UNASSIGNED: Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking. In this study we aimed to explore the association of current tobacco use with different types of tobacco exposure and environmental tobacco smoke (ETS) exposure on the risk of stroke and stroke subtypes, and by regions and country income levels.
UNASSIGNED: The INTERSTROKE study is a case-control study of acute first stroke and was undertaken with 13,462 stroke cases and 13,488 controls recruited between January 11, 2007 and August 8, 2015 in 32 countries worldwide. Association of risk of tobacco use and ETS exposure were analysed with overall stroke, ischemic and intracerebral hemorrhage (ICH), and with TOAST etiological stroke subtypes (large vessel, small vessel, cardioembolism, and undetermined).
UNASSIGNED: Current smoking was associated with an increased risk of all stroke (odds ratio [OR] 1.64, 95% CI 1.46-1.84), and had a stronger association with ischemic stroke (OR 1.85, 95% CI 1.61-2.11) than ICH (OR 1.19 95% CI 1.00-1.41). The OR and PAR of stroke among current smokers varied significantly between regions and income levels with high income countries (HIC) having the highest odds (OR 3.02 95% CI 2.24-4.10) and PAR (18.6%, 15.1-22.8%). Among etiological subtypes of ischemic stroke, the strongest association of current smoking was seen for large vessel stroke (OR 2.16, 95% CI 1.63-2.87) and undetermined cause (OR 1.97, 95% CI 1.55-2.50). Both filtered (OR 1.73, 95% CI 1.50-1.99) and non-filtered (OR 2.59, 95% CI 1.79-3.77) cigarettes were associated with stroke risk. ETS exposure increased the risk of stroke in a dose-dependent manner, exposure for more than 10 h per week increased risk for all stroke (OR 1.95, 95% CI 1.69-2.27), ischemic stroke (OR 1.89, 95% CI 1.59-2.24) and ICH (OR 2.00, 95% CI 1.60-2.50).
UNASSIGNED: There are significant variations in the magnitude of risk and PAR of stroke according to the types of tobacco used, active and ETS exposure, and countries with different income levels. Specific strategies to discourage tobacco use by any form and to build a smoke free environment should be implemented to ease the global burden of stroke.
UNASSIGNED: The Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MERCK, Sharp and Dohme, Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke.

BACKGROUND: Trihalomethanes (THM), a major class of disinfection by-products, are widespread and are associated with adverse health effects. We conducted a global evaluation of current THM regulations and concentrations in drinking water.
METHODS: We included 120 countries (∼7000 million inhabitants in 2016), representing 94% of the world population. We searched for country regulations and THM routine monitoring data using a questionnaire addressed to referent contacts. Scientific and gray literature was reviewed where contacts were not identified or declined participation. We obtained or estimated annual average THM concentrations, weighted to the population served when possible.
RESULTS: Drinking water regulations were ascertained for 116/120 (97%) countries, with 89/116 (77%) including THM regulations. Routine monitoring was implemented in 47/89 (53%) of countries with THM regulations. THM data with a varying population coverage was obtained for 69/120 (58%) countries consisting of ∼5600 million inhabitants (76% of world\'s population in 2016). Population coverage was ≥90% in 14 countries, mostly in the Global North, 50-89% in 19 countries, 11-49% among 21 countries, and ≤10% in 14 countries including India, China, Russian Federation and Nigeria (40% of world\'s population).
CONCLUSIONS: An enormous gap exists in THM regulatory status, routine monitoring practice, reporting and data availability among countries, especially between high- vs. low- and middle-income countries (LMICs). More efforts are warranted to regulate and systematically assess chemical quality of drinking water, centralize, harmonize, and openly report data, particularly in LMICs.

UNASSIGNED: Coronavirus disease 2019 (COVID-19) began in 2019 with several unknown factors. The World Health Organization (WHO) subsequently developed COVID-19 occupational safety and health (OSH) guidelines to reduce occupational COVID-19 transmission. Many countries also developed their own COVID-19 OSH guidelines, but whether these guidelines included WHO\'s guidelines and whether including WHO\'s guidelines in countries\' COVID-19 OSH guidelines reduced COVID-19 transmission is unknown.
UNASSIGNED: The objectives of our study were to (1) compare the COVID-19 OSH guidelines of several countries to WHO\'s OSH guidelines, (2) estimate associations between characteristics of countries and their OSH guidelines and the number of WHO\'s OSH guidelines included in countries\' OSH guidelines, and (3) estimate associations between WHO\'s OSH guidelines included in countries\' OSH guidelines and COVID-19 risk, death risk, and case-fatality proportion.
UNASSIGNED: This study represents international, ecological research of 36 countries from all six world health regions. Countries\' COVID-19 OSH guidelines were compared with WHO\'s OSH guidelines. Linear regression models adjusted for potential confounders were used to estimate associations of interest.
UNASSIGNED: The median number of WHO\'s 15 COVID-19 OSH guidelines included in countries\' COVID-19 OSH guidelines was eight. Countries\' COVID-19 OSH guidelines focused on workers included significantly more of WHO\'s COVID-19 OSH guidelines than countries\' COVID-19 OSH guidelines focused on general populations. Including \"provide personal protective equipment for workers\" and \"create workplace policy for wearing personal protective equipment\" in countries\' COVID-19 OSH guidelines were significantly related to decreased COVID-19 risk, death risk, and/or case-fatality proportion.
UNASSIGNED: Countries\' COVID-19 OSH guidelines should include WHO\'s guidelines, focus on workers, and include \"provide personal protective equipment for workers\" and \"create workplace policy for wearing personal protective equipment.\"

Whole grains are a vital part of a healthy diet, yet there are insufficient data on the whole-grain content of commercial food products. The purpose of this research is to examine the long-term change in (1) measured whole grains in food products, (2) Whole Grain Stamp usage and (3) the prominence of whole-grain ingredients and product categories, across the United States and Latin America. These changes were quantified by analyzing the Oldways Whole Grains Council\'s (WGC) Stamped Product Database from 2007 to 2020. Mean whole grains increased 36-76%, from 19 grams to 25.8 grams per serving in the U.S. and 18.1 grams to 31.9 grams per serving in Latin America. Whole Grain Stamp usage worldwide has increased from 250 products in 2005 to more than 13,000 products in 2020. These findings suggest that manufacturers are increasing the percentage of the grain that is whole in their products and developing more whole-grain products for consumers, thus providing an opportunity for consumers to meet national-level whole-grain recommendations.

The use of reporting terminologies for thyroid FNA cytology enables standardisation and international alignment of the reporting of thyroid cytology results, which is essential. There are currently three major internationally recognised systems: Bethesda (TBS), UK RCPath (Thy), and Italian (TIR). A fourth terminology system used in Japan has identical categories to TBS but with different nomenclature. The aim of this review is to discuss the strengths and weaknesses of the TBS, UK RCPath, and TIR systems, and to make the case for international terminology harmonisation and standardisation.

UNASSIGNED: In developing countries, long bone fractures following trauma are a significant contributor to morbidity, and operating room resources are often limited in these settings. The Surgical Implant Generation Network (SIGN) Fin nail may reduce the challenges of retrograde intramedullary nailing of femoral fractures without fluoroscopy. In contrast to the traditional SIGN nail placed in a retrograde fashion, the Fin nail does not require proximal interlocking screws. Instead, the nail achieves stability through an interference fit within the proximal femoral canal. The purpose of this study is to compare postoperative alignment in femoral shaft fractures treated with either a retrograde SIGN Fin nail or a standard retrograde SIGN nail.
UNASSIGNED: Using the SIGN online surgical database, we identified all femoral shaft fractures treated with a retrograde SIGN Fin nail at 2 African hospitals. Two examiners independently classified fracture patterns using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification system. Using an on-screen protractor tool, postoperative coronal and sagittal plane alignment were measured and recorded as deviation from anatomic alignment (DFAA), with units in degrees. Available patient demographics and surgical details were also recorded. Fin nail cases were matched in a 1:1 ratio to retrograde standard SIGN nail cases based on AO/OTA fracture type.
UNASSIGNED: Twenty-eight retrograde Fin nail cases were identified, and 28 matched retrograde SIGN nail cases were selected. The Fin nail and retrograde SIGN nail groups were well matched in terms of demographics, AO/OTA fracture type, and surgical characteristics. There was no significant difference in postoperative coronal or sagittal plane alignment between the groups. There were no cases in either group of average postoperative malalignment >5° in any plane.
UNASSIGNED: The SIGN Fin nail appears to achieve satisfactory radiographic alignment without the need for proximal interlocking screws, making it an attractive implant for retrograde femoral shaft fracture fixation in resource-limited settings. Further research is required to validate these findings and determine long-term Fin nail clinical outcomes.

OBJECTIVE: To conduct international comparisons of self-reports, collateral reports, and cross-informant agreement regarding older adult psychopathology.
METHODS: We compared self-ratings of problems (e.g. I cry a lot) and personal strengths (e.g. I like to help others) for 10,686 adults aged 60-102 years from 19 societies and collateral ratings for 7,065 of these adults from 12 societies.
METHODS: Data were obtained via the Older Adult Self-Report (OASR) and the Older Adult Behavior Checklist (OABCL; Achenbach et al., 2004).
RESULTS: Cronbach\'s alphas were .76 (OASR) and .80 (OABCL) averaged across societies. Across societies, 27 of the 30 problem items with the highest mean ratings and 28 of the 30 items with the lowest mean ratings were the same on the OASR and the OABCL. Q correlations between the means of the 0-1-2 ratings for the 113 problem items averaged across all pairs of societies yielded means of .77 (OASR) and .78 (OABCL). For the OASR and OABCL, respectively, analyses of variance (ANOVAs) yielded effect sizes (ESs) for society of 15% and 18% for Total Problems and 42% and 31% for Personal Strengths, respectively. For 5,584 cross-informant dyads in 12 societies, cross-informant correlations averaged across societies were .68 for Total Problems and .58 for Personal Strengths. Mixed-model ANOVAs yielded large effects for society on both Total Problems (ES = 17%) and Personal Strengths (ES = 36%).
CONCLUSIONS: The OASR and OABCL are efficient, low-cost, easily administered mental health assessments that can be used internationally to screen for many problems and strengths.

BACKGROUND: An increasing number of international students has been enrolling in medical studies in the English language offered by the countries of Eastern Europe. Development of practical skills is likely more challenging when students learn in the English language, while their patients are non-English speaking persons.
OBJECTIVE: To evaluate self-perception of practical skills of medical students in the English language program.
METHODS: From December 2016 to December 2017, a total of 52 students from the Studies in English program of two universities in Serbia were included in the study. Data were obtained by a previously validated questionnaire.
RESULTS: Participants were most confident when measuring blood pressure, checking the arterial pulse, and taking history. Students were the least confident when placing urinary catheters, performing rectal examinations, and suturing wounds. Male students reported higher confidence in \"Major interventions\" compared to females (p = 0.004), and no difference between male and female students was found in the total skill score of \"knowledge of Serbian language\" (p = 0.339). Adjusted analysis showed that a higher grade point average remains associated with a more confident perception of one\'s practical skills (B 26.48, 95% confidence interval 8.98-43.98). Rasch analysis showed that because the scores were distributed around the mean value between \"not confident at all\" and \"quite confident,\" the majority of students had similar perceptions of their skills.
CONCLUSIONS: Active supervision by teaching staff is also recommended in an attempt to rectify the lack of confidence at performing a range of clinical procedures which is present among international students.

Many people with ALS have been suggested to have a \"nice\" personality, but most ALS personality studies to date have had limited numbers of participants and have not taken into account personality differences between genders. We used Big Five Inventory data obtained from an online questionnaire looking for risk factors for ALS to investigate personality traits in large numbers of people with ALS and controls.
A total of 741 questionnaire respondents aged 40 years and over indicated the extent to which they agreed with each of the 44 Big Five Inventory statements. Respondents were 339 with ALS (212 male, 127 female) who responded to the statements as they applied to them before their diagnosis and 402 controls (120 male, 282 female). Unpaired t tests with 95% confidence intervals were used to compare mean values of Big Five-factor scores.
Female respondents taken together had higher mean scores for Agreeableness and Neuroticism than all male respondents. Male ALS respondents had higher mean scores than male controls for Conscientiousness and Extraversion. Female ALS respondents had higher mean scores than female controls for Agreeableness, Conscientiousness, and Extraversion, and a lower score for Neuroticism.
Many people with ALS have personality traits that are likely to underlie the perception they are particularly \"nice.\" This raises the possibility that genetic polymorphisms that influence personality could play a role in ALS. Furthermore, different personality traits could underlie lifestyle choices that are currently thought to be risk factors for ALS.

This study tested societal effects on caregiver/teacher ratings of behavioral/emotional problems for 10,521 preschoolers from 15 societies. Many societies had problem scale scores within a relatively narrow range, despite differences in language, culture, and other characteristics. The small age and gender effects were quite similar across societies. The rank orders of mean item ratings were similar across diverse societies. For 7,380 children from 13 societies, ratings were also obtained from a parent. In all 13 societies, mean Total Problems scores derived from parent ratings were significantly higher than mean Total Problems scores derived from caregiver/teacher ratings, although the size of the difference varied somewhat across societies. Mean cross-informant agreement for problem scale scores varied across societies. Societies were very similar with respect to which problem items, on average, received high versus low ratings from parents and caregivers/teachers. Within every society, cross-informant agreement for item ratings varied widely across children. In most respects, results were quite similar across 15 very diverse societies.