ResearchGlobal mesothelioma mortality Vanya Delgermaa et al.

BackgroundLittle is known about the global magnitude of mesothelioma. In particular, many developing countries, including some with extensive historical use of asbestos, do not report mesothelioma.ObjectivesWe estimated the global magnitude of mesothelioma accounting for reported and unreported cases.MethodsFor all countries with available data on mesothelioma frequency and asbestos use (n = 56), we calculated the 15-year cumulative number of mesotheliomas during 1994–2008 from data available for fewer years and assessed its relationship with levels of cumulative asbestos use during 1920–1970. We used this relationship to predict the number of unreported mesotheliomas in countries for which no information on mesothelioma is available but which have recorded asbestos use (n = 33).ResultsWithin the group of 56 countries with data on mesothelioma occurrence and asbestos use, the 15-year cumulative number of mesothelioma was approximately 174,300. There was a statistically significant positive linear relation between the log-transformed national cumulative mesothelioma numbers and the log-transformed cumulative asbestos use (adjusted R2 = 0.83, p < 0.0001). Extrapolated to the group of 33 countries without reported mesothelioma, a total of approximately 38,900 (95% confidence interval, 36,700–41,100) mesothelioma cases were estimated to have occurred in the 15-year period (1994–2008).ConclusionsWe estimate conservatively that, globally, one mesothelioma case has been overlooked for every four to five reported cases. Because our estimation is based on asbestos use until 1970, the many countries that increased asbestos use since then should anticipate a higher disease burden in the immediate decades ahead.

There is a paucity of information concerning the current situation of ARD in Asia. The marked increase in asbestos use in Asia since 1970, however, is likely to trigger a surge of ARD in the immediate decades ahead.

ObjectiveTo explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes.DesignCross-sectional observational study.Setting150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific.Participants1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017.Main outcome measuresExclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation.ResultsFifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose–response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30–59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60–89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF.ConclusionEENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.

Background Over the past few decades, economic, political, and social changes have directly and indirectly affected the health of the Mongolian population. To date, no comprehensive analysis has been conducted on the burden of diseases in this country. Thus, we aimed to describe the leading causes of death and disabling conditions and their trends between 1990 and 2019 in the Mongolian population. Methods We used the data from the Global Burden of Disease (GBD) 2019 study. In the current study, we examined life expectancy at birth, healthy life expectancy, the 20 leading causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted-life-years (DALYs), and the contribution of major risk factors to DALYs in Mongolia. Findings The life expectancy at birth in Mongolia has gradually increased since 1995 and reached 63.8 years for men and 72.7 for women in 2019. The highest increase in the age-standardised death rate between 1990 and 2019 occurred in alcohol use disorders (628.6%; 95% UI 10.0–1109.6) among men, and in liver cancer (129.1%; UI 65.3–222.4) among women. Ischaemic heart disease and stroke showed the highest rates of death, YLLs, and DALYs among both men and women. In 2019, the highest age-standardised rates of DALYs were attributable to high systolic blood pressure and dietary risks. Interpretation Although Mongolia saw substantial improvements across many communicable diseases, maternal and neonatal disorders, and under-5 mortality between 1990 and 2019, non-communicable diseases remained leading causes of mortality. The mortality from the most preventable causes such as injury, alcohol use, and dietary risks remain substantially high, suggesting that individual and social efforts are needed to tackle these diseases. Our analyses will support the development of policy priorities and action plans in multiple sectors to improve the overall health of the Mongolian population. Funding Bill & Melinda Gates Foundation.

BackgroundNational disparities in asbestos use will likely lead to an unequal burden of asbestos diseases.ObjectivesAs economic status may be linked to asbestos use, we assessed, globally, the relationship between indicators of national economic development and asbestos use.MethodsFor the 135 countries that have ever used asbestos, per capita asbestos use (kilograms per capita per year) was compared with per capita gross domestic product (GDP) in 1990 Geary–Khamis dollars (GKD) for the period 1920–2003. Countries were grouped into three income levels (high, middle, and low) that were adapted from the 2003 World Bank categories.ResultsThe historical pattern of asbestos use followed the environmental Kuznets curve in which use by high-income countries peaked when incomes attained 10,000–15,000 GKD and essentially ceased at income levels over 20,000 GKD. Currently, middle- and low-income countries are increasing their use of asbestos, closely following the paths once traced by higher income countries.ConclusionsDeveloping countries have the opportunity to eliminate asbestos use sooner than high-income countries and thus reduce the future burden of asbestos diseases.

The current burden of asbestos-related diseases (ARDs) in terms of PYLL is substantial. The future burden of ARDs can be eliminated by stopping the use of asbestos.

Objective The aim of our prospective cohort study was to assess cancer mortality risks among chromium platers. MethodsThe cohort comprised 1193 male platers (626 with exposure to chromium, the remainder with no exposure) with a follow-up period of 27 years (1 October 1976 to 31 December 2003). Mortality risk was assessed by the standardized mortality rate (SMR) with reference to the national population.Results Lung cancer mortality was elevated only in the chromium plater subgroup, with borderline statistical significance [SMR=1.46, observations (Obs) = 28, 95% confidence interval (95% CI) 0.98-2.04]. The chromium plater subgroup also showed elevated mortality risks for brain tumor (SMR=9.14, Obs=3, 95% CI 1.81-22.09) and malignant lymphoma (SMR=2.84, Obs=6, 95% CI 1.05-5.51). Risks were particularly elevated for lung cancer (SMR=1.59, Obs=23, 95% CI 1.01-2.38) and malignant lymphoma (SMR=3.80, Obs=6, 95% CI 1.39-8.29) among those with initial chromium exposure prior to 1970. ConclusionsIn Japan, occupational exposure to chromium through work as a chromium plater is a risk factor for lung cancer, especially for platers working prior to 1970. Occupational chromium exposure may also increase the risk of brain tumor and malignant lymphoma.