[Incidence of sudden cardiac death among diseases of the circulatory system during the COVID-19 pandemic in the Penza region]. / Chastota vnezapnoi serdechnoi smerti sredi boleznei sistemy krovoobrashcheniya v period pandemii COVID-19 v Penzenskoi oblasti.

OBJECTIVE: To study the incidence of sudden cardiac death (SCD) among overall and primary morbidity of diseases of the circulatory system (DCS) during the COVID-19 pandemic, as well as several years before it in urban and rural populations of the Penza region. MATERIAL AND METHODS: Statistical analysis of data using correlation (Pearson's coefficient), regression methods, t-test was performed to determine the significance of results. RESULTS: The higher incidence of DCS among men in urban areas has been found. COVID-19 morbidity did not cause an increase in the incidence of SCD in the rural population in comparison with primary DCS morbidity, which was strongly correlated with the prevalence of novel coronavirus infection.

FEATURES OF FUNCTIONING DISORDERS IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE.

OBJECTIVE: The aim: To reveal the peculiarities of functioning disorders in everyday life and the need for rehabilitation in the patients with stable ischemic heart disease (IHD). PATIENTS AND METHODS: Materials and methods: Used 346 medical cards of inpatients with stable (IHD), Department of Cardiology and Cardiorehabilitation, Kyiv City Clinical Hospital No. 4. Research methods: collection, grouping, analysis and generalization of data from doctors' records, medical-statistical, graphical. RESULTS: Results: It was established that the structure of hospitalized morbidity cases of IHD consisted of 34.7% of angina pectoris and 65.3% of cardiosclerosis. IHD was accompanied by other diseases in 92.8% of cases. It has been proven that among all cases, those with a moderate severity of functional impairment pre¬vail (25.0-49.0%). 28.9% of the patients have contraindications to physical cardiorehabilitation. The remaining the patients need a complex of rehabilitation measures, including physical rehabilitation, and patients with contraindications may use other components of cardiorehabilitation programs. CONCLUSION: Conclusions: It has been proven that patients with coronary heart disease, with or without comorbidities, experience impaired functions, reduced activity and participation in everyday life, as well as pain syndromes and painful sensations. This indicates the need for cardiac rehabilitation in the acute and post-acute periods.

EFFECT OF URBANIZATION ON DENSITY OF THE GENERAL PRACTITIONERS, AVERAGE LIFE EXPECTANCY AND MORTALITY FROM THE DISEASES OF CIRCULATORY SYSTEM.

OBJECTIVE: The aim: Comparative analysis of average life expectancy, mortality from diseases of the circulatory system, gross regional product, and density of general practitioners in regions with different levels of urbanization. PATIENTS AND METHODS: Materials and methods: We compared the following characteristics of groups classified by level of urbanization: average density of general practitioners per 10,000, average life expectancy and mortality from diseases of the circulatory system per 1,000, average gross regional product per 1 person. RESULTS: Results: The groups did not differ in average life expectancy. The highest rate of mortality from diseases of the circulatory system- in the group with average level of urbanization, the lowest- in the group with low level of urbanization (p<0.05). The highest value of gross regional product per person is in the group with high level of urbanization, and the lowest is in the group with low level (p<0.05). The lowest density of primary care doctors per 10,000 is in the group with high level of urbanization, and the highest is in the group with low level of urbanization (p<0.05). CONCLUSION: Conclusions: When planning staffing of health care institutions, it is necessary to take into account the level of urbanization of the region and ensure status of the general practitioner as a leading medical specialist responsible for medical care during the first meeting with the patient and his subsequent follow-up.

Mortality from diseases of the circulatory system in Brazil and its relationship with social determinants focusing on vulnerability: an ecological study.

BACKGROUND: Deaths from diseases of the circulatory system and ischemic heart diseases are declining, but slowly in developing countries, emphasizing its probable relationship with determinants of social vulnerability. OBJECTIVES: To analyze the temporal progression of mortality rates of diseases of the circulatory system and ischemic heart diseases from 1980 to 2019 and the association of the rates with the Municipal Human Development Index and Social Vulnerability Index in Brazil. METHODS: We estimated the crude and standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and analyzed the relationship between the obtained data and the Municipal Human Development Index and Social Vulnerability Index. Data on deaths and population were obtained from the DATASUS. The Municipal Human Development Index and the Social Vulnerability Index of each federative unit were extracted from the websites Atlas Brazil and Atlas of Social Vulnerability, respectively. RESULTS: The age-standardized mortality rates of diseases of the circulatory system and ischemic heart diseases showed a downward trend nationwide, which was unequal across the federative units. There was an inversely proportional relationship between the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and the Municipal Human Development Index. The downward mortality trend was observed when the indices were greater than 0.70 and 0.75, respectively. The Social Vulnerability Index was directly proportional to the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases. An upward mortality trend was observed with a Social Vulnerability Index greater than 0.35. CONCLUSIONS: Social determinants represented by the Municipal Human Development Index and the Social Vulnerability Index were related to mortality from diseases of the circulatory system and ischemic heart diseases across the Brazilian federative units. The units with most development and least social inequalities had the lowest mortality from these causes. The most vulnerable die the most.

NATIONAL TRENDS IN MORBIDITY AND MORTALITY FROM CIRCULATORY SYSTEM AND CEREBROVASCULAR DISEASES AND STROKES.

OBJECTIVE: The aim: To determine national trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes. PATIENTS AND METHODS: Materials and methods: Data from official sources of statistical information of Ukraine were used and systematic analysis and generalization of the obtained data was performed and trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes in Ukraine were calculated. RESULTS: Results: Were found tendencies to decrease of national levels of prevalence and primary morbidity in Ukraine for DCS (-16.3 % and -28.0 %), CVD (-22.8 % and 24.1 %) and strokes (-12.2 %) with significant trends (+83.9 %) of increase in primary incidence of strokes in 2010-2017 with fairly high and threatening levels for 2017 (respectively 22199563, 2521601 and 96978 - prevalence and 1725137, 290557 and 96978 - primary incidence). National levels of reduction of deaths from DCS in Ukraine from 440369 (2013) to 389348 (2019) with a trend of -11.6 % and a decrease in mortality due to CVD from 94267 (2013) to 76232 (2019) with a trend -19.1 % were found. CONCLUSION: Conclusions: The trends to reduce of national prevalence, primary morbidity and mortality rates in Ukraine for DCS, CVD and stroke are fully consistent with other global trends of reduction of these levels among world countries.

[Organizational reserves saving the population's health from diseases of the circulatory system].

Modern approaches to public health protection in the world are increasingly focused on health conservation, which involves focusing health care efforts on prevention. Timely identification of patients with arterial hypertension (AH) and provision of effective medical care is the main organizational reserve for preventing health losses. Based on the concept of "cardiovascular continuum", analysis of literature sources and the study itself, organizational measures have been developed to preserve health and prevent health losses and reduce mortality from diseases of the circulatory system. From the perspective of the concept of "cardiovascular continuum", the causes of death from BSC are two parallel interrelated processes: arterial hypertension and atherosclerosis, which are the consequences of endothelial dysfunction. Analysis of literature sources and survey results 123 of experts and healthcare professionals in a number of subjects of the Russian Federation show that adequate and timely medical care to the population at BSK, and a reduction in population systolic blood pressure and the reduction of lepidopteron low-density (LDL) are organizational reserves predotvratit loss health and reduce mortality from CVD. We have developed a set of measures to reduce mortality from circulatory diseases in accordance with the concept of the "cardiovascular continuum" include the following: increase population coverage with BSK medical assistance; medical surveillance and treatment of patients with prehypertension; decreased population levels of cholesterol in arterial hypertension (AH); carrying out of thrombolytic therapy; medical emergency cardiovascular conditions in accordance with the concept of "Golden hour"; improving the provision of medicines to the population, increasing the provision of cardiologists to the population. The implementation of a set of measures in the pilot rural district allowed reducing the total mortality of the population for the year of analysis by 12%.

Temporal trends in treatment-related incidence of diseases of the circulatory system among Hodgkin lymphoma patients.

While Hodgkin lymphoma (HL) survival has improved, treatment-related complications remain a concern. As a measure of treatment-related diseases of the circulatory system (DCS) we report excess incidence of DCS and absolute risks among HL patients diagnosed in the modern treatment era. From the Swedish Cancer Register, we identified all HL patients diagnosed 1985 through 2013, at ages 18-80 years. Excess incidence rate ratios (EIRRs) with 95% confidence intervals (CIs) comparing excess DCS incidence between calendar periods were estimated overall, and at 5 and 10 years after diagnosis using flexible parametric models. Model-based predictions were used to obtain probabilities of being diagnosed with DCS, in the presence of competing risks. During follow-up, 726 (16%) of the 4,479 HL patients experienced DCS. Overall, the excess DCS incidence was lower during all calendar periods compared to the first (2009-2013 vs. 1985-1988: EIRR = 0.63, 95% CI: 0.42-0.95). The 5- and 10-year excess incidence of DCS decreased between 1985 and 1994 for 25-year-olds (5-year-EIRR1994 = 0.32, 95% CI: 0.12-0.92) and 60-year-olds (5-year-EIRR1994 = 0.45, 95% CI: 0.24-0.88), but remained stable thereafter. No improvements were observed among 75-year-olds. The probability of excess DCS remained the same throughout the study period. In 2009, the percentage of patients aged 25, 60 and 75 experiencing excess DCS within 5 years was 3.4, 15.0 and 17.0% (males) and 2.3, 10.8 and 12.6% (females). Treatment-related incidence of DCS has declined since the mid-1980s, but more recent improvements are absent and an excess risk remains. Continued efforts towards less toxic treatments are warranted, alongside primary prevention strategies.

Bootstrap approach to validate the performance of models for predicting mortality risk temperature in Portuguese Metropolitan Areas.

BACKGROUND: There has been increasing interest in assessing the impacts of extreme temperatures on mortality due to diseases of the circulatory system. This is further relevant for future climate scenarios where marked changes in climate are expected. This paper presents a solid method do identify the relationship between extreme temperatures and mortality risk by using as predictors simulated temperature data for cold and hot conditions in two urban areas in Portugal. METHODS: Based on the mortality and meteorological data from Porto Metropolitan Area (PMA) and Lisbon Metropolitan Area (LMA), a distributed lag nonlinear model (DLNM) was implemented to estimate the temperature effects on mortality due to diseases of the circulatory system. The performance of the models was validated via bootstrapping approaching by creating resamples with replacement from the validating data. Bootstrapping was also used to identify the best candidate model and to evaluate the sensitivity of the spline functions to the exposure-lag-response relationship. RESULTS: It is found that the model is able to reproduce the temperature-related mortality risk for two metropolitan areas. Temperature previously simulated by climate models is useful and even better than observed temperature. Although, the biases in predictions in both metropolitan areas are low, mortality risk predictions in PMA are more accurate than in LMA. Using parametric bootstrapping, we found that the overall cumulative association estimated under different bi-dimensional exposure-lag-response relationship are relatively stable, especially for the model selected by Quasi-Akaike Information Criteria (QAIC). Exposure to summer temperature conditions is best related to mortality risk. The association between winter temperature and mortality risk is somewhat less strong. CONCLUSIONS: The use of QAIC to choose from several candidate models provides valid predictions and reduced the uncertainty in the estimated relative risk for circulatory disease mortality. Our findings can be applied to better understand the characteristics and facilitate the prevention of circulatory disease mortality in Porto and Lisbon Metropolitan Areas, namely if we consider the actual context of climate change.

The influence of weather-climatic and social factors on population mortality from circulatory diseases in Russia.

AIM: To study the links between the standard mortality rate of the population from circulatory system diseases (CSD) with factors: weather-climatic (inter-day jumps in air temperature and atmospheric pressure by seasons and for the year) and social (average annual income per person and the number of doctors of all specialties) in Russia for the period 1995-2015. MATERIALS AND METHODS: According to station data and data of reanalysis, seasonal and annual amounts of day-to-day jumps in air temperature were calculated more than the absolute value of 4° and 6°C and the atmospheric pressure more than the absolute value of 8 GPa. The links between climate variables and the mortality rate of the population, taking into account social factors, were investigated using factor analysis, including regression and variance analyses. RESULTS: Annual amounts of temperature (pressure) jumps of different signs vary greatly on the territory: the maximum amounts are 3-4 times higher than the minimum ones. The geographical distribution of air temperature fluctuations differs from the distribution of atmospheric pressure fluctuations. The sum of temperature jumps in the absolute value of more than 6°C is about twice less than the sum of jumps more than 4°C, but they are characterized by similarity of geographical distribution. The sum of the jumps of temperature (pressure) is reduced during the summer is approximately two times compared to the winter. The maximum jumps are observed mainly in the Northern regions with low population density, but with high per capita income, while the minimum is observed in the South-Western parts of the European part of the country with high population density, as well as middle and low income. Global warming does not significantly affect the reduction of annual amounts of temperature (pressure) jumps. Factor analysis of social and climatic variables in the territory for each year indicates the dominance of the influence of the social factor (per capita income) on the mortality rate from CSD. CONCLUSION: Factor analysis is integrated in the annual scale climatic and social variables showed a dominant effect on the coefficient of mortality from CSD, the factor of standard of living (per capita income of the population). Then the significance of the impact factors is consistently reduced: negative atmospheric pressure jumps, average seasonal pressure, health care level, positive pressure jumps. The significance of temperature variables is the smallest.

Influence of Demographic Factors on Standardised Rate Ratio of Age-adjusted Mortality Rates of Men in Comparison with Women Caused by Neoplasms and Circulatory System Diseases in Slovak Regions during 1996-2013.

AIM: The aim of our study was to find statistical associations including trends of standardised rate ratio of age-adjusted mortality rates for the male population as compared to the female population, in relation to available demographic factors (Chapter II - Neoplasms vs. Chapter IX - Diseases of the circulatory system, Slovak region and calendar year of death). METHODS: Dataset of individual cases of death in Slovakia with some demographic factors during 1996-2013 were provided by Slovak National Health Information Center. We used regression and correlation analyses, as well as analyses of variance and covariance along with descriptive statistics. RESULTS: The standardised rate ratio of age adjusted mortality rates of men versus age-adjusted mortality rates of women differs between Chapter II and Chapter IX (mean 2.08 vs. 1.35, p<0.001). There are also significant differences of standardised rate ratio among regions (p<0.05). Trends show that the standardised rate ratio has significant regional decline for Chapter II: Kosice (p<0.01), Trencín (p<0.001) and Zilina (p<0.05) whereas in Chapter IX Zilina region (p<0.01) is implicated. In other Slovak regions standardised rate ratio stagnates. CONCLUSIONS: Standardised rate ratios of age-adjusted mortality rates for the male population compared to the female population are significantly dependent on chapter, sex and region. Standardised rate ratios either decline or stagnate.

Age-adjusted Mortality Rates of Neoplasms and Circulatory System Diseases and Their Demographic Factors in Slovak Regions during 1996-2013.

AIM: Knowledge of the causes of deaths in Slovakia is lacking. This is significant because diet and lifestyle factors are different in central Europe compared to Western, Northern and Southern Europe. This study aims to discern trends of age-adjusted mortality rates caused by various diseases in relation to demographic factors. The aim of our study was to find certain statistical aspects including trends of age-adjusted mortality rates caused by neoplastic (Chapter II) and circulatory diseases (Chapter IX) in the Slovak population in relation to available demographic factors (sex, region and calendar year of death). METHODS: Dataset of individual deaths in Slovakia with certain demographic factors (sex, region and calendar year of death) during 1996-2013 were provided by the Slovak National Center of Health Informatics. Regression and correlation analyses and analyses of variance and of covariance were used to yield the level of significance. RESULTS: We found significant differences of age-adjusted mortality rates between men and women, between Chapter II and Chapter IX and among Slovak regions. Age-adjusted mortality rates decline significantly in most regions for both sexes with the exception of stagnation in four regions in a group of Chapter II women (Kosice, Nitra, Trencín and Zilina) and one region in Chapter IX, also in group of women (Zilina). CONCLUSIONS: Mortalities caused either by Chapter II or Chapter IX diseases are significantly dependent on chapter, sex and region with mortalities either declining or stagnating.

Influence of Demographic Determinants on the Number of Deaths Caused by Circulatory System Diseases in Comparison to the Number of Deaths Caused by Neoplasms in Slovak Regions from 1996-2014.

OBJECTIVES: The objective of our study was to evaluate the influence of available demographic determinants on the number of deaths caused by circulatory system diseases as compared to deaths caused by neoplasms in Slovakia in 1996-2014. METHODS: Mortality data were kindly provided by the National Health Information Centre in Slovakia. The first method was trend curve fitting of death ratios caused by circulatory system diseases (Chapter IX) and of deaths caused by neoplasms (Chapter II) as a function of age for both sexes. The second method comprised a decision tree for classification between deaths caused by Chapter IX and Chapter II diseases. Input variables were available demographic indicators: age, sex, marital status, region, and calendar year of death. Statistical data analyses were performed by IBM SPSS version 19 statistical software. RESULTS: We found that the odds ratios of deaths caused by circulatory system diseases (Chapter IX) in comparison with deaths caused by neoplasms (Chapter II) were non-decreasing. At first, the values of odds ratios are constant until they reach a critical sex-dependent value with a subsequent steady increase. In the case of men the odds ratio was greater than in the 60 years age-group where the odds ratio value increased slowly (from 1.14 at age 60 to 7.25 at age 90 years). The relative increase was 6.36 (7.25/1.14). The odds ratio in the women group was smaller but increased more rapidly (from 0.81 at age 60 to 12.27 at age 90 years). The relative increase was 15.15 in women (12.27/0.81). Hence, the odds ratio of death caused by Chapter IX diseases vs. Chapter II was greater in the older women group (i.e. higher age values). Utilizing the decision tree model, we have found that the most significant demographic determinant of death counts in both ICD Chapters was the age of the deceased, followed by marital status and finally gender. The last two predictors (year and region) were relatively negligible though formally significant. CONCLUSIONS: The proposed method could be useful for prognostic classification of patients and primarily beneficial for hospitals in human or financial resources planning.

Impact of Selected Socio-demographic Factors on the Development of Mortality due to Circulatory System Diseases in the Slovak Republic.

AIM: We mapped the situation within a group of diseases of the circulatory system (I00-I99) in the Slovak Republic during 1996-2014. We focused mainly on spatiotemporal differences in mortality while controlling for age and sex. METHODS: We performed binary logistic regression aiming to reveal socio-demographic factors that influence the odds of dying due to diseases of the circulatory system (I00-I99). In our analysis, the dependent variable was death diagnosis and the independent variables were age, region, gender, and marital status. RESULTS: Our findings suggest that odds of dying due to diseases of the circulatory system (I00-I99) increased for every year of age by 5.4%. Within the period from 1996 to 2014, the risk of dying from diseases of the circulatory system decreased by 2% every year. We also documented the fact that being female raised the odds of dying due to diseases of the circulatory system (I00-I99) by 12.9% compared to males. Furthermore, it could be argued that serious differences in terms of regional distribution of deaths caused by diseases of the circulatory system (I00-I99) exist in the Slovak Republic. CONCLUSIONS: We present the development of diseases of the circulatory system (I00-I99) in the Slovak Republic. Differences in spatial distribution of deaths are documented as well as related gender differences. Our study can serve as a tool for policy makers and benchmark for professionals.

[Assessment of the Possibility of Comparing Mortality Rates from Diseases of the Circulatory System in the United States and Russia].

OBJECTIVE: to compare and discuss causes of differences between standardized mortality rates (SMR) from diseases of the circulatory system (DCS) among men and women older than 50 years in Russia and USA. MATERIAL AND METHODS: Data on mortality rate in the USA were taken from WHO mortality database (WHO MD), those on the USA population by 5-years age bands from Human Mortality Database (HMD). Information on mortality rates in Russia was obtained from Rosstat. In analysis we used age-adjusted death rates and SMR for DCS or ages more or equal 50 years. For standardization of mortality rates we used data of the European Standard Population 2013. RESULTS: By 23 3-digit codes mortality rates among men in USA were higher than in Russia (in the structure of mortality among women there were 28 such codes). Portion of such deaths in Russia in total number of DCS deaths was 6.5% both for men and women, while figures for USA were 36.8 and 40%, respectively. About 99% of differences in SMR from DCS between countries were determined by 8 and 6 groups of causes in men and women, respectively. Analysis of 4-digit ICD codes showed that almost 40% of DSC class deaths both in Russia and USA had the forth digit of ICD-10 code 8 or 9 and were accompanied by wording "other" or "unspecified" or formulation of diseases which were not used in clinical practice and were absent in both guidelines issued by Russian or American professional societies. Despite existence of ICD rules the conducted analysis allows to state that those rules could be interpreted differently in various countries. This resulted in obtaining noncomparable data. CONCLUSION: Comparison of mortality rates in USA and Russia based on existing ICD coding rules cannot be correctly performed. Therefore, this comparison does not allow to assess contribution of financing and organization of medical service in differences in mortality rates between two countries.

Evaluation of relative biological effectiveness for diseases of the circulatory system based on microdosimetry.

In the next decade, the International Commission on Radiological Protection (ICRP) will issue the next set of general recommendations, for which evaluation of relative biological effectiveness (RBE) for various types of tissue reactions would be needed. ICRP has recently classified diseases of the circulatory system (DCS) as a tissue reaction, but has not recommended RBE for DCS. We therefore evaluated the mean and uncertainty of RBE for DCS by applying a microdosimetric kinetic model specialized for RBE estimation of tissue reactions. For this purpose, we analyzed several RBE data for DCS determined by past animal experiments and evaluated the radius of the subnuclear domain best fit to each experiment as a single free parameter included in the model. Our analysis suggested that RBE for DCS tends to be lower than that for skin reactions, and their difference was borderline significant due to large variances of the evaluated parameters. We also found that RBE for DCS following mono-energetic neutron irradiation of the human body is much lower than that for skin reactions, particularly at the thermal energy and around 1 MeV. This tendency is considered attributable not only to the intrinsic difference of neutron RBE between skin reactions and DCS but also to the difference in the contributions of secondary γ-rays to the total absorbed doses between their target organs. These findings will help determine RBE by ICRP for preventing tissue reactions.

The Association between Exposure to Second-Hand Smoke and Disease in the Chinese Population: A Systematic Review and Meta-Analysis.

Objective: To analyze the association between exposure to second-hand smoke (SHS) and 23 diseases, categorized into four classifications, among the Chinese population. Methods: We searched the literature up to June 30, 2021, and eligible studies were identified according to the PECOS format: Participants and Competitors (Chinese population), Exposure (SHS), Outcomes (Disease or Death), and Study design (Case-control or Cohort). Results: In total, 53 studies were selected. The odds ratio (OR) for all types of cancer was 1.79 (1.56-2.05), and for individual cancers was 1.92 (1.42-2.59) for lung cancer, 1.57 (1.40-1.76) for breast cancer, 1.52 (1.12-2.05) for bladder cancer, and 1.37 (1.08-1.73) for liver cancer. The OR for circulatory system diseases was 1.92 (1.29-2.85), with a value of 2.29 (1.26-4.159) for stroke. The OR of respiratory system diseases was 1.76 (1.13-2.74), with a value of 1.82 (1.07-3.11) for childhood asthma. The original ORs were also shown for other diseases. Subgroup analyses were performed for lung and breast cancer. The ORs varied according to time period and were significant during exposure in the household; For lung cancer, the OR was significant in women. Conclusion: The effect of SHS exposure in China was similar to that in Western countries, but its definition and characterization require further clarification. Studies on the association between SHS exposure and certain diseases with high incidence rates are insufficient.

Delaware's 1999-2017 Leading Causes of Death Information Illustrates Its Obesity and Obesity-Related Life-Limiting Disease Burdens.

Using commercially available but powerful big data analytics, this non-clinical obesity and underlying causes of death observational study, analyzed the very large US Centers for Disease Control and Prevention's (CDC) State of Obesity records, the CDC WONDER data, and the US census records. Compared to the 1999-to-2017 US obesity rate increase of 29.8%, an uncontrolled increase in Delaware's obesity rate (81.7%) was observed. During the same time period, CDC WONDER death certificate archives disclosed that there was a 60.53% surge in crude Delawarean mortality rate when obesity was listed as a single underlying cause of death. When any mention of obesity was documented on the death certificate, Delaware's 1999-2017 crude mortality rate advanced by 75.69% and its age-adjusted rate rose by 53.18%. Likewise, except for one year, Delaware's African American/Black population experienced higher crude mortality rate averages but however, between the years of 1997 and 2017, its Caucasian/White inhabitants had an enormous 87.34% death rate increase. With additional available CDC mortality data, Delaware males saw substantially larger age-adjusted death rate increases (79.87%) than their female counterparts (28.92%). Diabetes, circulatory system diseases, and neoplasms (cancer), are three common obesity comorbidities. For these three conditions, Delaware's 1999-2017 mortality rate figures mimic the falling national patterns of mortality rate averages, when each disease is listed as the single underlying cause of death, including observations where there are disproportionate numbers of cases that affect the African American/Black race.

Post-traumatic stress disorder in Italy: a comprehensive evaluation of all the ICD comorbidities and gender-related differences.

OBJECTIVES: The association between post-traumatic stress disorder (PTSD) and medical comorbidities is controversial since most studies focused on specific comorbidity and victim types. In Italy, data on this issue are scarce. A comprehensive evaluation of all the ICD medical categories co-occurring in PTSD may orient assessment and treatment during clinical and forensic practice. This is the first study evaluating all the ICD physical comorbidities and gender-related differences in Italian PTSD patients. Eighty-four PTSD patients (36 females, 48 males) were included. The Clinician-Administered PTSD Scale, Mini International Neuropsychiatric Interview and Davidson Trauma Scale were administered. RESULTS: Most patients had a PTSD consequent to an accident and half of them presented extreme symptom severity. No gender differences emerged on symptom severity/duration and age at the event. Metabolic (39.29%), circulatory (20.24%) and musculoskeletal systems/connective tissue diseases (17.86%) were the most frequent comorbidities. Metabolic/circulatory diseases were more frequent among males (p = 0.019 and p = 0.027, respectively) while females more frequently showed neoplasms (p = 0.039). Physical comorbidities represent a serious complication in PTSD patients and are more prevalent than in the Italian population. While gender is not associated with symptom presentation, it seems to play a key role in specific comorbidities including metabolic, circulatory and neoplastic diseases.

The Association between Exposure to Second-Hand Smoke and Disease in the Chinese Population: A Systematic Review and Meta-Analysis / 生物医学与环境科学（英文）

OBJECTIVE@#To analyze the association between exposure to second-hand smoke (SHS) and 23 diseases, categorized into four classifications, among the Chinese population.@*METHODS@#We searched the literature up to June 30, 2021, and eligible studies were identified according to the PECOS format: Participants and Competitors (Chinese population), Exposure (SHS), Outcomes (Disease or Death), and Study design (Case-control or Cohort).@*RESULTS@#In total, 53 studies were selected. The odds ratio (OR) for all types of cancer was 1.79 (1.56-2.05), and for individual cancers was 1.92 (1.42-2.59) for lung cancer, 1.57 (1.40-1.76) for breast cancer, 1.52 (1.12-2.05) for bladder cancer, and 1.37 (1.08-1.73) for liver cancer. The OR for circulatory system diseases was 1.92 (1.29-2.85), with a value of 2.29 (1.26-4.159) for stroke. The OR of respiratory system diseases was 1.76 (1.13-2.74), with a value of 1.82 (1.07-3.11) for childhood asthma. The original ORs were also shown for other diseases. Subgroup analyses were performed for lung and breast cancer. The ORs varied according to time period and were significant during exposure in the household; For lung cancer, the OR was significant in women.@*CONCLUSION@#The effect of SHS exposure in China was similar to that in Western countries, but its definition and characterization require further clarification. Studies on the association between SHS exposure and certain diseases with high incidence rates are insufficient.

Diseases of the circulatory system among adult people diagnosed with infantile autism as children: A longitudinal case control study.

BACKGROUND: Research dealing with adult people with autism spectrum disorders (ASD) noticeably lags behind studies of children and young individuals with ASD. AIMS: The objective of this study was to compare the prevalence and types of diseases of the circulatory system in a clinical sample of 118 adult people diagnosed with infantile autism (IA) as children with 336 sex and age matched controls from the general population. METHODS AND PROCEDURES: All participants were screened through the nationwide Danish National Hospital Register. The average observation time of both groups was 37.2 years, and mean age at follow-up was 49.6 years. OUTCOMES AND RESULTS: Of the 118 people with IA, 11 (9.3%) were registered with at least one disease of the circulatory system against 54 (16.1%) in the comparison group (p=0.09; OR=0.54; 95% CI 0.3-1.2). Ischemic heart diseases occurred significantly more frequently among people in the comparison group (p=0.02). CONCLUSIONS AND IMPLICATIONS: It is argued that diseases of the circulatory system may be underdiagnosed in people with IA because of the difficulties they face with respect to identifying and communicating symptoms of ill health. Bearing in mind that cardiovascular disease is the primary cause of death in most developed countries, it is suggested that to prevent disease and manage health conditions, health monitoring is essential in adult people with IA.