Impact of Scotland’s comprehensive, smoke-free legislation on stroke

<p>Background: Previous studies have reported a reduction in acute coronary events following smoke-free legislation. Evidence is lacking on whether stroke is also reduced. The aim was to determine whether the incidence of stroke, overalland by sub-type, fell following introduction of smoke-free legislation across Scotland on 26 March 2006.</p> <p>Methods and Findings: A negative binomial regression model was used to determine whether the introduction of smokefree legislation resulted in a step and/or slope change in stroke incidence. The model was adjusted for age-group, sex, socioeconomic deprivation quintile, urban/rural residence and month. Interaction tests were also performed. Routine hospital administrative data and death certificates were used to identify all hospital admissions and pre-hospital deaths due to stroke (ICD10 codes I61, I63 and I64) in Scotland between 2000 and 2010 inclusive. Prior to the legislation, rates of all stroke, intracerebral haemorrhage and unspecified stroke were decreasing, whilst cerebral infarction was increasing at 0.97% per annum. Following the legislation, there was a dramatic fall in cerebral infarctions that persisted for around 20 months. No visible effect was observed for other types of stroke. The model confirmed an 8.90% (95% CI 4.85, 12.77, p,0.001) stepwise reduction in cerebral infarction at the time the legislation was implemented, after adjustment for potential cofounders.</p> <p>Conclusions: Following introduction of national, comprehensive smoke-free legislation there was a selective reduction in cerebral infarction that was not apparent in other types of stroke.</p&gt

The Changes of Nutrition Labeling of Packaged Food in Hangzhou in China during 2008∼2010

OBJECTIVE: To understand the changes of the nutrition labeling of packaged food in China two years after the promulgation of the Regulation for Food Nutrition Labeling, which encourages food manufacturers to identify nutrition labeling. METHODS: Investigators copied out the nutrition information panel, nutrition claim and nutrient function claim of packaged food in a supermarket with prepared questionnaire and finished normative judgment in 2008 and 2010. RESULTS: 4693 and 5526 kinds of packaged food were investigated separately. Nutrition information panel, nutrition claim and nutrient function claim were found on the food label of 27.6%, 13.0% and 1.9% of packaged food respectively in 2008, while 35.1%, 7.7% and 2.3% in 2010. The nutrition information panel which labeled energy, protein, fat, carbohydrate and sodium was 597 (43.8%) and 1661 (85.9%) in 2008 and 2010, only 134 (9.8%) and 985 (51.0%) nutrition information panel were totally normalized. Nutrition claim and nutrient function claim focused on vitamin, mineral and dietary fiber. The total qualified proportions for nutrition claim were increased significantly for most of the nutrients, except for cholesterol. There were 6 (6.4%) and 5 (3.9%) nutrient function claims with hinting of therapeutic effects on diseases separately. CONCLUSION: Although the voluntary regulation remarkably improved the level of normalization for nutrition labeling, its role on the prevalence was minus. It's imperative to enforce nutrition labeling for not only China but also other countries, and furthermore, health education on nutrition labeling should be initiated to support the policy

Ethnic Variations in the Prevalence of Diabetic Retinopathy in People with Diabetes Attending Screening in the United Kingdom (DRIVE UK)

AIMS: To compare the prevalence of diabetic retinopathy (DR) in people of various ethnic groups with diabetes in the United Kingdom (UK). METHODS: The Diabetic Retinopathy In Various Ethnic groups in UK (DRIVE UK) Study is a cross-sectional study on the ethnic variations of the prevalence of DR and visual impairment in two multi-racial cohorts in the UK. People on the diabetes register in West Yorkshire and South East London who were screened, treated or monitored between April 2008 to July 2009 (London) or August 2009 (West Yorkshire) were included in the study. Data included age, sex, ethnic group, type of diabetes, presenting visual acuity and the results of grading of diabetic retinopathy. Prevalence estimates for the ethnic groups were age-standardised to the white European population for comparison purposes. RESULTS: Out of 57,144 people on the two diabetic registers, data were available on 50,285 individuals (88.0%), of these 3,323 had type 1 and 46,962 had type 2 diabetes. In type 2 diabetes, the prevalence of any DR was 38.0% (95% confidence interval (CI) 37.4% to 38.5%) in white Europeans compared to 52.4% (51.2% to 53.6%) in African/Afro-Caribbeans and 42.3% (40.3% to 44.2%) in South Asians. Similarly, sight threatening DR was also significantly more prevalent in Afro-Caribbeans (11.5%, 95% CI 10.7% to 12.3%) and South Asians (10.3%, 9.0% to 11.5%) compared to white Europeans (5.5%, 5.3% to 5.8%). Differences observed in Type 1 diabetes did not achieve conventional levels of statistical significance, but there were lower numbers for these analyses. CONCLUSIONS: Minority ethnic communities with type 2 diabetes in the UK are more prone to diabetic retinopathy, including sight-threatening retinopathy and maculopathy compared to white Europeans

Tobacco Smoking Using Midwakh Is an Emerging Health Problem – Evidence from a Large Cross-Sectional Survey in the United Arab Emirates

INTRODUCTION: Accurate information about the prevalence and types of tobacco use is essential to deliver effective public health policy. We aimed to study the prevalence and modes of tobacco consumption in the United Arab Emirates (UAE), particularly focusing on the use of Midwakh (Arabic traditional pipe). METHODS: We studied 170,430 UAE nationals aged ≥ 18 years (44% males and 56% females) in the Weqaya population-based screening program in Abu Dhabi residents during the period April 2008-June 2010. Self-reported smoking status, type, quantity and duration of tobacco smoked were recorded. Descriptive statistics were used to describe the study findings; prevalence rates used the screened sample as the denominator. RESULT: The prevalence of smoking overall was 24.3% in males and 0.8% in females and highest in males aged 20-39. Mean age (SD) of smokers was 32.8 (11.1) years, 32.7 (11.1) in males and 35.7 (12.1) in females. Cigarette smoking was the commonest form of tobacco use (77.4% of smokers), followed by Midwakh (15.0%), shisha (waterpipe) (6.8%), and cigar (0.66%). The mean durations of smoking for cigarettes, Midwakh, shisha and cigars were 11.4, 9.3, 7.6 and 11.0 years, respectively. CONCLUSIONS: Smoking is most common among younger UAE national men. The use of Midwakh and the relatively young age of onset of Midwakh smokers is of particular concern as is the possibility of the habit spreading to other countries. Comprehensive tobacco control laws targeting the young and the use of Midwakh are needed

Assessing the Short-Term Effects of Heatwaves on Mortality and Morbidity in Brisbane, Australia: Comparison of Case-Crossover and Time Series Analyses

BACKGROUND: Heat-related impacts may have greater public health implications as climate change continues. It is important to appropriately characterize the relationship between heatwave and health outcomes. However, it is unclear whether a case-crossover design can be effectively used to assess the event- or episode-related health effects. This study examined the association between exposure to heatwaves and mortality and emergency hospital admissions (EHAs) from non-external causes in Brisbane, Australia, using both case-crossover and time series analyses approaches. METHODS: Poisson generalised additive model (GAM) and time-stratified case-crossover analyses were used to assess the short-term impact of heatwaves on mortality and EHAs. Heatwaves exhibited a significant impact on mortality and EHAs after adjusting for air pollution, day of the week, and season. RESULTS: For time-stratified case-crossover analysis, odds ratios of mortality and EHAs during heatwaves were 1.62 (95% confidence interval (CI): 1.36-1.94) and 1.22 (95% CI: 1.14-1.30) at lag 1, respectively. Time series GAM models gave similar results. Relative risks of mortality and EHAs ranged from 1.72 (95% CI: 1.40-2.11) to 1.81 (95% CI: 1.56-2.10) and from 1.14 (95% CI: 1.06-1.23) to 1.28 (95% CI: 1.21-1.36) at lag 1, respectively. The risk estimates gradually attenuated after the lag of one day for both case-crossover and time series analyses. CONCLUSIONS: The risk estimates from both case-crossover and time series models were consistent and comparable. This finding may have implications for future research on the assessment of event- or episode-related (e.g., heatwave) health effects

A community-based validation study of the short-form 36 version 2 philippines (tagalog) in two cities in the philippines

10.1371/journal.pone.0083794PLoS ONE812-POLN

Obesity as Assessed by Body Adiposity Index and Multivariable Cardiovascular Disease Risk

To assess the role of body adiposity index (BAI) in predicting cardiovascular disease (CVD) and coronary heart disease (CHD) mortality, in comparison with body mass index (BMI), waist circumference (WC), and the waist circumference to hip circumference ratio (WHR). This study was a prospective 15 year mortality follow-up of 4175 Australian males, free of heart disease, diabetes and stroke. The Framingham Risk Scores (FRS) for CHD and CVD death were calculated at baseline for all subjects. Multivariable logistic regression was used to assess the effects of the measures of obesity on CVD and CHD mortality, before adjustment and after adjustment for FRS. The predictive ability of BAI, though present in the unadjusted analyses, was generally not significant after adjustment for age and FRS for both CVD and CHD mortality. BMI behaved similarly to BAI in that its predictive ability was generally not significant after adjustments. Both WC and WHR were significant predictors of CVD and CHD mortality and remained significant after adjustment for covariates. BAI appeared to be of potential interest as a measure of % body fat and of obesity, but was ineffective in predicting CVD and CHD

A Risk Score to Predict Type 2 Diabetes Mellitus in an Elderly Spanish Mediterranean Population at High Cardiovascular Risk

Abstract Introduction: To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. Materials and Methods: A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC). Results: The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of $6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. Discussion: We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire

Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study

Purpose To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia. Patients and methods Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients’ sociodemographic, medical and medication data. Results Two hundred and four patients, of which 71.6% were females, participated in the study. Patients’ mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score 65 years (OR 2.0 [95% CI: 1.0–4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1–0.6; P = 0.04]) were found to be independent predictors of medication adherence. Conclusion Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients