Prognostic value of electrocardiographic detection of unrecognized myocardial infarction in persons with stable coronary artery disease: data from the Heart and Soul Study

Unrecognized myocardial infarction (MI) carries a poor prognosis in the general population, but its prognostic value is less clear in high-risk patients. We sought to determine whether Q waves on electrocardiogram (ECG), suggestive of unrecognized MI, predict cardiovascular events in patients with stable coronary artery disease (CAD), but without a prior history of MI. We studied 462 patients enrolled in the Heart and Soul Study with stable CAD but without a prior history of MI. All patients had baseline ECGs. The baseline prevalence of unrecognized myocardial infarction was 36%. After a mean of 6.3 years of follow-up, there were a total of 141 cardiovascular events. The presence of Q waves in any ECG lead territory predicted cardiovascular events before (unadjusted HR 1.41, 95% CI 1.01-1.97) and after adjustment for demographics, medical history, diastolic function, and ejection fraction (HR 1.55, 95% CI 1.06-2.26). This association was partly attenuated after adjustment for the presence of inducible ischemia at baseline (HR 1.43, 95% CI 0.96-2.12). When specific territories were analyzed separately, Q waves in anterior leads were predictive of cardiovascular events in both unadjusted and adjusted models (adjusted HR 1.85, 95% CI 1.14-3.00), and this association was partly attenuated after adjustment for inducible ischemia. In conclusion, in patients with CAD but no history of prior MI, the presence of any Q waves or anterior Q waves alone is independently predictive of adverse cardiovascular events

Preferência pela via de parto nas parturientes atendidas em hospital público na cidade de Porto Velho, Rondônia

As parturientes que procuram o Centro Obstétrico do Hospital de Base de Porto Velho, Rondônia, para terem seus filhos são mulheres provenientes das camadas sociais desfavorecidas, ao contrário das mulheres com níveis de renda diferenciados que procuram os médicos em seus consultórios particulares e parem seus filhos por meio de cesarianas com dia e hora previamente marcados. O artigo aborda a questão do aumento da crescente incidência de cesarianas verificado em vários países latinos e também no mundo desenvolvido onde tem motivado necessárias e inadiáveis discussões no campo da Bioética e procura conhecer a opinião das parturientes quanto à via de parto que foram atendidas no Centro Obstétrico do Hospital de Base nos anos de 2006 e 2007.Women who come to give birth at the Obstetrics Center of the Hospital de Base in Porto Velho, in the Brazilian State of Rondônia are from underprivileged social groups. Wealthier women attend private clinics and give birth by way of caesarian section at a pre-scheduled date and time. This article addresses the question of the increase in the incidence of caesarian birth in Latin countries and also in the developed world, where this has provoked necessary and urgent bioethical discussion. It also investigates the opinions of women giving birth at the Obstetrics Center of the Hospital de Base in 2006 and 2007

Chilean women's preferences regarding mode of delivery: which do they prefer and why?

Objective Caesarean section rates in Chile are reported to be as high as 60% in some populations. The purpose of this study was to determine pregnant Chilean women's preferences towards mode of delivery.Design Interviewer-administered cross-sectional survey.Setting Prenatal clinics in Santiago, Chile.Population Pregnant women in Santiago, Chile.Methods Of 180 women completing the questionnaire, 90 were interviewed at a private clinic (caesarean delivery rate 60%) and 90 were interviewed at a public clinic (cesarean delivery rate 22%). Data collected included demographics, preferred mode of delivery, and women's attitudes towards vaginal and caesarean deliveries.Maion outcome measures Mode of delivery preferences, perceptions of mode of delivery measured on a 1-7 Likert scale.Results The majority of women (77.8%) preferred vaginal delivery, 9.4% preferred caesarean section, and 12.8% had no preference. There was no statistical difference in preference between the public clinic (11% preferred caesarean) and the private clinic (8% preferred caesarean, P = 0.74). Overall, women preferring caesarean birth were slightly older than other groups (31.6 years, versus 28.4 years for women who preferred vaginal and 27.3 years for women who had no preference, P = 0.05), but there were otherwise no differences in parity, income, or education. On a scale of 1-7, women preferring caesarean birth rated vaginal birth as more painful, while women preferring vaginal birth rated it as less painful (5.8 versus 3.7, P = 0.003). Whether vaginal or caesarean, each group felt that their preferred mode of delivery was safer for their baby (P < 0.001).Conclusions Chilean women do not prefer caesarean section to vaginal delivery, even in a practice setting where caesarean delivery is more prevalent. Thus, women's preferences is unlikely to be the most significant factor driving the high caesarean rates in Chile.NICHD NIH HH