The association between ownership of common household devices and obesity and diabetes in high,middle and low income countries

Background:

Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake.

Methods:

We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels.

Results:

Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32–1.55; diabetes: OR 1.38, 95% CI 1.28–1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29–1.49) and diabetes (OR 1.33, 95% CI 1.23–1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33–4.25; diabetes: OR 1.97, 95% CI 1.53–2.53) and decreased through country income levels such that we did not detect an association in high income countries.

Interpretation:

The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.The increasing global prevalence of obesity and type 2 diabetes mellitus has been driven predominantly by increases in high income countries.^1,2 However, increases are expected in low and middle income countries, due in part to rapid development and industrialization.Proximal determinants of obesity and diabetes include energy expenditure and intake;^3–5 however, the upstream factors are complex and entail numerous environmental factors. Of these, the increased use of common household devices (e.g., televisions, cars, computers) has been linked to increased sitting, decreased physical activity, obesity, metabolic syndrome and diabetes.^6–12 Time spent watching television has also been linked to poor diet¹³ and increased caloric intake.¹⁴ However, these findings are based on studies in high income countries where the ownership of these devices is common.^15,16 In low and middle income countries, such household devices are less prevalent, but their prevalence is rapidly increasing. Studies in countries with greater variability in the ownership of household devices are needed to understand the full effect of owning such devices on the risk of obesity and diabetes.We hypothesized that the ownership of a television, car or computer would be associated with an increased risk of obesity and diabetes and that these effects would be explained by reduced physical activity, increased sitting time and increased energy intake.     

Estimating diarrhea mortality among young children in low and middle income countries

Background

Diarrhea remains one of the leading causes of morbidity and mortality among children under 5 years of age, but in many low and middle-income countries where vital registration data are lacking, updated estimates with regard to the proportion of deaths attributable to diarrhea are needed.

Methods

We conducted a systematic literature review to identify studies reporting diarrhea proportionate mortality for children 1–59 mo of age published between 1980 and 2009. Using the published proportionate mortality estimates and country level covariates we constructed a logistic regression model to estimate country and regional level proportionate mortality and estimated uncertainty bounds using Monte-Carlo simulations.

Findings

We identified more than 90 verbal autopsy studies from around the world to contribute data to a single-cause model. We estimated diarrhea proportionate mortality for 84 countries in 6 regions and found diarrhea to account for between 10.0% of deaths in the Americas to 31.3% of deaths in the South-east Asian region.

Discussion

Diarrhea remains a leading cause of death for children 1–59 mo of age. Published literature can be used to create a single-cause mortality disease model to estimate mortality for countries lacking vital registration data.     

Changes in the association between summer temperature and mortality in Seoul, South Korea

The health impact of climate change depends on various conditions at any given time and place, as well as on the person. Temporal variations in the relationship between high temperature and mortality need to be explored in depth to explain how changes in the level of exposure and public health interventions modify the temperature–mortality relationship. We examined changes in the relationship between human mortality and temperature in Seoul, which has the highest population in South Korea, considering the change in population structure from 1993–2009. Poisson regression models were used to estimate short-term temperature-related mortality impacts. Temperature-related risks were divided into two “time periods” of approximately equal length (1993 and 1995–2000, and 2001–2009), and were also examined according to early summer and late summer. Temperature-related mortality in summer over the past 17 years has declined. These decreasing patterns were stronger for cardiovascular disease-related mortality than for all non-accidental deaths. The novel finding is that declines in temperature-related mortality were particularly noteworthy in late summer. Our results indicate that temperature-related mortality is decreasing in Seoul, particularly during late summer and, to a lesser extent, during early summer. This information would be useful for detailed public health preparedness for hot weather.     

Relation between income inequality and mortality: empirical demonstration

Objective To assess the extent to which observed associations between income inequality and mortality at population level are statistical artifacts. Design Indirect "what if" simulation using observed risks of mortality at individual level as a function of income to construct hypothetical state-level mortality specific for age and sex as if the statistical artifact argument were 100% correct. Method Data from the 1990 census for the 50 US states plus Washington, DC, were used for population distributions by age, sex, state, and income range; data disaggregated by age, sex, and state from the Centers for Disease Control and Prevention were used for mortality; and regressions from the national longitudinal mortality study were used for the individual-level relation between income and risk of mortality. Results Hypothetical mortality, although correlated with inequality (as implied by the logic of the statistical artifact argument), showed a weaker association with the level of income inequality in each state than the observed mortality. Conclusions The observed associations in the United States at the state level between income inequality and mortality cannot be entirely or substantially explained as statistical artifacts of an underlying individual-level relation between income and mortality. There remains an important association between income inequality and mortality at state level above anything that could be accounted for by any statistical artifact. This result reinforces the need to consider a broad range of factors, including the social milieu, as fundamental determinants of health.     

Genetic contributions to the association between height and intelligence: Evidence from Dutch twin data from childhood to middle age

A positive association between intelligence (IQ) and height has been reported previously. It is generally assumed that this association reflects the effect of childhood environment on IQ, but there is still little research supporting directly this hypothesis. We studied the association between height and IQ in 209 Dutch twin pairs at the ages of 5, 7, 10 and 12 years, 208 twin pairs at 16 and 18 years of age and 567 twin pairs and their siblings in adulthood. The heritability of height was high in all cohorts and across all ages (a² = 0.93 − 0.96). In adulthood, heritability was also high for full-scale IQ (FSIQ: a² = 0.83–0.84) and somewhat lower for verbal IQ (VIQ: a² = 0.66–0.84). In early childhood, the heritability was lower, and common environmental factors had a substantial effect on FSIQ and VIQ. A positive association of height and IQ was found in early childhood and adolescence. In adulthood, a correlation was found between height and FSIQ in young adulthood and between height and VIQ in middle age. All correlations could be ascribed to genetic factors influencing both height and IQ. Thus, these results show that the association between height and IQ should not be directly regarded as evidence for childhood living conditions affecting IQ, but the effect of genetic factors affecting independently or interacting with environmental factors should be considered as well.     

The relationship between wood density and mortality in a global tropical forest data set

Wood density is thought to be an important indicator of plant life history because it is coupled to many aspects of whole-plant form and function. We used a hierarchical Bayesian approach to explain variation in mortality rates with wood density, drawing on data for 765,500 trees from 1639 species at 10 sites located across the Old and New World tropics. Mortality rates declined with increasing wood density at five of 10 sites. Similar negative trends were detected at four additional sites, while one site showed no relationship. Our model explained 40% of variation in mortality on average. Both wood density and mortality rates show a high degree of phylogenetic conservatism. Grouping species by family across sites in a second analysis, we found considerable variation in the relationship between wood density and mortality, with 10 of 27 families demonstrating a strong negative relationship. Our results highlight the importance of wood density as a functional trait in tropical forests, as it is strongly linked to variation in survival. However, the relationship varied among families, plots, and even census intervals within sites, indicating that the factors responsible for the relationship between wood density and mortality vary spatially, taxonomically and temporally.     

Spatial association between speciated fine particles and mortality

Particulate matter (PM) has been linked to a range of serious cardiovascular and respiratory health problems, including premature mortality. The main objective of our research is to quantify uncertainties about the impacts of fine PM exposure on mortality. We develop a multivariate spatial regression model for the estimation of the risk of mortality associated with fine PM and its components across all counties in the conterminous United States. We characterize different sources of uncertainty in the data and model the spatial structure of the mortality data and the speciated fine PM. We consider a flexible Bayesian hierarchical model for a space-time series of counts (mortality) by constructing a likelihood-based version of a generalized Poisson regression model that combines methods for point-level misaligned data and change of support regression. Our results seem to suggest an increase by a factor of two in the risk of mortality due to fine particles with respect to coarse particles. Our study also shows that in the Western United States, the nitrate and crustal components of the speciated fine PM seem to have more impact on mortality than the other components. On the other hand, in the Eastern United States, sulfate and ammonium explain most of the fine PM effect.     

The relationship between socioeconomic status and infant mortality in metropolitan Ohio, 1999-2001

Empirical evidence has consistently documented the direct relationship between infant mortality and socioeconomic inequality in the United States and numerous other countries. While the majority of these studies reveal an inverse relationship between socioeconomic level and infant mortality, not even this finding is free from disagreement. Furthermore, the specific nature and magnitude of this relationship has varied over time. This study will examine the relationship between socioeconomic status and infant mortality in metropolitan Ohio by using birth and infant death data centered on the 2000 Census. The analyses presented herein will describe and analyze the relationship between infant mortality and socioeconomic status in metropolitan Ohio in the year 2000. The key finding is that in spite of remarkable declines in infant mortality during the past several decades, most notably in neonatal mortality, there continues to be a pronounced inverse association between the infant death rate and the economic status of a population.     

Modifiers of diurnal temperature range and mortality association in six Korean cities

Rapid temperature changes within a single day may be critical for populations vulnerable to thermal stress who have difficulty adjusting themselves behaviorally and physiologically. We hypothesized that diurnal temperature range (DTR) is associated with mortality, and that this association is modified by season and socioeconomic status (SES). We evaluated meteorological and mortality data from six metropolitan areas in Korea from 1992 to 2007. We applied generalized linear models (GLM) for quantifying the estimated effects of DTR on mortality after adjusting for mean temperature, dew point temperature, day of the week, and seasonal and long-term trends. Most areas showed a linear DTR–mortality relationship, with evidence of increasing mortality with increasing DTR. Deaths among the elderly (75 years or older), females, the less educated, and the non-hospital population were associated more strongly with DTR than with the corresponding categories. DTR was the greatest threat to vulnerable study populations, with greater influence in the fall season. DTR was found to be a predictor of mortality, and this relationship was modified by season and SES.     

Estimation of the ecosystem carbon budget in South Korea between 1999 and 2008

A carbon flux model, the vegetation integrated simulator for trace gases, was employed to estimate the carbon budgets of vegetation ecosystems in South Korea. The geographic information system was used to prepare the input variables for the model, such as climate, soil, and land-cover data, from reliable national inventories. Model simulation results indicated that the annual average gross primary production, net primary production, and soil respiration (SR) for 10 years were 91.89, 40.16, and 62.91 Tg C year^?1, respectively. The model also estimated a net ecosystem production with a value of 3.51 Tg C year^?1 between 1999 and 2008. Such results indicate that the vegetation ecosystems of South Korea offset 3.3 % of anthropogenic emissions as a net carbon sink. Latitudinal and topographical gradients over the total simulation area were found for all estimates. In addition, the estimates varied between seasons and years, especially in estimates for biomass growth and carbon uptake, because of variations in the weather conditions. Finally, model validation was conducted using measured soil efflux and flux measurement data from the Gwangneung experimental forest (GEF). The estimated SR accounted for 81.6 % of the observed SR at the GEF site (P < 0.005). Further, the model accounted well for the observed phase and amplitude of changes in the summer and autumn seasons.     

Economic returns to investment in AIDS treatment in low and middle income countries

Since the early 2000s, aid organizations and developing country governments have invested heavily in AIDS treatment. By 2010, more than five million people began receiving antiretroviral therapy (ART)--yet each year, 2.7 million people are becoming newly infected and another two million are dying without ever having received treatment. As the need for treatment grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realized from increasingly large investments in ART. This study estimates total program costs and compares them with selected economic benefits of ART, for the current cohort of patients whose treatment is cofinanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria. At end 2011, 3.5 million patients in low and middle income countries will be receiving ART through treatment programs cofinanced by the Global Fund. Using 2009 ART prices and program costs, we estimate that the discounted resource needs required for maintaining this cohort are $14.2 billion for the period 2011-2020. This investment is expected to save 18.5 million life-years and return $12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care. Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.     

Photosynthetic responses to temperature in tropical lotic macroalgae

A comparative analysis of the photosynthetic responses to temperature (10–30°C) was carried out under short‐term laboratory conditions by chlorophyll fluorescence and oxygen (0₂) evolution. Ten lotic macroalgal species from southeastern Brazil (20°11–20°48′S, 49°18–49°41′W) were tested, including Bacillariophyta, Chlorophyta, Cyanophyta, Rhodophyta and Xanthophyta. Temperature had significant effects on electron transport rate (ETR) only for three species (Terpsinoe musica, Bacillariophyta; Cladophora glomerata, Chlorophyta; and C. coeruleus, Rhodophyta), with highest values at 25–30°C, whereas the remaining species had no significant responses. It also had similar effects on non‐photochemical quenching and ETR. Differences in net photosynthesisldark respiration ratios at distinct temperatures were found, with an increasing trend of respiration with higher temperatures. This implies in a decreasing balance between net primary production and temperature, representing more critical conditions toward higher temperatures for most species. In contrast, high net photosynthesis and photosynthesisldark respiration ratios at high and wide ranges of temperature were found in three species of green algae, suggesting that these algae can be important primary producers in lotic ecosystems, particularly in tropical regions. Optimal photosynthetic rates were observed under similar environmental temperatures for five species (two rhodophytes, two chlorophytes and one diatom) considering both techniques, suggesting acclimation to their respective ambient temperatures. C. coeruleus was the only species with peaks of ETR and 0₂ evolution under similar field‐measured temperatures. All species kept values of ETR and net photosynthesis close to the optimum under a broad range of temperatures. Increased non‐photochemical quenching, as a measure of thermal dissipation of excess energy, toward higher temperatures was observed in some species, as well as positive correlation of non‐photochemical quenching with ETR, and were interpreted as two mechanisms of adaptation of the photosynthetic apparatus to temperature changes. Different optimal temperatures were found for individual species by each technique, generally under lower temperatures by 0₂ evolution, indicating dependence on distinct factors: increases in temperature generally induced higher ETR due to increased enzymatic activity, whereas increments of enzymatic activity were compensated by increased respiration and photorespiration leading to decreases in net photosynthesis.     

The study of microclimate in response to different plant community association in tropical moist deciduous forest from northern India

The data on microclimate were collected between 2010 and 2011 in five forest communities (dry miscellaneous, sal mixed, lowland miscellaneous, teak and savannah) in a tropical moist deciduous forest in Katerniaghat Wildlife Sanctuary, Uttar Pradesh, India to compare how vegetation structure affects microclimate. Diurnal variations in microclimatic variables [photosynthetically active radiation (PAR) at forest understory level, air temperature, soil surface temperature, ambient CO₂, air absolute humidity] were measured with LI-COR 840, LI-COR 191, LI-COR 190 SZ, LI-1400-101 and LI-1400-103 (LI-COR; Lincoln, NE, USA) at centre of three 0.5 ha plots in each forest community. The diurnal trend in microclimatic parameters showed wide variations among communities. PAR at forest floor ranged from 0.0024 to 1289.9 (μmol m⁻²s⁻¹) in post-monsoon season and 0.0012 to 1877.3 (μmol m⁻²s⁻¹) in mid-winter season. Among the five communities, the highest PAR value was observed in savannah and lowest in sal mixed forest. All the forest communities received maximum PAR at forest floor between 1000 and 1200 h. The ambient air temperature ranged from 19.15 to 26.69°C in post-monsoon season and 11.31 to 23.03°C in mid-winter season. Soil temperature ranged from 13.54 to 36.88°C in post-monsoon season and 6.39 to 29.17°C in mid-winter season. Ambient CO₂ ranged from 372.16 to 899.14 μmol mol⁻¹ in post-monsoon season and 396.65 to 699.65 μmol mol⁻¹ in mid-winter season. In savannah ecosystem, diurnal trend of ambient CO₂ was totally different from rest four communities. According to Canonical correspondence analysis, PAR and ambient CO₂ are most important in establishment of forest community, among microclimatic variables.     

Environmental temperature and mortality from acute myocardial infarction

Mortality from acute myocardial infarction (MI) over the 5 year period 1982–1987 in Brown County, Wisconsin, was analyzed to assess the relationship with environmental temperature. Deaths occurrring on the day of and the day following a significant snowfall as well as deaths occuring in health care facilities were eliminated from consideration because the focus was upon temperature, not snowfall or events within a hospital. These criteria resulted in the inclusion of 1,802 days and 926 cases of acute MI. The mean temperature on the day of death was obtained from climatological data and were grouped into six categories covering a range of temperatures from<–17.8°C (0°F) to 16.1°C (61°F). The number of deaths in each category was tabulated. The effect of temperature, sex, and age were analyzed by regression analysis. The results indicated a linear increase in mortality as mean daily temperature decreased over the temperature range. The inverse temperature effect was most pronounced in males over the age of 60. These results indicate that cold temperatures appear to be associated with an increased mortality from myocardial infarction.     

Cancer risk and all-cause mortality among Norwegian military United Nations peacekeepers deployed to Kosovo between 1999 and 2011

ObjectiveMedia reports of leukaemia and other cancers among European United Nations (UN) peacekeepers who served in the Balkans, and a scientific finding of excess Hodgkin lymphoma among Italian UN peacekeepers who served in Bosnia, suggested a link between cancer incidence and depleted uranium (DU) exposure. This spurred several studies on cancer risk among UN peacekeepers who served in the Balkans. Although these studies turned out to be negative, the debate about possible cancers and other health risks caused by DU exposure continues. The aim of the present study was to investigate cancer incidence and all-cause mortality in a cohort of 6076 (4.4% women) Norwegian military UN peacekeepers deployed to Kosovo between 1999 and 2011.MethodsThe cohort was followed for cancer incidence and mortality from 1999 to 2011. Standardised incidence ratios for cancer (SIR) and mortality ratios (SMR) were calculated from national rates.ResultsSixty-nine cancer cases and 38 deaths were observed during follow-up. Cancer incidence in the cohort was similar to that in the general Norwegian population. No cancers in the overall cohort significantly exceeded incidence rates in the general Norwegian population, but there was an elevated SIR for melanoma of skin in men of 1.90 (95% confidence interval [CI] 0.95–3.40). A fivefold increased incidence of bladder cancer was observed among men who served in Kosovo for ≥1 year, based on 2 excess cases (SIR = 5.27; 95% CI 1.09–15.4). All-cause mortality was half the expected rate (SMR = 0.49; 95% CI 0.35–0.67).ConclusionOur study did not support the suggestion that UN peacekeeping service in Kosovo is associated with increased cancer risk.     

The effects of monthly temperature fluctuations on mortality in the United States from 1921 to 1985

The impact of short-term temperature fluctuations on mortality has been studied mainly on historical populations, thus providing a limited ability to generalize to contemporary conditions, which would be more useful in determining public health policies aimed at reducing mortality. Therefore, this study examined the effects of monthly temperature fluctuations on mortality in the United States from 1921 to 1985. Monthly data about mortality from the Vital Statistics and temperature from the National Oceanic and Atmospheric Administration and the US Department of Agriculture Weather Bureau were used. Six states were selected to be studied (Massachusetts, Michigan, Washington, Utah, North Carolina, and Mississippi). The analysis was carried out using distributed lag models. The analysis-showed that warmer than usual temperatures in July and August, and unusually cold temperatures from January to June are linked to higher mortality. From September to December unusually low temperatures are associated with higher mortality in most states, while temperature has no significant effect on mortality in June and September. In January and February mortality is especially affected by unusually cold weather in the southern states of Mississippi and North Carolina. For example, a one degreee drop in the mean temperature in 1921 is associated with a more than 3.5% increase in the February crude death rate in Mississippi and North Carolina and a less than 1% increase in the four other states examined. Finally, in the months from January to March the relationship between monthly fluctuations in the crude death rate and temperature declined over time and became relatively weak by 1985.     

The ecology and distribution of lichens in tropical deciduous and evergreen forests of northern Thailand

During three years of research on epiphytic lichen communities as indicators of environmental change in northern Thailand plots were set up in a range of forest types between 400 and 1600 m in 1991/2 and revisited in 1993. Other areas were visited in 1993 and collections made in a wider range of geographical, altitudinal and vegetation conditions in Thailand. From this data factors influencing the distribution of lichens in a monsoon climate are outlined and characteristic components of the lichen flora given at family, generic and where possible specific level. Dominant taxa of the montane forests include hygrophilous macrolichens of the 'Lobarion' that are also a characteristic component of old growth fagaceous forests in Europe, whereas the evergreen forests are dominated by moisture-dependent crustose taxa with a trentepohlioid photobiont, and the deciduous dipterocarp forests by often brightly coloured xerophytic lichens with a trebouxioid photobiont. Taxa are proposed as indicators of forest type including those that are indicators of old-growth forests and of disturbance. Quantitative recording of selected taxa at genus and species level is suggested to estimate rates of change in monsoon forests in southeast Asia.