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Primary prevention of cardiovascular disease: A review of contemporary guidance and literature
Cardiovascular disease is a significant and ever-growing problem in the United Kingdom, accounting for nearly one-third of all deaths and leading to significant morbidity. It is also of particular and pressing interest as developing countries experience a change in lifestyle which introduces novel risk factors for cardiovascular disease, leading to a boom in cardiovascular disease risk throughout the developing world. The burden of cardiovascular disease can be ameliorated by careful risk reduction and, as such, primary prevention is an important priority for all developers of health policy. Strong consensus exists between international guidelines regarding the necessity of smoking cessation, weight optimisation and the importance of exercise, whilst guidelines vary slightly in their approach to hypertension and considerably regarding their approach to optimal lipid profile which remains a contentious issue. Previously fashionable ideas such as the polypill appear devoid of in-vivo efficacy, but there remain areas of future interest such as the benefit of serum urate reduction and utility of reduction of homocysteine levels.
Journal Article
Education in an era of schooling : critical perspectives of educational practice and action research : a festschrift for Stephen Kemmis
This book is a Festschrift for Emeritus Professor Stephen Kemmis, who has a long and eminent career as an educational researcher and academic spanning over 40 years. His work in curriculum, evaluation, critical practice, action research and practice theory has been influential across all continents of the world. The book examines critical perspectives on educational practice and the participatory nature of action research, including practitioner research particularly as undertaken by teachers in schools. Including vignettes from Kemmis' colleagues and mentors, it draws on contributions from a range of academics whose scholarship has been inspired, influenced and initiated by his work. The chapters stem from a range of countries, including Australia, Canada, Finland, Sweden, the United Kingdom, United States of America, and Trinidad and Tobago - a testimony to the enduring and global legacy of Kemmis' scholarship. Contributing authors include leading educational research scholars, indigenous elders from Australia, and community leaders concerned with environmental sustainability. The concluding focus of this book turns towards practice theory. Kemmis' later work led to the development of the theory of practice architectures and gave rise to the development of the theory of ecologies of practices in education. Research drawing on the theory of practice architectures and ecologies of practices resulted in the leading text \"Changing practices, changing education\" (Kemmis, Wilkinson, Edwards-Groves, Hardy, Grootenboer & Bristol, 2014, Springer) that reports on an Australian investigation of the ecological relationship between student learning, teaching, professional learning, leading and researching practices. This theory is now being applied to study practices across a wide range of international contexts, sites and disciplines including early childhood, school education, university education, vocational education and training, community environment, indigenous cultural sustainability and health.
Book
Emissions from conventional and electronic waterpipes relative to cigarettes and a heated tobacco product
Harms associated with the use of smoked tobacco products, including waterpipes, are due to inhalational exposure to toxicants either present in tobacco or formed during the process of combustion. We assessed levels of 37 toxicants in aerosol emissions from conventional waterpipe heated with different charcoals and also with a heat management device (HMD), from the IQOS heated tobacco product (HTP), and the ‘OOKA’ electronic waterpipe. We also utilised literature data on toxicant yields in 3R4F reference cigarette smoke. When taking use patterns into account, toxicant yields were substantially lower in conventional waterpipe aerosol compared with cigarette smoke. Toxicant yields in electronic waterpipe aerosol were substantially lower than those in conventional waterpipe aerosol, both on a per session basis and when taking typical use patterns into account. Numerous toxicants in conventional waterpipe aerosol were absent in electronic waterpipe aerosol. In summary, during typical use conventional waterpipe emits fewer, and lower levels of, a number of toxicants relative to combustible cigarette smoke. In addition, electronically heating shisha further reduces toxicant levels, and many toxicants are absent in OOKA electronic waterpipe aerosol. These findings have important implications concerning toxicant exposure among waterpipe users, and for understanding how to potentially reduce health risks associated with waterpipe use.
Journal Article
Indoor Air Quality Assessment During the Use of Tobacco and Nicotine Products
Chemical toxicants released into the environment during the use of tobacco and nicotine products potentially give rise to an elevated health risk among non-users. The aim of this study was to assess the levels of a wide range of chemical toxicants in the indoor air of an unventilated testing facility during various scenarios of tobacco and nicotine product use, including the use of conventional waterpipes, electronic vaping products (EVPs, also known as e-cigarettes), an electronic waterpipe which uses electrical heating of shisha tobacco instead of conventional charcoal heating, and combustible-cigarettes. In the one-occupant scenarios, increases in PM10 and PM2.5 were greatest during conventional waterpipe use, approximately 40% lower for OOKA electronic waterpipe use, and lowest for EVP use. An increase in the combustion by-product CO was greatest for conventional waterpipe use, and substantially lower for EVP and OOKA electronic waterpipe use, with the latter generating only a negligible amount of CO. The increase in formaldehyde levels was greatest for conventional waterpipe use, and substantially lower for OOKA electronic waterpipe use. In ten-occupant product use scenarios, increases in PM10 and PM2.5 were greatest for EVP use and slightly lower for OOKA electronic waterpipe use, lower during the cigarette smoking scenario, and lowest for the unattended conventional waterpipes scenario. Increases in CO and formaldehyde were highest for the conventional waterpipes scenario, substantially lower during cigarette smoking, and negligible for OOKA electronic waterpipe and EVP use. Increases in several other volatile organic compounds and some polycyclic aromatic hydrocarbons were mainly seen only during cigarette smoking and were negligible during the other product use scenarios. This pattern was similar for the tobacco-specific nitrosamines NNN, NNK, and NAT. These findings have important implications concerning the potential for secondhand toxicant exposure among waterpipe non-users, and for understanding how to potentially reduce health risks associated with such exposure. [Contrib. Tob. Nicotine Res. 34 (2025) 230–241]
Journal Article
Risk Profiles and Antithrombotic Treatment of Patients Newly Diagnosed with Atrial Fibrillation at Risk of Stroke: Perspectives from the International, Observational, Prospective GARFIELD Registry
Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated.
The Global Anticoagulant Registry in the FIELD (GARFIELD) is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5) took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults (≥18 years) diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with ≥1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes), and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD) age of the population was 70.2 (11.2) years; 43.2% were women. Mean±SD CHADS2 score was 1.9±1.2, and 57.2% had a score ≥2. Mean CHA2DS2-VASc score was 3.2±1.6, and 8,957 (84.4%) had a score ≥2. Overall, 38.0% of patients with a CHADS2 score ≥2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (score 0) received anticoagulant therapy.
These contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke.
ClinicalTrials.gov TRI08888.
Journal Article
Endogenous APOBEC3B overexpression characterizes HPV-positive and HPV-negative oral epithelial dysplasias and head and neck cancers
The DNA cytosine deaminase APOBEC3B (A3B) is a newly recognized endogenous source of mutations in a range of human tumors, including head/neck cancer. A3B inflicts C-to-T and C-to-G base substitutions in 5′-TCA/T trinucleotide motifs, contributes to accelerated rates of tumor development, and affects clinical outcomes in a variety of cancer types. High-risk human papillomavirus (HPV) infection causes A3B overexpression, and HPV-positive cervical and head/neck cancers are among tumor types with the highest degree of APOBEC signature mutations. A3B overexpression in HPV-positive tumor types is caused by the viral E6/E7 oncoproteins and may be an early off-to-on switch in tumorigenesis. In comparison, less is known about the molecular mechanisms responsible for A3B overexpression in HPV-negative head/neck cancers. Here, we utilize an immunohistochemical approach to determine whether A3B is turned from off-to-on or if it undergoes a more gradual transition to overexpression in HPV-negative head/neck cancers. As positive controls, almost all HPV-positive oral epithelial dysplasias and oropharyngeal cancers showed high levels of nuclear A3B staining regardless of diagnosis. As negative controls, A3B levels were low in phenotypically normal epithelium adjacent to cancer and oral epithelial hyperplasias. Interestingly, HPV-negative and low-grade oral epithelial dysplasias showed intermediate A3B levels, while high-grade oral dysplasias showed high A3B levels similar to oral squamous cell carcinomas. A3B levels were highest in grade 2 and grade 3 oral squamous cell carcinomas. In addition, a strong positive association was found between nuclear A3B and Ki67 scores suggesting a linkage to the cell cycle. Overall, these results support a model in which gradual activation of A3B expression occurs during HPV-negative tumor development and suggest that A3B overexpression may provide a marker for advanced grade oral dysplasia and cancer.
Journal Article