Long-term interleukin-6 levels and subsequent risk of coronary heart disease: Two new prospective studies and a systematic review

Background The relevance to coronary heart disease (CHD) of cytokines that govern inflammatory cascades, such as interleukin-6 (IL-6), may be underestimated because such mediators are short acting and prone to fluctuations. We evaluated associations of long-term circulating IL-6 levels with CHD risk (defined as nonfatal myocardial infarction [MI] or fatal CHD) in two population-based cohorts, involving serial measurements to enable correction for within-person variability. We updated a systematic review to put the new findings in context. Methods and Findings Measurements were made in samples obtained at baseline from 2,138 patients who had a first-ever nonfatal MI or died of CHD during follow-up, and from 4,267 controls in two cohorts comprising 24,230 participants. Correction for within-person variability was made using data from repeat measurements taken several years apart in several hundred participants. The year-to-year variability of IL-6 values within individuals was relatively high (regression dilution ratios of 0.41, 95% confidence interval [CI] 0.28-0.53, over 4 y, and 0.35, 95% CI 0.23-0.48, over 12 y). Ignoring this variability, we found an odds ratio for CHD, adjusted for several established risk factors, of 1.46 (95% CI 1.29-1.65) per 2 standard deviation (SD) increase of baseline IL-6 values, similar to that for baseline C-reactive protein. After correction for within-person variability, the odds ratio for CHD was 2.14 (95% CI 1.45-3.15) with long-term average ("usual'') IL-6, similar to those for some established risk factors. Increasing IL-6 levels were associated with progressively increasing CHD risk. An updated systematic review of electronic databases and other sources identified 15 relevant previous population-based prospective studies of IL-6 and clinical coronary outcomes (i.e., MI or coronary death). Including the two current studies, the 17 available prospective studies gave a combined odds ratio of 1.61 (95% CI 1.42-1.83) per 2 SD increase in baseline IL-6 (corresponding to an odds ratio of 3.34 [95% CI 2.45-4.56] per 2 SD increase in usual [long-term average] IL-6 levels). Conclusions Long-term IL-6 levels are associated with CHD risk about as strongly as are some major established risk factors, but causality remains uncertain. These findings highlight the potential relevance of IL-6-mediated pathways to CH

Western men and Eastern arts: The significance of Eastern martial arts disciplines in British men's narratives of masculinity

Previous Western sociological research on Eastern martial arts has identified a tension between ‘traditional’ Eastern forms of practice and ‘modernized’ Western methods of training and competition. In particular, the ‘sportization’ of Eastern styles, where combat-centred arts based upon moral philosophies have transformed more or less into competitive activities following Western models of rationalized sport, has been an important theme. However, it is also suggested that Eastern martial arts hold special significance in the West for their seemingly esoteric nature. In this regard, such martial arts are considered significant because they are not ‘sports’, but rather disciplines, with fairly different connotations for practitioners. Drawing on interview data, this paper explores how Western practitioners of Eastern martial arts articulate this difference, principally by examining the place of martial artistry in British men's narratives of masculinity. Comparing themselves favourably to assumed, typical visions of Western sporting masculinity, such men draw upon the imagined uniqueness of their martial arts to construct a sense of moral superiority over other men. In so doing, they contribute to a rejection of what they believe to be ‘mainstream’ sporting Western masculinity, thus indicating the role that ‘alternative’ visions of physical culture can play in men's active constructions of gender

Captive-taking in the context of domestic violence: A descriptive analysis

Captive-taking events in the context of domestic violence have received increased attention from law enforcement and mental health professionals. However, despite the high lethality risk of these situations, for both the partners involved as well as first responders (police officers, crisis negotiators), only a modicum of investigative activity has been directed to these incidents. Further, the few extant reports in this area are primarily clinical case studies or anecdotal accounts. The purpose of the present investigation was to expand on previous work by providing more descriptive analyses of these events in order to garner data potentially useful in crisis negotiators’ efforts to resolve these critical incidents in a peaceful, nonviolent manner. Specifically, three categories of variables (demographic, situational, and outcome) were examined in cases obtained from the Hostage/Barricade Database System (HOBAS) maintained by the Crisis Negotiation Unit of the Federal Bureau of Investigation (FBI). Results showed that (1) these incidents tend to be unplanned, (2) they occur in private residences, (3) third party intermediaries are judged to have minimal impact on the negotiated outcome, and (4) subjects tend to be white in their mid-30s or 40s with prior violent arrest and substance abuse histories. Further, white females are more likely to be victims. Extended family members and children are increasingly becoming involved in these situations. Additionally, five cases were chosen to reflect the primary categories of variables. Limitations of the study and implications for future research in this area are also discussed

Traditional Martial Arts versus Modern Self-Defense Training for Women: Some Comments

Most research conducted on women\u27s self-protection strategies has focused on modern self-defense training, as opposed to traditional martial arts instruction. Further, traditional martial arts’ training has been characterized by many as less useful for women than modern self-defense instruction. However, no investigations have compared the effectiveness of these two approaches. Several misconceptions concerning traditional martial arts may explain why this form of self-protection has not been utilized as often, or evaluated as frequently, as other methods. This paper: (1) distinguishes traditional martial arts from modern self-defense training, (2) reviews research that has assessed behavioral outcomes of self-defense training strategies, and (3) discusses factors that influence perceptions and efficacy of such programs. To assist in these efforts, we include the expertise and perspectives of an internationally-recognized grandmaster in the Okinawan martial art of Shorin Ryu Karate. Suggestions for directions that future research in this area might take are offered

Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization

Although the definition of multimorbidity as "the simultaneous presence of two or more chronic diseases" is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity

Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project

MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients