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Article

Preterm Birth: Epidemiology, Risk Factors, Pathogenesis, and Prevention  

Xiaojing Zeng, Wen Jiang, Xiaoqing He, and Jun Zhang

Preterm birth is a significant global public health issue. It is defined by the World Health Organization as infants born alive before 37 completed weeks of gestation. The preterm birth rate varies significantly across countries and regions. Globally, an estimated 13.4 million babies were born preterm in 2020 (i.e., 1 in 10 babies worldwide was preterm birth). It is the leading cause of under-5 child mortality worldwide, and preterm infants are particularly vulnerable to respiratory complications, feeding difficulty, poor body temperature regulation, and high risk of infection. Both genetic and nongenetic factors (exposome factors) contribute to the risk of preterm birth. Social and behavioral factors, medical and pregnancy conditions, and environmental exposures are common nongenetic risk factors for preterm birth. Individuals from certain ethnic and racial groups, in low- and middle-income countries, or with a low socioeconomic status are at an increased risk of having preterm birth, and social determinants of health are the root causes of these factors. Existing pregnancy complications, history of preterm birth, and other medical conditions are also common risk factors. Environmental exposures such as air pollution, climate change, and endocrine-disrupting chemicals have been increasingly realized as potential risk factors for preterm birth. Various pathological events in different feto-maternal systems have been reported to be involved in the development of preterm birth. Immunopathogenesis plays a pivotal role, and both pathogenic and nonpathogenic inflammation can induce preterm birth. Oxidative stress, decidual hemorrhage and vascular lesions, uterine overdistension, and cervical insufficiency have all been proposed to contribute to the pathophysiology of preterm birth. Prevention strategies for preterm birth include primary prevention aimed at the modifiable risk factors at the individual and societal levels and therapeutic approaches using pharmaceuticals and mechanical interventions, such as progesterone and cervical cerclage. A comprehensive approach is still needed to reduce the global disease burden of preterm birth.

Article

Diabetes in South Asians  

Sara Garduño‐Diaz and Santosh Khokhar

As of 2023, it is estimated that Type 2 diabetes (T2D) affects approximately 783 million people worldwide, with South Asians presenting the highest age-adjusted comparative diabetes prevalence among adults (90,204.5 people). Ethnicity has been highlighted as a major risk factor for the development of T2D with central adiposity, insulin resistance, and unfavorable lipid profile identified as predominant signals of alarm. Leading databases, including Web of Science, Medline, PubMed, Google Scholar, and ScienceDirect, were consulted, and manual searches were carried out for cited references in leading diabetes-related journals. Genetic predisposition, central adiposity, and unfavorable lifestyles, including physical inactivity and an unhealthy diet, have been found to be associated with the prevalence of T2D in migrant South Asians. Additionally, “Westernization,” acculturation, socioeconomic factors, and lack of awareness regarding seriousness and consequences of the disease have also been identified as contributors to the development of T2D in this population. However, the higher prevalence of T2D in migrant South Asians may not be entirely attributed to genetic predisposition; hence, ethnicity and associated modifiable risk factors warrant further investigation. Preventive measures and appropriate interventions are limited by the lack of ethnic-specific cut-off points for anthropometric and biological markers, as well as by the absence of reliable methods for dietary and physical activity assessment.

Article

Fall Prevention and Interventions for Older People  

Claudia Meyer and Lindy Clemson

Across the globe, falls among older people can have grave consequences for individuals and for the healthcare and aged-care systems more broadly. The synergy between intrinsic and situational risk factors adds complexity to the identification and management of falls, as does the public health response at primary, secondary, and tertiary levels of prevention. Falls among people age 65 years and over are recognized as a geriatric syndrome and as a marker of frailty, with increasing rates among those experiencing other chronic conditions, such as Parkinson’s disease, stroke, and dementia. Prevention or management of falls requires a combination of strategies as single or multicomponent interventions. Multimodal exercise, combining balance and functional exercise, environmental adaptation, medication reduction and withdrawal, cataract surgery, single-lens glasses, vitamin D supplementation, management of foot problems and footwear, and cardiac pacing have a degree of evidence to support their implementation. Multicomponent programs, such as i-FOCIS and PDSAFE, have important benefits for specific population groups. Importantly, over the past few decades, falls prevention has shifted from a biomedical approach to a holistic biopsychosocial model. This model aids promotion of a whole-of-community approach through building healthy public policy, creating supportive environments, and strengthening personal skills and community action. The biopsychosocial approach also focuses attention on understanding local contexts, ensuring that falls prevention interventional research can be adapted and fit-for-purpose for low-, middle- and high-income countries. The uptake of falls prevention evidence into practice and policy still faces challenges and new frontiers. Supporting the adoption, implementation, and sustainability of interventions is complex at the individual level, the service provider level, and the healthcare system level. Practice-change frameworks and models are useful, such as those utilized in the Stopping Elderly Accidents, Deaths and Injuries (USA), iSOLVE (Australia), and STRIDE (USA) trials. Falls prevention is complex, yet solutions can be relatively simple. Working together with older people, health professionals and community health leaders can champion ways of bringing falls prevention activities to scale. Research collaboration between stakeholders is a crucial mechanism for drawing together unique perspectives to address ongoing gaps and concerns.

Article

Prevention of Suicide  

Danuta Wasserman

Around 700,000 people take their lives each year worldwide. Suicide accounts for approximately 1.3% of all deaths and therefore represents a major public health problem. The global age-standardized suicide rate is 9 per 100,000 population, yet there are large variations among genders, ages, countries, and world regions. The stress–vulnerability model of suicidal behaviors has been proposed to explain how a diathesis, developed through the influence of genetic and neurodevelopmental factors in relation to perinatal, postnatal, and life experiences, interacts with different risk and protective factors that either decrease or enhance the individual’s level of resilience to stress and suicidal risk. Public health suicide prevention strategies include suicide means restriction, reducing harmful substance use, promoting responsible media reporting, public-awareness campaigns, gatekeeper trainings, school-based interventions, crisis helplines, and postvention. Mental health strategies comprise identification, treatment, and rehabilitation of persons in distress and at risk for suicide. Multicomponent strategies that use a combination of evidence-based methods from public and mental health sectors are recommended. Future work should aim at enhancing the quality of epidemiological data, improving the research on protective and ideation-to-action factors, expanding the quantity and quality of data coming from low- and middle-income countries, and evaluating the cost-effectiveness of different suicide prevention strategies.

Article

Monitoring Migrants’ Health Risk Factors for Noncommunicable Diseases  

Stefano Campostrini

Noncommunicable diseases (NCDs) have become the first cause of morbidity and mortality around the world. These have been targeted by most governments because they are associated with well-known risk factors and modifiable behaviors. Migrants present, as any population subgroup, peculiarities with regard to NCDs and, more relevantly, need specific information on associated risk factors to appropriately target policies and interventions. The country of origin, assimilation process, and many other migrant health aspects well studied in the literature can be related to migrants’ health risk factors. In most countries, existing sources of information are not sufficient or should be revised, and new sources of data should be found. Existing survey systems can meet organizational difficulties in changing their questionnaires; moreover, the number of changes in the adopted questionnaire should be limited for the sake of brevity to avoid excessive burden on respondents. Nevertheless, a limited number of additional variables can offer a lot of information on migrant health. Migrant status, country of origin, time of arrival should be included in any survey concerned about migrant health. These, along with information on other Social Determinants of Health and access to health services, can offer fundamental information to better understand migrants’ health and its evolution as they live in their host countries. Migrants are often characterized by a better health status, in comparison with the native population, which typically is lost over the years. Public health and health promotion could have a relevant role in modifying, for the better, this evolution, but this action must be supported by timely and reliable information.

Article

Early Life Origins of ASD and ADHD  

Yuelong Ji, Ramkripa Raghavan, and Xiaobin Wang

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by impairments in social interaction and communication and by the presence of restrictive, repetitive behavior. Attention deficit hyperactivity disorder (ADHD) is another common lifelong neurodevelopmental disorder characterized by three major presentations: predominantly hyperactive/impulsive, predominantly inattentive, and combined. Although ASD and ADHD are different clinical diagnoses, they share various common characteristics, including male dominance, early childhood onset, links to prenatal and perinatal factors, common comorbidity for each other, and, often, persistence into adulthood. They also have both unique and shared risk factors, which originate in early life and have lifelong implications on the affected individuals and families and society. While genetic factors contribute to ASD and ADHD risk, the environmental contribution to ASD and ADHD has been recognized as having potentially equal importance, which raises the hope for early prevention and intervention. Maternal folate levels, maternal metabolic syndrome, and metabolic biomarkers have been associated with the risk of childhood ASD; while maternal high-density lipoprotein, maternal psychosocial stress, and in utero exposure to opioids have been associated with the risk of childhood ADHD. As for shared factors, male sex, preterm birth, placental pathology, and early life exposure to acetaminophen have been associated with both ASD and ADHD. The high rate of comorbidity of ASD and ADHD and their many shared early life risk factors suggest that early identification and intervention of common early life risk factors may be cost-effective to lower the risk of both conditions. Efforts to improve maternal preconception, prenatal, and perinatal health will not only help reduce adverse reproductive and birth outcomes but will also help mitigate the risk of ASD and ADHD associated with those adverse early life events.

Article

Fetal Deaths in High-Income Countries  

Sarka Lisonkova and K. S. Joseph

Fetal death refers to the death of a post-embryonic product of conception while in utero or during childbirth, and it is one of the most distressing events faced by women and families. Birth following spontaneous fetal death is termed “miscarriage” if it occurs early in gestation, and “stillbirth,” if it occurs beyond the point of viability. There are substantial between-country differences in the criteria used for reporting stillbirths and these differences compromise international comparisons of stillbirth rates. In high-income countries, a majority of fetal deaths occur due to genetic causes, fetal infection, or other pregnancy complications. Congenital anomalies, placental insufficiency, and/or intrauterine growth restriction are frequent antecedents of fetal death. Maternal risk factors include advanced maternal age, high body mass index, smoking and substance use during pregnancy, prior stillbirth, chronic morbidity, and multifetal pregnancy. Disparities in education and socioeconomic status and other factors influencing maternal health also contribute to elevated rates of stillbirth among vulnerable women.

Article

Drowning: Global Burden, Risk Factors, and Prevention Strategies  

Aminur Rahman, Amy E. Peden, Lamisa Ashraf, Daniel Ryan, Al-Amin Bhuiyan, and Stephen Beerman

Drowning has been described as a major global public health problem and has recently been acknowledged by a United Nations Declaration on Global Drowning Prevention. While drowning impacts countries of all income levels, the burden is overwhelmingly borne by low- and middle-income countries (LMICs) who account for 90% of the global death toll. In addition, there is scarce data collection on drowning in LMICs, so the magnitude of drowning may be far greater than is represented. A range of factors including sex, age, education, income, access to water, a lack of swimming skills, certain occupations like commercial fishing, geographically isolated and flood-prone locations, preexisting medical conditions, and unsafe water transport systems, influence the risk of drowning. Some behavioral factors, such as alcohol or drug consumption, not wearing life jackets, and engaging in risky behaviors such as swimming or boating alone, increase drowning risk. Geopolitical factors such as migration and armed conflict can also impact drowning risk. There is a growing body of evidence on drowning prevention strategies. These include pre-event interventions such as pool fencing, enhancing community education and awareness, providing swimming lessons, use of lifejackets, close supervision of children by adults, and boating regulations. Interventions to reduce harm from drowning include appropriate training for recognition of a drowning event, rescue, and resuscitation. An active and/or passive surveillance system for drowning, focusing on individual settings and targeting populations at risk, is required. Drowning requires coordinated multisectoral action to provide effective prevention, rescue, and treatment. Therefore, all countries should aim to develop a national water safety plan, as recommended in the WHO Global Report on Drowning. Further research is required on the epidemiology and treatment of drowning in LMICs as well as non-fatal and intentional drowning in both high-income countries (HICs) and LMICs. Effective and context-specific implementation of drowning prevention strategies, including pilot testing, scale up and evaluation, are likely to help reduce the burden of both fatal and non-fatal drowning in all countries.