BACKGROUND & AIMS: :African swine fever (ASF) is a major limiting factor for pig production in most of the countries in Sub-Saharan Africa and the Indian Ocean. In the absence of vaccine, a good understanding of the ecology and epidemiology of the disease is fundamental to implement effective control measures. In selected countries of Southern and East Africa, the association between Ornithodoros moubata ticks and warthogs has been described in detail in the literature. However, for many other countries in the region, information related to the sylvatic cycle is lacking or incomplete. In West African countries, for instance, the role of wild pigs in the epidemiology of ASF has never been demonstrated and the existence and potential impact of a sylvatic cycle involving an association between soft ticks and warthogs is questionable. In other countries, other wild pig species such as the bushpigs (Potamochoerus spp.) can also be asymptomatically infected by the virus but their role in the epidemiology of the disease is unclear and might differ according to geographic regions. In addition, the methods and techniques required to study the role of wild hosts in ASF virus (ASFV) epidemiology and ecology are very specific and differ from the more traditional methods to study domestic pigs or other tick species. The aim of this review is (i) to provide a descriptive list of the methodologies implemented to study the role of wild hosts in African swine fever, (ii) to compile the available knowledge about the sylvatic cycle of ASFV in different regions of Sub-Saharan Africa and the Indian Ocean in addition to the one that has been described for East and Southern Africa, and (iii) to discuss current methodologies and available knowledge in order to identify new orientations for further field and experimental surveys.

背景与目标： : 非洲猪发热 (ASF) 是撒哈拉以南非洲和印度洋大多数国家生猪生产的主要限制因素。在没有疫苗的情况下，充分了解疾病的生态学和流行病学是实施有效控制措施的基础。在南部和东部非洲的某些国家/地区，文献中已详细描述了鸟鸟和疣猪之间的联系。但是，对于该区域的许多其他国家来说，与sylvatic循环有关的信息缺乏或不完整。例如，在西非国家，野猪在ASF流行病学中的作用从未得到证实，涉及软蜱和疣猪之间关联的三角循环的存在和潜在影响值得怀疑。在其他国家/地区，其他野生猪物种 (例如丛林猪 (Potamochoerus spp。)) 也可能被该病毒无症状感染，但其在疾病流行病学中的作用尚不清楚，并且可能因地理区域而异。此外，研究野生宿主在ASF病毒 (ASFV) 流行病学和生态学中的作用所需的方法和技术非常具体，并且与研究家猪或其他tick物种的更传统方法不同。这篇综述的目的是 (i) 提供一份用于研究野生宿主在非洲猪发热中的作用的方法的描述性列表，(ii) 汇编关于撒哈拉以南非洲和印度洋不同地区ASFV的sylvatic循环的现有知识，以及已经描述的东非和南部非洲的知识，(iii) 讨论当前的方法和可用知识，以便为进一步的现场和实验调查确定新的方向。

BACKGROUND & AIMS: :Cognitive dysfunction syndrome is a major disease affecting old cats and is the consequence of severe and irreversible loss of brain cells and brain atrophy. The present study focused on the hypothesis that the optimal strategy for promoting successful brain ageing is to target risk factors associated with brain ageing and dementia. We used a nutritional strategy involving supplementation with a blend of nutrients (antioxidants, arginine, B vitamins and fish oil) to test this hypothesis. Middle-aged and old cats between 5·5 and 8·7 years of age were assigned to cognitively equivalent control or treatment groups based on prior cognitive experience and performance on baseline cognitive tests. The cats in the treatment group were maintained on a diet supplemented with the nutrient blend and the cats in the control group were maintained on the identical base diet without the additional supplementation. After an initial wash-in period, all cats were tested on a battery of cognitive test protocols. The cats fed the test diet showed significantly better performance on three of four test protocols: a protocol assessing egocentric learning, a protocol assessing discrimination and reversal learning and a protocol focused on acquisition of a spatial memory task. The results support the hypothesis that brain function of middle-aged and old cats can be improved by the nutrient blend that was selected to minimise or eliminate the risk factors associated with brain ageing and dementia.

背景与目标： : 认知功能障碍综合征是影响老猫的主要疾病，是严重且不可逆转的脑细胞丧失和脑萎缩的后果。本研究的重点是以下假设: 促进成功的大脑衰老的最佳策略是针对与大脑衰老和痴呆症相关的危险因素。我们使用了一种营养策略，包括补充营养素 (抗氧化剂，精氨酸，b族维生素和鱼油)，以检验这一假设。根据先前的认知经验和基线认知测试的表现，将5·5至8·7岁的中年和老年猫分配到认知上等效的对照组或治疗组。治疗组中的猫维持在补充营养混合物的饮食中，而对照组中的猫维持在相同的基础饮食中，而无需额外补充。在最初的冲洗期后，所有猫都接受了一系列认知测试协议的测试。喂养测试饮食的猫在四个测试协议中的三个协议中表现出明显更好的性能: 评估以自我为中心的学习的协议，评估歧视和逆转学习的协议以及专注于获取空间记忆任务的协议。结果支持以下假设: 可以通过选择营养混合物来改善中老年猫的脑功能，以最大程度地减少或消除与脑衰老和痴呆症相关的危险因素。

BACKGROUND & AIMS: :The use of fillers for nonsurgical rhinoplasty has advanced in both materials and methods, and continues to gain popularity in North America. This technique is most often used for secondary revisions, although reports of fillers used in primary rhinoplasty in selected patients have been recently described. The present report details the use of a hyaluronic acid dermal filler in a young Middle Eastern man for a post-traumatic crooked nose deformity. Primary correction of the patient's right-sided nasal bone deviation using hyaluronic acid as a soft tissue filler was achieved with excellent results and patient satisfaction. The current use of fillers in nasal contouring is reviewed.

背景与目标： : 在非手术鼻整形术中使用填充物在材料和方法上都取得了进步，并在北美继续受到欢迎。尽管最近已经描述了在选定患者的初次鼻整形术中使用填充物的报道，但该技术最常用于二次修订。本报告详细介绍了一名中东年轻人在创伤后弯曲鼻子畸形中使用透明质酸皮肤填充剂的情况。使用透明质酸作为软组织填充剂对患者的右侧鼻骨偏斜进行了初步矫正，效果极佳，患者满意。回顾了填充剂在鼻腔轮廓中的当前使用。

BACKGROUND & AIMS: :It was recently suggested that cortisol levels in fingernails reflect cumulative hormone exposure over a relatively long period. This exploratory study cross-sectionally investigated the relationships between fingernail cortisol level and psychosocial stress in a sample of middle-aged workers (94 men and 29 women). The participants were asked to grow their fingernails for ∼2 weeks and then provide fingernail samples from every digit by using nail clippers. Further, they completed questionnaires for assessment of exposure to psychosocial stress in the past (stressful life events in the workplace in the previous year; e.g. change to a different line of work) and in the present (job stress and perceived stress). Results of a regression analysis adjusting for the effects of demographic variables showed that experience of stressful life events, but not job stress and perceived stress, was associated with elevated fingernail cortisol level. These findings indicate the potential of fingernail samples to retrospectively reflect individual differences in cortisol levels related to past psychosocial stress.

背景与目标： : 最近有人提出，指甲中的皮质醇水平反映了相对较长时间内累积的激素暴露。这项探索性研究从横截面上调查了中年工人 (94名男性和29名女性) 样本中指甲皮质醇水平与心理社会压力之间的关系。参与者被要求种植指甲约2周，然后使用指甲钳从每个数字中提供指甲样本。此外，他们完成了调查问卷，以评估过去 (上一年工作场所的压力生活事件; 例如改变工作方式) 和现在 (工作压力和感知压力) 的风险。调整人口统计学变量影响的回归分析结果表明，生活压力事件的经历，而不是工作压力和感知压力，与指甲皮质醇水平升高有关。这些发现表明，指甲样本有可能回顾性地反映与过去的心理社会压力有关的皮质醇水平的个体差异。

BACKGROUND & AIMS: One hundred and twelve forearms in 56 preserved cadavers were dissected to assess the incidence of Martin-Gruber connections in a population in South Africa. The connections were found in 13 cadavers (23%) and one was bilateral. There were no significant racial or sexual differences in the incidence. The course of Martin-Gruber connections and their anatomical relationship with the ulnar artery are illustrated.

背景与目标： 解剖了56具保存尸体中的112只前臂，以评估南非人口中Martin-Gruber连接的发生率。在13具尸体 (23%) 中发现了连接，其中1具是双侧的。发病率没有明显的种族或性别差异。说明了Martin-Gruber连接的过程及其与尺动脉的解剖关系。

BACKGROUND & AIMS: :A case with brain metastasis involving bilateral middle cerebellar peduncles (bMCP) was reported. A 71-year-old male with gastric cancer was treated for multiple brain metastasis by gamma knife radiosurgery (GKR) in September, 2004. Two months after the initial GKR, MRI showed asymmetrical enhanced lesions involving bMCP. A few months later, MRI revealed an expansional infiltration of bMCP lesions. The patient had presented with headache loss of appetite, cerebellar ataxia, diplopia and slight dysmetria. PET showed 2-deoxy-2- [18F] fluoro-D-glucose (FDG) uptake of the bMCP lesions. The lesions were diagnosed as brain metastasis of gastric cancer. The patient underwent his second GKR (marginal dose : 19Gy, maximum dose 38Gy) MRI revealed the disappearance of the tumors 3 months after the second GKR. One year later, the patient showed no evidence of recurrence. For the last time, our case was diagnosed as brain metastasis from gastric cancer without meningeal carcinomatosis. It was suggested that FDG-PET can provide additional information about the lesion of bMCP. GKR may be useful to treat the tumor in bMCP.

背景与目标： : 报告一例涉及双侧小脑中段 (bMCP) 的脑转移。2004年9月，一名71岁的胃癌男性接受了伽玛刀放射外科 (GKR) 治疗多发性脑转移。初始GKR后两个月，MRI显示涉及bMCP的不对称增强病变。几个月后，MRI显示bMCP病变的扩大浸润。患者出现头痛、食欲不振、小脑共济失调、复视和轻度失调。PET显示bMCP病变的2-脱氧-2- [18F] 氟-D-葡萄糖 (FDG) 摄取。病变诊断为胃癌脑转移。患者接受了第二次GKR (边缘剂量: 19Gy，最大剂量38Gy) MRI检查，发现第二次GKR后3个月肿瘤消失。一年后，患者没有复发的迹象。最后一次，我们的病例被诊断为胃癌脑转移，没有脑膜癌。建议fdg-pet可以提供有关bMCP病变的其他信息。GKR可能对治疗bMCP中的肿瘤有用。

BACKGROUND & AIMS: :The effect of body mass index (BMI) and obesity on apolipoprotein (apo) A-I levels and kinetics was examined by gender. Apo A-I kinetics were determined with a primed, constant infusion of deuterated leucine in the fed state in 19 men and 13 postmenopausal women. Compared with nonobese men, nonobese women had a higher level of high-density lipoprotein cholesterol (HDL-C) and apo A-I due to a 48% higher apo A-I production rate (PR) (P = .05). Obesity had no significant effects on apo A-I kinetics in women. In contrast, compared with nonobese men, obese men had a 9% lower apo A-I level due to a 64% higher fractional catabolic rate (FCR) partially offset by a 47% higher PR. Obese women had a 52% higher HDL-C than obese men (50 vs 33 mg/dL, respectively; P = .012), a finding related to the faster apo A-I FCR in obese men. BMI was directly correlated with apo A-I FCR (r = 0.84, P < .001) and PR (r = 0.79, P < .001) in men but not in women. Sixty-two percent of the variability in PR and 71% of the variability in FCR were due to BMI in men and only 3% and 23%, respectively, in women. In conclusion, BMI has a significant effect on apo A-I PR and FCR in men but not in women.

背景与目标： : 通过性别检查了体重指数 (BMI) 和肥胖对载脂蛋白 (apo) A-I水平和动力学的影响。在19名男性和13名绝经后女性中，通过在进食状态下持续不断地输注氘代亮氨酸来确定Apo A-I动力学。与非肥胖男性相比，非肥胖女性的高密度脂蛋白胆固醇 (hdl-c) 和apo a-I水平较高，原因是apo A-I的生产率 (PR) 48% 较高 (P = .05)。肥胖对女性的apo A-I动力学没有显着影响。相反，与非肥胖男性相比，肥胖男性的apo a-I水平9% 较低，这是由于64% 较高的分解代谢率 (FCR) 部分被47% 较高的PR抵消。肥胖女性的hdl-c比肥胖男性高52% (分别为50 vs 33 mg/dL; P = .012)，这一发现与肥胖男性的apo a-I FCR更快有关。BMI与男性的apo A-I FCR (r = 0.84，P <.001) 和PR (r = 0.79，P <.001) 直接相关，而女性则不相关。PR变异性的60 2% 和FCR变异性的71% 是由于男性的BMI，而女性分别只有3% 和23%。总之，BMI对男性的apo a-I PR和FCR有显着影响，而女性则没有。

BACKGROUND & AIMS: :Chromosome inversions suppress genetic recombination and establish co-adapted gene complexes, or supergenes. The 2La inversion is a widespread polymorphism in the Anopheles gambiae species complex, the major African mosquito vectors of human malaria. Here we show that alleles of the 2La inversion are associated with natural malaria infection levels in wild-captured vectors from West and East Africa. Mosquitoes carrying the more-susceptible allele (2L+a) are also behaviorally less likely to be found inside houses. Vector control tools that target indoor-resting mosquitoes, such as bednets and insecticides, are currently the cornerstone of malaria control in Africa. Populations with high levels of the 2L+a allele may form reservoirs of persistent outdoor malaria transmission requiring novel measures for surveillance and control. The 2La inversion is a major and previously unappreciated component of the natural malaria transmission system in Africa, influencing both malaria susceptibility and vector behavior.

背景与目标： : 染色体倒位抑制遗传重组并建立共同适应的基因复合物或超基因。2La反转是冈比亚按蚊物种复合体 (人类疟疾的主要非洲蚊子媒介) 中广泛存在的多态性。在这里，我们显示2La反转的等位基因与来自西非和东非的野生捕获载体中的自然疟疾感染水平有关。携带更敏感的等位基因 (2L a) 的蚊子在行为上也不太可能在房屋内被发现。针对室内静止蚊子的病媒控制工具，如蚊帐和杀虫剂，目前是非洲疟疾控制的基石。2L a等位基因水平高的人群可能会形成持续的室外疟疾传播库，需要采取新的监测和控制措施。2La倒置是非洲自然疟疾传播系统的主要且以前未被重视的组成部分，影响疟疾的易感性和媒介行为。

BACKGROUND & AIMS: :Middle East and North Africa (MENA) encompass very unique populations, with a rich history and encompasses characteristic ethnic, linguistic and genetic diversity. The genetic diversity of MENA region has been largely unknown. The recent availability of whole-exome and whole-genome sequences from the region has made it possible to collect population-specific allele frequencies. The integration of data sets from this region would provide insights into the landscape of genetic variants in this region. We integrated genetic variants from multiple data sets systematically, available from this region to create a compendium of over 26 million genetic variations. The variants were systematically annotated and their allele frequencies in the data sets were computed and available as a web interface which enables quick query. As a proof of principle for application of the compendium for genetic epidemiology, we analyzed the allele frequencies for variants in transglutaminase 1 (TGM1) gene, associated with autosomal recessive lamellar ichthyosis. Our analysis revealed that the carrier frequency of selected variants differed widely with significant interethnic differences. To the best of our knowledge, al mena is the first and most comprehensive repertoire of genetic variations from the Arab, Middle Eastern and North African region. We hope al mena would accelerate Precision Medicine in the region.

背景与目标： : 中东和北非 (MENA) 涵盖了非常独特的人口，具有丰富的历史，并包含了独特的种族，语言和遗传多样性。MENA地区的遗传多样性在很大程度上是未知的。该地区最近获得的全外显子组和全基因组序列使收集特定人群的等位基因频率成为可能。来自该地区的数据集的整合将提供对该地区遗传变异景观的见解。我们系统地整合了来自该地区的多个数据集的遗传变异，以创建超过2600万个遗传变异的汇编。对变体进行了系统注释，并计算了它们在数据集中的等位基因频率，并可以作为web界面使用，从而可以快速查询。作为遗传流行病学学纲要应用原理的证明，我们分析了转谷氨酰胺酶1 (TGM1) 基因变异的等位基因频率，与常染色体隐性层状鱼鳞病有关。我们的分析表明，所选变体的载波频率差异很大，种族间差异很大。据我们所知，al mena是来自阿拉伯，中东和北非地区的第一个也是最全面的遗传变异库。我们希望al mena能够加快该地区的精准医学。

BACKGROUND & AIMS: AIM:To evaluate the immunohistochemical and molecular presentation of protein p27 in cholesteatoma. METHODS:42 cholesteatoma samples and 6 external ear canal skin (EECS) specimens were investigated and analyzed taking into consideration congenital, acquired, recurrent cholesteatoma, and EECS. RESULTS:The expression of p27 was found in 16 (38.1%) out of 42 specimens of cholesteatoma and in 5 (83.3%) out of 6 specimens of EECS. There was a significant difference in p27-positive staining rate between EECS and cholesteatoma epithelium (p < 0.008). The presence of p27 was detected in 10 cases of acquired cholesteatoma, 2 cases of congenital and 3 cases of recurrent cholesteatoma. There was no significant difference between the presence of p27 in cholesteatoma and EECS (p = 0.01). CONCLUSION:The down-regulation of p27 is a key player in cell cycle control and plays an undefined role in the pathogenesis of all types of cholesteatoma.

背景与目标：

BACKGROUND & AIMS: HYPOTHESIS:To assess the effects of positive and negative middle ear pressures on auditory threshold. BACKGROUND:Nonatmospheric middle ear pressures can alter auditory threshold by their effects on tympanic membrane and ossicular chain mobility. METHODS:Experiments were conducted on guinea pigs by inducing alterations in pressure (positive and negative) with a syringe connected to the middle ear bulla cavity, the magnitude of the pressure being assessed with a water manometer. Elevated middle ear fluid pressures were also induced by attaching a saline-filled vertical tube to the saline-filled middle ear. The effect of these altered middle ear air and fluid pressures were assessed by recording auditory nerve-brainstem evoked responses. RESULTS:There was no effect on auditory threshold of positive middle ear air pressures (up to 250 mm H2O). A negative middle ear air pressure of -50 mm H2O induced a significant 9.5-dB threshold elevation, whereas more negative pressures (up to -150 mm H2O) did not induce an additional threshold elevation. Filling the middle ear cavity with saline induced a 10- to 16-dB elevation, whereas additional fluid pressures (up to 200 mm H2O) did not induce further elevations. CONCLUSION:The major factor inducing threshold elevation in serious otitis media is not the alteration in middle ear pressure but rather the reduction in the volume of compressible air in the middle ear by the fluid.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. METHODS:Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. RESULTS:Twenty-nine studies from sub-Saharan Africa including 148,912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60-84) had a CD4 cell count measured, 40 (95% CI 26-55) were eligible for ART and 25 (95% CI 13-37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25%vs. 54%, P < 0.0001), but eligible patients were more likely to die (11%vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. CONCLUSIONS:Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.

背景与目标：

BACKGROUND & AIMS: :South Africa has long recognized partnerships between the public and private sectors as a policy objective in health, but experience is still limited and poorly documented. The objectives of this article are to understand the factors that increase the likelihood of success of public-private interactions in South Africa, and identify and discuss opportunities for them to be scaled up. There is a strong legislative framework and a number of guidelines and tools that have been developed by the Treasury for managing partnerships. The review of literature confirmed the need for the state to have effective regulations in order to oversee quality and standards and to provide stewardship and oversight. The public sector requires sufficient capacity not only to manage relationships with the private sector but also to enable innovation and experimentation. Evaluation is an integral part of all interactions not only to learn from successes but also to identify any perverse incentives that may lead to unintended consequences. Four case studies show that the private for-profit sector is already engaged in a number of projects that are closely aligned to current health system reform priorities. Factors that increase the likelihood of interactions being successful include: increasing the government's capacity to manage public-private relationships; choosing public-private interactions that are strategically important to national goals; building a knowledge base on what works, where and why; moving from pilots to large scale initiatives; harnessing the contracting expertise in private providers; and encouraging innovation and learning.

背景与目标： : 南非长期以来一直承认公共部门和私营部门之间的伙伴关系是卫生方面的政策目标，但经验仍然有限，而且文献记载很少。本文的目的是了解增加南非公私互动成功可能性的因素，并确定和讨论扩大它们的机会。财政部为管理伙伴关系制定了强有力的立法框架和许多准则和工具。对文献的审查证实，国家需要制定有效的法规，以监督质量和标准，并提供管理和监督。公共部门不仅需要足够的能力来管理与私营部门的关系，而且还需要创新和实验。评估是所有互动的组成部分，不仅要从成功中学习，而且要确定可能导致意外后果的任何不正当激励措施。四个案例研究表明，私营营利部门已经参与了许多与当前卫生系统改革优先事项密切相关的项目。增加互动成功可能性的因素包括: 提高政府管理公私关系的能力; 选择对国家目标具有战略重要性的公私互动; 建立有效的知识基础，在何处以及为什么; 从试点转向大规模计划; 利用私人供应商的合同专业知识; 鼓励创新和学习。

BACKGROUND & AIMS: BACKGROUND:Migraine has been associated with a dysfunctional activation of the trigeminovascular system. Calcitonin gene-related peptide, a neuropeptide released from the trigeminal nerve fibres, has an important role in the pathophysiology of migraine and is a current therapeutic target for migraine treatment. METHODS:We examined the effects of two novel calcitonin gene-related peptide receptor antagonists, ubrogepant and atogepant, on the relaxations induced by α calcitonin gene-related peptide in human isolated middle meningeal, cerebral and coronary arteries. Furthermore, the contractile responses to atogepant and ubrogepant per se were studied and compared to the responses elicited by zolmitriptan in proximal and distal human coronary arteries. RESULTS:In intracranial arteries, both blockers antagonized the calcitonin gene-related peptide-induced relaxations more potently when compared to the inhibition observed in distal human coronary arteries, with atogepant showing a higher potency. When analysing their antagonistic profile in HCA, ubrogepant showed a competitive antagonist profile, while atogepant showed a non-competitive one. Neither of the gepants had vasoconstrictor effect at any of the concentrations studied in human coronary arteries, whereas zolmitriptan elicited concentration-dependent contractions. CONCLUSION:ubrogepant and atogepant differentially inhibit the calcitonin gene-related peptide-dependent vasodilatory responses in intracranial arteries when compared to distal human coronary arteries. Also, both gepants are devoid of vasoconstrictive properties in human coronary arteries.

背景与目标：

BACKGROUND & AIMS: Importance:Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. Objective:To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. Design, Setting, and Participants:This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. Exposures:Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. Main Outcomes and Measures:Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. Results:Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). Conclusions and Relevance:In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.

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