Association Between Helicobacter Pylori Infection and Graves' Disease: a Meta-Analysis

Background & Aims: Helicobacter pylori (H. pylori) infection is proposed to be related with autoimmune diseases, such as Graves' Disease (GD). This study aimed to assess the association between H. pylori infection and GD. Methods: A systematic literature review was conducted using Pubmed and Cochrane library. The quality of enrolled studies was assessed by the Critical Appraisal Skills Program Oxford. A fixed-effect model approach was used if there was no heterogeneity; otherwise, a random-effect model was used. Heterogeneity was assessed using I2. Publication bias was assessed by funnel plot. All data were analyzed using REVIEW MANAGER 5.3. Results: Six studies from Europe and Asia involving 983 patients were included. Overall H. pylori infection was significantly associated with GD (OR 2.7; 95% CI: 1.47-4.99; p < 0.001). In subgroup analysis of 3 studies using non-serological diagnostic method, the prevalence rate of H. pylori infection was higher in GD group (78.26% VS 42.42%) with significant relationship (OR 4.93; 95% CI: 3.16-7.69; p < 0.00001; I2 = 0%). The CagA antibody prevalence was significantly higher in GD group (46.57% VS 20.29%; OR 4.41; 95% CI: 2.65-7.33; p < 0.00001; I2 = 56%). No publication bias was observed. Conclusion: Our study showed association between H. pylori infection and GD. It might suggest the need of H. pylori examination in GD patients and the impact of H. pylori eradication in the treatment of GD

Exploring socioenvironmental influences on adolescent girls eating attitudes in Jakarta : A comparative study

A balanced diet is vital in adolescence because of the growth spurts occurring in different areas. However, girls in the adolescent phase are at risk of developing unhealthy eating attitudes, leading to severe physical and psychological consequences, including body dissatisfaction, depression, etc. This study was aimed to assessing the socioenvironmental influences on eating attitudes among adolescent girls in DKI Jakarta, Indonesia

Perubahan Densitas Mineral Tulang Lumbal Perempuan Pengguna Kontrasepsi Suntik Depo Medroksi Progesteron Asetat (DMPA) selama 6 Bulan di Puskesmas Tebet, Jakarta Selatan

Tujuan: Untuk mengetahui densitas mineral tulang (DMT) lumbal perempuan Indonesia berusia 20 - 35 tahun sebelum dan setelah pemberian kontrasepsi suntik DMPA selama 6 bulan, dan mengetahui hubungan antara faktor asupan kalsium dan aktivitas fisik perempuanperempuan tersebut dengan DMT lumbal. Tempat: Puskeskmas Kecamatan Tebet, Jakarta Timur, Departemen Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo dan Klinik Imunoendokrinologi Yasmin, Jakarta Pusat. Rancangan/rumusan data: Penelitian ini bersifat eksperimental self-controlled dengan rancangan pra-intervensi dan pasca-intervensi pada kelompok subyek. Bahan dan cara kerja: Sembilan-belas responden perempuan paritas satu berusia antara 20-35 tahun menjalani pemeriksaan densitas mineral tulang (DMT) lumbal 1-4 dengan menggunakan densitometri DEXA (dual energy x-ray absorptiometry). Para responden adalah akseptor KB suntik depo medroksi progesteron asetat (DMPA) pertama kali, dengan jadual pemberian sebesar 150 mg DMPA intramuskular tiap tiga bulan. Selain itu, didapatkan data mengenai berat badan, tinggi badan, indeks massa tubuh (IMT), asupan kalsium per hari dan aktivitas fisik responden. Kemudian dilakukan pemeriksaan DMT lumbal 1-4 yang kedua setelah 6 bulan penggunaan kontrasepsi DMPA. Hasil: Didapatkan rata-rata usia subyek (n = 11) adalah 25,0 ± 4,2 tahun (rentang 20 - 33 tahun). Rata-rata berat badan, tinggi badan dan indeks massa tubuh berturut-turut adalah sebesar 49,7 ± 6,2 kg (41 - 60 kg); 151,8 ± 6,2 cm (142 - 163 cm) dan 21,61 ± 2,74 kg/m2 (17,69 - 26,67 kg/m2). Densitas mineral tulang (DMT) L1-L4 awal menunjukkan rata-rata 0,958 ± 0,023 g/cm2 (0,876 - 1,080 g/cm2), rata-rata nilai T awal sebesar -1,26 ± 0,61 (-1,85 sampai dengan -0,25). Nilai rata-rata asupan kalsium per hari sebesar 329,01 ± 228,22 mg (78,25 - 784,55 mg). Rata-rata DMT L1-L4 akhir adalah sebesar 0,969 ± 0,078 g/cm2 (0,844 - 1,084 g/cm2), rata-rata nilai T akhir sebesar -1,17 ± 0,65 (-2,21 sampai dengan -0,22). Rata-rata pengeluaran energi total (Total Energy Expenditure [TEE]), laju metabolik basal (Basal Metabolic Rate [BMR]) dan faktor aktivitas (Activity Factor [AF]) berturut-turut adalah sebesar 2157,51 ± 342,55 kkal (1679,58 - 2753,49 kkal); 1288,05 ± 69,64 kkal (1189,20 - 1411,30 kkal) dan 1,68 ± 0,24 (1,4 - 2,1). Rata-rata persentase perubahan DMT adalah sebesar 1,13 ± 2,86% (-3,76 sampai dengan 6,74%). Terdapat korelasi yang sangat lemah dan tidak bermakna statistik antara faktor aktivitas dengan persentase perubahan DMT (r = 0,066, p = 0,846), antara IMT dengan persentase perubahan DMT (r = 0,098, p = 0,774). Sedangkan korelasi antara asupan kalsium per hari dengan persentase perubahan DMT adalah lemah (r = 0,457) dengan tingkat kemaknaan 0,158 (tidak bermakna). Analisis multivariat menunjukkan tidak ada perubahan yang bermakna secara statistik antara persentase perubahan DMT dengan IMT, asupan kalsium dan faktor aktivitas (p = 0,515). Kesimpulan: Pada sebelas responden yang diteliti, tidak terdapat perubahan bermakna DMT lumbal 1-4 setelah pemberian DMPA selama 6 bulan pertama dan tidak terdapat korelasi yang bermakna antara penggunaan DMPA selama 6 bulan pertama dengan indeks massa tubuh, asupan kalsium dan aktivitas fisik. [Maj Obstet Ginekol Indones 2007; 31-4: 243-50] Kata kunci: densitas mineral tulang (DMT), depo medroksi progesteron asetat (DMPA), indeks massa tubuh (IMT), asupan kalsium, faktor aktivitas

The relationship of safety climate and psychological wellbeing with Indonesian civil pilots’ safety behavior

Safety behavior is very important in reducing occurrence of aviation accidents. The relationship of safety climate and psychological well-being with Indonesian civil pilots’ safety behavior. This was a cross-sectional study using the consecutive sampling technique that queried on safety climate, psychological well-being and safety behavior. Data were analyzed with multiple linear regression. Both alone and together, safety climate (ß = 0.646) and psychological well-being (ß = 0.231; p = 0.044) were positively and significantly related to safety behavior. Safety climate and psychological well-being simultaneously had a positive and significant impact on the Indonesian civil pilots’ safety behavior, with R2 = 0.742 and p-value ≤ 0.001. Even so, the safety climate had a more dominant impact on the safety behavior than the psychological well-bein

Bridging the gap: financing health promotion and disease prevention in Indonesia

Background Spending on preventive care in low- and middle-income countries (LMICs), including Indonesia, is much lower than spending on curative care. There has been a pressing need to develop a clear pathway to increase spending on preventive care. This study aimed to assess the current financing landscape for health promotion and disease prevention in Indonesia and, subsequently, to develop a framework and recommendations for future health promotion financing in the country. Methods We adopted a mixed-method approach to gather information from all relevant stakeholders from December 2022 to June 2023. For the qualitative approach, we conducted (a) in-depth interviews (IDIs) and (b) focus group discussions (FGDs) with government officials at national and district levels, academics, professional organizations, healthcare workers in primary healthcare centres (PHCs), community health volunteers, non governmental organizations and private companies. For the quantitative approach, we applied a national online survey to healthcare workers involved in health promotion in PHCs. IDIs and FGDs were conducted with purposefully selected resource persons at the national level, five selected districts across Indonesia, and within 15 primary health offices and their communities. All qualitative data were recorded, transcribed, coded, interpreted, and then triangulated with national survey findings to develop the financing framework. Results We identified gaps between the theory and practice of health promotion and disease prevention. These included the limited scope of health promotion initiatives, lack of direction and coordination between ministries, agencies and government levels, limited availability and capacity of health promoters, various yet uncoordinated funding resources and inflexibility in using the funds. To bridge the gap, the framework we developed suggests strengthening the legal and regulatory basis, strategically prioritizing financing arrangements, promoting evidence-based health promotion activities, developing the capacity of health promoters, enhancing the health financing information system and improving monitoring and evaluation. Conclusions Identified gaps and challenges in health promotion and disease prevention initiatives inform the development of our framework for future health promotion financing. This framework assists the national government in organizing national health promotion financing strategies and potentially serves as a valuable model for other LMICs

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income&nbsp;countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of&nbsp;countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.

BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. FUNDING: Wellcome Trust, AstraZeneca Young Health Programme

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups