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Background Diet is a modifiable risk factor for non-communicable diseases which are the major causes of death worldwide. French dietary guidelines, updated in 2017, provide recommendations for a healthier diet. We aimed to study the association between adherence to these dietary guidelines and mortality in the E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) French cohort. A secondary objective was to investigate the role of dietary exposure to chemical contaminants in this association. Methods We studied 72 585 women of the E3N prospective cohort, which completed a food frequency questionnaire in 1993. We estimated adherence to French dietary guidelines using the simplified “ Programme National Nutrition Santé —guidelines score 2” (sPNNS-GS2, range -20.4 to 12.6). We estimated the association between sPNNS-GS2 and all-cause or cause-specific mortality using Cox proportional hazard models. Causes of death were coded and validated by the French Epidemiology Center on Medical Causes of Death (Inserm-CépiDc). Results During follow-up (1993–2014), we identified 6 441 deaths. The mean sPNNS-GS2 was 3.8 (SD 3.0). In the fully adjusted model, we found a non-linear association between sPNNS-GS2 and all-cause, all-cancer, breast cancer and lung cancer mortality ( p -values for the overall association < 0.001), with a diminution of the risk as sPNNS-GS2 increases up to its median or 65 th percentile (depending on the outcome), and then a plateau (for all-cause and breast cancer mortality) or an inversion of the trend (for all-cancer and lung cancer mortality). Furthermore, we identified a linear inverse association with cardiovascular diseases mortality (HR oneSTD [95%CI]: 0.86 [0.76; 0.97]), and no association with colorectal cancer mortality. We observed similar results when additionally adjusting on dietary exposure to chemical contaminants. Conclusions This study conducted in a large prospective cohort following more than 70 000 women for over 20 years suggested that higher adherence to French dietary guidelines was associated with a reduced risk of mortality from all-cause, cardiovascular diseases, all-cancer, breast cancer, and lung cancer, except for high values of adherence for lung cancer mortality. These results contribute to informing on the importance of following the French nutritional recommendations.

Background: The increasing emergencies and humanitarian challenges have worsened the mental health condition of women in the Eastern Mediterranean Region. Aim: To assess the prevalence, determinants and interventions to address mental health among women in fragile and humanitarian settings in the Eastern Mediterranean Region. Methods: Using the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, we reviewed 59 peer-reviewed published studies (PubMed, IMEMR) and grey literature (WHO/IRIS) from January 2001 to February 2023, focusing on women’s mental health in the Eastern Mediterranean Region. We then conducted a descriptive analysis of the sociodemographic characteristics. Results: Among the 59 studies reviewed, only 13 of the 48 peer-reviewed studies focused primarily on women’s mental health, 11 grey literature records mostly presented grouped regional data, 11 of the 25 studies on mental health among migrants were about those taking refuge in high-income countries. The average prevalence of mental disorders from 32 cross-sectional studies on women aged 12–75 years was 49%, average prevalence of anxiety was 68%, post-traumatic stress disorder was 52%, and depression was 43%. Women exhibited higher level depression than men. Age, educational disparities, and limited access to services were important risk factors for mental health disorder. Several promising. interventions emerged. Conclusion: More efforts should be made to provide customized, context-specific solutions to the mental health challenges of women in humanitarian and fragile settings in the Eastern Mediterranean Region, including allocation of more resources to mental health programmes, addressing barriers, enhancing mental health surveillance, and reduction of stigma.

Purpose Patterns of change from the traditional Palaeolithic lifestyle to the modern lifestyle may partly explain the epidemic proportions of non-communicable diseases (NCDs). We investigated to what extent adherence to the Palaeolithic diet (PD) and the Palaeolithic-like lifestyle was associated with type 2 diabetes (T2D) and hypertension risks. Methods A study of 70,991 women from the E3N ( Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale ) cohort, followed up for nearly 20 years. There were 3292 incident T2D and 12,504 incident hypertension cases that were validated. Dietary data were collected at baseline in 1993 via a food frequency questionnaire. The PD score and the Palaeolithic-like lifestyle score (PD, physical activity, smoking status, and body mass index [BMI]) were derived and considered in quintiles. Multivariable Cox regression models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident T2D and hypertension. Results In the fully adjusted models, a 1-SD increase of the PD score was associated with 4% and 3% lower risks of T2D and hypertension, respectively. Those in the highest versus the lowest quintile of the score had HR (95% CI) of 0.88 (0.79, 0.98) and 0.91 (0.86, 0.96) for T2D and hypertension, respectively ( P -trend < 0.0001). Associations were stronger for the Palaeolithic-like lifestyle score; in the fully adjusted model, a 1-SD increase of the score was associated with 19% and 6% lower risks of T2D and hypertension, respectively. Risks lowered successively with each increase in quintile; those in the highest versus the lowest quintile had HR (95% CI) of 0.58 (0.52, 0.65) and 0.85 (0.80, 0.90) for T2D and hypertension, respectively ( P -trend < 0.0001). Conclusions Our data suggest that adhering to a PD based on fruit, vegetables, lean meats, fish, and nuts, and incorporating a Palaeolithic-like lifestyle could be promising options to prevent T2D and hypertension.

Background Outbreaks of infectious diseases generate outbreaks of scientific evidence. In 2016 epidemics of Zika virus emerged, and in 2020, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic of coronavirus disease 2019 (COVID-19). We compared patterns of scientific publications for the two infections to analyse the evolution of the evidence. Methods We annotated publications on Zika virus and SARS-CoV-2 that we collected using living evidence databases according to study design. We used descriptive statistics to categorise and compare study designs over time. Results We found 2286 publications about Zika virus in 2016 and 21,990 about SARS-CoV-2 up to 24 May 2020, of which we analysed a random sample of 5294 (24%). For both infections, there were more epidemiological than laboratory science studies. Amongst epidemiological studies for both infections, case reports, case series and cross-sectional studies emerged first, cohort and case-control studies were published later. Trials were the last to emerge. The number of preprints was much higher for SARS-CoV-2 than for Zika virus. Conclusions Similarities in the overall pattern of publications might be generalizable, whereas differences are compatible with differences in the characteristics of a disease. Understanding how evidence accumulates during disease outbreaks helps us understand which types of public health questions we can answer and when.

Background: Low health literacy is associated with decreased patient compliance and worse outcomes - with clinicians increasingly relying on printed materials to lower such risks. Yet, many of these documents exceed recommended comprehension levels. Furthermore, patients look increasingly to social media (SoMe) to answer healthcare questions. The character limits built into Twitter encourage users to publish small quantities of text, which are more accessible to patients with low health literacy. The present authors hypothesize that SoMe posts are written at lower grade levels than traditional medical sources, improving patient health literacy. Methods: The data sample consisted of the first 100 original tweets from three trending medical hashtags, leading to a total of 300 tweets. The Flesch-Kincaid Readability Formula (FKRF) was used to derive grade level of the tweets. Data was analyzed via descriptive and inferential statistics. Results: The readability scores for the data sample had a mean grade level of 9.45. A notable 47.6% of tweets were above ninth grade reading level. An independent-sample t-test comparing FKRF mean scores of different hashtags found differences between the means of the following: #hearthealth versus #diabetes (t = 3.15, p = 0.002); #hearthealth versus #migraine (t = 0.09, p = 0.9); and #diabetes versus #migraine (t = 3.4, p = 0.001). Conclusions: Tweets from this data sample were written at a mean grade level of 9.45, signifying a level between the ninth and tenth grades. This is higher than desired, yet still better than traditional sources, which have been previously analyzed. Ultimately, those responsible for health care SoMe posts must continue to improve efforts to reach the recommended reading level (between the sixth and eighth grade), so as to ensure optimal comprehension of patients.

Migri-Heal®, is a novel herbal remedy that was introduced for the treatment of migraine headaches. Previous studies revealed that this drug may reduce nitric oxide (NO) in an in vitro inflammatory model. The aim of the present study was to investigate the anti-inflammatory effect of Migri-Heal® on primary mix glial cells stimulated with LPS. In the current study, neonatal rat primary mix glial cells were isolated from the mixed glial cultures via shaking, and cultured in Dulbecco's' modified Eagle's medium supplemented with 10% fetal bovine serum. Following pretreatment with Migri-Heal® (25, 75, 100, 150, 200 and 300 µg/ml) and cells were treated with LPS (10 µg/ml) for 1 h, and incubated for 48 h. The present study determined that 150 µg/ml Migri-Heal® significantly reduced the production of NO in rat mix glial cells stimulated with 10 µg/ml LPS. Migri-Heal® also suppressed mRNA expression level of LPS-induced inducible nitric oxide synthase and tumor necrosis factor α, which was accompanied by inhibition of the transcription factor nuclear factor-κB. Additionally, MTT assay determined that Migri-Heal® was not cytotoxic, suggesting that the anti-inflammatory effects of Migri-Heal® observed were not due to cell death. In conclusion, the findings of the present study demonstrated that Migri-Heal® may be useful as a potential anti-inflammatory agent in inflammatory diseases. However, additional studies are required to confirm these findings.

BackgroundThe Palaeolithic diet (PD) has gained popularity globally. There is emerging evidence of its putative health benefits as short-term effects on chronic diseases have been reported. We evaluated the association between long-term adherence to the PD and breast cancer (BC) risk among postmenopausal women.Methods65,574 women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort were followed from 1993 to 2014. Incident BC cases were identified and validated. The PD score was calculated using dietary intake self-reported at baseline (1993) and follow-up (2005) or baseline only if censored before follow-up. Multivariable Cox proportional hazards regression models were used to estimate BC hazard ratios (HR) and 95% confidence intervals (CI).ResultsOver a mean follow-up of 20 years, 3968 incident BC cases occurred. An increase of 1 standard deviation in the PD score was associated with an 8% lower BC risk, fully-adjusted model: HR1-SD 0.92, 95% CI; 0.89, 0.95. Compared to women with low adherence to the PD, women with high adherence had a 17% lower BC risk, HRQ5 vs Q1 0.83, 95% CI; 0.75, 0.92, Ptrend < 0.01. When considering BC subtypes, we observed the same pattern of association (Pheterogeneity > 0.10 for all).ConclusionsHigh adherence to a PD characterised by fruit, vegetables, nuts, fish, and lean meat and limited in dairy, grains, legumes, refined sugar, and alcohol was associated with a lower BC risk. The lack of heterogeneity according to BC subtypes could indicate the involvement of non-hormonal mechanisms. The protocol is registered at clinicaltrials.gov as NCT03285230.RegistryThe protocol is registered at clinicaltrials.gov as NCT03285230.

•Previous studies have reported that obesity and type 2 diabetes (T2D) are associated with low adherence to the 2017 French food-based dietary guidelines.•Our findings suggest that higher adherence to the simplified French dietary guidelines is associated with a lower risk of T2D in women.•A significant proportion of this association was mediated by obesity as measured by the BMI or WHR.•These results improve our understanding of the pathways in the French dietary guidelines-T2D association. Obesity and type 2 diabetes (T2D) have been associated with low adherence to the 2017 French food-based dietary guidelines, as assessed by the Programme National Nutrition Santé - guidelines score 2 (PNNS-GS2). Whether the association between T2D and PNNS-GS2 is direct or mediated by obesity has been little investigated. The study included 71,450 women from the E3N-EPIC cohort, mean age of 52.9 y (SD 6.7). The simplified PNNS-GS2 was derived via food history questionnaire. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D. Causal mediation analyses were used to decompose the total effect of sPNNS-GS2 on T2D into a direct effect and indirect effect mediated by body mass index (BMI) or the waist-hip ratio (WHR). During a mean follow-up of 19 y, 3679 incident T2D cases were identified and validated. There was a linear association between adherence to sPNNS-GS2 and T2D (P-nonlinearity = 0.92). In the fully adjusted model, each 1-SD increase in the sPNNS-GS2 was associated with a lower T2D risk [HR (95% CI), 0.92 (0.89, 0.95)]. The overall associations were mainly explained by sPNNS-GS2-associated excess weight, with BMI and WHR mediating 52% and 58% of the associations, respectively. Higher adherence to French food-based dietary guidelines was associated with a lower risk of T2D in women, and a significant portion of this effect could be attributed to excess weight measured by BMI or WHR. This finding helps better understand the mechanisms underlying the diet-T2D association.

Associations between acrylonitrile exposure and lung cancer were also observed in other studies, including a large case-control study.3 For bladder cancer, there was a positive exposure–response relationship for mortality based on categories of participants' individual average exposure in the pooled cohort study2 and imprecise associations in the other cohorts; thus, chance, bias, and confounding could not be reasonably ruled out. Talc is a high-production-volume mineral used in plastics, ceramics, paint, paper, roofing materials, rubber products, animal feed, food, fertilisers, cosmetics, and pharmaceuticals. Orally ingested talc is excreted shortly after dosing, and no or negligible intestinal absorption or translocation to other organs has been observed. Since Volume 93, more consistent positive associations for ever-use versus never-use have been reported in pooled cohort studies and case-control studies, including evidence of an exposure–response relationship with frequency or duration of use.9,10 However, bias from differential exposure misclassification could not be excluded based on a bias analysis conducted by the Working Group and confounding by asbestos contamination of the talc also could not be ruled out. The rationale for “sufficient” evidence included the unusual tumour types reported by this study (ie, bilateral malignant pheochromocytomas); and that tumours were observed in both sexes in a study conducted under Good Laboratory Practice.11 Talc induces chronic inflammation; in experimental systems in vivo, consistent and coherent evidence was observed in various tissues following different routes and exposures of up to 2 years.11 Talc alters cell proliferation, cell death, or nutrient supply; talc promoted anchorage-independent growth in human primary and immortalised ovarian epithelial cells.

The serum copper (Cu) to zinc (Zn) ratio could be an important determinant of Type 2 diabetes (T2D) risk, but prospective epidemiological data are scarce. We aimed to investigate the association between T2D incidence and the dietary Cu/Zn ratio. A total of 70,991 women from the E3N cohort study were followed for 20 years. The intakes of copper and zinc were estimated at baseline using a validated food frequency questionnaire. We identified and validated 3292 incident T2D cases. Spline analysis showed that a Cu/Zn ratio < 0.55 was associated with a lower risk of T2D. Subgroup analyses comparing women in the highest versus the lowest quintile of Cu/Zn ratio showed the same pattern of association for obese women and those with zinc intake ≥8 mg/day. However, for women with zinc intake <8 mg/day, higher Cu/Zn ratio appeared to be associated with higher T2D risk. Our findings suggest that a lower dietary Cu/Zn ratio is associated with a lower T2D risk, especially among obese women and women with zinc intake >8 mg/day. Further studies are warranted to validate our results.