Abstract Background Few previous studies have investigated consumption distributions of sugar-sweetened beverages (SSBs) over time and individual-level associations despite recent interest in SSBs ...regarding obesity control. Objective To assess consumption patterns and individual-level associations. Design Trend and cross-sectional analyses of 24-hour dietary recall data and demographic characteristics and socioeconomic status (SES) drawn from National Health and Nutrition Examination Survey (1999-2000, 2001-2002, 2003-2004, 2005-2006, and 2007-2008) data. Participants/setting Children (aged 2 to 11 years, n=8,627), adolescents (aged 12 to 19 years, n=8,922), young adults (aged 20 to 34 years, n=5,933), and middle-aged and elder adults (aged ≥35 years, n=16,456). Statistical analyses performed Age-stratified regression analyses for SSBs overall and by subtypes. Results The prevalence of heavy total SSB consumption (≥500 kcal/day) increased among children (4% to 5%) although it decreased among adolescents (22% to 16%) and young adults (29% to 20%). Soda was the most heavily consumed SSB in all age groups except for children. Prevalence of soda consumption decreased, whereas heavy sports/energy drink consumption tripled (4% to 12%) among adolescents. Black children and adolescents showed higher odds of heavy fruit drink consumption (odds ratios 1.71 and 1.67) than whites. Low-income children had a higher odds of heavy total SSB consumption (odds ratio 1.93) and higher energy intake from total SSBs and fruit drinks (by 23 and 27 kcal/day) than high-income children. Adolescents with low- vs high-educated parents had higher odds of heavy total SSB consumption (odds ratio 1.28) and higher energy intake from total SSBs and soda (by 27 and 21 kcal/day). Low vs high SES was associated with a higher odds of heavy consumption of total SSBs, soda, and fruit drinks among adults. Conclusions Prevalence of soda consumption fell, but consumption of nontraditional SSBs rose. Heterogeneity of heavy consumption by SSB types across racial/ethnic subpopulations and higher odds of heavy SSB consumption among low-SES populations should be considered in targeting policies to encourage healthful beverage consumption.
Acute Traumatic Coagulopathy occurs immediately after massive trauma when shock, hypoperfusion, and vascular damage are present. Mechanisms for this acute coagulopathy include activation of protein ...C, endothelial glycocalyx disruption, depletion of fibrinogen, and platelet dysfunction. Hypothermia and acidaemia amplify the endogenous coagulopathy and often accompany trauma. These multifactorial processes lead to decreased clot strength, autoheparinization, and hyperfibrinolysis. Furthermore, the effects of aggressive crystalloid administration, haemodilution from inappropriate blood product transfusion, and prolonged surgical times may worsen clinical outcomes. We review normal coagulation using the cell-based model of haemostasis and the pathophysiology of acute traumatic coagulopathy. Developed trauma systems reduce mortality, highlighting critical goals for the trauma patient in different phases of care. Once patients reach a trauma hospital, certain triggers reliably indicate when they require massive transfusion and specialized trauma care. These triggers include base deficit, international normalized radio (INR), systolic arterial pressure, haemoglobin concentration, and temperature. Early identification for massive transfusion is critically important, as exsanguination in the first few hours of trauma is a leading cause of death. To combat derangements caused by massive haemorrhage, damage control resuscitation is a technique that addresses each antagonist to normal haemostasis. Components of damage control resuscitation include damage control surgery, permissive hypotension, limited crystalloid administration, haemostatic resuscitation, and correction of hyperfibrinolysis.
The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, ...including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
Disability reproductive justice Powell, Robyn M
University of Pennsylvania law review,
07/2022, Letnik:
170, Številka:
7
Journal Article
Recenzirano
The fragility of reproductive rights in the US has never been so clear. From the Supreme Court's recent 'Dobbs v Jackson Women's Health Organization' decision, which overturned 'Roe v Wade', to a ...quickly growing number of states passing draconian state laws that drastically limit - and in some states, ban - access to safe and legal abortion care, reproductive freedom is under siege at every turn. This difficult reality has elevated the importance of reproductive rights to the forefront of many people's consciousness. At the same time, the discourse concerning reproductive rights has been narrowly focused and has failed to recognize the scope of reproductive decision-making beyond abortion. In addition, the reproductive rights movement has traditionally overlooked the myriad other ways in which marginalized populations, including people with disabilities, experience reproductive oppression. This article responds to the contemporary besiege on reproductive freedom and the persistent reproductive oppression experienced by people with disabilities by proposing a vision to help activists, legal professionals, scholars, and policymakers conceive of and articulate the basic contours of a paradigm shift that supports the coalescence of the disability justice and reproductive justice movements. To do so, first the article examines the origins of weaponizing sexuality and reproduction to subjugate disabled people in the US. Drawing on legal scholarship and social science research, it then elucidates the scope of the problem by describing the social context and institutions that propagate the sexual and reproductive oppression of people with disabilities and highlights contemporary examples of such injustices. Thereafter, the article introduces and explores the tenets of two complementary frameworks for analyzing and confronting the reproductive oppression of people with disabilities: disability justice and reproductive justice. Finally, guided by the tenets of disability justice and reproductive justice, it further develops a jurisprudential and legislative framework for achieving and delivering reproductive justice for people with disabilities.
The goal of sugar-sweetened beverage (SSB) taxes is to raise the prices of SSBs to decrease consumption. Price promotions play an important role in the sales of SSBs and could potentially be used by ...manufacturers to weaken the impact of such taxes. The purpose of this study is to determine how price promotions changed after the introduction of the 2017 Oakland SSB tax. A difference-in-differences study design was used to compare changes in prices and the prevalence and amount of price promotions for beverages in Oakland, California, relative to Sacramento, California, using two different datasets. Nielsen Retail Scanner data included price promotions for beverages sold and store audit data included price promotions offered by retailers. Changes were analyzed for SSBs, noncalorically sweetened beverages, and unsweetened beverages. After the implementation of the tax, the prevalence of price promotions for SSBs did not change significantly in Oakland relative to the comparison site of Sacramento. However, the depth of price promotions increased by an estimated 0.35 cents per ounce (P<0.001) based on the Nielsen retail scanner data and by 0.39 cents per ounce (P<0.001) based on the store audit data. This increase in the amount by which SSBs were price promoted following the introduction of the Oakland SSB tax may reflect a strategy by manufacturers to weaken the tax and/or retailers to bolster demand.
Summary
Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health ...outcomes. This study provided a systematic review of recent U.S. studies on the price elasticity of demand for sugar‐sweetened beverages (SSBs), fast food, and fruits and vegetables, as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be −1.21, −0.52, −0.49 and −0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state‐level sales taxes that were relatively low. Higher fast‐food prices were associated with lower weight outcomes particularly among adolescents, suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low‐income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower‐socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks.
Social Determinants of Cardiovascular Disease Powell-Wiley, Tiffany M; Baumer, Yvonne; Baah, Foster Osei ...
Circulation research,
03/2022, Letnik:
130, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Social determinants of health (SDoH), which encompass the economic, social, environmental, and psychosocial factors that influence health, play a significant role in the development of cardiovascular ...disease (CVD) risk factors as well as CVD morbidity and mortality. The COVID-19 pandemic and the current social justice movement sparked by the death of George Floyd have laid bare long-existing health inequities in our society driven by SDoH. Despite a recent focus on these structural drivers of health disparities, the impact of SDoH on cardiovascular health and CVD outcomes remains understudied and incompletely understood. To further investigate the mechanisms connecting SDoH and CVD, and ultimately design targeted and effective interventions, it is important to foster interdisciplinary efforts that incorporate translational, epidemiological, and clinical research in examining SDoH-CVD relationships. This review aims to facilitate research coordination and intervention development by providing an evidence-based framework for SDoH rooted in the lived experiences of marginalized populations. Our framework highlights critical structural/socioeconomic, environmental, and psychosocial factors most strongly associated with CVD and explores several of the underlying biologic mechanisms connecting SDoH to CVD pathogenesis, including excess stress hormones, inflammation, immune cell function, and cellular aging. We present landmark studies and recent findings about SDoH in our framework, with careful consideration of the constructs and measures utilized. Finally, we provide a roadmap for future SDoH research focused on individual, clinical, and policy approaches directed towards developing multilevel community-engaged interventions to promote cardiovascular health.
Once considered a 'hot topic' among scholars, research on coups d'état has waned in recent years. This decline is surprising given that 7 coups have happened between January 2008 and December 2010, ...bringing the last decade's total to almost three dozen. One explanation for the lack of coup research is the absence of a temporally and spatially comprehensive dataset to test theories. Also absent is a discussion of what makes coups distinct from other forms of anti-regime activity. This article seeks to remedy these problems. The authors present a new dataset on coups from 1950 to 2010. They begin by explaining their theoretical definition and coding procedures. Next, they examine general trends in the data across time and space. The authors conclude by explaining why scholars studying a variety of topics, including civil wars, regime stability, and democratization, would benefit by paying closer attention to coups.
•Innovative design of a synergistic hybrid solar natural gas power plant.•Utilizes natural gas for steam superheating for efficient power production.•Design is more flexible, reliable, and efficient ...than stand-alone solar thermal plant.•Detailed dynamic, systems-level model coupled with robust controls developed.•Annual results showing the synergy between the two energy sources, with solar to electric efficiency improving by 71.9%.
Solar power is considered among the leading renewable energy technologies. Abundant supply, flexibility of installation, and decreasing cost makes it an interesting renewable energy resource. However, there are challenges associated with the reliability of solar power due to its intermittent nature. This work demonstrates the synergies that exist in integrated hybrid systems, where a dispatchable fuel is used in conjunction with concentrated solar power. In this simulation-based study, a parabolic trough solar concentrator is used to collect solar energy. The heat collected from the solar field is used to generate steam in a Rankine cycle. The system also utilizes natural gas combustion in the steam generator to provide supplemental steam when the solar intensity is reduced due to cloud cover or at night. Natural gas is also used for superheating the steam, which allows the system to produce higher temperatures and achieve increased thermodynamic cycle efficiencies. This flexible design produces 100 MW at nominal conditions, while it is capable of producing a maximum of 140 MW when sufficient solar energy is available. The novel contributions of this work include a complete, systems-level, dynamic model of a hybrid solar plant. The model is complete with a control system that smoothly transitions the plant from pure natural gas mode at night to solar hybrid mode during the day. It evaluates innovative design features such as flexible fuel operation, steam superheating to boost efficiency, and preheating by solar or waste heat. Furthermore, this work demonstrates that by hybridizing a solar system with a dispatchable energy source, both the reliability and efficiency of the solar power production are increased. The annual solar-to-electric efficiency increases from 15.2% to 26.13% with hybridization, which indicates that utilization of the solar energy is effectively increased.
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