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Apolipoprotein E (APOE) ε4, the strongest genetic risk factor for late onset Alzheimer's disease (LOAD), has been associated with cognitive decline independent from AD pathology, but the role for other LOAD risk genes in normal cognitive aging is less studied. We examined the effect of APOE ε4 and several different polygenic risk scores (PRS) for LOAD on cognitive level and decline in aging, using longitudinal data from the UK Biobank. While PRS-LOAD including all variants (except APOE) predicted cognitive level, APOE ε4 and PRS-LOAD based on 17 non-APOE gene variants with strong association to AD (p < 5e-8) predicted age-related decline in verbal numeric reasoning. The effect on decline were partly driven by 4 variants involved in the immune system. Those variants also predicted serum levels of the inflammatory marker C-reactive protein (CRP), but CRP did not mediate the effect on decline. Those findings suggest genetic variations in immune functions play a role in aspects of cognitive aging that may be independent of LOAD pathology as well as systemic inflammation measured by CRP.

Main focuses of the review were that during the pandemic of SARS-CoV-2 were gastrointestinal disorders were accompanying. Viral RNA and viral particles are found in feces for more than 30 days. Although SARS-CoV-2 primarily causes lung infection through binding to ACE2 receptors, intestinal epithelial cells, especially enterocytes of the small intestine, also express ACE2 receptors. It is also known that a respiratory viral infection causes disturbances in the gut microbiota. Diet, environmental factors, and genetics play an important role in the formation of gut microbiota, which can affect immunity. The diversity of gut microbiota diminishes in old age, and Covid-19 has been mostly fatal in older patients, further indicating the role that gut microbiota may play in this disease. It is therefore plausible that the gut microbiota could be a new therapeutic target and that probiotics could have a role in the management of these patients.

Summary Background Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs—and its variation between countries and population groups—by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage. Methods In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval. Findings Our pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9–74·3) had ever had their blood pressure measured, 39·2% of participants (38·2–40·3) had been diagnosed with hypertension, 29·9% of participants (28·6–31·3) received treatment, and 10·3% of participants (9·6–11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade. Interpretation Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Funding Harvard McLennan Family Fund, Alexander von Humboldt Foundation.

BACKGROUND The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required. OBJECTIVES The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation. METHODS Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics. RESULTS The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6-19.4%). Mean intake of fruits was 1.15 (1.10-1.20) servings per day and for vegetables, 2.46 (2.40-2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P

Background Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population’s median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. Methods and findings We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%–4.2%) and 1.6% (1.3%–2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%–37.2%) for males and 41.6% (23.9%–53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%–58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. Conclusions This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk., Author summary Why was this study done? CVD burden in low-income and middle-income countries (LMICs) is high and rising. CVD risk estimation using validated risk prediction equations is recommended in most guidelines; however, there are few population-representative analyses of CVD risk and its association with socio-demographic characteristics. Despite guidelines recommending using CVD risk estimates as an essential first step in guiding management practices, the extent to which risk-based approaches are being implemented in LMICs is not well characterised. What did the researchers do and find? We analysed population-representative survey data from 45 LMICs to determine country-specific levels of CVD risk, associations between socio-demographic factors and levels of CVD risk, and adherence to WHO guidelines on use of blood pressure medication. We found high variation in CVD risk profiles, with higher levels of risk in the Europe and the Eastern Mediterranean region and lower levels of risk in sub-Saharan Africa, as well as an inverse association between CVD risk and higher education and employment in most countries. We found an underuse of medicines in people at elevated CVD risk across all countries (only 24.2% of males and 41.6% of females at high CVD risk are taking guideline-recommended BP medication) and an overuse of medicines in people at lower levels of CVD risk, with 47% of all BP medication being used by people at low CVD risk without a guideline indication for use. What do these findings mean? There is large variation in CVD risk across LMICs, and an inverse association between CVD risk and higher education and employment in most countries. There is an overuse of medicines in people at lower levels of CVD risk and an underuse of medicines in people at elevated CVD risk across all countries. The large heterogeneity of the findings in this study reflects varying country contexts. Country-specific targeted policies are needed to improve the identification and management of those at highest CVD risk.

Background The information on dental caries experience and its determinants in Central Asia is limited. The aim of the present study was to provide estimates of the mean levels, prevalence and severity of dental caries, and to identify the factors associated with these characteristics in the population of school-aged children from four regions in Kazakhstan.Methods We examined 2149 schoolchildren aged 11–15 years from 4 regions of Kazakhstan. The overall response rate was 68%. Dental caries experience was assessed clinically, and standardized questionnaire was used to gather sociodemographic and oral health behavior information. Caries experience was measured by using DMFT (decayed, missing, and filled teeth) index. Negative binomial hurdle regression model was used to assess the relationship between the caries experience and covariates.Results The overall prevalence of dental caries was 74%, obvious decayed teeth was found in 44% of subjects, while only 6% had missing teeth and 24% had their teeth treated. The mean DMFT index was 2.48 among 12-year-olds and 3.9 among 15-year-olds. There were large differences of dental caries experience between the regions, with all indicators (decayed, missed and filled teeth) being less favourable in Semey region. The caries prevalence experience in the studied population was associated with higher age, geographic region, ethnicity, mother’s education, material deprivation, frequent consumption of sugar-added drinks, age of start brushing the teeth and dental attendance pattern. Age, region, ethnicity, dietary habits and dental attendance pattern were found to be significantly associated with the predicted degree of caries experience among those with caries experience.Conclusions The high prevalence of dental caries and large differences in caries indices between the regions in Kazakhstan might be related to rapid westernization in the Central Asian region and associated nutrition transition. Also, the increasing burden of untreated caries in less advantaged populations was observed. Parent education and material deprivation may be a very important determinants of the oral health among adolescents in Kazakhstan.

Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. Methods and findings We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases (‘NCD readiness indicators’ from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08–3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09–4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02–1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06–1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11–1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01–1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12–2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01–1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09–1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01–1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes. Conclusion In this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries’ preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care., Author summary Why was the study done? Diseases such as high blood pressure and diabetes are becoming increasingly common in low- and middle-income countries (LMICs). Treatment for these conditions is simple and cheap. However, without treatment, sufferers are at high risk of adverse consequences, such as heart attacks and strokes. It is important therefore to be able to measure whether patients who need treatment are getting it. Currently, LMICs’ progress towards being able to treat patients with hypertension and diabetes is measured using proxies, for example, whether policies, guidelines, funding, structures, or human resources are in place. What did the researchers find? We measured whether 187,552 people with hypertension living in 43 LMICs and 40,795 people with diabetes living in 28 LMICs had their high blood pressure or diabetes treated well; i.e., they had these conditions diagnosed, treated, or controlled. We found that most proxy measures were not reflective of whether patients had their condition treated well. What do these findings mean? To judge countries’ progress towards ability to treat hypertension and diabetes requires directly assessing whether people with these diseases are getting the treatment that they need. The main limitation of the study was that a one-time measurement of blood pressure or blood glucose was used to define whether participants had high blood pressure or diabetes. To make a concrete clinical diagnosis requires more detailed investigation.

Introduction: The immune-modulatory effects of synbiotics and their ability to reduce free radical levels may be useful for functional food that is able to be active throughout whole period of colonization of the gastrointestinal tract.The aim of the present study was to investigate the immune-modulatory and antioxidant effects of the synbiotic product "NАR," a probiotic beverage.Methods: The presence of IL-2, IL-4, IL-6, IL-8, IL-10, αTNF, γIFN, Ig A, Ig M, and Ig E was studied in vitro using a solid immunosorbent analysis. The total antioxidant activities of superoxide dismutase and glutathione reductase were determined by a spectrophotometry using the Sigma-Aldrich sets.Results: Studies of the immune-modulatory properties of the synbiotic product NAR showed 1.7 fold increase of γINF levels (p

ObjectiveVery little is known about prevalence of common cardiovascular risk factors in Central Asia. The aim of the study was to assess the prevalence, awareness, treatment and control of arterial hypertension, and factors associated with these indices in a population sample of Astana, the new capital city of Kazakhstan.DesignCross-sectional study of subjects registered in eight outpatient policlinics in Astana.MethodsA total of 497 adults (response rate 56%) aged 50–75 years randomly selected from registers of the policlinics were examined. Hypertension was defined as a mean systolic and/or diastolic blood pressure of ≥140/90 mm Hg and/or antihypertensive medication use during the last two weeks. Awareness and treatment were based on self-report. Hypertension control was defined as blood pressure

Background The high and fluctuating mortality and rising health inequalities in post-Soviet countries have attracted considerable attention. However, there are very few individual-level data on distribution of health outcomes in Central Asian countries of the former Soviet Union. We analysed socioeconomic predictors of two self-rated health outcomes in a national survey in Kazakhstan. Methods We used data from the 2012 Kazakhstan Household Health Survey on 12,560 respondents aged 15+. Self-rated health, self-reported worsening of health, and a range of socio-demographic variables were collected in an interview. The self-rated health outcomes were dichotomized and logistic regression was used to estimate their associations with education, income, ownership of a car, second house and computer, marital status, ethnicity and urban/rural residence. Results The prevalence of poor/very poor self-rated health was 5.3%, and 11.0% of participants reported worse health compared to 1 year ago. After controlling for age, sex and region, all socio-demographic factors were related to self-rated health. After adjusting for all variables, education and car ownership showed the most consistent effects; the odds ratio of poor health and worsening of health were 0.43 (95% confidence interval 0.32-0.58) and 0.54 (0.44-0.68) for university vs. primary education, respectively, and 0.64 (0.51-0.82) and 0.68 (0.58-0.80) for car ownership, respectively. Unmarried persons, ethnic Russians and urban residents also had increased prevalence of poor health in multivariable models. Conclusions Despite the limitations of using subjective health measures, these data suggest strong associations between two measures of self-rated health and a number of socioeconomic characteristics. Future studies and health policy initiatives in Kazakhstan and other Central Asian countries should take social determinants of health into account.

Introduction: Lactobacilli are a bacteria commonly found in the gastrointestinal tract. Some species of this genus have probiotic properties. The most common of these is Lactobacillus rhamnosus , a microoganism, generally regarded as safe (GRAS). It is also a homofermentative L-(+)-lactic acid producer. The genus Lactobacillus is characterized by an extraordinary degree of the phenotypic and genotypic diversity. However, the studies of the genus were conducted mostly with the unequally distributed, non-random choice of species for sequencing; thus, there is only one representative genome from the Lactobacillus rhamnosus clade available to date. The aim of this study was to characterize the genome sequencing of selected strains of Lactobacilli . Methods: 109 samples were isolated from national domestic dairy products in the laboratory of Center for life sciences. After screaning isolates for probiotic properties, a highly active Lactobacillus spp strain was chosen. Genomic DNA was extracted according to the manufacturing protocol (Wizard® Genomic DNA Purification Kit). The Lactobacillus rhamnosus strain was identified as the highly active Lactobacillus strain accoridng to its morphological, cultural, physiological, and biochemical properties, and a genotypic analysis. Results: The genome of Lactobacillus rhamnosus was sequenced using the Roche 454 GS FLX (454 GS FLX) platforms. The initial draft assembly was prepared from 14 large contigs (20 all contigs) by the Newbler gsAssembler 2.3 (454 Life Sciences, Branford, CT). Conclusion: A full genome-sequencing of selected strains of lactic acid bacteria was made during the study.

Cardiovascular diseases are the most common cause of mortality and morbidity in most populations. As the traditional modifiable risk factors (smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity) were defined decades ago, we decided to analyze recent data in patients who survived acute coronary syndrome (ACS). The Czech part of the study included data from 999 males, and compared them with the post-MONICA study (1,259 males, representing general population). The Lithuanian study included 479 male patients and 456 age-matched controls. The Kazakhstan part included 232 patients and 413 controls. In two countries, the most robust ACS risk factor was smoking (OR 3.85 in the Czech study and 5.76 in the Lithuanian study), followed by diabetes (OR 2.26 and 2.07) and hypertension (moderate risk elevation with OR 1.43 and 1.49). These factors did not influence the ACS risk in Kazakhstan. BMI had no significant effect on ACS and plasma cholesterol was surprisingly significantly lower (P