Gender differences in cardiovascular disease risk: Adolescence to young adulthood.

BACKGROUND AND AIMS: Gender differences in cardiovascular disease (CVD) have been well documented but rarely for young adults and the extent to which gender related lifestyle differences may contribute to gender differences in CVD risk experienced by young adults have not been reported. METHODS AND RESULTS: Data are from a long-running cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We track gender differences in CVD related behaviours at 21 and 30 years (consumption of a Western Diet/Health-Oriented Diet, cigarette smoking, vigorous physical exercise, heavy alcohol consumption). At 30 years we compare males and females for CVD risk, and the extent to which lifestyle behaviours at 21 and 30 years contribute to CVD risk. At both 21 and 30 years of age, males more frequently consume a Western Diet and less often a Health Oriented Diet. By contrast, males are also much more likely to report engaging in vigorous physical activity. On most CVD markers, males exhibit much higher levels of risk than do females at both 21 and 30 years. At 30 years of age males have about five times the odds of being at high risk of CVD. Some lifestyle behaviours contribute to this additional risk. CONCLUSION: Young adult males much more frequently engage in most CVD related risk behaviours and males have a higher level of CVD risk. Gender differences in CVD risk remain high even after adjustment for CVD lifestyles, though dietary factors independently contribute to CVD risk at 30 years.

Dietary patterns and young adult body mass change: A 9-year longitudinal study.

PURPOSE: While excessive weight gain is highest during young adulthood, the extent to which specific dietary patterns are associated with changes in measures of body mass in this course of life remains unknown. We aimed to examine the associations of dietary patterns at 21 years with changes in body weight and body mass index (BMI) between 21 and 30 years. METHODS: We used data on young adults from a long-running birth cohort in Australia. Western and prudent dietary patterns were identified applying principal component analysis to 33 food groups obtained by a food frequency questionnaire at 21 years. Body weight and height were measured at 21 and 30 years. Multivariable regression models, using generalized estimating equations, were adjusted for concurrent changes in sociodemographic and lifestyle variables in evaluating the effect of identified dietary patterns on changes in weight and BMI over time. RESULTS: In the fully adjusted model, young adults in the highest tertile of the Western pattern had a mean weight gain of 9.9 (95% CI 8.5, 11.3) kg compared to those in the lowest that had a mean weight gain of 7.1 (95% CI 5.6, 8.5) kg, P-for linear trend = 0.0015. The corresponding values for mean gains in BMI were 3.1 (95% CI 2.7, 3.6) kg/m2 for young adults in the highest tertile compared to 2.4 (95% CI 1.9, 2.9) kg/m2 for those in lowest, P-for linear trend = 0.0164. There was no evidence of a significant association between the prudent pattern and mean changes in each outcome over time in this study. CONCLUSIONS: The findings of the current study show that greater adherence to the Western diet at 21 years was positively associated with increases in body weight and BMI from 21 to 30 years of age, whereas the prudent diet had no significant association with these outcomes. The findings provide evidence that the adverse effects of the Western diet on weight gain in young adulthood could partly be prevented through optimising diet in the early course of life.

Dietary patterns explaining variations in blood biomarkers in young adults are associated with the 30-year predicted cardiovascular disease risks in midlife: A follow-up study.

BACKGROUND AND AIMS: To examine a combined effect of dietary intakes, blood lipid and insulin resistance in young adulthood on the risk of predicted CVD through midlife. METHODS AND RESULTS: Data of young adults from a birth cohort study in Australia were used. Reduced rank regression (RRR) and partial least squares (PLS) methods identified dietary patterns rich in meats, refined grains, processed and fried foods, and high-fat dairy and low in whole grains and low-fat dairy from dietary intakes obtained at 21-years, and blood lipids and measures of insulin resistance measured at 30-years of age. Using standard CVD risk factors measured at 30-years of age, the Framingham Heart Study risk-prediction algorithms were used to calculate the 30-year predicted Framingham CVD risk scores. The scores represent Hard CVD events; coronary death, myocardial infarction and stroke and Full CVD events; Hard CVD plus coronary insufficiency and angina pectoris, transient ischaemic attack, intermittent claudication, and congestive heart failure in midlife. Sex-specific upper quartiles of CVD risk scores were used to define high-risk groups. Modified Poisson regression models were used to estimate relative risks (RRs) with 95% CI. Greater adherence to the diet identified applying RRR in young adulthood was associated with higher risks of predicted Hard CVD (RR: 1.60; 1.14, 2.25) and Full CVD (RR: 1.46; 1.04, 2.05) events in midlife. The diet from PLS showed similar trend of association for the risk of predicted Hard CVD events (RR: 1.49; 1.03, 2.16) in adjusted models. CONCLUSION: Dietary patterns associated with variations in blood lipids and insulin resistance in young adulthood are associated with increased risks of predicted CVD events in midlife. The findings suggest that diet induced altered blood lipids and insulin resistance in the life course of young adulthood could increase the risks of CVD events in later life.

Neglected tropical diseases in Australia: a narrative review.

•Neglected tropical diseases (NTDs) represent a threat to the health, wellbeing and economic prosperity of billions of people worldwide, often causing serious disease or death. •Commonly considered diseases of low and middle-income nations, the presence of NTDs in high income countries such as Australia is often overlooked. •Seven of the 20 recognised NTDs are endemic in Australia: scabies, soil-transmitted helminths and strongyloidiasis, echinococcosis, Buruli ulcer, leprosy, trachoma, and snakebite envenoming. •Dengue, while not currently endemic, poses a risk of establishment in Australia. There are occasional outbreaks of dengue fever, with local transmission, due to introductions in travellers from endemic regions. •Similarly, the risk of introduction of other NTDs from neighbouring countries is a concern. Many NTDs are only seen in Australia in individuals travelling from endemic areas, but they need to be recognised in health settings as the potential consequences of infection can be severe. •In this review, we consider the status of NTDs in Australia, explore the risk of introducing and contracting these infections, and emphasise the negative impact they have on the health of Australians, especially Aboriginal and Torres Strait Islander peoples.

Schistosomiasis in the People's Republic of China - down but not out.

Schistosomiasis has been subjected to extensive control efforts in the People's Republic of China (China) which aims to eliminate the disease by 2030. We describe baseline results of a longitudinal cohort study undertaken in the Dongting and Poyang lakes areas of central China designed to determine the prevalence of Schistosoma japonicum in humans, animals (goats and bovines) and Oncomelania snails utilizing molecular diagnostics procedures. Data from the Chinese National Schistosomiasis Control Programme (CNSCP) were compared with the molecular results obtained.Sixteen villages from Hunan and Jiangxi provinces were surveyed; animals were only found in Hunan. The prevalence of schistosomiasis in humans was 1.8% in Jiangxi and 8.0% in Hunan determined by real-time polymerase chain reaction (PCR), while 18.3% of animals were positive by digital droplet PCR. The CNSCP data indicated that all villages harboured S. japonicum-infected individuals, detected serologically by indirect haemagglutination assay (IHA), but very few, if any, of these were subsequently positive by Kato-Katz (KK).Based on the outcome of the IHA and KK results, the CNSCP incorporates targeted human praziquantel chemotherapy but this approach can miss some infections as evidenced by the results reported here. Sensitive molecular diagnostics can play a key role in the elimination of schistosomiasis in China and inform control measures allowing for a more systematic approach to treatment.

Dietary patterns and the risk of abnormal blood lipids among young adults: A prospective cohort study.

BACKGROUND AND AIMS: The extent to which dietary patterns influence the risk of abnormal blood lipids throughout young adulthood remains unclear. The aim was to investigate whether early young adulthood dietary patterns predict the risk of abnormal blood lipids during later young adulthood. METHODS AND RESULTS: We used data from a long running birth cohort study in Australia. Western dietary pattern rich in meats, processed foods and high-fat dairy products and prudent pattern rich in fruit, vegetables, fish, nuts, whole grains and low-fat dairy products were derived using principal component analysis at the 21-year follow-up from dietary data obtained using a food frequency questionnaire. After 9-years, fasting blood samples of all participants were collected and their total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterols and triglyceride (TG) levels were measured. Abnormal blood lipids were based on clinical cut-offs for total, LDL and HDL cholesterols, and TG and relative distributions for total:HDL and TG:HDL cholesterols ratios. Log-binomial models were used to estimate risk of each outcome in relation to dietary patterns. Greater adherence to the Western pattern predicted increased risks of high LDL (RR: 1.47; 95%CI: 1.06, 2.03) and TG (1.90; 1.25, 2.86), and high ratios of total:HDL (1.48; 1.00, 2.19) and TG:HDL (1.78; 1.18, 2.70) cholesterols in fully adjusted models. Conversely, a prudent pattern predicted reduced risks of low HDL (0.58; 0.42, 0.78) and high TG (0.66; 0.47, 0.92) and high total:HDL (0.71; 0.51, 0.98) and TG:HDL (0.61; 0.45, 0.84) cholesterols ratios. CONCLUSION: This is the first prospective study to show greater adherence to unhealthy Western diet predicted increased risks of abnormal blood lipids, whereas healthy prudent diet predicted lower such risks in young adults. Addressing diets in early course may improve cardiovascular health of young adults.

Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways.

CONTEXT: Too many people living with chronic kidney disease are opting for and starting on hospital-based dialysis compared to a home-based kidney replacement therapy. Dialysis services are becoming financially unsustainable. OBJECTIVE: This study aimed to assess the efficacy of coproductive research in chronic kidney disease service improvement to achieve greater sustainability. DESIGN: A 2-year coproductive service improvement study was conducted with multiple stakeholders with the specific intention of maximizing engagement with the national health kidney services, patients and public. SETTING AND PARTICIPANTS: A national health kidney service (3 health boards, 18 dialysis units), patients and families (n = 50), multidisciplinary teams including doctors, nurses, psychologists, social workers, and so forth (n = 68), kidney charities, independent dialysis service providers and wider social services were part of this study. FINDINGS: Coproductive research identified underutilized resources (e.g., patients on home dialysis and social services) and their potential, highlighted unmet social care needs for patients and families and informed service redesign. Education packages were reimagined to support the home dialysis agenda including opportunities for wider service input. The impacts of one size fits all approaches to dialysis on specialist workforce skills were made clearer and also professional, patient and public perceptions of key sustainability policies. DISCUSSION AND CONCLUSIONS: Patient and key stakeholders mapped out new ways to link services to create more sustainable models of kidney health and social care. Maintaining principles of knowledge coproduction could help achieve financial sustainability and move towards more prudent adult chronic kidney disease services. PATIENT OR PUBLIC CONTRIBUTION: Involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.

Predicting Child Maltreatment over the Early Life Course: A Prospective Study.

A large number of early life exposures predict child maltreatment. Using data from a 30-year birth cohort study we examine 12 early life course risk factors of four types of self-reported childhood maltreatment recalled at the 30-year follow-up. Of the 7223 children in the sample at birth, 2425 responded to the Child Trauma Questionnaire at the 30-year follow-up. On adjusted analysis being a teenage mother predicts childhood physical and sexual abuse, as well as child neglect. More numerous maternal marital partner changes in the 5 years after the birth predict offspring experiences of emotional abuse, sexual abuse and childhood neglect. Policy responses should focus on the broad social context in which children are reared as the most effective approach to reducing the high level of childhood abuse and neglect.

Virtual Learning Collaborative Compared to Technical Assistance as a Strategy for Implementing Health Promotion in Routine Mental Health Settings: A Hybrid Type 3 Cluster Randomized Trial.

BACKGROUND: Despite widespread use of learning collaboratives, few randomized trials have evaluated their effectiveness as a strategy for implementing evidence based practices. This randomized trial evaluated the effectiveness of a virtual learning collaborative (VLC) in the implementation of a health promotion program for persons with serious mental illness (SMI) aimed at reducing cardiovascular risk reduction in routine mental health settings, compared to routine technical assistance (TA). METHODS: Fifty-five mental health provider organizations were recruited to participate in a Hybrid Type 3 cluster randomized implementation-effectiveness trial of the InSHAPE health promotion program for persons with SMI. Sites were stratified by size and randomized prior to implementation to an 18-month group-based VLC with monthly learning sessions or individual site TA with four scheduled conference calls over 18 months. Primary implementation and service outcomes were InSHAPE program fidelity, participation, and reach. Primary clinical outcomes were weight loss, cardiorespiratory fitness, and cardiovascular risk reduction (≥ 5% weight loss or > 50 m increase on the 6-Minute Walk Test). Program fidelity was assessed at 6, 12, and 24 months; program participation and participant-level outcomes were assessed at 3, 6, 9, and 12 months. RESULTS: VLC (N = 27) and TA (N = 28) sites were similar in organizational characteristics (all p > 0.05). At 12-month follow-up mean program fidelity score was higher in VLC compared to TA (90.5 vs. 79.1; p = 0.002), with over double the proportion with good fidelity (VLC = 73.9% vs. TA = 34.8%; p = 0.009). Over half of individuals in both VLC and TA achieved cardiovascular risk-reduction at 6-month follow-up (VLC: 51.0%; TA: 53.5%; p = 0.517) and at 12-month follow-up (62% VLC and TA; p = 0.912). At 12-month follow-up VLC compared to TA was associated with greater participation (VLC 69.5% vs. TA 56.4% attending at least 50% of sessions, p = 0.002); larger caseloads (VLC = 16 vs. TA = 11; p = 0.024); greater reach consisting of 45% greater number of participants receiving InSHAPE (VLC = 368 vs. TA = 253), and 58% greater number of participants achieving cardiovascular risk reduction (VLC = 150 vs. TA = 95). CONCLUSION: Virtual learning collaboratives compared to routine technical assistance as an implementation strategy for evidence-based health promotion promote greater intervention fidelity, greater levels of intervention participation, greater reach, and a greater number of participants achieving clinically significant risk reduction outcomes, while achieving similarly high levels of intervention effectiveness for participants who completed at least 6 months of the program.

Extreme weather conditions and dengue outbreak in Guangdong, China: Spatial heterogeneity based on climate variability.

BACKGROUND: Previous studies have shown associations between local weather factors and dengue incidence in tropical and subtropical regions. However, spatial variability in those associations remains unclear and evidence is scarce regarding the effects of weather extremes. OBJECTIVES: We examined spatial variability in the effects of various weather conditions on the unprecedented dengue outbreak in Guangdong province of China in 2014 and explored how city characteristics modify weather-related risk. METHODS: A Bayesian spatial conditional autoregressive model was used to examine the overall and city-specific associations of dengue incidence with weather conditions including (1) average temperature, temperature variation, and average rainfall; and (2) weather extremes including numbers of days of extremely high temperature and high rainfall (both used 95th percentile as the cut-off). This model was run for cumulative dengue cases during five months from July to November (accounting for 99.8% of all dengue cases). A further analysis based on spatial variability was used to validate the modification effects by economic, demographic and environmental factors. RESULTS: We found a positive association of dengue incidence with average temperature in seven cities (relative risk (RR) range: 1.032 to 1.153), a positive association with average rainfall in seven cities (RR range: 1.237 to 1.974), and a negative association with temperature variation in four cities (RR range: 0.315 to 0.593). There was an overall positive association of dengue incidence with extremely high temperature (RR:1.054, 95% credible interval (CI): 1.016 to 1.094), without evidence of variation across cities, and an overall positive association of dengue with extremely high rainfall (RR:1.505, 95% CI: 1.096 to 2.080), with seven regions having stronger associations (RR range: 1.237 to 1.418). Greater effects of weather conditions appeared to occur in cities with higher economic level, lower green space coverage and lower elevation. CONCLUSIONS: Spatially varied effects of weather conditions on dengue outbreaks necessitate area-specific dengue prevention and control measures. Extremes of temperature and rainfall have strong and positive associations with dengue outbreaks.

A regional suitable conditions index to forecast the impact of climate change on dengue vectorial capacity.

BACKGROUND: The mosquitoes Aedes aegypti and Ae. albopictus are the primary vectors of dengue virus, and their geographic distributions are predicted to expand further with economic development, and in response to climate change. We aimed to estimate the impact of future climate change on dengue transmission through the development of a Suitable Conditions Index (SCI), based on climatic variables known to support vectorial capacity. We calculated the SCI based on various climate change scenarios for six countries in the Asia-Pacific region (Australia, China, Indonesia, The Philippines, Thailand and Vietnam). METHODS: Monthly raster climate data (temperature and precipitation) were collected for the period January 2005 to December 2018 along with projected climate estimates for the years 2030, 2050 and 2070 using Representative Concentration Pathway (RCP) 4·5, 6·0 and 8·5 emissions scenarios. We defined suitable temperature ranges for dengue transmission of between 17·05-34·61 °C for Ae. aegypti and 15·84-31·51 °C for Ae. albopictus and then developed a historical and predicted SCI based on weather variability to measure the expected geographic limits of dengue vectorial capacity. Historical and projected SCI values were compared through difference maps for the six countries. FINDINGS: Comparing different emission scenarios across all countries, we found that most South East Asian countries showed either a stable pattern of high suitability, or a potential decline in suitability for both vectors from 2030 to 2070, with a declining pattern particularly evident for Ae. albopictus. Temperate areas of both China and Australia showed a less stable pattern, with both moderate increases and decreases in suitability for each vector in different regions between 2030 and 2070. INTERPRETATION: The SCI will be a useful index for forecasting potential dengue risk distributions in response to climate change, and independently of the effects of human activity. When considered alongside additional correlates of infection such as human population density and socioeconomic development indicators, the SCI could be used to develop an early warning system for dengue transmission.

Does the millennial generation of women experience more mental illness than their mothers?

BACKGROUND: There is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age. METHODS: Pregnant women were recruited during 1981-1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008-11). Offspring were administered the CIDI at the 30-year follow-up (2010-2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes. RESULTS: When comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD. CONCLUSIONS: In the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Lifestyle correlates of dietary patterns among young adults: evidence from an Australian birth cohort.

OBJECTIVE: Previous studies of sociodemographic and lifestyle correlates of dietary patterns among young adults have primarily focused on physical activity and smoking, with inconclusive results. This study aims to examine the associations between a broader range of lifestyles of young adults and their patterns of food consumption. DESIGN: Cross-sectional. SETTING: Brisbane, Australia. PARTICIPANTS: The data set are from a long running birth cohort study which commenced in 1981. Details of dietary intake and sociodemographic and lifestyle factors were from the 21-year follow-up of the Mater-University of Queensland Study of Pregnancy (MUSP) birth cohort. The effective cohort (n 2665, 57 % women) is of young adult offspring. Usual dietary intake was assessed using a Food Frequency Questionnaire (FFQ). Data on sociodemographic and lifestyle variables were obtained from self-reports. RESULTS: Western and prudent dietary patterns were identified for the combined cohort of women and men using principal components analysis. Multivariable linear regression models were used to examine the associations between lifestyle variables and dietary patterns adjusting for potential confounders. Results from multivariable adjusted models showed that physical activity, watching TV and smoking were strongly associated with each dietary pattern; alcohol consumption and BMI showed weaker associations (P < 0·05 for all). CONCLUSIONS: Our study describes a clustering of unhealthy lifestyles in young adults. Young adults with unhealthy lifestyles less often adhere to a healthy prudent dietary pattern and more often an unhealthy Western pattern. Dietary preferences are enmeshed in a lifestyle matrix which includes physical activity, sedentary activity, smoking and alcohol consumption of young adults.

Intimate partner violence and subsequent depression and anxiety disorders.

PURPOSE: The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years). METHODS: Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview. RESULTS: We found a temporal relationship between almost all forms of IPV at 21 years and females' new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males' subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males. CONCLUSION: Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.

The nonlinear association between outdoor temperature and cholesterol levels, with modifying effect of individual characteristics and behaviors.

Few studies have been conducted to investigate the underlying mechanisms of the effect of temperature on cardiovascular disease at population level, especially among Chinese population. A total of 56,039 participants were recruited from Kailuan cohort study, China. The lipoprotein profile indicators, including triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein, were collected. Non-linear associations between temperature and the lipoprotein profile indicators were examined using a nonlinear function for temperature. Stratified analyses were performed in groups by individual characteristics (age, gender, and body mass index) and individual behaviors (physical activities and smoking habits). Generally, a non-linear relationship was found between cholesterol levels and temperature. A 1 °C decrease in temperature below the threshold was related with 0.004 mmol/L (95% CI 0.0004, 0.008), 0.022 mmol/L (95% CI 0.020, 0.025), and 0.009 mmol/L (95% CI 0.008, 0.011) increase in TG, LDL, and HDL, respectively; a 1 °C increase in temperature above the threshold was associated with 0.005 mmol/L (95% CI 0.003, 0.007), 0.012 mmol/L (95% CI 0.009, 0.015), and 0.002 mmol/L (95% CI 0.001, 0.004) increase in TG, LDL, and HDL, respectively. Stratified analyses showed that effect estimates on TG and LDL were larger among females, subjects with higher BMI, and those with smoking habits, while effect estimates on HDL were smaller among these subjects (expect for female). Our results suggest both cold and hot effect of temperature on cholesterol. Furthermore, females, and people with higher BMI or smoking habit may be more susceptible to outdoor temperature.

On the estimation of population cause-specific mortality fractions from in-hospital deaths.

BACKGROUND: Almost all countries without complete vital registration systems have data on deaths collected by hospitals. However, these data have not been widely used to estimate cause of death (COD) patterns in populations because only a non-representative fraction of people in these countries die in health facilities. Methods that can exploit hospital mortality statistics to reliably estimate community COD patterns are required to strengthen the evidence base for disease and injury control programs. We propose a method that weights hospital-certified causes by the probability of death to estimate population cause-specific mortality fractions (CSMFs). METHODS: We used an established verbal autopsy instrument (VAI) to collect data from hospital catchment areas in Chandpur and Comilla Districts, Bangladesh, and Bohol province, the Philippines, between 2011 and 2014, along with demographic covariates for each death. Hospital medical certificates of cause of death (death certificates) were collected and mapped to the corresponding cause categories of the VAI. Tariff 2.0 was used to assign a COD for community deaths. Logistic regression models were created for broad causes in each country to calculate the probability of in-hospital death, given a set of covariate values. The reweighted CSMFs for deaths in the hospital catchment population, represented by each hospital death, were calculated from the corresponding regression models. RESULTS: We collected data on 4228 adult deaths in the Philippines and 3725 deaths in Bangladesh. Short time to hospital and education were consistently associated with in-hospital death in the Philippines and absence of a disability was consistently associated with in-hospital death in Bangladesh. Non-communicable diseases (excluding stroke) and stroke were the leading causes of death in both the Philippines (33.9%, 19.1%) and Bangladesh (46.1%, 21.1%) according to the reweighted method. The reweighted method generally estimated CSMFs that fell between those derived from hospitals and those diagnosed by Tariff 2.0. CONCLUSIONS: Statistical methods can be used to derive estimates of cause-specific probability of death in-hospital for Bangladesh and the Philippines to generate population CSMFs. In regions where hospital death certification is of reasonable quality and routine verbal autopsy is not applied, these estimates could be applied to generate cost-effective and robust CSMFs for the population.

Exposure to Heat Wave During Pregnancy and Adverse Birth Outcomes: An Exploration of Susceptible Windows.

BACKGROUND: Several studies have investigated the acute effects of high ambient temperature or extreme weather on preterm birth and stillbirth. However, little was known about whether there are any particular stages during which high ambient temperature or heat wave exposure is most harmful to fetal growth. The aim of this study was to examine the effects of heat wave exposure in different gestational months on the risk of preterm birth and stillbirth. METHODS: Based on all singleton birth records between 2000 and 2010 and the corresponding environmental data in Brisbane, Australia, we explored relationships between heat wave exposure in different months of pregnancy and preterm birth or stillbirth. Six heat wave definitions were used in this study. After controlling for confounding factors, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using extended Cox proportional hazards regression models with time-dependent covariates. RESULTS: For most heat wave definitions, the adjusted HRs of preterm birth varied by different gestational months and ranged from 1.08 (HR = 1.08; 95% CI = 1.00, 1.18) to 1.53 (HR = 1.53; 95% CI = 1.41, 1.68). Heat wave exposure in early pregnancy was more likely to increase the risk of stillbirth compared with heat wave exposure in late pregnancy. CONCLUSIONS: Overall, we found relationships between preterm birth and heat wave exposure in all months of pregnancy based on most heat wave definitions. We did not find a specifically high period of susceptibility during pregnancy for preterm birth associated with heat wave exposure. However, earlier gestational months might be key exposure windows for heat-wave-affected stillbirth.

HIV Prevalence Among Tuberculosis Patients in Sub-Saharan Africa: A Systematic Review and Meta-analysis.

HIV associated tuberculosis (TB) morbidity and mortality is a major concern in sub-Saharan Africa. Understanding the level of HIV infection among TB patients is vital for adequate response. We conducted a systematic review and meta-analysis to estimate the prevalence of HIV in TB patients in sub-Saharan Africa. We searched PubMed, EMBASE, Web of Science and CINAHL databases. A meta-analysis with a random-effects model was performed. Potential sources of heterogeneity in the prevalence estimates were explored using meta-regression analysis. We identified 68 studies that collectively included 62,969 TB patients between 1990 and 2017. The overall estimate of HIV prevalence in TB patients was 31.8% (95% CI 27.8-36.1). There was substantial heterogeneity in the prevalence estimates in Southern, Central, Eastern, and Western sub-Saharan Africa regions (43.7, 41.3, 31.1 and 25.5%, respectively). We noted an apparent reduction in the estimate from 33.7% (95% CI 27.6-40.4) in the period before 2000 to 25.7% (95% CI 17.6-336.6) in the period after 2010. The Eastern and Southern sub-Saharan Africa region had higher prevalence [34.4% (95% CI 29.3-34.4)] than the Western and Central region [27.3% (95% CI 21.6-33.8)]. The prevalence of HIV in TB patients has declined over time in sub-Saharan Africa. We argue that this is due to strengthened HIV prevention and control response and enhanced TB/HIV collaborative activities. Countries and regions with high burdens of HIV and TB should strengthen and sustain efforts in order to achieve the goal of ending both HIV and TB epidemics in line with the Sustainable Development Goals.

Projecting environmental suitable areas for malaria transmission in China under climate change scenarios.

INTRODUCTION: The proportion of imported malaria cases in China has increased over recent years, and has presented challenges for the malaria elimination program in China. However, little is known about the geographic distribution and environmental suitability for malaria transmission under projected climate change scenarios. METHODS: Using the MaxEnt model based on malaria presence-only records, we produced environmental suitability maps and examined the relative contribution of topographic, demographic, and environmental risk factors for P. vivax and P. falciparum malaria in China. RESULTS: The MaxEnt model estimated that environmental suitability areas (ESAs) for malaria cover the central, south, southwest, east and northern regions, with a slightly wider range of ESAs extending to the northeast region for P. falciparum. There was spatial agreement between the location of imported cases and area environmentally suitable for malaria transmission. The ESAs of P. vivax and P. falciparum are projected to increase in some parts of southwest, south, central, north and northeast regions in the 2030s, 2050s, and 2080s, by a greater amount for P. falciparum under the RCP8.5 scenario. Temperature and NDVI values were the most influential in defining the ESAs for P. vivax, and temperature and precipitation the most influential for P. falciparum malaria. CONCLUSION: This study estimated that the ESA for malaria transmission in China will increase with climate change and highlights the potential establishment of further local transmission. This model should be used to support malaria control by targeting areas where interventions on malaria transmission need to be enhanced.

Spatiotemporal heterogeneity of malnutrition indicators in children under 5 years of age in Bangladesh, 1999-2011.

OBJECTIVE: To examine changes in the spatial clustering of malnutrition in children under 5 years of age (under-5s) for the period 1999 to 2011 in Bangladesh. DESIGN: We used data from four nationally representative Demographic and Health Surveys (DHS) conducted in 1999-2000, 2004, 2007 and 2011 in Bangladesh involving a total of 24 211 under-5s located in 1661 primary sampling units (PSU; geographical unit of analysis) throughout Bangladesh. The prevalence of stunting (height/length-for-age Z-score <-2), underweight (weight-for-age Z-score <-2) and wasting (weight-for-height/length Z-score <-2) at each PSU site and for each survey year were estimated based on the WHO child growth standard. The extent of spatial clustering was quantified using semivariograms. SETTING: Whole of Bangladesh. SUBJECTS: Children under 5 years of age. RESULTS: Our results demonstrate that in 1999-2000 most PSU throughout Bangladesh experienced stunting, underweight and wasting prevalence which exceeded the WHO thresholds. By 2011, this situation improved, although in two of the six divisions (Barisal and Sylhet) PSU still exhibited higher levels of malnutrition compared with other divisions of the country. The pattern of spatial clustering for stunting, underweight and wasting also changed between 1999 and 2011 both at national and sub-national (division) levels. CONCLUSIONS: We identified divisions where malnutrition indicators (stunting, underweight and wasting) remain highly clustered and other divisions where they are more widely spread in Bangladesh. This has important implications on how interventions for malnutrition need to be delivered (geographically targeted interventions v. random interventions) within each division of the country.