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AIM: Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. This study sought to determine the specific effect of GLV intake on the incidence of CVD. METHODS: Previously published cohort studies on GLV intake and incidence of CVD were retrieved through a systematic search of Google Scholar, EMBASE, MEDLINE, HINARI and Cochrane Library. A methodological evaluation of studies was carried out using the network of Ottawa scale, and a fixed-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI). Heterogeneity was determined using the I2 statistic. Sensitivity analysis was done using the leave-one-study-out technique. All statistical analysis was carried out at p < 0.05 using RevMan 5.4. RESULTS: The pooled RR (95% CI) of incident CVD events from 17 studies was 0.93 (0.92–0.95). Specifically, GLV intake was inversely related with incident cerebral infarction (RR: 0.92; 95% CI: 0.88–0.96), heart disease (RR: 0.93; 95% CI: 0.87–0.99) and other CVD events (RR: 0.95; 95% CI: 0.93–0.98). CONCLUSION: GLV intake was associated with a lower incidence of CVD, and may be a promising primary-prevention strategy against CVD events. The findings are especially important in LMICs where the burden of CVD remains high.

Data on the burden and outcomes of recurrent strokes in sub-Saharan Africa are limited, impeding efforts at optimal recurrent stroke prevention.To assess the prevalence, risk factor profile, stroke types and mortality from recurrent strokes in Ghana and Nigeria.We analyzed data from 3553 stroke cases involved in the Stroke Investigative Research and Educational Networks (SIREN) study for proportion with recurrent strokes. Conditional logistic regression models were constructed to interrogate for risk factors of recurrent stroke compared with stroke-free controls. Generalized Linear models were used to assess correlates of recurrent strokes relative to index strokes.Among stroke cases, 335 (9.4%) were recurrent strokes, of which 79.9% were ischemic and 20.1% hemorrhagic. Those with recurrent stroke were significantly older than index stroke cases 62.2 ± 12.9 years vs 58.9 ± 14.0 years, p 0.01 respectively. Topmost risk factors associated with recurrent stroke were hypertension adjusted odds ratio 50.7 (95%CI: 6.6-392.7), dyslipidemia 2.8 (1.3-6.2), diabetes mellitus 4.0 (2.1-7.7) and family history of cardiovascular disease (CVD) 2.1 (1.1-4.2). The relative risk (95%CI) of factors associated with recurrent stroke vs index stroke were age 50 years (1.5: 1.1-2.0); Hausa ethnicity (1.5:1.1-2.1), Yoruba ethnicity with Akan as referent; table added salt (0.4:0.2-0.8) and current alcohol intake (0.6:0.4-0.9). In-patient mortality among those with recurrent stroke vs. primary stroke was 20.5% vs. 21.4%.Several modifiable lifestyle related factors may warrant additional emphasis as targets for reducing the burden of recurrent stroke in sub-Saharan Africa.

Background and purpose The role of copy number variation (CNV) variation in stroke susceptibility and outcome has yet to be explored. The Copy Number Variation and Stroke (CaNVAS) Risk and Outcome study addresses this knowledge gap. Methods Over 24,500 well-phenotyped IS cases, including IS subtypes, and over 43,500 controls have been identified, all with readily available genotyping on GWAS and exome arrays, with case measures of stroke outcome. To evaluate CNV-associated stroke risk and stroke outcome it is planned to: 1) perform Risk Discovery using several analytic approaches to identify CNVs that are associated with the risk of IS and its subtypes, across the age-, sex- and ethnicity-spectrums; 2) perform Risk Replication and Extension to determine whether the identified stroke-associated CNVs replicate in other ethnically diverse datasets and use biomarker data (e.g. methylation, proteomic, RNA, miRNA, etc.) to evaluate how the identified CNVs exert their effects on stroke risk, and lastly; 3) perform outcome-based Replication and Extension analyses of recent findings demonstrating an inverse relationship between CNV burden and stroke outcome at 3 months (mRS), and then determine the key CNV drivers responsible for these associations using existing biomarker data. Results The results of an initial CNV evaluation of 50 samples from each participating dataset are presented demonstrating that the existing GWAS and exome chip data are excellent for the planned CNV analyses. Further, some samples will require additional considerations for analysis, however such samples can readily be identified, as demonstrated by a sample demonstrating clonal mosaicism. Conclusion The CaNVAS study will cost-effectively leverage the numerous advantages of using existing case-control data sets, exploring the relationships between CNV and IS and its subtypes, and outcome at 3 months, in both men and women, in those of African and European-Caucasian descent, this, across the entire adult-age spectrum.

Additional file 2. A Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Checklist.

Additional file 1. Supplementary Table S1: Critical assessment of included studies using the Newcastle-Ottawa Scale (NOS). Supplementary Figure S1: Funnel plot of lipid profile; total cholesterol (A), triglyceride (B), HDL (c) and LDL (D) between cases and non-cases of ovarian tumours; summarizing the publication bias in the meta-analysis. Supplementary Figure S2: Graphical illustration of the results of the critical assessment of studies; Is the Case Definition Adequate? (S1), representativeness of the Cases (S2), selection of Controls (S3), definition of Controls (S4), comparability of cases and controls on the basis of the design or analysis (C1), ascertainment of exposure (E1), same method of ascertainment of exposure for cases and controls (E2), overall risk of bias of all studies included. Supplementary Table S2: Sensitivity Analysis (using one study leave out method) of pooled mean differences of Lipid profiles between cases and non-cases of ovarian tumour.

The World Health Organization's Quality of Life Instrument (WHOQOL-BREF) is widely validated and popularly used in assessing perceived quality of life (QOL) of adolescents and the general population. Though the WHOQOL-BREF has been used in some studies in Nigeria, its theoretical structure has not been comprehensively investigated. This study examined the factor structure of the Adopted WHOQOL-BREF questionnaire and it theoretical structure in a large sample of adolescents in Nigeria.Data on demographic characteristics and QOL were extracted from 1,963 adolescents who participated in a state-wide study on psychosocial functioning and quality of life of adolescents in Benue State, Nigeria. Descriptive statistics were used to present the distribution of the data while Cronbach's alpha and Polychoric ordinal alpha were used to describe the internal consistency (reliability) of the adapted WHOQOL-BREF and alpha value of 0.700 was considered reliable. Structural analysis was performed to extract the underlying factors while confirmatory factor analyses were used to assess some hypothesized structure of the adapted WHO-QOL BREF. Relative Chi-square test (Participants were mostly male (54.8%) and 14.7±1.4 years old with 51.0% residing in rural areas. The overall internal consistency of the 4-factor model was 0.862 (for Cronbach's Alpha) and 0.989 (for Polychoric Alpha) while the 2-factor model had 0.870 (for Cronbach's Alpha) and 0.990 (for Polychoric Alpha). The Cattelle's Scree plot, Horn's parallel analysis and the confirmatory factor analysis revealed a 2-factor model as the best model for the WHO-QOL BREF. The 23-item 2-factor structure had a relative Chi-square test valueThe adapted WHO QOL BREF can be safely used to assess quality of life among Adolescents in Nigeria and related settings. Using the two factors extracted in the present study may yield better results in settings similar to the present study location.