Healthcare interactions prior to first hospital admission with alcohol-related liver disease.

BACKGROUND AND AIMS: To examine the healthcare contacts of patients in the year before an index admission to hospital with alcohol-related liver disease (ArLD) to identify where opportunities for earlier identification of alcohol use disorders (AUD) and ArLD and intervention may occur. METHODS: A retrospective cohort study using the regional database encompassing NHS organisations across North West London (344 general practitioner [GP] practices, 4 acute hospital trusts and 2 mental health and community health trusts). Patients who had an index admission with ArLD were identified through healthcare coding and compared with a control cohort. Healthcare contacts, blood tests and AUD testing in the year preceding admission were measured. RESULTS: The ArLD cohort had 1494 participants with an index hospital admission with ArLD. The control cohort included 4462 participants. In the year preceding an index admission with ArLD, 91% of participants had at least one contact with primary care with an average of 2.97 (SD 2.45) contacts; 80% (n = 1199/1494) attended ED, 68% attended an outpatient clinic, and 42% (n = 628/1494) had at least one inpatient admission. Only 9% of the ArLD (137/1494) had formal testing for AUD. Abnormal bilirubin and platelets were more common in the ArLD than the control cohort 25% (138/560) and 28% (231/837), respectively, v 1% (12/1228) and 1% (20/1784). CONCLUSIONS: Prior to an index admission with ArLD patients have numerous interactions with all healthcare settings, indicating missed opportunities for early identification and treatment.

Effectiveness of lipid-based nutrient supplementation during the first 1000 days of life for early childhood development: A community-based trial from Pakistan.

A community-based, cluster non-randomized controlled trial was conducted in Kurram district, Pakistan between January 2018 to December 2020. Age-appropriate lipid-based nutrient supplements and health education (sessions conducted in the households) were given to pregnant women and their born children (6-23 months) in the intervention arm (n = 40 clusters) versus health education only in the control arm (n = 40 clusters) to evaluate its effect on child development. The first and second developmental assessments were completed at ~24 months (n = 689) and ~32 months (n = 608), respectively, using the Caregiver-Reported Early Development Instrument Long form. The overall and domain-specific (motor, language, cognitive and socio-emotional) scores were computed with higher scores indicating better child development. Higher development scores, including overall (ß = 0.40, 95% confidence interval [CI]: 0.14, 0.65; p = 0.002), cognitive (ß = 0.27, 95% CI: 0.10, 0.45; p = 0.002), motor (ß = 0.39, 95% CI: 0.22, 0.56; p < 0.001) and language (ß = 0.33, 95% CI: 0.14, 0.51; p = 0.001) were reported for children who received the intervention compared to the control arm at first developmental assessment. However, the effect was not sustained after the discontinuation of the intervention. The LNS received by the mothers (during pregnancy and first 6 months after delivery) and by children during 6-23 months of age was beneficial for the children. The trial is registered in the International Standard Randomised Controlled Trial Number Registry (ID: ISRCTN94319790) on December 11, 2017.

Analysis of aerosol optical depth and relation to covariates during pre-monsoon season (2002-2019) over Pakistan using ARIMAX model and cross-wavelet analysis.

The pre-monsoon season heavily influences the precipitation amount in Pakistan. When hydrometeorological parameters interact with aerosols from multiple sources, a radiative climatic response is observed. In this study, aerosol optical depth (AOD) space-time dynamics were analyzed in relation to meteorological factors and surface parameters during the pre-monsoon season in the years 2002-2019 over Pakistan. Level-3 (L3) monthly datasets from Moderate Resolution Imaging Spectroradiometer (MODIS) and Multi-Angle Imaging Spectroradiometer (MISR) were used. Tropical Rainfall Measuring Mission (TRMM) derived monthly precipitation, Atmospheric Infrared Sounder (AIRS) derived air temperature, after moist relative humidity (RH) from Modern-Era Retrospective analysis for Research and Applications, Version-2 (MERRA-2), near-surface wind speed, and soil moisture data derived from Global Land Data Assimilation System (GLDAS) were also used on a monthly time scale. For AOD trend analysis, Mann-Kendall (MK) trend test was applied. Moreover, Autoregressive Integrated Moving Average with Explanatory variable (ARIMAX) technique was applied to observe the actual and predicted AOD trend, as well as test the multicollinearity of AOD with covariates. The periodicities of AOD were analyzed using continuous wavelet transformation (CWT) and the cross relationships of AOD with prevailing covariates on a time-frequency scale were analyzed by wavelet coherence analysis. A high variation of aerosols was observed in the spatiotemporal domain. The MK test showed a decreasing trend in AOD which was most significant in Baluchistan and Punjab, and the overall trend differs between MODIS and MISR datasets. ARIMAX model shows the correlation of AOD with varying meteorological and soil parameters. Wavelet analysis provides the abundance of periodicities in the 2-8 months periodic cycles. The coherency nature of the AOD time series along with other covariates manifests leading and lagging effects in the periodicities. Through this, a notable difference was concluded in space-time patterns between MODIS and MISR datasets. These findings may prove useful for short-term and long-term studies including oscillating features of AOD and covariates.

Role of Primary Care Physicians in management of Schizophrenia in Low and Middle Income Countries (LMIC): A systematic review.

Many people with Schizophrenia lack the resources and access to mental health services especially in low and middle income countries. Integration of mental health into primary care services can be a cost effective way of reducing the disability associated with Schizophrenia. Our aim was to review the studies conducted on role of Primary care physicians in management of Schizophrenia in low and middle income countries. PRISMA guidelines were followed and we registered the study protocol at PROSPERO. Four Electronic Databases (Medline, Psycinfo, CINAHL and Embase) were searched in May 2022. Relevant articles after search were 504 of which 61 full text were examined. A total of 20 studies were included in the final review comprising of observational, experimental and qualitative studies. Most studies reported on abilities of Primary care physicians including their knowledge, perceptions, skills and competencies in identifying and management of Schizophrenia and related Psychosis. Findings suggest that there is considerable amount of stigma, lack of awareness and social support about people diagnosed with Schizophrenia. Significant improvement was observed in diagnosis and management of schizophrenia by Primary care physicians who received appropriate training by experts in the field. This review suggests that appropriate training of General practitioners in diagnosing and treating schizophrenia can help in reduction of huge Treatment Gap in Schizophrenia. They can also be utilised in delivering psycho social interventions to improve overall quality of patient care.

Clinical characteristics and comorbidities associated with testosterone prescribing in men.

OBJECTIVE: Testosterone replacement therapy (TRT) is recommended for the treatment of symptomatic hypogonadism in men. Data on prescription behaviours are, however, limited and conflicting. The objective of this study was to investigate clinical characteristics associated with the likelihood of being prescribed TRT by general practitioners (GP) in North-West London (NWL). DESIGN: Retrospective cohort study using Discover database of GP-registered patients in NWL between 2015 and 2019. PATIENTS: We identified 20,299 men aged ≥18 years with serum total testosterone measurement (TT) and without prior TRT prescription records. MEASUREMENTS: We determined whether TRT was subsequently commenced, while analysing clinical characteristics related to hypogonadism. RESULTS: Of all men having TT measurement, 19,583 (96.4%) were not commenced on TRT (Group A) and 716 (3.5%) men were commenced on TRT (Group B). Men prescribed TRT (Group B) had higher mean age, body mass index (BMI) and higher risks of hypertension, depression type 2 diabetes and ischaemic heart disease; conversely, men in Group B had lower mean pretreatment TT and were less likely to have prostate cancer. Four-hundred and thirty-six men (24.3%) with TT < 8 nmol/L and symptoms of low libido were not prescribed TRT. CONCLUSIONS: Our study highlights several factors which may influence the decisions made by clinicians when initiating TRT in primary care. Clearer guidance for clinicians may help to improve the consistency of treatment of men with hypogonadism.

Identification of palliative care needs among people with dementia and its association with acute hospital care and community service use at the end-of-life: A retrospective cohort study using linked primary, community and secondary care data.

BACKGROUND: Hospital admissions among people dying with dementia are common. It is not known whether identification of palliative care needs could help prevent unnecessary admissions. AIM: To examine the proportion of people with dementia identified as having palliative care needs in their last year of life, and the association between identification of needs and primary, community and hospital services in the last 90 days. DESIGN: Retrospective cohort study using Discover, an administrative and clinical dataset from 365 primary care practices in London with deterministic individual-level data linkage to community and hospital records. SETTING/PARTICIPANTS: People diagnosed with dementia and registered with a general practitioner in North West London (UK) who died between 2016 and 2019. The primary outcome was multiple non-elective hospital admissions in the last 90 days of life. Secondary outcomes included contacts with primary and community care providers. We examined the association between identification of palliative care needs with outcomes. RESULTS: Among 5804 decedents with dementia, 1953 (33.6%) were identified as having palliative care needs, including 1141 (19.7%) identified before the last 90 days of life. Identification of palliative care needs before the last 90 days was associated with a lower risk of multiple hospital admissions (Relative Risk 0.70, 95% CI 0.58-0.85) and more contacts with the primary care practice, community nurses and palliative care teams in the last 90 days. CONCLUSIONS: Further investigation of the mechanisms underlying the association between identification of palliative care needs and reduced hospital admissions could help reduce reliance on acute care for this population.

Magnetic Field Treatments Improves Sunflower Yield by Inducing Physiological and Biochemical Modulations in Seeds.

Magnetic seed enhancement has been practicing as a promising tool to improve germination and seedling growth of low vigor seeds stored under suboptimal conditions, but there is still ambiguity regarding the prospects for magnetism in oilseeds. Present study elucidates the potential of magnetic seed stimulation to improve sunflower germination, growth and yield. Germination and emergence tests were performed to optimize the strength of the magnetic field to sunflower seed enhancement. The seeds were directly exposed to magnetic field strengths of 50, 100 and 150 millitesla (mT) for 5, 10 and 15 min (min) and then standard germination tests were performed. Secondly, the emergence potential of untreated seeds was compared with seed exposed to hydropriming, priming with 3% moringa leaf extract (MLE), priming with magnetically treated water (MTW) for 10 min and priming with 3% MLE solution prepared in magnetically treated water (MTW + MLE). Germination, emergence, seedling growth and seed biochemical properties were used to select the best treatment for field evaluation. The results of the study revealed that magnetic seed treatment with 100 mT for 10 min and seed priming with 3% MLE solution in magnetically treated water (MTW + MLE) significantly improved emergence, crop growth rate and sunflower yield.

Correlation between maternal and neonatal blood Vitamin D level: Study from Pakistan.

In Pakistan, there is limited evidence for the levels and relationship of 25 (OH) Vitamin D (25(OH)D) status in pregnant women and their newborns, while the association between maternal 25(OH)D and newborn anthropometric measurements remains unexplored. Sociodemographic data were collected from 213 pregnant mothers during their visit to a tertiary care hospital at the time of childbirth. Anthropometric measurements were performed on all mothers and their newborns and blood samples collected from both for 25(OH)D levels. Participants were classified into two groups according to their 25(OH)D status: sufficient (25(OH)D ≥50 nmol L-1 ) and deficient (25(OH)D <50 nmol L-1 ). Simple and multiple regression models were used for analysis. Among 213 pregnant women, prevalence of 25(OH)D deficiency was 61.5%, and their newborn was 99.5% (mean 25(OH)D levels: 46.3 [11.3] and 24.9 [5.4] nmol L-1 , respectively). Maternal sociodemographic characteristics were similar between 25(OH)D deficient and sufficient mothers, whereas newborn 25(OH)D levels were significantly lower in the former (22.60 [4.53] vs. 27.67 [3.82] nmol L-1 , respectively, P < 0.001). There was a strong positive association between maternal and newborn 25(OH)D levels (r, 0.66; r2 , 43%, B [SE], 0.3 [0.02]; P < 0.001). Association of maternal 25(OH)D levels with newborn weight, length and head circumference was not significant (all P > 0.05). Our study shows a high prevalence of 25(OH)D deficiency in pregnant women and their newborns and a strong positive association between maternal and newborn 25(OH)D levels. Findings of this study indicate the importance of maintaining sufficient 25(OH)D levels during pregnancy.

How an electronic health record became a real-world research resource: comparison between London's Whole Systems Integrated Care database and the Clinical Practice Research Datalink.

BACKGROUND: In the UK, several initiatives have resulted in the creation of local data warehouses of electronic patient records. Originally developed for commissioning and direct patient care, they are potentially useful for research, but little is known about them outside their home area. We describe one such local warehouse, the Whole Systems Integrated Care (WSIC) database in NW London, and its potential for research as the "Discover" platform. We compare Discover with the Clinical Practice Research Datalink (CPRD), a popular UK research database also based on linked primary care records. METHODS: We describe the key features of the Discover database, including scope, architecture and governance; descriptive analyses compare the population demographics and chronic disease prevalences with those in CPRD. RESULTS: As of June 2019, Discover held records for a total of 2.3 million currently registered patients, or 95% of the NW London population; CPRD held records for over 11 million. The Discover population matches the overall age-sex distribution of the UK and CPRD but is more ethnically diverse. Most Discover chronic disease prevalences were comparable to the national rates. Unlike CPRD, Discover has identifiable care organisations and postcodes, allowing mapping and linkage to healthcare provider variables such as staffing, and includes contacts with social, community and mental health care. Discover also includes a consent-to-contact register of over 3000 volunteers to date for prospective studies. CONCLUSIONS: Like CPRD, Discover has been a number of years in the making, is a valuable research tool, and can serve as a model for other areas developing similar data warehouses.

Quantification and risk assessment of heavy metal build-up in soil-plant system after irrigation with untreated city wastewater in Vehari, Pakistan.

In peri-urban areas of district Vehari, farmers are using untreated city wastewater for crop irrigation owing to the scarcity of good-quality irrigation water. This practice may pose severe environmental and health issues to local inhabitants attributed to the high levels of potentially toxic metals in wastewater. The present study evaluated the potential impacts of wastewater irrigation on metals (Cd, Cr, Cu, Fe, Ni, Mn, Pb and Zn) build-up in the soil-plant continuum and associated health risks. In this study, wastewater (n = 17), soil (n = 108) and plant (n = 65) samples were collected from 15 peri-urban sites of three tehsils of district Vehari. Results showed that the mean concentration (mg/L) of Cd (0.02), Mn (0.25) and Fe (1.57) in wastewater samples was higher than their respective threshold values. Similarly, Cd, Mn and Fe concentration in soil was beyond the permissible limits of agricultural soil receiving wastewater irrigation. However, plants showed high accumulation of Pb, Cr and Fe than their respective limits depending on the vegetable/crop species. The health risk parameters showed that Pb and Cd are the major toxic chemical substances to human health, and the daily intake of crop plants can pose a potential health threat due to wastewater-irrigated crop consumption. Results highlighted the necessity of wastewater pretreatment to avoid the soil and vegetable contamination by wastewater irrigation and to reduce the associated health risks.

Prevalence of stroke in Pakistan: Findings from Khyber Pakhtunkhwa integrated population health survey (KP-IPHS) 2016-17.

OBJECTIVE: To study the prevalence of stroke and associated risk factors in Khyber Pakhtunkhwa (KP) province of Pakistan. METHODS: This study was a part of cross-sectional KP Integrated Population Health Survey 2016-17 conducted on population aging ≥18 years at 24 districts of KP. Primary (n=1061) and secondary sampling units (n=15724) were developed, based on urban/rural and socio-economic status. Each primary-unit comprised of 250-300 households. Sample was selected through a multi-staged stratified systematic cluster sampling technique by taking every 16th household per rural and every 12th household per urban-unit. A validated "Cincinnati Stroke Scale" for identification of stroke patients in community was used along with demographics and potential risk factors. RESULTS: Among the 15724 randomly selected households, 22500 participants (51.4% females; 74.6% rural areas, mean age 42±12.6 years) were interviewed. Stroke was identified in 271 cases (137 males, 134 females; Mean age=43.39±0.85 years) and prevalence of stroke was 1.2% (1200 per 100,000 population). Obesity/overweight (38.8%), hypertension (21.8%), smoking (6.6%) and known diabetes mellitus (5.9%) were the common associated risk factors of stroke. Age groups >60 years (adjusted OR=1.68; 95% CI: 1.05-2.68); urban area (adjusted OR=1.68; 95% CI: 1.29-2.19); unemployment (adjusted OR=3.78; 95% CI: 2.49-5.73) and lower formal (primary) education (adjusted OR 2.18; 95% CI: 1.30-3.64) were significantly associated with stroke (p <0.05). CONCLUSION: Prevalence of stroke is 1.2% in the province of KP. Obesity, hypertension, smoking and Diabetes Mellitus are the common associated risk factors of stroke. Higher age, urban area, unemployment and lower formal education are significantly associated with stroke.

A comparison of satellite-based indices for hazard assessment of MSW open dumps using spatial analysis.

This study compares the suitability of different satellite-based vegetation indices (VIs) for environmental hazard assessment of municipal solid waste (MSW) open dumps. The compared VIs, as bio-indicators of vegetation health, are normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and modified soil adjusted vegetation index (MSAVI) that have been subject to spatio-temporal analysis. The comparison has been made based on three criteria: one is the exponential moving average (EMA) bias, second is the ease in visually finding the distance of VI curve flattening, and third is the radius of biohazardous zone in relation to the waste heap dumped at them. NDVI has been found to work well when MSW dumps are surrounded by continuous and dense vegetation, otherwise, MSAVI is a better option due to its ability for adjusting soil signals. The hierarchy of the goodness for least EMA bias is MSAVI> SAVI> NDVI with average bias values of 101 m, 203 m, and 270 m, respectively. Estimations using NDVI have been found unable to satisfy the direct relationship between waste heap and hazardous zone size and have given a false exaggeration of 374 m for relatively smaller dump as compared to the bigger one. The same false exaggeration for SAVI and MSAVI is measured to be 86 m and -14 m, respectively. So MSAVI is the only VI that has shown the true relation of waste heap and hazardous zone size. The best visualization of distance-dependent vegetation health away from the dumps is also provided by MSAVI.

Association of arg16gly and gln27glu, b2-adrenergic receptor gene polymorphism with asthma. A systematic review and meta-analysis of case control studies.

The study was planned to assimilate quantitatively the available evidences on association of Arg16Gly and Glu27Gln with asthma and to produce more precise results. All case-control studies conducted on adults were searched on Medline, Embase, PubMed, Wiley online library according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The strength of association was measured by odds ratios with 95% confidence interval. A total of 17 case-control studies were included in the meta-analysis and there was no significant association of asthma with Arg16Gly (odds ratio = 1.19; 95% confidence interval = 0.75-1.50, p=0.459) and Glu27Gln of ADRb2 polymorphism (odds ratio=0.87, 95% confidence interval =0.44-1.71, p=0.683). Moreover, neither Gly16 allele (odds ratio = 0.98; 95% confidence interval = 0.70-1.38, p=0.867) nor Glu27 allele (odds ratio = 0.67, 95% confidence interval = 0.38-1.19, p=0.169) contributed to asthma susceptibility. There was also no significant association between haplotypes of both single nucleotide polymorphisms and asthma (p>0.05). Data indicated that adrenergic receptor b2 did not contribute markedly to susceptibility to asthma (p>0.05).

Cardiometabolic disease and features of depression and bipolar disorder: population-based, cross-sectional study.

BACKGROUND: The relative contribution of demographic, lifestyle and medication factors to the association between affective disorders and cardiometabolic diseases is poorly understood. AIMS: To assess the relationship between cardiometabolic disease and features of depresion and bipolar disorder within a large population sample. METHOD: Cross-sectional study of 145 991 UK Biobank participants: multivariate analyses of associations between features of depression or bipolar disorder and five cardiometabolic outcomes, adjusting for confounding factors. RESULTS: There were significant associations between mood disorder features and 'any cardiovascular disease' (depression odds ratio (OR) = 1.15, 95% CI 1.12-1.19; bipolar OR = 1.28, 95% CI 1.14-1.43) and with hypertension (depression OR = 1.15, 95% CI 1.13-1.18; bipolar OR = 1.26, 95% CI 1.12-1.42). Individuals with features of mood disorder taking psychotropic medication were significantly more likely than controls not on psychotropics to report myocardial infarction (depression OR = 1.47, 95% CI 1.24-1.73; bipolar OR = 2.23, 95% CI 1.53-3.57) and stroke (depression OR = 2.46, 95% CI 2.10-2.80; bipolar OR = 2.31, 95% CI 1.39-3.85). CONCLUSIONS: Associations between features of depression or bipolar disorder and cardiovascular disease outcomes were statistically independent of demographic, lifestyle and medication confounders. Psychotropic medication may also be a risk factor for cardiometabolic disease in individuals without a clear history of mood disorder.

Chronic multisite pain in major depression and bipolar disorder: cross-sectional study of 149,611 participants in UK Biobank.

BACKGROUND: Chronic pain has a strong association with major depressive disorder (MDD), but there is a relative paucity of studies on the association between chronic multisite pain and bipolar disorder (BD). Such studies are required to help elucidate the complex biological and psychological overlap between pain and mood disorders. The aim of this study is to investigate the relationship between chronic multisite pain and mood disorder across the unipolar-bipolar spectrum. METHODS: We conducted a cross-sectional study of 149,611 UK Biobank participants. Self-reported depressive and bipolar features were used to categorise participants into MDD and BD groups and a non-mood disordered comparison group. Multinomial logistic regression was used to establish whether there was an association between extent of chronic pain (independent variable) and mood disorder category (dependent variable), using no pain as the referent category, and adjusting for a wide range of potential sociodemographic, lifestyle and comorbidity confounders. RESULTS: Multisite pain was significantly more prevalent in participants with BD and MDD, for example, 4-7 pain sites: BD 5.8%, MDD 4.5%, and comparison group 1.8% (p < 0.001). A relationship was observed between extent of chronic pain and risk of BD and persisted after adjusting for confounders (relative to individuals with no chronic pain): 2-3 sites RRR of BD 1.84 (95% CI 1.61, 2.11); 4-7 sites RRR of BD 2.39 (95% CI 1.88, 3.03) and widespread pain RRR of BD 2.37 (95% CI 1.73, 3.23). A similar relationship was observed between chronic pain and MDD: 2-3 sites RRR of MDD 1.59 (95% CI 1.54, 1.65); 4-7 sites RRR of MDD 2.13 (95% CI 1.98, 2.30); widespread pain RRR of MDD 1.86 (95% CI 1.66, 2.08). CONCLUSIONS: Individuals who report chronic pain and multiple sites of pain are more likely to have MDD and are at higher risk of BD. These findings highlight an important aspect of comorbidity in MDD and BD and may have implications for understanding the shared neurobiology of chronic pain and mood disorders.

Gender differences in the association between adiposity and probable major depression: a cross-sectional study of 140,564 UK Biobank participants.

BACKGROUND: Previous studies on the association between adiposity and mood disorder have produced contradictory results, and few have used measurements other than body mass index (BMI). We examined the association between probable major depression and several measurements of adiposity: BMI, waist circumference (WC), waist-hip-ratio (WHR), and body fat percentage (BF%). METHODS: We conducted a cross-sectional study using baseline data on the sub-group of UK Biobank participants who were assessed for mood disorder. Multivariate logistic regression models were used, adjusting for potential confounders including: demographic and life-style factors, comorbidity and psychotropic medication. RESULTS: Of the 140,564 eligible participants, evidence of probable major depression was reported by 30,145 (21.5%). The fully adjusted odds ratios (OR) for obese participants were 1.16 (95% confidence interval (CI) 1.12, 1.20) using BMI, 1.15 (95% CI 1.11, 1.19) using WC, 1.09 (95% CI 1.05, 1.13) using WHR and 1.18 (95% CI 1.12, 1.25) using BF% (all p < 0.001). There was a significant interaction between adiposity and gender (p = 0.001). Overweight women were at increased risk of depression with a dose response relationship across the overweight (25.0-29.9 kg/m2), obese I (30.0-34.9 kg/m2), II (35.0-39.9 kg/m2) and III (≥40.0 kg/m2) categories; fully adjusted ORs 1.14, 1.20, 1.29 and 1.48, respectively (all p < 0.001). In contrast, only obese III men had significantly increased risk of depression (OR 1.29, 95% CI 1.08, 1.54, p = 0.006). CONCLUSION: Adiposity was associated with probable major depression, irrespective of the measurement used. The association was stronger in women than men. Physicians managing overweight and obese women should be alert to this increased risk.

Association between physical and mental health-related quality of life and adverse outcomes; a retrospective cohort study of 5,272 Scottish adults.

BACKGROUND: Health-related quality of life (HRQoL) is associated with adverse outcomes in disease-specific populations. This study examines whether it is also independent predictor of incident cancer, coronary heart disease (CHD) and mortality in the general population. METHODS: The records of adult participants in the Scottish Health Survey 2003 were linked with hospital admissions, cancer registrations and death certificates. Cox proportional hazard models were used to explore the associations between quintiles of physical and mental component summary score (PCS and MCS respectively) of the SF-12 and adverse outcomes. Higher quintiles of both PCS and MCS indicate better health status. RESULTS: Among the 5,272 study participants, the mean PCS score was 49 (standard deviation (SD) 10.3). Participants were followed-up for a mean of 7.6 years. On survival analysis the lowest quintile of PCS was a strong predictor of all-cause death (hazard ratio (HR) 2.81, 95% CI 1.76, 4.49), incident cancer (HR 1.63, 95% CI 1.10, 2.42), and CHD events (HR 1.99, 95% CI 1.00, 3.96), compared to the highest quintile. This association was independent of adiposity and other confounders. The mean MCS score 52 (SD 8.8). MCS quintile was not associated with incident cancer and CHD, and the association between MCS and all-cause death (HR 1.33, 95% CI 1.01, 1.75) became non-significant after adjustment for adiposity. CONCLUSION: Physical HRQoL is a significant predictor of a range of adverse outcomes, even after adjustment for adiposity and other confounders. This study highlights the importance of perceived health in the general population.

Classification of aerosols using particle linear depolarization ratio (PLDR) over seven urban locations of Asia.

Active lidar remote sensing has been used to obtain detailed and quantitative information about the properties of aerosols. We have analyzed the spatio-temporal classification of aerosols using the parameters of particle linear depolarization ratio and single scattering albedo from Aerosol Robotic Network (AERONET) over seven megacities of Asia namely; Lahore, Karachi, Kanpur, Pune, Beijing, Osaka, and Bandung. We find that pollution aerosols dominate during the winter season in all the megacities. The concentrations, however, vary concerning the locations, i.e., 70-80% pollution aerosols are present over Lahore, 40-50% over Karachi, 90-95% over Kanpur and Pune, 60-70% and over Beijing and Osaka. Pure Dust (PD), Pollution Dominated Mixture (PDM), and Dust Dominated Mixture (DDM) are found to be dominant during spring and summer seasons.This proposes that dust over Asia normally exists as a mixture with pollution aerosols instead of pure form. We also find that black carbon (BC) dominated pollution aerosols.

Real-world study of the multimorbidity and health service utilisation among individuals with non-diabetic hyperglycemia and type 2 diabetes mellitus in North West London.

INTRODUCTION: The prevalence of non-diabetic hyperglycemia (NDH) and type 2 diabetes mellitus (T2DM) is increasing. While T2DM is recognised to be associated with multimorbidity and early mortality, people with NDH are frequently thought to be devoid of such complications, potentially exposing individuals with NDH to suboptimal care. We therefore used the Discover London Secure Data Environment (SDE) dataset to appreciate the relationship of NDH/T2DM with multimorbidity, healthcare usage, and clinical outcomes. RESEARCH DESIGN AND METHODS: The dataset was retrospectively analysed between January 1, 2015 and December 31, 2020 to understand the relationship between NDH/T2DM and multimorbidity primary/secondary healthcare usage and clinical outcomes. This was compared with a cohort of individuals with thyroid disease but no NDH/T2DM. RESULTS: The dataset identified 152,384 and 124,190 adults with NDH and T2DM compared with 11,626 individuals with thyroid disease (control group). Individuals with NDH and individuals with T2DM had a high burden of disease, with only 13.1% of individuals with either NDH or T2DM not found to be suffering from at least one of the disease states of interest. The three most common comorbidities experienced by individuals with NDH were hypertension (41.4%), hypercholesterolemia (37.5%), and obesity (29.8%) compared with retinopathy (68.7%), hypertension (59.4%), and obesity (45.8%) in individuals with T2DM. Comparatively, the most common comorbidities in the control group were depression (30.8%), hypercholesterolemia (24.4%), and hypertension (17.1%). 28 (control group), 12 (NDH), and 16 (T2DM) primary care contacts per individual per year were identified, with 27,881, 282,371, and 314,880 inpatient admissions for the control, NDH, and T2DM cohorts, respectively. Prescription of drugs used to treat T2DM in individuals with NDH and T2DM was 27,772 (18.2%) and 109,361 (88.1%), respectively, accounting for approximately one in five individuals with NDH developing T2DM. CONCLUSION: Both NDH and T2DM were associated with significant multimorbidity alongside primary and secondary care utilisation. Given the morbidity highlighted with NDH, we highlight the need for earlier detection of NDH, recognition of multimorbidity associated with both NDH and T2DM, as well as the need for the further implementation of interventions to prevent progression to T2DM/multimorbidity.

COVID-19 Vaccine Effectiveness Studies against Symptomatic and Severe Outcomes during the Omicron Period in Four Countries in the Eastern Mediterranean Region.

Vaccine effectiveness (VE) studies provide real-world evidence to monitor vaccine performance and inform policy. The WHO Regional Office for the Eastern Mediterranean supported a regional study to assess the VE of COVID-19 vaccines against different clinical outcomes in four countries between June 2021 and August 2023. Health worker cohort studies were conducted in 2707 health workers in Egypt and Pakistan, of whom 171 experienced symptomatic laboratory-confirmed SARS-CoV-2 infection. Test-negative design case-control studies were conducted in Iran and Jordan in 4017 severe acute respiratory infection (SARI) patients (2347 controls and 1670 cases) during the Omicron variant dominant period. VE estimates were calculated for each study and pooled by study design for several vaccine types (BBIBP-CorV, AZD1222, BNT162b2, and mRNA-1273, among others). Among health workers, VE against symptomatic infection of a complete primary series could only be computed compared to partial vaccination, suggesting a benefit of providing an additional dose of mRNA vaccines (VE: 88.9%, 95%CI: 15.3-98.6%), while results were inconclusive for other vaccine products. Among SARI patients, VE against hospitalization of a complete primary series with any vaccine compared to non-vaccinated was 20.9% (95%CI: 4.5-34.5%). Effectiveness estimates for individual vaccines, booster doses, and secondary outcomes (intensive care unit admission and death) were inconclusive. Future VE studies will need to address challenges in both design and analysis when conducted late during a pandemic and will be able to utilize the strengthened capacities in countries.