The importance of characterizing residual household waste at the local level: A case study of Saguenay, Quebec (Canada).

Knowledge of the quantity and the type of residual household waste (RHW) generated by a population within a given territory is essential for developing affordable, effective, and sustainable management strategies for waste. This study aims to accurately describe the composition of residential residual materials collected directly from households over the course of a year. Household waste was collected from urban and rural sectors that were representative of the study territory. Samples were collected during the winter, summer, and fall of 2014. A total of 3039 kg of RHW was collected and sorted into 9 categories and 39 subcategories. Statistical analysis showed, except for organic matter, that the weight percentage of each category of material did not significantly differ among sampling periods or locations. Therefore, the results for a category were compiled to generate a single value to calculate the relative abundance of each type of residual material. Organic matter made up the majority fraction of the RHW (53% to 66%). This was followed by plastics (9%), bulky items and renovation/demolition debris (6%), textiles (5%), metals (4%), paper and cardboard fiber (4%), glass (2%), and household hazardous waste (2%). This approach has allowed us to improve the accuracy of the data used in MRM, contribute to the creation of a regional dataset for waste, and develop a methodology more applicable to local realities. Specific to the immediate needs of municipal MRM, we updated knowledge regarding the generation, recovery, and disposal of the contents of the residential sector, and tracked the evolution and the variation of contents over a given period. We believe our methodology is applicable to other regions having similar characteristics in terms of climate, socio-economic status, and other parameters that affect the composition of RHW.

Association between low muscle mass, functional limitations and hospitalisation in heart failure: NHANES 1999-2004.

BACKGROUND/OBJECTIVES: Muscle mass decreases with age, and heart failure (HF) patients may experience greater reductions due to pathophysiological processes associated with this disease. Reduced muscle mass may predispose HF patients to functional limitations and increased morbidity and mortality. This study estimated the associations between HF, low muscle mass (LMM), functional limitations and hospitalisation, as well as the combined effect of HF and LMM on these outcomes in a nationally representative sample. DESIGN: A cross-sectional survey. SETTING: the National Health and Nutrition Examination Survey 1999-2004. SUBJECTS: A total of 402 HF (weighted 3,994,205) and 7,061 non-HF participants (weighted 91,058,850), ≥45 years with dual-energy X-ray absorptiometry measurements. METHODS: the 20th percentile of the sex-specific distribution of lean appendicular mass residuals from linear regression with height and fat mass as predictors, served as the LMM cut-point. Logistic regression provided adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of HF and LMM with functional limitations and hospitalisation. RESULTS: There were statistically significant adjusted associations between HF and limitations in household chores, walking one-fourth of a mile and hospitalisation (OR (95% CI): 2.5 (1.7 -3.8), 1.9 (1.2 -3.0) and 1.6 (1.1 -2.4), respectively). LMM was significantly associated with limitations in household chores and walking one-fourth of a mile (OR (95% CI): 1.5 (1.2, 1.9) and 1.4 (1.2, 1.7), respectively). Interaction between HF and LMM was noted for the associations with functional limitations. CONCLUSIONS: This hypothesis-generating study found a synergistic interaction between HF and LMM; the presence of LMM increased the negative effects of HF. HF patients may experience increased disease burden due to LMM.

Cholesterol screening in US adults and awareness of high cholesterol among individuals with severe hypertriglyceridemia: National Health and Nutrition Examination Surveys 2001-2008.

BACKGROUND: Cholesterol screening is an effective method for identifying individuals with elevated triglyceride levels. Individuals with severe hypertriglyceridemia (SHTG; ≥500 mg/dL) have a substantially higher risk for developing coronary heart disease and acute pancreatitis than individuals with lower triglyceride levels. OBJECTIVE: The aims of this study were to estimate the proportion of US adults who reported having their cholesterol checked, to evaluate the characteristics associated with having cholesterol checked, and to assess factors that are associated with awareness of having high cholesterol among adults with SHTG. METHODS: The sample included 7988 adults who participated in the National Health and Nutrition Examination Surveys 2001-2008. Polytomous logistic regression models were used to identify factors that were associated with time since the last cholesterol screening, categorized as never screened, screened less than 2 years ago, and screened 2 or more years ago. RESULTS: Approximately 71% of the US adults reported ever having their cholesterol checked. Only 56% of the individuals with SHTG were aware of having high cholesterol. Factors associated with awareness of high cholesterol among those with SHTG included obesity, education, having insurance, having diabetes, and having a history of cardiovascular events. CONCLUSIONS: Most adults in the United States have had their cholesterol checked; however, only half of those with SHTG were aware of having high cholesterol. Awareness is the first step in implementing strategies to attenuate the health risks associated with dyslipidemia.

Prevalence, clinical characteristics and treatment patterns of low high-density lipoprotein cholesterol in the US population: National Health and Nutrition Examination Survey 2005-2008.

AIMS: The aims of this study were to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-C) in US adults, assess the association between low HDL-C levels and clinical characteristics, and quantify the utilization of dyslipidemic agents as it relates to the distribution of HDL-C. METHODS: We analyzed a sample of 4129 adults (>20 years) who underwent fasting blood evaluations in the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Sex-specific crude and adjusted logistic models were developed to evaluate the association between individual characteristics and low HDL-C, in which low HDL-C was defined as less than 40  mg/dl for men and less than 50  mg/dl for women. RESULTS: Approximately 24% of men and 27% of women had low HDL-C levels. Factors most strongly associated with low HDL-C levels for men included being obese [odds ratio (OR) = 3.27, 95% confidence interval (CI): 1.98-5.40], having elevated triglyceride levels (>200  mg/dl: OR = 8.17, 95% CI: 5.54-12.03) and having apolipoprotein B levels more than 117  mg/dl (OR = 5.99, 95% CI: 2.74-13.13). The same factors were associated with low HDL-C levels among women: being obese (OR = 2.89, 95% CI: 1.78-4.71), having elevated triglyceride levels (>200  mg/dl: OR = 13.35, 95% CI: 7.49-23.77) and having apolipoprotein B levels more than 117  mg/dl (OR = 5.88, 95% CI: 2.29-15.11). Approximately 82% of men and 79% of women with low HDL-C levels reported not using any dyslipidemic medication. CONCLUSION: Although having low HDL-C was common among US adults, few reported taking a dyslipidemic agent. Our study also confirmed some of the known risk factors associated with low HDL-C levels in the general US population.

Prevalence of severe (500 to 2,000 mg/dl) hypertriglyceridemia in United States adults.

A growing amount of evidence has supported an association between elevated triglyceride levels and cardiovascular disease. However, little information regarding co-morbidities, levels of other cholesterol types, or medication use among adults with severe hypertriglyceridemia (SHTG; (500 to 2,000 mg/dl) is available. We examined the data from 5,680 subjects, ≥ 20 years old, who had participated in the National Health and Nutrition Examination Survey from 2001 and 2006, to evaluate the epidemiology of adults with SHTG. Approximately 1.7% of the sample had SHTG, equating to roughly 3.4 million Americans. The participants with SHTG tended to be men (75.3%), non-Hispanic whites (70.1%), and aged 40 to 59 years (58.5%). More than 14% of those with SHTG reported having diabetes mellitus, and 31.3% reported having hypertension. Only 14% of the subjects with SHTG reported using statins, and 4.0% reported using fibrates. The factors significantly associated with having SHTG included high-density lipoprotein <40 mg/dl (odds ratio [OR) 11.45, 95% confidence interval [CI] 6.28 to 20.86), non-high-density lipoprotein 160 to 189 mg/dl (OR 9.74, 95% CI 1.68 to 56.40) or non-high-density lipoprotein ≥ 190 mg/dl (OR 24.99, 95% CI 3.90 to 160.31), diabetes mellitus (OR 3.04, 95% CI 1.45 to 6.37), and chronic renal disease (OR 7.32, 95% CI 1.45 to 36.94). In conclusion, SHTG is rare among adults in the United States and the use of pharmacologic intervention is low among those with SHTG.

Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: a preliminary report.

OBJECTIVE: To describe the changes in demographics, antidiabetic treatment, and glycemic control among the prevalent U.S. adult diagnosed type 2 diabetes population between the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the initial release of NHANES 1999-2000. RESEARCH DESIGN AND METHODS: The study population was derived from NHANES III (n = 1,215) and NHANES 1999-2000 (n = 372) subjects who reported a diagnosis of type 2 diabetes with available data on diabetes medication and HbA(1c). Four therapeutic regimens were defined: diet only, insulin only, oral antidiabetic drugs (OADs) only, or OADs plus insulin. Multiple logistic regression was used to examine changes in antidiabetic regimens and glycemic control rates over time, adjusted for demographic and clinical risk factors. The outcome measure for glycemic control was HbA(1c). Glycemic control rates were defined as the proportion of type 2 diabetic patients with HbA(1c) level <7%. RESULTS: Dietary treatment in individuals with diabetes decreased as the sole therapy from 27.4 to 20.2% between the surveys. Insulin use also decreased from 24.2 to 16.4%, while those on OADs only increased from 45.4 to 52.5%. Combination of OADs and insulin increased from 3.1 to 11.0%. Glycemic control rates declined from 44.5% in NHANES III (1988-1994) to 35.8% in NHANES 1999-2000. CONCLUSIONS: Treatment regimens among U.S. adults diagnosed with type 2 diabetes have changed substantially over the past 10 years. However, a decrease in glycemic control rates was also observed during this time period. This trend may contribute to increased rates of macrovascular and microvascular diabetic complications, which may impact health care costs. Our data support the public health message of implementation of early, aggressive management of diabetes.