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In Genesis 28:10–22, we find a pivotal moment in Jacob’s life that reveals a practical blueprint for modern believers to find purpose in Christ when examined. The blueprint is modeled after Jacob’s ladder experience, which for Jacob changes his life from then on. After that encounter with God, he knows his destiny and purpose, suddenly having confidence in where he is going, which is missing for many Christians. Jacob stumbles into this seemingly by accident, but it is possible to retrace his steps for practical application through careful examination and breaking down his steps incrementally. It takes Jacob a lifetime to have such a revelation but utilizing the blueprint presented; this work aims to show how it is helpful for Christians today.

BACKGROUND:Diabetes is infrequently coded as the primary cause of death but may contribute to cardiovascular disease (CVD) mortality in response to fine particulate matter (PM2.5) exposure. We analyzed all contributing causes of death to examine susceptibility of diabetics to CVD mortality from long-term exposure. METHODS:We linked a subset of the 2001 Canadian Census Health and Environment Cohort (CanCHEC) with 10 years of follow-up to all causes of death listed on death certificates. We used survival models to examine the association between CVD deaths (n=123,500) and exposure to PM2.5 among deaths that co-occurred with diabetes (n=20,600) on the death certificate. More detailed information on behavioral covariates and diabetes status at baseline available in the Canadian Community Health Survey (CCHS) - mortality cohort (n=12,400 CVD deaths, with 2,800 diabetes deaths) complemented the CanCHEC analysis. RESULTS:Among CanCHEC subjects, co-mention of diabetes on the death certificate increased the magnitude of association between CVD mortality and PM2.5 (HR=1.51 [1.39-1.65] per 10 μg/m) – versus all CVD deaths (HR=1.25 [1.21-1.29]) or CVD deaths without diabetes (HR=1.20 [1.16-1.25]). Among CCHS subjects, diabetics who used insulin or medication (included as proxies for severity) had higher HR estimates for CVD deaths from PM2.5 (HR=1.51 [1.08-2.12]) relative to the CVD death estimate for all respondents (HR=1.31 [1.16-1.47]). CONCLUSIONS:Mention of diabetes on the death certificate resulted in higher magnitude associations between PM2.5 and CVD mortality, specifically amongst those who manage their diabetes with insulin or medication. Analyses restricted to the primary cause of death likely underestimate the role of diabetes in air pollution-related mortality.

Increasing evidence suggests that residential exposures to natural environments, such as green spaces, are associated with many health benefits. Only a single study has examined the potential link between living near water and mortality. We sought to examine whether residential proximity to large, natural water features (e.g., lakes, rivers, coasts, \"blue space\") was associated with cause-specific mortality. Our study is based on a population-based cohort of nonimmigrant adults living in the 30 largest Canadian cities [i.e., the 2001 Canadian Census Health and Environment Cohort) (CanCHEC)]. Subjects were drawn from the mandatory 2001 Statistics Canada long-form census, who were linked to the Canadian mortality database and to annual income-tax filings, through 2011. We estimated associations between living within of blue space and deaths from several common causes of death. We adjusted models for many personal and contextual covariates, as well as for exposures to residential greenness and ambient air pollution. Our cohort included approximately 1.3 million subjects at baseline, 106,180 of whom died from nonaccidental causes during follow-up. We found significant, reduced risks of mortality in the range of 12-17% associated with living within of water in comparison with living farther away, among all causes of death examined, except with external/accidental causes. Protective effects were found to be higher among women and all older adults than among other subjects, and protective effects were found to be highest against deaths from stroke and respiratory-related causes. Our findings suggest that living near blue spaces in urban areas has important benefits to health, but further work is needed to better understand the drivers of this association. https://doi.org/10.1289/EHP3397.