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Although the prevalence of overweight/obesity is lower in Asian countries, the risk of type 2 diabetes (T2DM) is disproportionally higher. We identified and characterized the trajectory patterns of body mass index (BMI) before the onset of T2DM in a Taiwanese population. Using the Taiwan MJ cohort study, we sampled the health examination data of 22,934 participants, including 7618 cases of T2DM and 15,316 controls. We used latent class trajectory analysis to identify distinct groups of pre-disease BMI trajectory. To compare the trajectories of cardiometabolic risk factors among different groups, we used linear mixed-effects models. These 22,934 participants included 13,074 men (57%) and 9860 women (43%) who were on average followed for 9.0 years. We identified three distinct pre-disease BMI trajectories in cases: "stable overweight" (n = 7016, 92.1%), "weight gain" (n = 333, 4.4%) and "obesity" (n = 269, 3.5%). The "stable overweight" group had a mean BMI of 24.6 kg/m2 at 15 years prior to diagnosis, had a 1.2 unit increase during follow-up, and had a mean BMI of 25.8 kg/m2 at the time of diagnosis. The "weight gain" group had the most increasing trends in blood pressure/low-density lipoprotein cholesterol over time. The BMI trajectory patterns among individuals who later developed diabetes in Taiwan seemed comparable to that of Western populations, but our population developed T2DM at a much lower BMI. Given that most cases belong to the "stable overweight" group, we also support using a population-based strategy for diabetes prevention instead of focusing on the high risk individuals. [ABSTRACT FROM AUTHOR]

Background: Cohort studies on the association between long-term exposure to fine particulate matter (PM2.5) and mortality have been well established for America and Europe, but limited and inconsistent in Asia with much higher air pollution. This study aims to investigate the associations between ambient PM2.5 and all-cause and cause-specific mortality over a period of rising and then declining PM2.5.Methods: We enrolled a total of 400,459 adults from an open cohort between 2001 and 2016, and followed them up until 31 May 2019. We obtained mortality data from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. We estimated ambient PM2.5 exposures using a satellite-based spatiotemporal model. We performed a Cox regression model with time-dependent covariates to investigate the associations of PM2.5 with deaths from all causes and specific causes.Results: This study identified 14,627 deaths and had a total of 5 million person-years of follow-up. Each 10 µg/m3 increase in PM2.5 was associated with an increased hazard risk of 29% (95% confidence interval: 24%-35%) in all-cause mortality. Risk of death increased by 30% for natural causes, 20% for cancer, 42% for cardiovascular disease (CVD) causes, and 53% for influenza and pneumonia causes, for each 10 µg/m3 increase in PM2.5. Sensitivity analyses generally yielded similar results.Conclusion: Long-term exposure to ambient PM2.5 was associated with increased risks of all-cause mortality and deaths from cancers, natural causes, CVD, and influenza and pneumonia. Longitudinal study design should be encouraged for air pollution epidemiologic investigation. [ABSTRACT FROM AUTHOR]

Background and Aims: White blood cell (WBC) count is an easily obtainable biomarker of systematic inflammation. Our study aimed to investigate the associations of differential WBC count with all-cause and cause-specific mortality in a general Asian population.Methods and Results: Cox proportional hazards model was used to evaluate the associations of WBC count with mortality separately for men and women, with adjustment for multiple variables including age, smoking, and other lifestyle factors. Stratified analyses by age, smoking, diabetes, and hypertension were conducted to explore potential effect modification. Elevated WBC count was significantly associated with increased mortality risk. The adjusted hazard ratios of total WBC (10th decile compared to decile of lowest risk) for all-cause mortality were 1.42 (95% CI: 1.33, 1.53) for men and 1.54 (95% CI: 1.42, 1.68) for women. Similar risks were observed for neutrophils, monocytes, and neutrophil/lymphocyte (NL) ratio. The highest deciles of neutrophils, monocytes, and NL ratio were also positively associated with risk of cardiovascular/cerebrovascular, cancer, and respiratory mortality after adjusting for covariates. Results for all-cause mortality remained statistically significant for participants who were <60 years old, non-smokers, non-diabetic, and non-hypertensive.Conclusions: Total and differential WBC counts (neutrophils, monocytes, and NL ratios) are positively associated with increased risk of all-cause mortality, cardiovascular and cerebrovascular, cancer, and respiratory mortality among Taiwanese adults. [ABSTRACT FROM AUTHOR]

It is crucial to have simple and appropriate measures to identify people with adiposity-related risk. We compared the associations of mortality with body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and body fat percentage (BF%) in a prospective cohort. A total of 463,002 adults were recruited between 1996 and 2017. Vital data were obtained from the National Death Registry System in Taiwan. Cox proportional hazards model was used to assess the associations of BMI, WC, WHtR, and BF% with mortality. Clear U-shape relationships were observed for all four parameters. In both men and women, the lowest risk of mortality was observed in the BMI category of 23.5–24.9 kg/m2. Regarding WC, men in the third quintile (79.0–82.9 cm) and women in the fourth quintile (70.0–74.9 cm) had the lowest risk of mortality. For WHtR, men in the third quintile (0.46–0.49) and women in the fourth quintile (0.45–0.48) had the lowest risk of mortality. For BF%, both men and women in the fourth quintile (24.0–27.2% and 28.7–32.8%, respectively) had the lowest risk of mortality. The WC, WHtR, and BF% exhibited slightly associations with the risk of mortality across the three BMI categories [low (10.8–20.9 kg/m2), normal (21.0–27.4 kg/m2) and high (27.5–51.7 kg/m2)]. C-statistics of the four parameters ranged from 0.51 to 0.69. Our results suggest that BMI should remain the primary marker for screening excessive adiposity. However, our findings also support the use of the WC, WHtR, and/or BF%, in addition to BMI when assessing the risk of mortality. [ABSTRACT FROM AUTHOR]

We evaluated global and regional burdens of, risk factors for, and epidemiologic trends in pancreatic cancer among groups of different sexes and ages. We used data from the GLOBOCAN database to estimate pancreatic cancer incidence and mortality in 184 countries. We examined the association between lifestyle and metabolic risk factors, extracted from the World Health Organization Global Health Observatory database, and pancreatic cancer incidence and mortality by univariable and multivariable linear regression. We retrieved country-specific age-standardized rates (ASRs) of incidence and mortalities from cancer registries from 48 countries through 2017 for trend analysis by joinpoint regression analysis. The highest incidence and mortality of pancreatic cancer were in regions with very high (ASRs, 7.7 and 4.9) and high human development indexes (ASRs, 6.9 and 4.6) in 2018. Countries with higher incidence and mortality were more likely to have higher prevalence of smoking, alcohol drinking, physical inactivity, obesity, hypertension, and high cholesterol. From 2008 to 2017, 2007 to 2016, or 2003 to 2012, depending on the availability of the data, there were increases in incidence among men and women in 14 (average annual percent changes [AAPCs], 8.85 to 0.41) and 17 (AAPCs, 6.04 to 0.87) countries, respectively. For mortality, the increase was observed in 8 (AAPCs, 4.20 to 0.55) countries among men and 14 (AAPCs, 5.83 to 0.78) countries among women. Although the incidence increased in 18 countries (AAPCs, 7.83 to 0.91) among individuals 50 years or older, an increasing trend in pancreatic cancer was also identified among individuals younger than 50 years and 40 years in 8 (AAPCs, 8.75 to 2.82) and 4 (AAPCs, 11.07 to 8.31) countries, respectively. In an analysis of data from 48 countries, we found increasing incidence and mortality trends in pancreatic cancer, especially among women and populations 50 years or older, but also among younger individuals. More preventive efforts are recommended for these populations. [ABSTRACT FROM AUTHOR]

Information on the relation of air pollution with non-alcoholic fatty liver disease (NAFLD) is scarce. We thus conducted a large cross-sectional study in Asia to investigate the role of air pollution in NAFLD. We recruited 329,048 adults (mean age: 41.0 years) without other liver disease (hepatitis and cirrhosis) or excessive alcohol consumption in Taiwan and Hong Kong from 2001 to 2018. The concentrations of nitrogen dioxide (NO 2) and ozone (O 3) were estimated using a space–time regression model, and the concentrations of fine particulate matter (PM 2.5) was evaluated using a satellite-based spatio-temporal model. NAFLD was determined using either the fatty liver index (FLI) or the hepatic steatosis index (HSI). The NAFLD-related advanced fibrosis was defined according to BARD score or the fibrosis-4 (FIB-4). A logistic regression model was adopted to explore the relationships of ambient air pollution with the odds of NAFLD and NAFLD-related advanced fibrosis. We found positive relationships between PM 2.5 and the odds of NAFLD and advanced fibrosis, with every standard deviation (SD, 7.5 µg/m3) increases in PM 2.5 exposure being associated with a 10% (95% confidence interval [CI]: 9%–11%) increment in the prevalence of NAFLD and an 8% (95% CI: 7%–9%) increment in the prevalence of advanced fibrosis. Similarly, the prevalence of NAFLD and advanced fibrosis increased by 8% (95% CI: 7%–9%) and 7% (95% CI: 6%–8%) with per SD (18.9 µg/m3) increasement in NO 2 concentration, respectively. Additionally, for every SD (9.9 µg/m3) increasement in O 3 concentration, the prevalence of NAFLD and advanced fibrosis decreased by 12% (95% CI: 11%–13%) and 11% (95% CI: 9%–12%), respectively. Higher ambient PM 2.5 and NO 2 are linked with higher odds of NAFLD and advanced fibrosis. Our findings indicate that reducing PM 2.5 and NO 2 concentrations may be an effective way for preventing NAFLD. Further studies on O 3 are warranted. [Display omitted] • Ambient PM 2.5 and NO 2 are linked with higher odds of NAFLD and advanced fibrosis • The impact on NAFLD is more pronounced in females, never-smokers, and younger adults • Reducing PM 2.5 and NO 2 levels serves as an effective way for preventing NAFLD [ABSTRACT FROM AUTHOR]

Many countries dedicated in mitigation of air pollution in the past several decades. However, little is known about how air quality improvement affects health. Therefore, we conducted current study to investigate dynamic changes in long-term exposure to ambient particulate matter (PM2.5) and incidence of hypertension in a large longitudinal cohort. We recruited 134 978 adults aged 18 years or above between 2001 and 2014. All the participants received a series of standard medical examinations, including measurements of blood pressure. The PM2.5 concentration was estimated using a satellite-based spatiotemporal model at a high resolution (1×1 km2). The change in long-term exposure to PM2.5 (ΔPM2.5) was defined as the difference between the values measured during follow-up and during the immediately preceding visit, and a negative value indicated an improvement in PM2.5 air quality. Time-varying Cox model was used to examine the associations between ΔPM2.5 and the development of hypertension. The results show that PM2.5 concentrations increased in 2002, 2003, and 2004, but began to decrease in 2005. Every 5 µg/m3 change in exposure to PM2.5 (ie, a ΔPM2.5 of 5 µg/m3) was associated with a 16% change in the incidence of hypertension (hazard ratio, 0.84; 95% CI, 0.82-0.86). Both stratified and sensitivity analyses generally yielded similar results. We found that an improvement in PM2.5 exposure is associated with a decreased incidence of hypertension. Our findings demonstrate that air pollution mitigation is an effective strategy to reduce the risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Abstract Long-term exposed to ambient particulate matter (PM) has been recognized as a risk factor for cardiovascular diseases (CVDs) mortality but few studies examine the utility of WHO's interim targets (2006) concerning PM control on CVD mortality. This review aimed to synthesize the long-term exposed to ambient PM exposures on overall CVD mortality according to WHO's interim targets; meanwhile, subgroup analysis by ethnicity, smoking status and PM assessment method were also conducted. We systematically searched studies published between January 1974 and Jul 2017 in PubMed and Embase. Quality of each study was assessed using Critical Appraisal Skill Programme (CASP) checklist. Fixed-effects or random-effects model of meta-analysis was determined by the test of heterogeneity. Subgroup analyses were conducted according to ethnicity, smoking status, PM assessment method and interim PM targets of WHO guidelines. Overall, 16 eligible studies were included, covering 15,511,997 participants and 542,991 CVD deaths. Five studies concerning PM2.5 were rated as good quality. The pooled hazard ratio (HR) of every 10μg/m3 increment of PM2.5 exposure for CVD mortality was 1.12 (95%CI = 1.08–1.16), but it was not significant for PM10 (HR = 1.02, 95%CI = 0.89–1.16). Compared with the annual PM2.5 exposure level within WHO's interim targets (1.11–1.16), significantly smaller HR was observed for subjects with an exposure level below WHO's air quality guideline (HR = 1.03, 95%CI = 1.02–1.04). The pooled HR was relatively higher for studies in Asian and with at least 11 years' follow-up and those adopting relatively poor methods (category 1) in assessing PM2.5, whilst the risk was similar regardless of smoking status. Egger and Begg's tests showed no evidence for publication bias. Long-term ambient PM2.5 exposure level was positively associated with the overall CVD mortality. Different interim targets above the WHO's Air Quality Guideline level exerted a similar scale of CVD risk, but there is no evidence for a threshold. Graphical abstract Image 1 Highlights • Synthesized current evidence for the effect of ambient PM exposure on CVD mortality in healthy non-occupational populations. • Provided a new view by comparing the effect of ambient PM exposure within and beyond WHO interim targets on CVD mortality. • Specifically provided the effect of ambient PM exposure stratified by follow-up years and monitoring method which has not been explored previously. • Applied CASP quality assessment method to evaluate the quality of environmental epidemiological studies. [ABSTRACT FROM AUTHOR]

Background The prothrombotic effects of particulate matter (PM) may underlie the association of air pollution with increased risks of cardiovascular disease. This study aimed to investigate the association between long-term exposure to PM with an aerodynamic diameter ≤2.5 μm (PM 2.5 ) and platelet counts, a marker of coagulation profiles. Methods The study participants were from a cohort consisting of 362,396 Taiwanese adults who participated in a standard medical examination program between 2001 and 2014. Platelet counts were measured through Complete Blood Count tests. A satellite-based spatio-temporal model was used to estimate 2-year average ambient PM 2.5 concentration at each participant's address. Mixed-effects linear regression models were used to investigate the association between PM 2.5 exposure and platelet counts. Results This analysis included 175,959 men with 396,248 observations and 186,437 women with 397,877 observations. Every 10-μg/m 3 increment in the 2-year average PM 2.5 was associated with increases of 0.42% (95% CI: 0.38%, 0.47%) and 0.49% (95% CI: 0.44%, 0.54%) in platelet counts in men and women, respectively. A series of sensitivity analyses, including an analysis in participants free of cardiometabolic disorders, confirmed the robustness of the observed associations. Baseline data analyses showed that every 10-μg/m 3 increment in PM 2.5 was associated with higher risk of 17% and 14% of having elevated platelet counts (≥90th percentile) in men and women, respectively. Conclusions Long-term exposure to PM 2.5 appears to be associated with increased platelet counts, indicating potential adverse effects on blood coagulability. [ABSTRACT FROM AUTHOR]

Despite increasing concerns about the detrimental effects of air pollution on respiratory health, limited evidence is available on these effects in the Hong Kong population, especially in children. In this prospective cohort study between 2012 and 2017, we aimed to investigate the associations between exposure to air pollution (concentrations of fine particulate matter [PM 2.5 ] and nitrogen dioxide [NO 2 ]) and respiratory health (lung function parameters and respiratory diseases and symptoms) in schoolchildren. We recruited 5612 schoolchildren aged 6–16 years in Hong Kong. We estimated the annual average concentrations of ambient PM 2.5 and NO 2 at each participant's address using spatiotemporal models. We conducted spirometry tests on all participants to measure their lung function parameters and used a self-administered questionnaire to collect information on their respiratory diseases and symptoms and a wide range of covariates. Linear mixed models were used to investigate the associations between exposure to air pollution and lung function. Mixed-effects logistic regression models with random effects were used to investigate the associations of exposure to air pollution with respiratory diseases and symptoms. In all of the participants, every 5-μg/m3 increase in the ambient PM 2.5 concentration was associated with changes of − 13.90 ml (95 % confidence interval [CI]: −23.65 ml, −4.10 ml), − 4.20 ml (−15.60 ml, 7.15 ml), 27.20 ml/s (−3.95 ml/s, 58.35 ml/s), and − 19.80 ml/s (−38.35 ml/s, −1.25 ml/s) in forced expiratory volume in 1 s, forced vital capacity, peak expiratory flow, and maximal mid-expiratory flow, respectively. The corresponding lung function estimates for every 5-μg/m3 increase in the ambient NO 2 concentration were − 2.70 ml (−6.05 ml, 0.60 ml), − 1.40 ml (−5.40 ml, 2.60 ml), − 6.60 ml/s (−19.75 ml/s, 6.55 ml/s), and − 3.05 ml/s (−11.10 ml/s, 5.00 ml/s), respectively. We did not observe significant associations between PM 2.5 /NO 2 exposure and most respiratory diseases and symptoms. Stratified analyses by sex and age showed that the associations between exposure to air pollution and lung function parameters were stronger in male participants and older participants (11–14 year old group) than in female participants and younger participants (6–10 year old group), respectively. Our results suggest that chronic exposure to air pollution is detrimental to the respiratory health of schoolchildren, especially that of older boys. Our findings reinforce the importance of air pollution mitigation to protect schoolchildren's respiratory health. [Display omitted] • This study investigated air pollution and respiratory health in school children. • PM 2.5 level was associated with a lower FEV1/MMEF and a higher risk of sinusitis. • NO 2 was associated with a higher risk of allergic rhinitis. • Air pollution was associated with adverse respiratory health in children. [ABSTRACT FROM AUTHOR]

Summary: Background: abitual snoring and elevated high-sensitive C-reactive protein (HsCRP) have both been associated with increased risk of cardiovascular disease. However, snoring and HsCRP are elevated in obese states which may thus be the primary determinant of both. We therefore investigated whether snoring may mediate the increased vascular risk directly through increased inflammation as indicated by HsCRP levels or if other determinants predominated in a large older Chinese population. Methods: A total of 2508 males and 5709 females aged 50–85 years received a medical check-up including measurement of blood pressure, obesity indices, fasting total, LDL-, HDL-cholesterol, triglycerides, glucose and HsCRP. Information on self-reported snoring status was collected by standardized interview. Results: The age-adjusted geometric mean HsCRP concentrations increased significantly with higher snoring frequency in both genders (linear trend, p =0.02 for men and p <0.001 for women), but the association was no longer significant after controlling for waist and BMI. Furthermore, HsCRP levels were not significantly associated with snoring frequency groups stratified by BMI/waist quintiles in both genders, except for the 4th waist quintile in men. No interaction was observed between snoring and BMI/waist on HsCRP levels. The multivariate analysis showed that, in both genders, obesity, but not HsCRP, was associated with snoring. Conclusions: Our results showed that snoring frequency did not have an independent effect on inflammation after adjusting for adiposity, and may thus contribute to vascular disease through alternative mechanisms. [ABSTRACT FROM AUTHOR]

Background & Aims: Patients with chronic hepatitis C virus (HCV) infections are treated with pegylated interferon and ribavirin (PEG-IFN/RBV), which is effective in less than 50% of those infected with HCV genotype 1. Genome-wide association studies have linked response to PEG-IFN/RBV with common single nucleotide polymorphisms in the vicinity of interferon (IFN)-λ genes on chromosome 19. We investigated the association between the polymorphism rs12979860 and treatment response in a diverse cohort of chronic HCV patients. Methods: A cross-sectional study of 1021 consecutive patients enrolled in the Duke Hepatology Clinic Research Database and Biorepository. We analyzed DNA, clinical and demographic data, along with validated data of the response of 231 subjects to PEG-IFN/RBV. The study included Caucasians (n = 178), African Americans (n = 53), and HCV genotypes 1 (n = 186) and 2/3 (n = 45). The rs12979860 genotype was tested for an association with sustained virologic response, defined as undetectable levels of HCV RNA 24 weeks after treatment ended. Results: The rs12979860 CC genotype (found in ∼40% of Caucasians) predicted a sustained virologic response to therapy among Caucasians (odds ratio, 5.79; 95% confidence interval, 2.67–12.57; P = 9.0 × 10−6), independent of HCV genotype and other covariates. Rs12979860 CC predicted a sustained response with 78% specificity and 65% sensitivity in patients infected with HCV genotype 1). Conclusions: rs12979860 genotype is a significant independent predictor of response to PEG-IFN/RBV in patients with chronic HCV infection; tests for this genotype might be used to determine the best course of treatment for patients considering antiviral therapy. [Copyright &y& Elsevier]

Abstract: Hyperglycemia increases cardiovascular disease risk, but the association between increasing glycemia and cardiovascular risk factors, angina, and coronary heart disease in normoglycemic subjects is less clear, particularly in Chinese. We report on possible associations in a large group of Mainland Chinese subjects. A total of 10400 older subjects (≥50 years) were recruited, and vascular risk factors were measured, including anthropometry, blood pressure, and fasting plasma biochemical factors including glucose, lipid profile, and C-reactive protein (CRP). Subjects were categorized by glycemic status, and the relationship between glycemia and cardiovascular risk factors was investigated using analysis of variance and multiple linear regression analyses. Tertiles of fasting glucose levels showed a clear positive relationship with cardiovascular risk factors including age, obesity, blood pressure, lipid levels, and CRP (P < .001 for all). The overall prevalence of self-reported vascular disease was low, but significantly associated with increasing glycemia. Multiple regression showed that waist circumference (standardized regression coefficient β = .10, P < .001), triglycerides (β = 0.16, P < .001), CRP (β = 0.06, P < .001), female sex (β = .03, P = .007), high-density lipoprotein cholesterol (β = −.02, P = .016), and mean arterial pressure (β = .06, P < .001) were independently associated with fasting glucose levels. Among the normoglycemic subjects (n = 5190), increasing glycemia was still associated with increasing obesity indices, systolic blood pressure, triglyceride, and CRP levels (all P < .05). Increasing glycemia, even in the reference range, is associated with increasing prevalence of vascular risk factors. Control of these risk factors, particularly obesity, the most important avoidable independent determinant of glycemia in normoglycemic subjects, is critical to reduce the risk of the associated vascular disease. [Copyright &y& Elsevier]

• This study utilized one large cohort with individual-level personal risk factors and linked to neighborhood greenspace exposure. • This study aimed to observe changes in fasting glucose as an earlier indicator for diabetes development. • The higher residential greenness appears to be associated with lower glucose and higher physical activity can strengthen this association. • Ensuring greenness in each neighborhood so as to maximize positive health outcomes is an important issue when conducting green space planning. Growing evidence suggests that greenness exposure improves health status, but few studies address diabetes, and research mainly comes from Western countries. This study hypothesizes that higher greenness exposure benefits glucose control with increased intensity of physical activity. We used data from a longitudinal health examination database in Taiwan during 2000–2014. The normalized difference vegetation index (NDVI) was used as an objective indicator of greenness in the neighborhood. Fasting plasma glucose served as an indicator of early diabetes diagnosis. A metabolic equivalent value (MET) based on a compendium of physical activities was used to estimate the intensity of physical activity. We applied a linear mixed-effect model with an individual-level random effect to investigate the relationship between neighborhood greenness and the fasting plasma glucose value stratified by four levels of physical activity. There are 341,211 participants with no diabetes, and 773,602 check-up visits included here. The fasting glucose among participants living in areas with higher green space was lower than that of those living in less green areas. The beneficial effects of greenspace on glucose were stronger for those with more physical activity, especially in the 500-m buffer. In the physically inactive group, compared with the lowest quantile (Q1) of cumulative average greenness, people living in the highest quantile (Q4) of greenness had 0.35 mg less glucose in each dl of plasma [95% confidence interval: −0.50, −0.20]. In the physically active group, people residing in the highest quantile (Q4) of greenness had 0.48 mg less glucose in each dl of plasma [95% confidence interval: −0.73, −0.23]. Higher residential greenness appears to be associated with lower glucose. Higher physical activity can mediate this association. Our results provide evidence that ensuring access to greenspace in residential neighborhoods may provide positive health outcomes and improve public health, and should be implemented in urban planning. [ABSTRACT FROM AUTHOR]

Background Despite the popular use of household cleaning products worldwide, there is no published study investigating the health effects of these products on rhinitis in children. Objective We sought to investigate the household use of cleaning products and rhinitis patterns in Chinese children. Methods A total of 2299 children were recruited from 21 primary schools with wide geographic coverage in Hong Kong. Self-administered questionnaires were completed by parents/guardians to collect detailed information on respiratory symptoms and household use of 14 types of chemical cleaning products, as well as clean water. Students were categorized into 4 mutually exclusive rhinitis patterns (never, occasional, frequent, and persistent). The total chemical burden (TCB) score was used as the exposure indicator by calculating the total time of exposure to the 14 cleaning products. Multinomial logistic regression was used to assess the relationship between rhinitis patterns and the use of household cleaning products. Results Every 10-unit increment of TCB score was associated with an increase in the odds of occasional (odds ratio [OR], 1.21; 95% CI, 1.05-1.41), frequent (OR, 1.36; 95% CI, 1.13-1.60), and persistent (OR, 1.21; 95% CI, 1.01-1.56) rhinitis after adjustment for a wide range of potential confounders. Compared with the children within the lowest tertile of TCB scores, the adjusted ORs of occasional, frequent, and persistent rhinitis in children within the highest tertile were 1.29 (95% CI, 1.01-1.65), 1.97 (95% CI, 1.40-2.76), and 1.67 (95% CI, 1.10-2.54), respectively. Conclusion Frequent use of chemical cleaning products at home is associated with an increase in the odds of rhinitis in Chinese primary school children. [ABSTRACT FROM AUTHOR]

Background: Relatively few studies have explored the relationship between air pollution and cause-specific mortality among hypertensive patients. This study evaluated whether short term exposures to nitrogen dioxide (NO2), ozone (O3), particulate matter <10 mm in diameter (PM10) were associated with higher risk of mortality among a large hypertensive patients.Methods: A total of 223,287 hypertensive patients who attended any public health-care services in Hong Kong and prescribed at least 1 antihypertensive agent for the first time between 2001 and 2005 were followed up until 2010. A time-stratified, bi-directional case-crossover design was adopted to study the association between environmental exposures and mortality outcomes.Results: For all-cause mortality, significant positive associations were observed for NO2 and PM10 at lag 0 to 3 days per 10 MIUg/m3 increase in concentration and the excess risks ranged from 1.187%- 2.501%. Significant positive associations were found for O3 at lag 1 and 2 days and the excess risks were 1.654% (95% C.I. 0.469%, 2.852%) and 1.207% (95% C.I. 0.025%, 2.404%), respectively. We found similarly positive associations between NO2 (excess risks: 1.786%-2.798%), PM10 (1.126%-1.847%), O3 (3.035%-3.355%) and mortality due to respiratory disease. In stratified analysis, these significant results were observed amongst those aged >65 years and in cold seasons only.Conclusions: Older hypertensive patients are susceptible to all-cause and respiratory disease-specific deaths from these air pollutants in cold weather. This implies urgent need for protective air pollution standards for this susceptible population. [ABSTRACT FROM AUTHOR]

Background: Existing trials almost exclusively used atenolol to represent the entire beta-blocker class. We compared the incidence of all-cause and cardiovascular (CVS) mortality, blood pressure (BP) control and adherence levels between patients newly prescribed atenolol vs. metoprolol.Methods: This cohort study included all public, clinical settings in Hong Kong between 2001 and 2005, followed up till 2010. We compared outcomes between 22,479 new atenolol users and 29,972 new metoprolol users. The difference in mortality between drugs was evaluated by Cox proportional hazard regression models. Binary logistic regression analyses were used to compare the BP control rates and adherence levels.Results: Among atenolol and metoprolol users, 7.0% (1,577 of 22,479) and 13.1% (3,940 of 29,972) died, respectively (p<0.005). The incidence of CVS mortality among atenolol users was lower than metoprolol users (1.4% vs. 3.7%, p<0.001). When compared with atenolol users, metoprolol users were 1.13-fold (95% C.I. 1.06-1.20) and 1.56-fold (95% C.I. 1.27-1.90), respectively, more likely to encounter all-cause and CVS mortality; less likely to be drug adherent (Adjusted Relative Risk [RR]: 0.95, 95% C.I.: 0.90-0.99, p=0.013); and less likely to achieve optimal overall BP control (RR 0.94, 95% C.I. 0.90-0.99, p=0.023) and diastolic BP control (RR 0.86, 95% C.I. 0.77-0.97, p=0.013).Conclusions: These findings imply an intra-class difference for beta-blockers when used as first-line antihypertensive prescriptions in real-life clinical settings. More outcome studies on the effectiveness of different subtypes within other major antihypertensive drug classes are warranted. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, defined as having more than one co-existing chronic condition, induces substantial disease burden. This study aimed to evaluate whether multimorbidity is associated with poor medication adherence and poor blood pressure (BP) control.Methods: A multistage, cluster random sampling was adopted to recruit adult hypertensive patients attending general outpatient clinics in Hong Kong in 2012. Data on BP and the number of chronic medical conditions were collected onsite using a standardised protocol. Adherence to medication was assessed by Morisky Medication Adherence Scale (MMAS-8). A binary logistic regression analysis was conducted with multimorbidity as the outcome variable, and poor adherence (MMAS-8 score  6) and suboptimal BP control (SBP/DBP > 130/80 mmHg for those with diabetes or chronic kidney disease; and > 140/90 mmHg for others) were included as covariates.Results: From a total of 1,445 completed surveys, the proportion of hypertensive patients having 0, 1 and ≥ 2 additional conditions was 53.6% [775/1,445], 37.5% [542/1,445] and 8.9% [128/1,445]. The corresponding rate of poor adherence was 54.3% [379/698], 37.2% [260/698], and 8.5% [59/698], whereas the rate of suboptimal BP control was 48.0% [294/613], 41.3% [253/613], and 10.8% [66/613], respectively. When compared with patients with no additional conditions, multimorbid patients were significantly more likely to have suboptimal BP control (AOR= 1.47, 95% CI 1.18-1.84, p < 0.001).Conclusions: Multimorbidity was common among hypertensive patients, and was associated with poor BP control. They should receive more clinical attention to achieve better clinical outcomes. [ABSTRACT FROM AUTHOR]