Cardiovascular disease and the changing face of global public health : a focus on low and middle income countries

Eighty percent of the global 17 million deaths due to cardiovascular disease (CVD) occur in low and middle income countries (LMICs). The burden of CVD and other noncommunicable diseases (NCDs) is expected to markedly increase because of the global aging of the population and increasing exposure to detrimental lifestyle-related risk in LMICs. Interventions to reduce four main risks related to modifiable behaviors (tobacco use, unhealthy diet, low physical activity and excess alcohol consumption) are key elements for effective primary prevention of the four main NCDs (CVD, cancer, diabetes and chronic pulmonary disease). These behaviors are best improved through structural interventions (e.g., clean air policy, taxes on cigarettes, new recipes for processed foods with reduced salt and fat, urban shaping to improve mobility, etc.). In addition, health systems in LMICs should be reoriented to deliver integrated cost-effective treatment to persons at high risk at the primary health care level. The full implementation of a small number of highly cost effective, affordable and scalable interventions ("best buys") is likely to be the necessary and sufficient ingredient for curbing NCDs in LMICs. NCDs are both a cause and a consequence of poverty. It is therefore important to frame NCD prevention and control within the broader context of social determinants and development agenda. The recent emphasis on NCDs at a number of health and economic forums (including the September 2011 High Level Meeting on NCDs at the United Nations) provides a new opportunity to move the NCD agenda forward in LMICs

Hypertension Prevalence Based on Blood Pressure Measurements on Two vs. One Visits: A Community-Based Screening Programme and a Narrative Review.

We assessed the difference in the prevalence of hypertension in community surveys when blood pressure (BP) was measured on two vs. one visits and its impact on hypertension awareness, treatment and control proportions. A community-based BP screening programme was conducted in public places in the Seychelles (619 adults) and BP was rechecked a few days later among untreated participants with high BP (≥140/90 mmHg). A narrative review of the literature on this question was also conducted. Only 64% of untreated participants with high BP still had high BP at the second visit. The prevalence of hypertension in the whole sample decreased by 13% (from 33.8% to 29.5%) when BP was measured on two vs. one visits. These results concurred with our findings in our narrative review based on 10 surveys. In conclusion, the prevalence of hypertension can be markedly overestimated in community surveys when BP is measured on two vs. one visits. The overestimation could be addressed by measuring BP on a second visit among untreated individuals with high BP or, possibly, by taking more readings at the first visit. These findings have relevance for clinical practice, policy and surveillance

Beauty is in the efficient coding of the beholder

Sexual ornaments are often assumed to be indicators of mate quality. Yet it remains poorly known how certain ornaments are chosen before any coevolutionary race makes them indicative. Perceptual biases have been proposed to play this role, but known biases are mostly restricted to a specific taxon, which precludes evaluating their general importance in sexual selection. Here we identify a potentially universal perceptual bias in mate choice. We used an algorithm that models the sparseness of the activity of simple cells in the primary visual cortex (or V1) of humans when coding images of female faces. Sparseness was found positively correlated with attractiveness as rated by men and explained up to 17% of variance in attractiveness. Because V1 is adapted to process signals from natural scenes, in general, not faces specifically, our results indicate that attractiveness for female faces is influenced by a visual bias. Sparseness and more generally efficient neural coding are ubiquitous, occurring in various animals and sensory modalities, suggesting that the influence of efficient coding on mate choice can be widespread in animals

Physical Fighting and Associated Factors among Adolescents Aged 13-15 Years in Six Western Pacific Countries.

Youth violence is an important public health challenge around the world, yet the literature on this problem in low- and middle-income countries (LMICs) has been limited. The present study aims to examine the prevalence of adolescent physical fighting (defined as having been involved in at least one physical fight during the past 12 months) in selected LMICs, and its relations with potential risk factors. We included 6377 school-going adolescents aged 13-15 years from six Western Pacific (WP) countries that had recently conducted a Global School-based Student Health Survey. Information was gathered through a self-administered anonymous closed-ended questionnaire. The prevalence of adolescent physical fighting varied across countries, ranging from 34.5% in Kiribati to 63.3% in Samoa. The prevalence was higher in boys than in girls, and lower at age 15 than 13-14 years. Physical fighting was significantly associated (pooled odds ratios (ORs), 95% confidence intervals (CIs)) with smoking (1.78, 1.53-2.06), drinking (1.57, 1.33-1.85), drug use (1.72, 1.33-2.23), and missing school (1.72, 1.51-1.95). The association with physical fighting increased with increasing number of joint adverse behaviors (increased from 1.99 (1.73-2.29) for one risk behavior to 4.95 (4.03-6.07) for at least 3 risk behaviors, versus having none of the 4 risk behaviors). The high prevalence of physical fighting and the associations with risk behaviors emphasize the need for comprehensive prevention programs to reduce youth violence and associated risk behaviors