Built Environment and Cardiovascular Diseases - Insights from a Global Review.

Purpose Of Review: This narrative review aims to synthesize global literature on the relationship between cardiovascular diseases (CVD) and components of built environment (green spaces, walkability, food environment, accessibility and availability of recreational and healthcare facilities, and effects of air and noise pollution).

Recent Findings: Increased green space and neighborhood walkability are associated with lower CVD mortality and morbidity; however, benefits have shown differential effects by socioeconomic status (SES). Air pollution is a leading environmental risk factor contributing to CVDs, and it disproportionately impacts low SES populations and women.

Prevalence of metabolic syndrome and its association with cardiovascular disease risk and common risk factors amongst healthcare workers in Pakistan.

Metabolic syndrome (MetS) significantly increases the risk of cardiovascular disease (CVD). Healthcare workers (HCWs) are at a higher risk of CVD. However, little is known about the association between MetS and CVD risk in healthcare workers in Pakistan.

Burden of cardiometabolic diseases and depression in a low-income, urban community in Pakistan: a cross-sectional survey.

Background: With the rising epidemic of cardiometabolic diseases (CMDs) in low- and middle-income countries, urban populations face unique challenges such as poor sanitation, environmental pollution, and limited access to healthcare. This study estimates the point prevalence of CMDs and associated risk factors in adults in Karachi, analyses CMD prevalence by sex, and explores the relationship between CMDs and depression.

Methods: A door-to-door survey was conducted in a densely populated urban community within a 0.

Diabetes and obesity susceptibility genes: a cross-sectional analysis of methylation patterns from Karachi, Pakistan.

Purpose Of Study: Environmental factors are pivotal in shaping disease outcomes for obesity, diabetes, and metabolic syndrome (MetS), especially in the Pakistani population. This study aimed to determine whether promoter methylation levels of 12 diabetes and obesity susceptibility genes are associated with MetS phenotypes and risk of T2DM in Pakistani individuals.

Study Design: A cross-sectional study was undertaken whereby methylation-specific PCR assays were conducted on 203 adult subjects recruited from the community in Karachi, Pakistan.

Integrating a Community-Based Health Information System with a Patient-Centered Medical Home to improve care of patients with hypertension: a longitudinal observational study protocol.

Background: The primary healthcare system in Pakistan focuses on providing episodic, disease-based care. Health care for low-middle income communities is largely through a fee-for-service model that ignores preventive and health-promotive services. The growing burden of cardiovascular illnesses requires restructuring of the primary health care system allowing a community-to-clinic model of care to improve patient- and community-level health indicators.

Evaluation of FamMed essentials: a blended-learning program for capacity building of general practitioners in Pakistan.

Background: To provide access to primary care and universal health coverage, Pakistan requires 60,000 trained family physicians by 2030. At present, most primary care is provided by general practitioners (GPs) who do not have any post-graduate training. Empowering GPs through competency-based programs, that strengthen their knowledge and skills, may be a cost-effective strategy for improving healthcare quality.

Effectiveness of inactivated COVID-19 vaccines against SARS-CoV-2 infections among healthcare personnel in Pakistan: a test-negative case-control study.

Objective: During the COVID-19 pandemic, several vaccines that were efficacious in randomised controlled trials were authorised for mass vaccination. In developing countries, inactivated vaccines were widely administered. While inactivated vaccines have been deemed effective in reducing disease severity, for healthcare personnel (HCP), effectiveness against SARS-CoV-2 infections is essential to reduce the risk to vulnerable patients and ensure a stable healthcare workforce.

The Pandemic of Coronary Heart Disease in South Asia: What Clinicians Need to Know.

Purpose Of Review: South Asia has around 1/6 of the current global population. Epidemiological studies suggest that South Asians living in South Asia and diaspora are at an increased risk of premature atherosclerotic cardiovascular diseases (ASCVDs). This is due to an interplay of genetic, acquired, and environmental risk factors.

Needs assessment of general practitioners in Pakistan: A descriptive cross-sectional survey.

Background: With the growing and complex nature of medicine, it is imperative for physicians to update their knowledge and skills to reflect current standards of care. In Pakistan, 71% of primary care needs are met by general practitioners (GPs). GPs are not required to complete structured training and no regulatory mandates exist for continuing medical education.

Using rapid antigen testing for early, safe return-to-work for healthcare personnel after SARS-CoV-2 infection in a healthcare system in Pakistan: A retrospective cross-sectional study.

Anticipating staff shortage during the Omicron variant surge, we modified the US Centers for Disease Control and Prevention's contingency guidelines at a healthcare system in Pakistan. Infected staff had a SARS-CoV-2 rapid antigen test after 5-7 days of isolation, to decide a safe return-to-work. This led to signifcant cost savings without compromising patient/staff safety.

Teaching Clinical Skills Using Online Modality through Modified Peyton's Framework: An Experience from a Medical University in Pakistan.

Introduction: Medical institutions worldwide faced an unprecedented situation during COVID-19 of identifying alternative strategies to sustain the continuum of learning process. This led to several innovations in the traditional medical curriculum. This study explored the effectiveness and feasibility of using the Peyton's framework modified for a virtual platform (Microsoft Teams) for teaching clinical skills to first and second-year medical students at The Aga Khan University, Karachi, Pakistan.

Does the CDC COVID-19 Exposure Assessment Criteria for Healthcare Personnel Work in a Healthcare Setting in Pakistan?

Objective: To evaluate the real-world performance of the CDC's "Interim US guidance for risk assessment and work restriction for healthcare personnel with exposure to COVID-19" at a private healthcare system in Pakistan.

Study Design: Retrospective observational study.

Place And Duration Of Study: The Aga khan University Hospital, Karachi, and its associated healthcare facilities in all four provinces of Pakistan, from February to September 2020.

Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary.

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development.

Metabolic syndrome among children aged 6 to 11 years, Al Ain, United Arab Emirates: Role of obesity.

Objectives: To evaluate the association of metabolic syndrome with the varying degrees of obesity among children aged 6 to 11 years in Al Ain, United Arab Emirates (UAE).

Methods: As an ancillary to the primary study examining prevalence of MetS in a random sample of 1186 adolescents from 114 schools in Al Ain, parents and siblings aged 6 to 11 years were invited to participate in this study. After informed consent from parents and assent from children, trained nurses administered questionnaires to assess socio-demographic and lifestyle variables and conducted anthropometric measurements.

Isotemporal Analysis of the Association of Objectively Measured Physical Activity With Depressive Symptoms: Results From Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Background: The burden of depression among Hispanics/Latinos indicates the need to identify factors related to depressive symptoms. This paper examines the relationship of physical activity (PA) and sedentary behavior (SB) with depressive symptoms in Hispanic/Latinos.

Methods: The Hispanic Community Health Study / Study of Latinos (HCHS/SOL) is a population-based, cohort study of Hispanic/Latinos in 4 United States metropolitan areas.

Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy.

Study Objective: In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy.

Differences in Cardiometabolic Risk between Insulin-Sensitive and Insulin-Resistant Overweight and Obese Children.

Background: It is known that 15-30% overweight/obese adults do not suffer cardiometabolic consequences. There is limited literature examining factors that can be used to assess cardiometabolic health in overweight/obese children. If such factors can be identified, they would aid in differentiating those most in need for aggressive management.

Progression from metabolically benign to at-risk obesity in perimenopausal women: a longitudinal analysis of study of women across the nation (SWAN).

Background: Little is known about the natural history of progression from a metabolically benign overweight/obese (MBO) to at-risk overweight/obese (ARO) phenotype. Improved understanding would help clinicians focus on controlling risk factors that predispose an obese individual to progression.

Methods: Using discrete-time proportional hazard modeling on data from the Study of Women's Health Across the Nation (SWAN), we examined the incident progression from MBO (less than two metabolic syndrome abnormalities) to ARO (two or more metabolic syndrome abnormalities) and factors associated with progression over a 7-year period.

The adipokine profile of metabolically benign obese and at-risk normal weight postmenopausal women: the Women's Health Initiative Observational Study.

Objective: Nearly, a third of obese individuals, termed metabolically benign obese, have a low burden of adiposity-related cardiometabolic abnormalities, whereas a substantial proportion of normal-weight individuals possess risk factors.

Methods: In cross-sectional analyses of 699 normal weight and 1,294 overweight/obese postmenopausal women enrolled in a nested case-control stroke study ancillary to the Women's Health Initiative Observational Study, we compared levels of adiponectin, leptin, and resistin among metabolically benign normal weight, at-risk normal weight, metabolically benign obese, and at-risk obese women using components of the ATP III definition of the metabolic syndrome (metabolically benign: ≤1 of the four components; at-risk phenotype: ≥2 components or diabetes).

Results: Overall, 382/699 normal-weight women (54.

Evaluation of a community-based weight management program for predominantly severely obese, difficult-to-reach, inner-city minority adolescents.

Background: Few interventions targeting severely obese minority youth have been implemented in community-based settings. We evaluate a 9-month multicomponent, community-based program for obese, inner-city adolescents.

Methods: Of 5250 estimated eligible adolescents, 349 were recruited; they had a mean age of 15 ± 2 years, mean BMI %ile 98.

Ectopic fat and adipokines in metabolically benign overweight/obese women: the Kronos Early Estrogen Prevention Study.

Objective: It is unclear why despite a comparable cardiometabolic risk profile, "metabolically benign" overweight/obese individuals show an elevated risk of cardiovascular disease compared to normal weight individuals.

Design And Methods: In cross-sectional analyses, we compared levels of ectopic fat (epicardial, pericardial, and hepatic fat) and adipokines (leptin, soluble leptin receptor, and high molecular weight [HMW] adiponectin) among metabolically benign (MBO) and at-risk overweight/obese (ARO), and metabolically benign normal weight (MBNW) women, screened for the Kronos Early Estrogen Prevention Study. We defined "metabolically benign" with ≤ 1, and "at-risk" with ≥2 components of the metabolic syndrome.

Independent and synergistic associations of asthma and obesity with systemic inflammation in adolescents.

Introduction: Both asthma and obesity often occur in the same individual. Each increases the risk of cardiovascular disease (CVD) with systemic inflammation likely playing a vital role. We examined the independent and synergistic associations of asthma and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP) levels in adolescents.

Associations between retinol-binding protein 4 and cardiometabolic risk factors and subclinical atherosclerosis in recently postmenopausal women: cross-sectional analyses from the KEEPS study.

Background: The published literature regarding the relationships between retinol-binding protein 4 (RBP4) and cardiometabolic risk factors and subclinical atherosclerosis is conflicting, likely due, in part, to limitations of frequently used RBP4 assays. Prior large studies have not utilized the gold-standard western blot analysis of RBP4 levels.

Methods: Full-length serum RBP4 levels were measured by western blot in 709 postmenopausal women screened for the Kronos Early Estrogen Prevention Study.

Associations of obesity and asthma with functional exercise capacity in urban minority adolescents.

Purpose: To examine the independent association of asthma and obesity and of their co-existence with functional exercise capacity among urban adolescents.

Methods: One hundred eighteen Hispanic- and African-American adolescents including 33 obese asthmatics, 18 normal-weight asthmatics, 38 obese non-asthmatics, and 29 normal-weight non-asthmatics underwent anthropometric measures, 6-minute walk test (6MWT) as measure of functional exercise capacity and spirometry as measure of pulmonary function. The 6-minute walk distance (6MWD) was compared between the four study groups.