Stressful life-events exposure is associated with 17-year mortality, but it is health-related events that prove predictive

Objectives Despite the widely-held view that psychological stress is a major cause of poor health, few studies have examined the relationship between stressful life-events exposure and death. The present analyses examined the association between overall life-events stress load, health-related and health-unrelated stress, and subsequent all-cause mortality.\ud \ud Design This study employed a prospective longitudinal design incorporating time-varying covariates.\ud \ud Methods Participants were 968 Scottish men and women who were 56 years old. Stressful life-events experience for the preceding 2 years was assessed at baseline, 8–9 years and 12–13 years later. Mortality was tracked for the subsequent 17 years during which time 266 participants had died. Cox's regression models with time-varying covariates were applied. We adjusted for sex, occupational status, smoking, BMI, and systolic blood pressure.\ud \ud Results Overall life-events numbers and their impact scores at the time of exposure and the time of assessment were associated with 17-year mortality. Health-related event numbers and impact scores were strongly predictive of mortality. This was not the case for health-unrelated events.\ud \ud Conclusions The frequency of life-events and the stress load they imposed were associated with all-cause mortality. However, it was the experience and impact of health-related, not health-unrelated, events that proved predictive. This reinforces the need to disaggregate these two classes of exposures in studies of stress and health outcomes.\u

Yhdyskuntarakenteen tulevaisuus kaupunkiseuduilla – Kaupunkikudokset ja vyöhykkeet

Tutkimuksen tavoitteena on tunnistaa kaupunkiseutujen yhdyskuntarakenteen tulevaisuuteen vaikuttavia keskeisiä tekijöitä ja arvioida millaista tulevaisuutta nykyinen kehitys ja suunnitelmat ennakoivat yhdyskuntarakenteen kestävyyden näkökulmasta. Lähtökohtana on kaupunkiseutujen pitkään jatkunut yhdyskuntarakenteen laajenemis- ja hajautumiskehitys, joka näyttää taloustaantuman myötä hidastuneen ja kääntyneen osin tiivistymisen suuntaan erityisesti keskustoissa ja niiden välittömässä läheisyydessä. Kehitys vaihtelee suuresti kaupunkiseutujen välillä, koska valtakunnallinen rakennemuutos eriyttää kehitystä voimakkaasti kasvaviin ja taantuviin kaupunkiseutuihin. Samalla kun suurimmilla kasvuseuduilla investoidaan joukkoliikenteen kehittämiseen, hajautumiskehitys jatkuu väestöään menettävillä alueilla jo ennestään harvan rakenteen väljentyessä. Raportti perustuu kolmen kaupunkikudoksen – jalankulkukaupunki, joukkoliikennekaupunki ja autokaupunki – teoriaan, jossa kaupunkiseutu hahmotetaan historian eri vaiheissa syntyneinä kaupunkikudoksina. Tutkimuksessa on uudistettu yhdyskuntarakenteen tulkintaa kaupunkikudosten teoriaan tukeutuen sekä kerätty yhteiskehittämishankkeessa mukana olleilta 14 kaupunkiseudulta tietoa nykyisestä suunnittelutilanteesta, hankkeisiin ja suunnitelmien toteutukseen liittyvistä polkuriippuvuuksista ja suunnitelmien ajoituksesta sekä uusista avauksista. Suunnitelmista keskeiset muutoskohteet on viety aikajanalle ja kartalle osaksi paikkatietopohjaista analyysiä. Tavoitteena on ollut tuottaa tulevaisuusarvio kaupunkiseutujen yhdyskuntarakenteen kehityksestä vuoteen 2030. Tulosten perusteella 2010-luvulla voimistunut jalankulkukaupungin kehittäminen jatkuu tulevaisuudessa, ja monella kaupunkiseudulla on useita jalankulkuun ja pyöräilyyn liittyviä kehityshankkeita. Joukkoliikennekaupungin vahvistuminen on suurimpia kaupunkiseutuja lukuun ottamatta epävarmempaa, ja monella seudulla joukkoliikennekaupungin säilyminen ja muodostaminen vaatisi maankäytön suuntaamista vahvemmin tukemaan joukkoliikennekäytäviä. Autokaupungin kasvu näyttäisikin suunnitelmien perusteella jatkuvan vuoteen 2030, mikä on monilta osin ristiriidassa kaupunkiseutujen omien yhdyskuntarakenteen tavoitteiden kanssa. Yhtenä keskeisenä haasteena tunnistettiin lapsiperheille soveltuvien laadukkaiden asuntojen saatavuus jalankulku- ja joukkoliikennekaupungissa, jotta suurten asuntojen kysyntä ei kohdistuisi taloustilanteen elpyessä kehysalueille kauas työpaikoista ja palveluista

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services

Level walking in adults with and without Developmental Coordination Disorder: An analysis of movement variability

Several studies have shown that Developmental Coordination Disorder (DCD) is a condition that continues beyond childhood. Although adults with DCD report difficulties with dynamic balance, as well as frequent tripping and bumping into objects, there have been no specific studies on walking in this population. Some previous work has focused on walking in children with DCD but variation in the tasks and measures used has led to inconsistent findings. The aim of the current study therefore was to examine the characteristics of level walking in adults with and without DCD. Fifteen adults with DCD and 15 typically developing (TD) controls walked barefoot at a natural pace up and down an 11 m walkway for one minute. Foot placement measures and velocity and acceleration of the body were recorded, as well as measures of movement variability. The adults with DCD showed similar gait patterns to the TD group in terms of step length, step width, double support time and stride time. The DCD group also showed similar velocity and acceleration to the TD group in the medio-lateral, anterior-posterior and vertical direction. However, the DCD group exhibited greater variability in all foot placement and some body movement measures. The finding that adults with DCD have a reduced ability to produce consistent movement patterns is discussed in relation to postural control limitations and compared to variability of walking measures found in elderly populations

Changes in Dietary Fat Intake and Projections for Coronary Heart Disease Mortality in Sweden: A Simulation Study.

OBJECTIVE: In Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025. METHODS: We compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends. RESULTS: In the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur. CONCLUSION: CHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity

The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries.

OBJECTIVE: To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. METHODS: Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders. FINDINGS: Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. CONCLUSION: Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities

Using technology to support HIV self-testing among MSM

PURPOSE OF REVIEW: Technology-based HIV self-testing (HST) interventions have the potential to improve access to HIV testing among gay, bisexual, and other MSM, as well as address concerns about HST use, including challenges with linkage to appropriate follow-up services. This review examines studies that use technology-based platforms to increase or improve the experience of HST among MSM. RECENT FINDINGS: Seven published studies and eight funded studies were included in this review. Comprehensive prevention interventions with free HST kit distribution and interventions that provide free HST kits and support the HST process address a greater number of barriers (e.g., access, correct use of testing kits, and correct interpretation of results) than studies that only distribute free HST kits through technology-based platforms. SUMMARY: By addressing HIV-testing barriers and specific HST concerns, these interventions address a critical need to improve first time and repeat testing rates among MSM. Additional research is needed to determine the efficacy of recent formative HST interventions. If proven efficacious, scale-up of these strategies have the potential to increase HIV testing among MSM via expanded HST uptake

Dynamisk Modellering av Glukosavkännande signalvägar i Saccharomyces Cerevisiae

Det blir allt vanligare att människor insjuknar i metaboliska sjukdomar som diabetes. För att motverka denna negativa hälsotrend krävs kunskap om cellulära processer för glukosreglering. Denna kunskap kan fås genom att studera interaktioner mellan substanser i komplexa biologiska system. I följande arbete var syftet att konstruera en dynamisk modell som beskriver nätverket för glukosreguleringen i Saccharomyces cerevisiae, utifrån en befintlig modell. Arbetets modell skapades genom att formulera ordinära differentialekvationer (ODE:er) som beskriver nätverkets koncentrationsförändringar. ODE-systemet löstes med en kostnadsfunktion, där en optimeringsalgoritm implementerades från grunden för att estimera okända parametrar i nätverket. Estimeringen lyckades inte på ett övertygande sätt bestämma parametervärdena och en diskussion fördes därför angående huruvida mängden tillgänglig data eller andra metodval hade kunnat förbättra modellen. Slutsatsen blev att större set data och en kraftigare optimeringsalgoritm troligtvis hade resulterat i mindre avvikande prediktioner

Association of genetic variation with systolic and diastolic blood pressure among African Americans: the Candidate Gene Association Resource study

The prevalence of hypertension in African Americans (AAs) is higher than in other US groups; yet, few have performed genome-wide association studies (GWASs) in AA. Among people of European descent, GWASs have identified genetic variants at 13 loci that are associated with blood pressure. It is unknown if these variants confer susceptibility in people of African ancestry. Here, we examined genome-wide and candidate gene associations with systolic blood pressure (SBP) and diastolic blood pressure (DBP) using the Candidate Gene Association Resource (CARe) consortium consisting of 8591 AAs. Genotypes included genome-wide single-nucleotide polymorphism (SNP) data utilizing the Affymetrix 6.0 array with imputation to 2.5 million HapMap SNPs and candidate gene SNP data utilizing a 50K cardiovascular gene-centric array (ITMAT-Broad-CARe [IBC] array). For Affymetrix data, the strongest signal for DBP was rs10474346 (P= 3.6 × 10−8) located near GPR98 and ARRDC3. For SBP, the strongest signal was rs2258119 in C21orf91 (P= 4.7 × 10−8). The top IBC association for SBP was rs2012318 (P= 6.4 × 10−6) near SLC25A42 and for DBP was rs2523586 (P= 1.3 × 10−6) near HLA-B. None of the top variants replicated in additional AA (n = 11 882) or European-American (n = 69 899) cohorts. We replicated previously reported European-American blood pressure SNPs in our AA samples (SH2B3, P= 0.009; TBX3-TBX5, P= 0.03; and CSK-ULK3, P= 0.0004). These genetic loci represent the best evidence of genetic influences on SBP and DBP in AAs to date. More broadly, this work supports that notion that blood pressure among AAs is a trait with genetic underpinnings but also with significant complexit

Long-Term Exposure to Transportation Noise and Risk of Incident Stroke: A Pooled Study of Nine Scandinavian Cohorts

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