Epidemiological, Clinical Aspects and Factors Associated with Typical Gastroesophageal Reflux Disease in the General Population of Parakou, Republic of Benin

Introduction: Gastroesophageal reflux disease (GERD) is a benign and chronic disease that can impair the quality of life. Objective: To study the epidemiological, clinical aspects and factors associated with typical GERD in the general population of Parakou in the Republic of Benin. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection which took place from May 1, 2019 to June 30, 2019. The study population consisted of any subject aged at least 15 years and living in Parakou. Subjects aged at least 15 years, present on the day of the survey and having given their free and informed verbal consent were included. The Short form of QRS®(Reflux-Qual Short form) questionnaire and the “Hospital Anxiety and Depression” score were used to assess the quality of life and anxiety/depression, respectively. The sampling was probabilistic through a 2-stage cluster sampling. The variable of interest was the presence of GERD. Results: Out of 390 subjects surveyed, 28 had symptoms of typical GERD, representing a prevalence of 7.18%. The average age of these subjects was 27.11 ± 7.88 years. Fifteen subjects (53.57%) were male, giving a sex ratio of 1.15. Fourteen (50%) had a secondary level of education, 12 (42.86%) were pupils/students, 18 (64.29%) were single. The monthly income of 22 subjects (78.57%) was lower than the guaranteed interprofessional minimum wage (40,000 FCFA). The average duration of progression of symptoms was 15.89 ± 4.97 months. Symptoms occurred less than twice a week in 22 subjects (78.57%). The clinical manifestations were both diurnal and nocturnal in 12 subjects (42.86%). None of the 28 subjects with GERD had clinical warning signs. Asthma, diabetes, consumption of high fat or spice foods, carbonated drinks, non-steroidal anti-inflammatory drugs, alcoholic beverages and tobacco were statistically associated with the occurrence of GERD. Each of the 28 subjects had at least one associated factor. A significant impair in quality of life was observed in 27 patients (96.43%). Conclusion: Typical GERD is relatively common in the general population of Parakou in the Republic of Benin. It often affects young males. Among the risk factors identified, the most common are carbonated drinks, spicy meals and diabetes. GERD significantly impairs quality of life. Raising awareness about the disease and its associated factors is necessary among the general population.

Epidemiology of hepatitis B virus in Bangladeshi general population

BACKGROUND:Hepatitis B virus(HBV)is encountered sporadically the year round in Bangladesh.It results in a wide range of liver diseases,with asymptomatic acute hepatitis at one end to hepatocellular carcinoma(HCC)at the other end of the spectrum. METHODS:All 1018 individuals of different age groups and sex with varied religious,educational and social backgrounds were tested for HBsAg by ELISA.The positive samples were further tested by ELISA for HBeAg.Before testing,blood samples were preserved at-20℃.The study was conducted in a semi-urban location on the outskirts of Dhaka. RESULTS:Of the 1018 individuals,5.5%tested positive for HBsAg.None were tested positive for anti-HCV.Among the HBsAg-positive population,58.93%were HBeAg- positive and the rest 41.07%HBeAg-negative.There was a male predominance and those who were tested positive were mostly between 16 and 50 years of age.Major risk factors for exposure to HBV appeared to be injudicious use of injectable medications,treatment by unqualified, traditional practitioners,mass-vaccination against cholera and smallpox,barbers and body piercing. CONCLUSION:HBV remains a major cause of morbidity and mortality in Bangladesh and we have a long way to go before we may bid farewell to this deadly menace.

Functional Constipation in the General Population in Cotonou:Prevalence and Associated Socio-Demographic Factors

Background: Constipation is considered rare in sub-Saharan Africa because of the high fiber content of the local diet. However, certain factors could intervene in this pathology. The purpose of this study was to assess the prevalence of constipation in the general population in Cotonou and to determine the associated socio-demographic factors. Methods: This was a cross-sectional descriptive and analytical study conducted from July to August 2017 in 7 districts of the township of Cotonou, according to a cluster sampling. We included anyone over the age of 15 living in the city of Cotonou for at least 6 months. Constipation was either self-reported or functional (meeting the Rome IV criteria). Results: A total of 1058 participants were included: 574 men (sex ratio of 1.2), mean age of 29 years [range 15 - 92]. Self-reported constipation was noted in 512 patients (48.5%). It was functional in 256 cases (24.2%). In the latter category, there was a predominance of women (138, 53.9%), of secondary education (46.5%), of self-employed professionals (50.4%), from the Ouémé-Plateau (41.8%). Were associated with the occurrence of functional constipation (univariate analysis), age ≥ 60 years (p = 0.049), female gender (p = 0.003), and subjects living alone (166, 64.8%) vs. those living in a relationship (90, 35.2%, p = 0.001). Conclusion: Constipation was not as rare in Cotonou. It was more common in women, subjects over 60 years old or living alone.

Risk factors for major gastrointestinal bleeding in the general population in Finland

BACKGROUND Data on non-drug related risk-factors for gastrointestinal bleeding(GIB)in the general population are limited,especially for life-style factors,clinical measurements and laboratory parameters.AIM To identify and investigate non-drug risk factors for major GIB in the general population of Finland.METHODS We performed a retrospective cohort study using data from the FINRISK health examination surveys,which have been conducted every 5 years across Finland from 1987 to 2007.Participants were adults aged 25 years to 74 years,excluding those with a previous hospitalization for GIB.Follow-up from enrollment was performed through linkage to national electronic health registers and ended at an event of GIB that led to hospitalization/death,death due to any other cause,or after 10 years.Covariates included demographics,socioeconomic and lifestyle factors,clinical measurements,laboratory parameters and comorbidities.Variable selection was undertaken using Least Absolute Shrinkage and Selection Operator(LASSO)and factors associated with GIB were identified using Cox regression.RESULTS Among 33,508 participants,403(1.2%)experienced GIB[256 men(63.5%);mean age,56.0 years(standard deviation(SD)±12.1)]and 33105 who did not experience GIB[15768 men(47.6%);mean age,46.8(SD±13)years],within 10 years of follow-up.Factors associated with a significantly increased risk of GIB were baseline age[per 10-year increase;hazard ratio(HR)1.62,95%confidence interval(CI):1.42-1.86],unemployment(HR:1.70,95%CI:1.11-2.59),body mass index(BMI)(HR:1.15,95%CI:1.01-1.32),gamma-glutamyl transferase(GGT)(HR:1.05,95%CI:1.02-1.09),precursors of GIB(HR:1.90,95%CI:1.37-2.63),cancer(HR:1.47,95%CI:1.10-1.97),psychiatric disorders(HR:1.32,95%CI:1.01-1.71),heart failure(HR:1.46,95%CI:1.04-2.05),and liver disorders(HR:3.20,95%CI:2.06-4.97).Factors associated with a significantly decreased risk of GIB were systolic blood pressure(SBP)(HR:0.78,95%CI:0.64-0.96),6-10 cups of coffee a day(HR:0.67,95%CI:0.46-0.99),or>10 cups(HR:0.43,95%CI:0.23-0.81).CONCLUSION Our study confirms established risk-factors for GIB and identifies potential risk-factors not previously reported such as unemployment,BMI,GGT,SBP and coffee consumption.

Is hepatic steatosis associated with left ventricular mass index increase in the general population?

AIM To investigate the association between hepatic steatosis and change in left ventricular mass index(LVMI) over five years, and examine whether systolic and diastolic blood pressures are mediators of the association between hepatic steatosis and LVMI using a general population sample.METHODS We analyzed data from the Study of Health in Pomerania. The study population comprised 1298individuals aged 45 to 81 years. Hepatic steatosis was defined as the presence of a hyperechogenic pattern of the liver together with elevated serum alanine transferase levels. Left ventricular mass was determined echocardiographically and indexed to height2.7. Path analyses were conducted to differentiate direct and indirect paths from hepatic steatosis to LVMI encompassing systolic and diastolic blood pressure as potential mediating variables.RESULTS Hepatic steatosis was a significant predictor for all measured echocardiographic characteristics at baseline. Path analyses revealed that the association of hepatic steatosis with LVMI change after five years was negligibly small(β =-0.12, s.e. = 0.21, P = 0.55). Systolic blood pressure at baseline was inversely associated with LVMI change(β =-0.09, s.e. = 0.03, P < 0.01), while no association between diastolic blood pressure at baseline and LVMI change was evident(β = 0.03, s.e. = 0.05, P = 0.56). The effect of the indirect path from hepatic steatosis to LVMI via systolic baseline blood pressure was small(β =-0.20, s.e. = 0.10, P = 0.07). No indirect effect was observed for the path via diastolic baseline blood pressure(β = 0.03, s.e. = 0.06, P = 0.60). Similar associations were observed in the subgroup of individuals not receiving beta-blockers, calcium channel blockers, or drugs acting on the reninangiotensin system.CONCLUSION Baseline associations between hepatic steatosis and LVMI do not extend to associations with LVMI change after five years. More studies are needed to study the longitudinal effects of hepatic steatosis on LVMI.

Hepatitis C virus among blood donors and general population in Middle East and North Africa:Meta-analyses and meta-regressions

BACKGROUND Despite the Middle East and North Africa(MENA)Region reported to have the highest prevalence of hepatitis C virus(HCV)globally,HCV infection levels in the majority of MENA countries remain inadequately characterized.Blood donor data have been previously used as a proxy to assess levels and trends of HCV in the general population,however,it is unclear how comparable these populations are in MENA and whether blood donors provide an appropriate proxy.AIM To delineate HCV epidemiology among blood donors and the general population in the MENA.METHODS The data source was the systematically gathered MENA HCV Epidemiology Synthesis Project Database.Random-effects meta-analyses and meta-regressions were conducted.For comparison,analyses were conducted for Europe,utilizing the Hepatitis C Prevalence Database of the European Centre for Disease Prevention and Control.RESULTS One thousand two hundred and thirteen HCV antibody prevalence measures and 84 viremic rate measures were analyzed for MENA.Three hundred and seventyseven antibody prevalence measures were analyzed for Europe.In MENA,pooled mean prevalence was 1.58%[95%confidence interval(CI):1.48%–1.69%]among blood donors and 4.49%(95%CI:4.10%–4.90%)in the general population.In Europe,pooled prevalence was 0.11%(95%CI:0.10%–0.13%)among blood donors and 1.59%(95%CI:1.25%–1.97%)in the general population.Prevalence in the general population was 1.72-fold(95%CI:1.50–1.97)higher than that in blood donors in MENA,but it was 15.10-fold(95%CI:11.48–19.86)higher in Europe.Prevalence was declining at a rate of 4%per year in both MENA and Europe[adjusted risk ratio:0.96(95%CI:0.95–0.97)in MENA and 0.96(95%CI:0.92–0.99)in Europe].Pooled mean viremic rate in MENA was 76.29%(95%CI:67.64%–84.02%)among blood donors and 65.73%(95%CI:61.03%–70.29%)in the general population.CONCLUSION Blood donor data provide a useful proxy for HCV infection in the wider population in MENA,but not Europe,and could improve HCV burden estimations and assess progress toward HCV elimination by 2030.

Seroepidemiology of Helicobacter pylori infection in general population in a northern Mexican city

Background: The seroepidemiology of Helicobacter pylori infection in general population in Durango City, Mexico has not been previously studied. Aims: To determine the seroprevalence of anti-H. pylori antibodies in the general population in Durango City, Mexico;and to determine socio-demographic, clinical, and behavioral characteristics of the general population associated with H. pylori seropositivity. Methods: The prevalence of anti-H. pylori IgG antibodies was examined in 345 individuals in Durango City, Mexico, using enzyme-linked immunoassays. Socio-demographic, clinical, and behavioral characteristics of the general population associated with H. pylori seroprevalence were also investigated. Results: In total, 231 (67%) of the 345 participants (mean age, 45.3. ± 17.5 years) had H. pylori IgG antibodies, 146 (63.2%) of whom had H. pylori IgG antibody levels higher than 100 U/mL. Both H. pylori seroprevalence and antibody levels increased significantly with age, and were similar in males and females. An increased H. pylori seroprevalence was found in subjects with low education and employed. In contrast, a low seroprevalence was found in subjects living in suburban areas. One of four subjects with gastritis symptoms had anti-H. pylori antibodies. The seroprevalence of H. pylori was significantly higher among women with abortion history than among those without such history. Multivariate analysis of behavioral variables showed that H. pylori seropositivity was negatively associated with raising farm animals (OR = 0.48;95% CI: 0.25-0.91;P = 0.02). Conclusions: In the general population studied, H. pylori seroreactivity increased significantly with age, not only in frequency but also in intensity. Residence, education, and occupation of the study population influenced the seropositivity rate of H. pylori.

Pesticide exposures and respiratory health in general populations

Human exposures to pesticides can occur in the workplace,in the household and through the ambient environment.While several articles have reviewed the impact of pesticide exposures on human respiratory health in occupational settings,to the best of our knowledge,this article is the first one to review published studies on the association between pesticide exposures and human respiratory health in the general populations.In this article,we critically reviewed evidences up to date studying the associations between non-occupational pesticide exposures and respiratory health in general populations.This article also highlighted questions arising from these studies,including our recent analyses using the data from the Canadian Health Measures Survey（CHMS）,for future research.We found few studies have addressed the impact of environmental pesticide exposures on respiratory health,especially on lung function,in general populations.In the studies using the data from CHMS Cycle 1,exposures to OP insecticides,pyrethroid insecticides,and the organochlorine pesticide DDT were associated with impaired lung function in the Canadian general population,but no significant associations were observed for the herbicide 2,4-D.Future research should focus on the potential age-specific and pesticide-specific effect on respiratory health in the general population,and repeated longitudinal study design is critical for assessing the temporal variations in pesticide exposures.Research findings from current studies of non-occupational pesticide exposures and their health impact in general population will help to improve the role of regulatory policies in mitigating pesticide-related public health problems,and thereafter providing greater benefit to the general population.

Risk prediction models for hepatocellular carcinoma in different populations

Hepatocellular carcinoma （HCC） is a malignant disease with limited therapeutic options due to its aggressive progression. It places heaW burden on most low and middle income countries to treat HCC patients. Nowadays accurate HCC risk predictions can help making decisions on the need for HCC surveillance and antiviral therapy. HCC risk prediction models based on major risk factors of HCC are useful and helpful in providing adequate surveillance strategies to individuals who have different risk levels. Several risk prediction models among cohorts of different populations for estimating HCC incidence have been presented recently by using simple, efficient, and ready-to-use parameters. Moreover, using predictive scoring systems to assess HCC development can provide suggestions to improve clinical and public health approaches, making them more cost-effective and effort-effective, for inducing personalized surveillance programs according to risk stratification. In this review, the features of risk prediction models of HCC across different populations were summarized, and the perspectives of HCC risk prediction models were discussed as well.

A physically active lifestyle is related to a lower level of skin autofluorescence in a large population with chronic-disease(LifeLines cohort)

Background:Physical activity(PA)has substantial health benefits and is important in combatting chronic diseases,which have been associated with elevated levels of advanced glycation endproducts(AGEs).AGEs play a role in the aging process,and an association between PA and AGEs has been reported.We aimed to investigate the relationship between PA and AGE accumulation in a general population and in a population with chronic diseases.Methods:This large cross-sectional population study used data from adult participants in the LifeLines project,with participant information drawn from the LifeLines database as well data from patients with diabetes mellitus or renal and/or cardiovascular diseases.Tissue AGE accumulation was assessed non-invasively by skin-autofluorescence(SAF)using an AGE reader(DiagnOptics Technologies BV,Groningen,the Netherlands).PA was assessed using the short questionnaire to assess health-enhancing physical activity(SQUASH).Multivariate linear regression analyses were adjusted for age,body mass index,sex,and smoking status.Results:Data from 63,452 participants(general population n=59,177,chronic disease n=4275)were analyzed.The general population was significantly younger(43.58±11.77 years,mean±SD)and had significantly lower SAF(1.90±0.42 arbitrary units(AU))compared to the population with chronic disease(age:55.51±12.07 years;SAF:2.27±0.51 AU).In the group with chronic disease,more hours of moderate to vigorous physical activities per week were associated with lower SAF(β=-0.002,95%confidence interval(95%CI):-0.002 to-0.001).For the general population,there was no association between hours of moderate to vigorous activity and SAF(β=3.2×10^(-5),95%CI:0.000-0.001,p=0.742).However,there was an association in the general population between total hours of PA per week and SAF(β=4.2×10^(-4),95%CI:0.000-0.001,p<0.001),but this association was not found in the chronic disease population(β=-3.2×10^(-4),95%CI:-0.001 to 0.000,p=0.347).Conclusion:Our study demonstrates that an inverse relationship exists between PA and AGE accumulation in the population with chronic disease.More hours of moderate to vigorous activity is associated a significantly decreased SAF.More PA is associated a lower SAF,even after for the established predictors(age,body mass index,smoking status,and sex).Our findings could help to promote health and prolong longevity.

Preliminary prediction of the control reproduction number of COVID-19 in Shaanxi Province,China

Objectives Firstly,according to the characteristics of COVID-19 epidemic and the control measures of the government of Shaanxi Province,a general population epidemic model is es-tablished.Then,the control reproduction number of general population epidemic model is obtained.Based on the epidemic model of general population,the epidemic model of general population and college population is further established,and the control reproduction number is also obtained.Methods For the established epidemic model,firstly,the expression of the control reproduc-tion number is obtained by using the next generation matrix.Secondly,the real-time reported data of COVID-19 in Shaanxi Province is used to fit the epidemic model,and the parameters in the model are estimated by least square method and MCMC.Thirdly,the Latin hypercube sampling method and partial rank correlation coefficient(PRCC)are adopted to analyze the sensitivity of the model.Conclusions The control reproduction number remained at 3 from January 23 to January 31,then gradually decreased from 3 to slightly greater than 0.2 by using the real-time reports on the number of COVID-19 infected cases from Health Committee of Shaanxi Province in China.In order to further control the spread of the epidemic,the following measures can be taken:(i)reducing infection by wearing masks,paying attention to personal hygiene and limiting travel;(i)improving isolation of suspected patients and treatment of symptomatic individuals.In particular,the epidemic model of the collge population and the general population is estab-lished,and the control reproduction number is given,which will provide theoretical basis for the prevention and control of the epidemic in the colleges.

Mental Health Disorders of the Indonesian People in the Early Stages of the COVID-19 Pandemic:Who is Vulnerable to Experiencing it?

The extraordinary situation related to COVID-19 makes people worry about their health,family health,work,finances,and other daily activities.This condition can lead to social unrest,which has consequences for mental health problems.This study aims to determine the mental health consequences at the beginning of the COVID-19 pandemic in Indonesia.This is a cross-sectional study involving a target population aged 18 years and over who had access to electronic communication devices.An online questionnaire was randomly distributed and snowballed throughout 34 provinces in Indonesia.The study was conducted from 2 to 4 May 2020.Non-parametric and multi-variate linear regression analyses were performed to identify factors associated with anxiety and depression.Two thousand seven hundred forty-three participants were involved in this study,with 69.16%female.In sum,6.92%of participants had General Anxiety Disorder-7(GAD-7)scores≥10 for moderate-severe anxiety symptoms,and 8.57%had Patient Health Questionnaire-9(PHQ-9)scores≥10 for moderate-severe depressive symptoms.The multivariate linear regression analyses showed that the strongest factors influencing anxiety and depression were a history of mental illnesses,chronic illnesses,the group affected by layoffs or job seekers,unemployed,students,younger age group,living in a rented house,single,and female.In contrast,the lower and secondary education level seems to reduce the risk of depression compared to those with higher education levels.Anxiety and depression occur during the periods of activity restriction during the COVID-19 pandemic and are influenced by several modifiable and non-modifiable factors.There is an urgent need to emphasize vulnerable groups such as those with a history of illness,those affected by layoffs/looking for work,and the younger age group.

J-shaped association between dietary zinc intake and new-onset hypertension:a nationwide cohort study in China

We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults.A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey were included.Dietary intake was assessed by three consecutive 24-h dietary recalls combined with a household food inventory.Participants with systolic blood pressure≥140 mmHg or diastolic blood pressure≥90 mmHg or diagnosed by a physician or under antihypertensive treatment during the follow-up were defined as having new-onset hypertension.During a median follow-up duration of 6.1 years,4269 participants developed new-onset hypertension.Overall,the association between dietary zinc intake and new-onset hypertension followed a J-shape(P for non-linearity<0.001).The risk of new-onset hypertension significantly decreased with the increment of dietary zinc intake(per mg/day:hazard ratio(HR)0.93;95%confidence interval(CI)0.88–0.98)in participants with zinc intake<10.9 mg/day,and increased with the increment of zinc intake(per mg/day:HR 1.14;95%CI 1.11–1.16)in participants with zinc intake≥10.9 mg/day.In conclusion,there was a J-shaped association between dietary zinc intake and new-onset hypertension in general Chinese adults,with an inflection point at about 10.9 mg/day.

Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China

Background:Functional dyspepsia(FD)has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma(ESCC).This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia(OD)in such a population.Methods:A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC.All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire,and they underwent gastroscopy.After exclusion of gastroesophageal reflux disease,uninvestigated dyspepsia(UID)was divided into OD and FD for further analyses.Results:A total of 2916 participants were enrolled from July 2013 to March 2014 in China.We detected 166 UID cases with questionnaires,in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy.OD cases presented as reflux esophagitis(RE),ESCC,and duodenal ulcer.Heartburn(52.94%)and reflux(29.41%)were common in OD,but no symptomatic differences were found between FD and OD.Male sex,low education level,and liquid food were the risk factors for OD,while frequent fresh vegetable consumption was a protective factor.FD included 56(37.58%)cases of postprandial distress syndrome(PDS),52(34.89%)of epigastric pain syndrome(EPS),nine(6.04%)of PDS+EPS,and 32(21.48%)of FD+functional esophageal disorders.The Helicobacter pylori infection rate in FD patients was not higher than that in the control group(34.23%vs.42.26%,P=0.240).Frequent spicy food consumption was associated with PDS(odds ratio[OR]:2.088,95%confidence interval[CI]:1.028–4.243),while consumption of deep well water was protective for PDS(OR:0.431,95%CI:0.251–0.741).Conclusions:The prevalence of FD was 5.11%in the studied population.Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.Trial Registration:ClinicalTrials.gov,NCT01688908;https://clinicaltrials.gov/ct2/show/record/NCT01688908.

Serum lipid profiles are associated with semen quality

We aimed to explore the associations between different lipid profiles and semen quality in a large-scale general male population. Sperm concentration, total sperm motility, progressive motility, and normal sperm morphology of total 7601 participants were recorded. The association of these semen parameters with the triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein of serum lipid profiles was analyzed. Sperm concentration was statistically positively correlated with triglyceride and very low-density lipoprotein （adjusted P= 0.001 and P= 0.005, respectively）. Total sperm motility and progressive motility were statistically increased with increasing low-density lipoprotein and cholesterol levels （both adjusted P = 0.008 and P 〈 0.001, respectively）. The similar J-shaped associations （high-low-low-high） were noted between individual lipid profile and normal sperm morphology, especially low-density lipoprotein and cholesterol with statistical significance （adjusted P = 0.017 and P= 0.021, respectively）. The prevalence of abnormal total sperm motility and progressive motility was decreased in participants with high levels of cholesterol （P = 0.008 and P = 0.019, respectively）, and the reverse J-shaped associations （low-high-high-low） were noted between high-density lipoprotein, triglyceride, very low-density lipoprotein, and the prevalence of abnormal normal sperm morphology （P = 0.010, P = 0.037, and P = 0.025, respectively）. A high cholesterol level was associated with better sperm motility. Similar J-shaped associations were noted between all lipid profiles and normal sperm morphology; meanwhile, the reverse J-shaped trends were identified between them and abnormal normal sperm morphology prevalence.