Seasonal variation of cerebrovascular diseases

The seasonal variation in all admissions of all types of cerebro-vascular disease within the West Midlands Region was examined between the years 1973–1980. There was a fluctuation for both sexes with a peak in winter, between the months of October and April; a trough was observed in late summer, in July and August. Multivariate analysis of the meteorological factors showed an association between hours of sunshine and intracerebral haemorrhage. The meteorological variables were strongly correlated with each other making the selection of the most predictable variable to stroke difficult.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41646/1/701_2005_Article_BF01400492.pd

Detection of high cardiovascular risk patients with ankylosing spondylitis based on the assessment of abdominal aortic calcium as compared to carotid ultrasound

ABSTRACT: Background: This study aimed to determine whether, besides carotid ultrasound (US), a lateral lumbar spine radiography may also help identify ankylosing spondylitis (AS) patients at high risk of cardiovascular (CV) disease. Methods: A set of 125 AS patients older than 35 years without a history of CV events, diabetes mellitus, or chronic kidney disease was recruited. Carotid US and lateral lumbar spine radiography were performed in all of them. The CV risk was calculated according to the total cholesterol systematic coronary risk evaluation (TC- CORE) algorithm. Presence of carotid plaques was defined following the Mannheim Carotid Intima-media Thickness and Plaque Consensus. Abdominal aortic calcium (AAC) in a plain radiography was defined as calcific densities visible in an area parallel and anterior to the lumbar spine. Results: Carotid US showed higher sensitivity than lateral lumbar spine radiography to detect high CV risk in the 54 patients with moderate TC-SCORE (61% versus 38.9%). Using carotid plaques as the gold standard test, a predictive model that included a TC-SCORE >= 5% or the presence of AAC in the lateral lumbar spine radiography in patients with both moderate and low CV risk (< 5%) according to the TC-SCORE yielded a sensitivity of 50.9% with a specificity of 95.7% to identify high/very high CV-risk AS patients. A positive correlation between AAC and carotid plaques was observed (r2 = 0.49, p < 0.001). Conclusions: A lateral lumbar spine radiography is a useful tool to identify patients with AS at high risk of CV disease

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015:a systematic analysis for the Global Burden of Disease Study 2015

Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores.Findings We generated 9.3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17.2 billion, 95% uncertainty interval [UI] 15.4-19.2 billion) and diarrhoeal diseases (2.39 billion, 2.30-2.50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2.36 billion (2.35-2.37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo.Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Copyright (C) The Author(s). Published by Elsevier Ltd.</p

Robustness and autonomy in biological systems: how regulatory mechanisms enable functional integration, complexity and minimal cognition through the action of second-order control constraints

Living systems employ several mechanisms and behaviors to achieve robustness and maintain themselves under changing internal and external conditions. Regulation stands out from them as a specific form of higher-order control, exerted over the basic regime responsible for the production and maintenance of the organism, and provides the system with the capacity to act on its own constitutive dynamics. It consists in the capability to selectively shift between different available regimes of self-production and self-maintenance in response to specific signals and perturbations, due to the action of a dedicated subsystem which is operationally distinct from the regulated ones. The role of regulation, however, is not exhausted by its contribution to maintain a living system’s viability. While enhancing robustness, regulatory mechanisms play a fundamental role in the realization of an autonomous biological organization. Specifically, they are at the basis of the remarkable integration of biological systems, insofar as they coordinate and modulate the activity of distinct functional subsystems. Moreover, by implementing complex and hierarchically organized control architectures, they allow for an increase in structural and organizational complexity while minimizing fragility. Finally, they endow living systems, from their most basic unicellular instances, with the capability to control their own internal dynamics to adaptively respond to specific features of their interaction with the environment, thus providing the basis for the emergence of minimal forms of cognition

The distribution and association of blood pressure in an adolescent population

In this report we describe the distribution of blood pressure and its association in adolescence. Six hundred and twenty-five subjects aged 13 to 18 were drawn from three general practices in different urban and rural settings. Systolic pressures were higher and rose with age in boys x̄ = 119 mm Hg) compared with girls x̄ = 114 mm Hg), who showed no age association. Diastolic pressures (phase 5) were higher in girls x̄ = 64 mm Hg) than in boys x̄ = 60 mm Hg) and showed no association with age in either sex. Initial blood pressures were generally higher than those recorded after a further five minutes' rest in the sitting position, although diastolic pressures rose on the second reading in the older subjects. Systolic pressures of subjects from the suburban practice and in the late autumn were relatively low; diastolic pressures tended to be lower in the spring and in subjects from the rural practice. Systolic pressures were lower in the morning and this was found to be primarily related to fasting status. Individuals with a positive family history of hypertension had significantly higher blood pressures than those with a negative history. Boys who frequently played sports had lower diastolic pressures, largely accounting for the above sex difference. We conclude that although blood pressure measurement in adolescence is a difficult screening procedure it should be offered to selected groups such as those with a family history of hypertension.link_to_subscribed_fulltex

Changes in blood lipids and blood pressure during adolescence

A total of 625 adolescents from three general practices participated in a cross-sectional study of cardiovascular disease risk factors. The girls had higher serum total and high density lipoprotein (HDL) cholesterol concentrations than the boys, while the boys had higher serum triglyceride concentrations. Smoking (equally prevalent in both sexes) was associated with lower HDL cholesterol concentrations, particularly in boys, while in girls use of oral contraceptives were associated with higher total cholesterol and lower HDL cholesterol concentrations. HDL and total cholesterol concentrations showed striking associations with age, height, and sexual maturation in boys, but not in girls. Triglyceride concentrations were associated with age in boys. Systolic blood pressure and serum urate concentrations were higher in boys and rose steeply with age, but no age association was seen for urate concentrations or systolic blood pressure in girls or for diastolic pressures in either sex. Girls, however, had higher diastolic pressures. There was a strong association between urate concentration and the other cardiovascular disease risk factors, especially HDL cholesterol. Adolescence is associated with considerable changes in cardiovascular disease risk factors, and there are striking sex differences in these changes.link_to_subscribed_fulltex

Serum lipids in a teenage population: Geographic, seasonal and familial factors

The lipid results of a cross-sectional study of cardiovascular disease risk factors in over 600 13-18 year olds drawn from general practices in contrasting areas are reported. Differences were noted between the 3 practices, including a significant variation in the blood group distribution. HDL cholesterol showed a marked variation between the 3 practices which was unlikely to be due solely to seasonal variation. Alcohol consumption though not a univariate correlate of HDL cholesterol was however a strong partial correlate, as were age, height, sexual maturation, adiposity and smoking. Using 6 factors in each sex, 13% of the interchild variance of HDL cholesterol in boys could be explained in a multiple linear regression analysis, and 8% in girls. Including the practice variation as a further independent variable increased the explanation to 18% in boys and 15% in girls. An intraclass correlation (sib-sib) of 0.36 was found for HDL cholesterol, suggesting a strong familial influence. The implications of these results are discussed, along with the difficulties of screening for hyperlipidaemia in this age group.link_to_subscribed_fulltex