factor for cerebrovascular ischaemic events

Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: a cross-sectional study.

BACKGROUND AND PURPOSE: Long obstructive sleep apnoeas (LOSAs) can cause brain ischaemia through paradoxical embolism since they can lead to right to left shunting (RLSh) but this has never been assessed as a risk factor for stroke. We investigated whether the combination of LOSA and RLSh is associated with ischaemic stroke or transient ischaemic attack (TIA) on waking (wake-up stroke). METHODS: We prospectively considered patients aged over 18 years, admitted to 13 stroke units for acute ischaemic stroke or TIA. Patients had to be able to give consent, to specify whether the event occurred on waking, and to cooperate sufficiently to undergo contrast transcranial Doppler examination and cardiorespiratory sleep study within 10 days of the onset of symptoms. Single LOSA events, lasting 20 s or more, were considered a possible harbinger of RLSh. RESULTS: Between April 2008 and March 2010, 335 patients (109 women; 61 TIA, mean age 64 years) were enrolled; 202 (60%) had at least one LOSA and 116 (35%) a RLSh; 69 (21%) had both. There were significantly more wake-up strokes/TIAs in subjects with RLSh plus LOSA than those without this association (27/69 vs 70/266; OR 1.91, controlled for age, sex, hypertension, diabetes, atrial fibrillation, antithrombotic therapy; 95% CI 1.08 to 3.38; p=0.03). No other risk factor was associated with an increase in the incidence of events on waking. CONCLUSIONS: The study suggests that the combination of LOSA and RLSh could be a new major, potentially treatable risk factor for cerebrovascular ischaemic events

Thymoquinone ameliorates diabetic phenotype in Diet-Induced Obesity mice via activation of SIRT-1-dependent pathways.

Thymoquinone, a natural occurring quinone and the main bioactive component of plant Nigella sativa, undergoes intracellular redox cycling and re-oxidizes NADH to NAD+. TQ administration (20 mg/kg/bw/day) to the Diet-Induced Obesity (DIO) mice reduced their diabetic phenotype by decreasing fasting blood glucose and fasting insulin levels, and improved glucose tolerance and insulin sensitivity as evaluated by oral glucose and insulin tolerance tests (OGTT and ITT). Furthermore, TQ decreased serum cholesterol levels and liver triglycerides, increased protein expression of phosphorylated Akt, decreased serum levels of inflammatory markers resistin and MCP-1, and decreased NADH/NAD+ ratio. These changes were paralleled by an increase in phosphorylated SIRT-1 and AMPKα in liver and phosphorylated SIRT-1 in skeletal muscle. TQ also increased insulin sensitivity in insulin-resistant HepG2 cells via a SIRT-1-dependent mechanism. These findings are consistent with the TQ-dependent re-oxidation of NADH to NAD+, which stimulates glucose and fatty acid oxidation and activation of SIRT-1-dependent pathways. Taken together, these results demonstrate that TQ ameliorates the diabetic phenotype in the DIO mouse model of type 2 diabetes

Landscape Analysis: What Are the Forefronts of Change in the US Hospitals?

Compilation of information is increasingly becoming more important for health organizations from financial and time aspects. By methodical study of adaptive systems, healthcare organizations can gain new insights of burdensome issues within the organization as well as healthcare delivery management. These actions have become more important with the changes in the healthcare environment in the last couple of decades where several external entities have impacts on healthcare organizations directly and/or indirectly. One of the most onerous tasks ahead of organizations is to anticipate these changes and prepare for them. Knowing the external environment can be the key to leading a successful and competitive health system. However, identifying and behaving toward all the external changes pose great time and resource challenges for organizations. Health organizations can posit the question of “what are the current external changes that have the power to affect them?” This study will take a look into emerging extrinsic changes for the US healthcare environment in different areas. A literature review will be performed in order to pinpoint the different contemporary change perspectives and their sub-criteria. In order to better illustrate these issues, Ishikawa diagram (cause-and-effect diagram) is used in this study