Immigrant status and increased risk of heart failure: the role of hypertension and life-style risk factors

<p>Abstract</p> <p>Background</p> <p>Studies from Sweden have reported association between immigrant status and incidence of cardiovascular diseases. The nature of this relationship is unclear. We investigated the relationship between immigrant status and risk of heart failure (HF) hospitalization in a population-based cohort, and to what extent this is mediated by hypertension and life-style risk factors. We also explored whether immigrant status was related to case-fatality after HF.</p> <p>Methods</p> <p>26,559 subjects without history of myocardial infarction (MI), stroke or HF from the community-based Malmö Diet and Cancer (MDC) cohort underwent a baseline examination during 1991-1996. Incidence of HF hospitalizations was monitored during a mean follow-up of 15 years.</p> <p>Results</p> <p>3,129 (11.8%) subjects were born outside Sweden. During follow-up, 764 subjects were hospitalized with HF as primary diagnosis, of whom 166 had an MI before or concurrent with the HF. After adjustment for potential confounding factors, the hazard ratios (HR) for foreign-born were 1.37 (95% CI: 1.08-1.73, <it>p </it>= 0.009) compared to native Swedes, for HF without previous MI. The results were similar in a secondary analysis without censoring at incident MI. There was a significant interaction (<it>p </it>< 0.001) between immigrant status and waist circumference (WC), and the increased HF risk was limited to immigrants with high WC. Although not significant foreign-born tended to have lower one-month and one-year mortality after HF.</p> <p>Conclusions</p> <p>Immigrant status was associated with long-term risk of HF hospitalization, independently of hypertension and several life-style risk factors. A significant interaction between WC and immigrant status on incident HF was observed.</p

Increasing caesarean section rates among low-risk groups : a panel study classifying deliveries according to Robson at a university hospital in Tanzania

Background: Rising caesarean section (CS) rates have been observed worldwide in recent decades. This study sought to analyse trends in CS rates and outcomes among a variety of obstetric groups at a university hospital in a low-income country. Methods: We conducted a hospital-based panel study at Muhimbili National Hospital, Dar es Salaam, Tanzania. All deliveries between 2000 and 2011 with gestational age &gt;= 28 weeks were included in the study. The 12 years were divided into four periods: 2000 to 2002, 2003 to 2005, 2006 to 2008, and 2009 to 2011. Main outcome measures included CS rate, relative size of obstetric groups, contribution to overall CS rate, perinatal mortality ratio, neonatal distress, and maternal mortality ratio. Time trends were analysed within the ten Robson groups, based on maternal and obstetric characteristics. We applied the chi(2) test for trend to determine whether changes were statistically significant. Odds ratios of CS were evaluated using multivariate logistic regression, accounting for maternal age, referral status, and private healthcare insurance. Results: We included 137,094 deliveries. The total CS rate rose from 19% to 49%, involving nine out of ten groups. Multipara without previous CS with single, cephalic pregnancies in spontaneous labour had a CS rate of 33% in 2009 to 2011. Adjusted analysis explained some of the increase. Perinatal mortality and neonatal distress decreased in multiple pregnancies (p &lt; 0.001 and p = 0.003) and nullipara with breech pregnancies (p &lt; 0.001 and p = 0.024). Although not statistically significant, there was an increase in perinatal mortality (p = 0.381) and neonatal distress (p = 0.171) among multipara with single cephalic pregnancies in spontaneous labour. The maternal mortality ratio increased from 463/100, 000 live births in 2000 to 2002 to 650/100, 000 live births in 2009 to 2011 (p = 0.031). Conclusion: The high CS rate among low-risk groups suggests that many CSs might have been performed on questionable indications. Such a trend may result in even higher CS rates in the future. While CS can improve perinatal outcomes, it does not necessarily do so if performed routinely in low-risk groups

Avaliação da resistência de força explosiva em voleibolistas através de testes de saltos verticais Assessment of explosive strength-endurance in volleyball players through vertical jumping test

O propósito deste estudo foi verificar a existência de diferenças entre o teste de salto vertical com natureza contínua de 60 segundos (TSVC) e o teste de salto vertical com natureza intermitente de quatro séries de 15 segundos (TSVI). Os dados foram obtidos através de amostra composta por 10 voleibolistas do sexo masculino (19,01 ± 1,36 anos; 191,5 ± 5,36cm; e 81,74 ± 7,45kg), todos com participação voluntária. As variáveis estudadas foram: as estimativas do pico de potência (PP), potência média (PM) e o índice de fadiga (IF). O desempenho estimado através dos testes TSVC, com duração de 60 segundos, e o TSVI foi determinado em quatro séries de 15 segundos, com 10 segundos de recuperação entre cada série. Os dados foram determinados através da estatística descritiva e do teste de Wilcoxon; o nível de significância utilizado foi de p < 0,05. Foi possível averiguar entre os testes diferenças estatisticamente significantes no desempenho da PM (p < 0,05) e o IF (p < 0,01). A PM apresentou valores médios no TSVI significativamente superiores aos do TSVC. No entanto, os testes TSVC e o TSVI diferiram na estimativa da resistência de força explosiva.<br>The aim of this study was to verify the differences between the continuous jump test of 60 seconds (CJ60 sec) and the intermittent jump test of 4 sets of 15 seconds (IJ4x15 sec). The sample was composed of 10 male volleyball players with 19.01 ± 1.36 years, 191.5 ± 5.36 cm height and 81.74 ± 7.45 of body mass, who participated in this research as volunteers. The variables studied were estimated as the peak power (PP), mean power (MP) and fatigue index (FI). These performances were measured through tests of vertical jump with duration the 60 seconds and with the performance of 4 sets of 15 seconds with 10 seconds of recovery between the sets. The data were analyzed through descriptive statistics and the Wilcoxon test. The significance level was of p < 0.05. It was possible to analyze that the continuous and the intermittent jump test presented significant differences in MP (p < 0.05), FI (p < 0.01), and in the number of the vertical jump in 60 seconds (p < 0.01), and the height in 60 seconds exercise (p < 0.05). The MP found in IJ4x15sec was significantly higher than in the CJ60 sec in volleyball players. In conclusion, the results suggest the existence of significant differences between the CJ60sec and IJ4x15 sec