scholarly journals The disease of theories: unravelling the mechanisms of pre-eclampsia

2017 ◽  
Vol 39 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Eric M. George
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Premature Birth ◽  
Molecular Mechanisms ◽  
The United States ◽  
Life Meaning ◽  
Increased Risk ◽  
Health Complications ◽  
Developed World

Perhaps no disease of pregnancy has been more thoroughly studied than pre-eclampsia (PE), and yet despite all of our efforts we are only beginning to understand the molecular mechanisms which underpin the disease. Many people are surprised by the frequency of PE in the population, as it is believed to occur in approximately one pregnancy out of 20 in the United States, with similar rates throughout the developed world. In severe cases the disorder can progress to eclampsia, which is characterized by maternal seizures and can lead to death. PE can only be treated by ending the pregnancy, often by inducing labour prior to term, making PE a leading cause of premature birth and all of the associated health complications which accompany it. All in all, PE is one of the leading causes of maternal and fetal morbidity and mortality. It is now also becoming apparent that PE disposes both the mother and the baby to increased risk of cardiovascular disease throughout life, meaning that we still don't fully understand the long-term implications of the disease.

scholarly journals Food Insecurity Is Associated With Cardiovascular and All‐Cause Mortality Among Adults in the United States

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Yangbo Sun ◽  
Buyun Liu ◽  
Shuang Rong ◽  
Yang Du ◽  
Guifeng Xu ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Food Security ◽  
Food Insecurity ◽  
The United States ◽  
Sampling Weights ◽  
Cardiovascular Disease Mortality ◽  
Disease Mortality ◽  
Increased Risk ◽  
The Us

Background Food insecurity is a global leading public health challenge that affects not only developing countries but also developed countries, including the United States. About 50 million Americans are food insecure. In this study we examined the associations of the adult food insecurity with all‐cause and cardiovascular disease mortality in a nationally representative sample of US adults. Methods and Results We included 27 188 US adults (age ≥40 years of age) who participated in the US National Health and Nutrition Examination Survey from 1999 to 2014. Food insecurity status was assessed using the Food Security Survey Module developed by the US Department of Agriculture. Mortality from all causes and cardovascular disease was ascertained through data linkage to the National Death Index through December 31, 2015. We used multivariable Cox proportional hazards regression with sampling weights to estimate hazard ratios ( HR s) and 95% CIs of all‐cause and cardiovascular disease mortality, according to food security status. During 205 389 person‐years of the period, 5039 deaths occurred, including 1084 cardiovascular disease deaths. After adjustment for age, sex, race/ethnicity, education, income, and dietary and lifestyle factors, participants with very low food security had higher risk of all‐cause and cardiovascular disease mortality, with multivariable‐adjusted HR s of 1.32 (95% CI , 1.07–1.62), and 1.53 (95% CI, 1.04–2.26), respectively, compared with those with high food security. Conclusions Food insecurity is significantly associated with increased risk of excess death from cardiovascular disease and all causes in US adults.

scholarly journals Child Marriage and the Failure of International Law: a Comparison of American, Indian, and Canadian Domestic Policies

2018 ◽  
Vol 18 (1) ◽  
pp. 105-125
Author(s):  
Marcy J. Robles
Keyword(s):  
United States ◽  
American Indian ◽  
International Law ◽  
The United States ◽  
Term Effect ◽  
Child Marriage ◽  
International Treaties ◽  
Long Term Effect ◽  
Health Complications

Summary What is child marriage? The recognized definition does not adequately encompass the experience of child marriage. Child marriage stems from many elements, including coercion, force, and economic deprivation. Furthermore, child marriages have a long-term effect on child spouses, ranging from psychological damage, to health complications, to education and personal limitations. This paper argues that current international treaties and agreements do not specifically or directly address the issue of child marriage. Of those that make an attempt to, fail as a result of lack of enforcement or too much deference to religion as an exception of child marriage prohibition. In comparing three countries – The United States, India, and Canada, it is clear that Canadian policies work best and should be implemented on a larger scale. Current U.S. policies do not fully combat the child marriage phenomena, and although it is ahead of India in this area, it still has a long way to go in terms of development.

scholarly journals Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study

2020 ◽  
Author(s):  
Xiao Wu ◽  
Rachel C Nethery ◽  
M Benjamin Sabath ◽  
Danielle Braun ◽  
Francesca Dominici
Keyword(s):  
United States ◽  
Air Pollution ◽  
Death Rate ◽  
The United States ◽  
Sensitivity Analyses ◽  
List Type ◽  
County Level ◽  
Cross Sectional ◽  
Increased Risk

AbstractObjectivesUnited States government scientists estimate that COVID-19 may kill tens of thousands of Americans. Many of the pre-existing conditions that increase the risk of death in those with COVID-19 are the same diseases that are affected by long-term exposure to air pollution. We investigated whether long-term average exposure to fine particulate matter (PM2.5) is associated with an increased risk of COVID-19 death in the United States.DesignA nationwide, cross-sectional study using county-level data.Data sourcesCOVID-19 death counts were collected for more than 3,000 counties in the United States (representing 98% of the population) up to April 22, 2020 from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center.Main outcome measuresWe fit negative binomial mixed models using county-level COVID-19 deaths as the outcome and county-level long-term average of PM2.5 as the exposure. In the main analysis, we adjusted by 20 potential confounding factors including population size, age distribution, population density, time since the beginning of the outbreak, time since state’s issuance of stay-at-home order, hospital beds, number of individuals tested, weather, and socioeconomic and behavioral variables such as obesity and smoking. We included a random intercept by state to account for potential correlation in counties within the same state. We conducted more than 68 additional sensitivity analyses.ResultsWe found that an increase of only 1 μg/m3 in PM2.5 is associated with an 8% increase in the COVID-19 death rate (95% confidence interval [CI]: 2%, 15%). The results were statistically significant and robust to secondary and sensitivity analyses.ConclusionsA small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate. Despite the inherent limitations of the ecological study design, our results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis. The data and code are publicly available so our analyses can be updated routinely.Summary BoxWhat is already known on this topicLong-term exposure to PM2.5 is linked to many of the comorbidities that have been associated with poor prognosis and death in COVID-19 patients, including cardiovascular and lung disease.PM2.5 exposure is associated with increased risk of severe outcomes in patients with certain infectious respiratory diseases, including influenza, pneumonia, and SARS.Air pollution exposure is known to cause inflammation and cellular damage, and evidence suggests that it may suppress early immune response to infection.What this study addsThis is the first nationwide study of the relationship between historical exposure to air pollution exposure and COVID-19 death rate, relying on data from more than 3,000 counties in the United States. The results suggest that long-term exposure to PM2.5 is associated with higher COVID-19 mortality rates, after adjustment for a wide range of socioeconomic, demographic, weather, behavioral, epidemic stage, and healthcare-related confounders.This study relies entirely on publicly available data and fully reproducible, public code to facilitate continued investigation of these relationships by the broader scientific community as the COVID-19 outbreak evolves and more data become available.A small increase in long-term PM2.5 exposure was associated with a substantial increase in the county’s COVID-19 mortality rate up to April 22, 2020.

scholarly journals Lyme Neuroborreliosis: Mechanisms of B. burgdorferi Infection of the Nervous System

2021 ◽  
Vol 11 (6) ◽  
pp. 789
Author(s):  
Lenzie Ford ◽  
Danielle M. Tufts
Keyword(s):  
United States ◽  
Nervous System ◽  
Antibiotic Treatment ◽  
Molecular Mechanisms ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
The United States ◽  
Sensu Stricto ◽  
Lyme Neuroborreliosis

Lyme borreliosis is the most prevalent tick-borne disease in the United States, infecting ~476,000 people annually. Borrelia spp. spirochetal bacteria are the causative agents of Lyme disease in humans and are transmitted by Ixodes spp ticks. Clinical manifestations vary depending on which Borrelia genospecies infects the patient and may be a consequence of distinct organotropism between species. In the US, B. burgdorferi sensu stricto is the most commonly reported genospecies and infection can manifest as mild to severe symptoms. Different genotypes of B. burgdorferi sensu stricto may be responsible for causing varying degrees of clinical manifestations. While the majority of Lyme borreliae-infected patients fully recover with antibiotic treatment, approximately 15% of infected individuals experience long-term neurological and psychological symptoms that are unresponsive to antibiotics. Currently, long-term antibiotic treatment remains the only FDA-approved option for those suffering from these chronic effects. Here, we discuss the current knowledge pertaining to B. burgdorferi sensu stricto infection in the central nervous system (CNS), termed Lyme neuroborreliosis (LNB), within North America and specifically the United States. We explore the molecular mechanisms of spirochete entry into the brain and the role B. burgdorferi sensu stricto genotypes play in CNS infectivity. Understanding infectivity can provide therapeutic targets for LNB treatment and offer public health understanding of the B. burgdorferi sensu stricto genotypes that cause long-lasting symptoms.

scholarly journals Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi‐Ethnic Study of Atherosclerosis

2021 ◽  
Author(s):  
Olatokunbo Osibogun ◽  
Oluseye Ogunmoroti ◽  
Lena Mathews ◽  
Victor Okunrintemi ◽  
Martin Tibuakuu ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Cardiovascular Health ◽  
Hispanic Americans ◽  
The United States ◽  
Foreign Born ◽  
Cross Sectional ◽  
Lower Odds ◽  
Increased Risk ◽  
At Home

Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi‐ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross‐sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign‐born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non‐Hispanic White‐, 26% non‐Hispanic Black‐, 12% Chinese‐ and 22% Hispanic‐Americans. US‐born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50–0.79], P <0.001) compared with foreign‐born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08–3.36], P =0.03; and 1.65 [1.04–2.63], P =0.03, respectively). Foreign‐born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43–0.91], P =0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.

scholarly journals Racial Diversity Among American Cardiologists: Implications for the Past, Present, and Future

Circulation ◽  
2021 ◽  
Vol 143 (24) ◽  
pp. 2395-2405
Author(s):  
Amber E. Johnson ◽  
Mehret Birru Talabi ◽  
Eliana Bonifacino ◽  
Alison J. Culyba ◽  
Esa M. Davis ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Racial Diversity ◽  
The United States ◽  
Care Quality ◽  
Research Quality ◽  
Workforce Diversity ◽  
Evidence Based ◽  
Racially Diverse ◽  
Increased Risk

In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular disease and are less likely to receive high-quality, evidence-based medical care as compared with their White American counterparts. Although the United States population is diverse, the cardiovascular workforce that provides its much-needed care lacks diversity. The available data show that care provided by physicians from racially diverse backgrounds is associated with better quality, both for minoritized patients and for majority patients. Not only is cardiovascular workforce diversity associated with improvements in health care quality, but racial diversity among academic teams and research scientists is linked with research quality. We outline documented barriers to achieving workforce diversity and suggest evidence-based strategies to overcome these barriers. Key strategies to enhance racial diversity in cardiology include improving recruitment and retention of racially diverse members of the cardiology workforce and focusing on cardiovascular health equity for patients. This review draws attention to academic institutions, but the implications should be considered relevant for nonacademic and community settings as well.

Coronary artery bypass grafting in women

2021 ◽  
pp. 405-410
Author(s):  
Jessica Yu Rove ◽  
Jennifer S. Lawton
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
The United States ◽  
Bypass Grafting ◽  
Artery Disease ◽  
Developed World

Cardiovascular disease poses the greatest health threat to women in the developed world. Despite the fact that up until 2013 in the United States more women than men died annually of cardiovascular disease, women remain underdiagnosed and undertreated for cardiovascular disease. This chapter acknowledges perceived and actual differences in the manifestation of coronary artery disease between women and men. Further, it summarizes data on the modern performance and outcomes of coronary artery bypass surgery in women compared to men.

scholarly journals Characteristics of and meningococcal disease prevention strategies for commercially insured persons receiving eculizumab in the United States

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241989
Author(s):  
Catherine H. Bozio ◽  
Cheryl Isenhour ◽  
Lucy A. McNamara
Keyword(s):  
United States ◽  
Disease Prevention ◽  
Meningococcal Disease ◽  
The United States ◽  
Prescription Data ◽  
Meningococcal Vaccine ◽  
Prevention Strategies ◽  
Meningococcal Vaccines ◽  
Increased Risk

Introduction Eculizumab is a licensed treatment for several rare, complement-mediated diseases. Eculizumab use is associated with an approximately 2,000-fold increased meningococcal disease risk. In the United States, meningococcal vaccines are recommended for eculizumab recipients but there are no recommendations on use of long-term antibiotic prophylaxis. We describe characteristics of and meningococcal vaccine and antibiotic receipt in U.S. eculizumab recipients to inform meningococcal disease prevention strategies. Methods Persons in the IBM® MarketScan® Research Databases with ≥1 claim for eculizumab injection during 2007–2017 were included. Indication for eculizumab use, meningococcal vaccine receipt, and antibiotic receipt were assessed using International Classification of Diseases-9/10 diagnosis codes, vaccine administration procedure codes, and antibiotic codes from pharmacy claims, respectively. Results Overall 696 persons met the inclusion criteria. Paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS) were the most common indications for eculizumab use (41% and 37%, respectively); 20% had an undetermined indication. From June 2015 through December 2017, 28% (41/148) of continuously-enrolled patients received ≥1 serogroup B vaccine dose. For serogroup ACWY conjugate vaccine, 45% (91/201) of patients received ≥1 dose within five years of their most recent eculizumab dose, as recommended. Of eculizumab recipients with outpatient prescription data, 7% (41/579) received antibiotics for ≥50% of the period of increased risk for meningococcal disease. Conclusion Many eculizumab recipients had an undetermined indication for eculizumab use; few were up-to-date for recommended meningococcal vaccines or were prescribed antibiotics long-term. These findings can inform further investigation of how to best protect this population from meningococcal disease.

scholarly journals Universal Healthcare in the United States of America: A Healthy Debate

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 580
Author(s):  
Gabriel Zieff ◽  
Zachary Y. Kerr ◽  
Justin B. Moore ◽  
Lee Stoner
Keyword(s):  
United States ◽  
Economic Status ◽  
The United States ◽  
Economic Costs ◽  
Quality Healthcare ◽  
Universal Healthcare ◽  
Increased Risk ◽  
Pros And Cons ◽  
Universal Healthcare System

This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio–economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.

scholarly journals Long-Term Association of Air Pollution and Hospital Admissions Among Medicare Participants Using a Doubly Robust Additive Model

Circulation ◽  
2021 ◽  
Vol 143 (16) ◽  
pp. 1584-1596 ◽  
Author(s):  
Mahdieh Danesh Yazdi ◽  
Yan Wang ◽  
Qian Di ◽  
Yaguang Wei ◽  
Weeberb J. Requia ◽  
...  
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Tropospheric Ozone ◽  
Hospital Admissions ◽  
Fine Particulate Matter ◽  
The United States ◽  
Fine Particulate ◽  
Increased Risk ◽  
Doubly Robust

Background: Studies examining the nonfatal health outcomes of exposure to air pollution have been limited by the number of pollutants studied and focus on short-term exposures. Methods: We examined the relationship between long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 micrometers (PM 2.5 ), NO 2 , and tropospheric ozone and hospital admissions for 4 cardiovascular and respiratory outcomes (myocardial infarction, ischemic stroke, atrial fibrillation and flutter, and pneumonia) among the Medicare population of the United States. We used a doubly robust method for our statistical analysis, which relies on both inverse probability weighting and adjustment in the outcome model to account for confounding. The results from this regression are on an additive scale. We further looked at this relationship at lower pollutant concentrations, which are consistent with typical exposure levels in the United States, and among potentially susceptible subgroups. Results: Long-term exposure to fine PM 2.5 was associated with an increased risk of all outcomes with the highest effect seen for stroke with a 0.0091% (95% CI, 0.0086–0.0097) increase in the risk of stroke for each 1-µg/m 3 increase in annual levels. This translated to 2536 (95% CI, 2383–2691) cases of hospital admissions with ischemic stroke per year, which can be attributed to each 1-unit increase in fine particulate matter levels among the study population. NO 2 was associated with an increase in the risk of admission with stroke by 0.00059% (95% CI, 0.00039–0.00075) and atrial fibrillation by 0.00129% (95% CI, 0.00114–0.00148) per ppb and tropospheric ozone was associated with an increase in the risk of admission with pneumonia by 0.00413% (95% CI, 0.00376–0.00447) per parts per billion. At lower concentrations, all pollutants were consistently associated with an increased risk for all our studied outcomes. Conclusions: Long-term exposure to air pollutants poses a significant risk to cardiovascular and respiratory health among the elderly population in the United States, with the greatest increase in the association per unit of exposure occurring at lower concentrations.

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