Electrocardiographic indicators of autonomic balance and mortality : a case-cohort approach.

The aim of the study reported in this thesis is. to investigate in a population of apparently healthy middle-aged civil servants, the predictive value for cardiovascular mortality of presumed electrocardiographic indicators of autonomic imbalance. For the sympathetic/parasympathetic balance RR- and PQ-interval lengths were considered as indicators. QT-interval length was taken as a manifestation of the balance between left and right sympathetic innervation. Minor abnormalities in ST-segment level and T-wave amplitude may reflect both kinds of imbalance. however. may also be a consequence of myocardial or epicardial disease. The following questions were studied in relation to these electrocardiographic parameters: Are these parameters separately. at rest or after exercise. associated with the risk of allcause. cardiovascular and coronary heart disease mortality? Are the observed associations between these parameters and mortality risk independent of established cardiovascular risk factors? To what extent do these electrocardiographic parameters combined predict coronary heart disease mortality risk? In addition to the electrocardiographic subject matter. this thesis also contains a methodological digression. Its purpose is to evaluate the performance of the case-cohort sampling design relative to other cost-efficient designs and to extend methods of data analysis for this design

Obesity prevalence and time trend among youngsters in China, 1982-2002

Purpose of present study is to describe the prevalence and trend of overweight and obesity, as well as its coexistence with stunting, among youngsters in China, from 1982 to 2002. Data from children 7-17 years of age from three cross-sectional national surveys: 1982 China National Nutrition Survey (5 334 boys and 4 793 girls), 1992 China National Nutrition Survey (8 048 boys and 7 453 girls) and 2002 China National Nutrition and Health Survey (23 242 boys and 21 638 girls) were used in this study. Overweight and obesity were defined according to age, sex specific BMI cut-off points from the International Obesity Task Force, while stunting was defined as height-for-age below -2 standard deviation from the NCHS/WHO reference median value. Results: Overweight prevalence of Chinese youngsters was 1.2%, 3.7% and 4.4%, while the obesity prevalence was 0.2%, 0.9% and 0.9% in 1982, 1992 and 2002, respectively. Both the overweight and obesity prevalence and their increment were higher among boys in urban areas. In 1982, 28.4% of overweight and 69.6% of obese youngsters were stunted, this decreased to 22.0% and 46.4% in 1992, and then to 5.7% and 7.7% in 2002, respectively. Conclusion: The prevalence of overweight and obesity in Chinese youngsters were low in 1982. There has been a rapid increase since then. If this trend continues, overweight will soon reach epidemic proportions. Stunting among overweight and obese youngsters decreased dramatically at the same time

Anemia Prevalence among Pregnant Women and Birth Weight in Five Areas in China

Objectives: To investigate the current prevalence of anemia among pregnant women in different areas of China and the association with birth weight and educational level. Methods: A total of 6,413 women aged 24-37 in the third trimester of pregnancy from five areas were randomly selected from all gravidas who gave birth in the hospitals from 1999 to 2003. Blood hemoglobin concentration (Hb) was measured by the cyanomethemoglobin method; Hb <110 g/l was considered as anemia. Results: The overall prevalence of anemia was 58.6%, ranging from 48.1 to 70.5% in the five areas. There was a significant difference in the prevalence of anemia between women who have mental jobs and those who have physical jobs (52.3 vs. 61.1%, p <0.01). The prevalence of anemia depended on the level of education: with 52.9, 62.4 and 66.5%, for college, secondary school and primary education, respectively, and the difference was statistically significant (p = 0.005). Results showed that higher birth weight was associated with Hb concentrations ranging from 90 to 140 g/l, whereas lower birth weight occurred below 80 g/l and above 140 g/l Hb. Conclusions: The prevalence of anemia in Chinese pregnant women was high both in rural areas and towns. Area of residence, education level and type of job influenced the prevalence of anemia. Low maternal Hb concentrations influenced birth weight

Supplementation of iron alone and combined with vitamins improves haematological status, erythrocyte membrane fluidity and oxidative stress in anaemic pregnant women

Pregnancy is a condition exhibiting increased susceptibility to oxidative stress, and Fe plays a central role in generating harmful oxygen species. The objective of the present study is to investigate the changes in haematological status, oxidative stress and erythrocyte membrane fluidity in anaemic pregnant women after Fe supplementation with and without combined vitamins. The study was a 2 months double-blind, randomised trial. Pregnant women (n 164) were allocated to four groups: group C was the placebo control group; group I was supplemented daily with 60 mg Fe (ferrous sulphate) daily; group IF was supplemented daily with Fe plus 400 µg folic acid; group IM was supplemented daily with Fe plus 2 mg retinol and 1 mg riboflavin, respectively. After the 2-month trial, Hb significantly increased by 15·8, 17·3 and 21·8 g/l, and ferritin by 2·8, 3·6 and 11·0 µg/l, in the I, IF and IM groups compared with placebo. Polarisation (¿) and microviscosity (¿) decreased significantly in other groups compared with placebo, indicating an increase in membrane fluidity. Significant decreases of ¿ and ¿ values compared with group C were 0·033 and 0·959 for group I, 0·037 and 1·074 for group IF and 0·064 and 1·865 for group IM, respectively. In addition, significant increases of glutathione peroxidase activities and decreases of malondialdehyde were shown in all treated groups, as well as increases of plasma retinol and urine riboflavin in group IM. The findings show that supplementation with Fe and particularly in combination with vitamins could improve the haematological status as well as oxidative stress and erythrocyte membrane fluidit

Does media use result in more active communicators? Differences between native Dutch and Turkish-Dutch patients in information-seeking behavior and participation during consultations with general practitioners

This study investigates differences between native Dutch and Turkish-Dutch patients with respect to media usage before and patient participation during medical consultations with general practitioners. In addition, the authors assessed the relation between patient participation and communication outcomes. The patients were recruited in the waiting rooms of general practitioners, and 191 patients (117 native Dutch, 74 Turkish-Dutch) completed pre- and postconsultation questionnaires. Of this sample, 120 patients (62.8%; 82 native Dutch, 38 Turkish-Dutch) agreed to have their consultations recorded to measure patient participation. Compared with Turkish-Dutch patients of similar educational levels, results showed that native Dutch patients used different media to search for information, participated to a greater extent during their consultations and were more responsive to their general practitioner. With respect to the Turkish-Dutch patients, media usage was related to increased patient participation, which was correlated with having fewer unfulfilled information needs; however, these relations were not found in the native Dutch patient sample. In conclusion, interventions that enhance participation among ethnic minority patients will better fulfill informational needs when such interventions stimulate information-seeking behavior in that group before a medical consultation

Plasma carotenoid concentrations in relation to acute respiratory infections in elderly people

A high plasma carotenoid concentration could improve the immune response and result in decreased risk of infectious diseases. However, data on the relationship of plasma carotenoid concentration with acute respiratory infections, which occur frequently in elderly people, are scarce. We investigated, therefore, the relationship of plasma concentrations of six major carotenoids (ß-carotene, a-carotene, ß-cryptoxanthin, lycopene, lutein and zeaxanthin) with the incidence and severity of acute respiratory infections. Baseline data from an intervention trial were used. Participants were 652 non-institutionalized elderly people (=60 years old) enrolled via two community-based sampling strategies in the Wageningen area of The Netherlands in 1998–99. Plasma carotenoid concentrations were divided into quartiles, the lowest being the reference. Frequency and severity of episodes during the previous 1 year, i.e. staying in bed, medical consultation and episode-related medication, were self-reported by means of a questionnaire. On average 1·6 episodes per person were recorded. The incidence rate ratio of acute respiratory infections at high ß-carotene status was 0·71 (95% CI 0·54–0·92) as compared with the low ß-carotene concentration group. No association was observed between ß-carotene and illness severity. a-Carotene, ß-cryptoxanthin, lycopene, lutein and zeaxanthin were not related to incidence or severity of the infections. We conclude that elderly people with a high plasma ß-carotene concentration may have a lower occurrence of acute respiratory infections

Environmental Survival of Mycobacterium avium subsp. paratuberculosis in Different Climatic Zones of Eastern Australia.

The duration of survival of both the S and C strains of Mycobacterium avium subsp. paratuberculosis in feces was quantified in contrasting climatic zones of New South Wales, Australia, and detailed environmental temperature data were collected. Known concentrations of S and C strains in feces placed on soil in polystyrene boxes were exposed to the environment with or without the provision of shade (70%) at Bathurst, Armidale, Condobolin, and Broken Hill, and subsamples taken every 2 weeks were cultured for the presence of M. avium subsp. paratuberculosis. The duration of survival ranged from a minimum of 1 week to a maximum of 16 weeks, and the provision of 70% shade was the most important factor in extending the survival time. The hazard of death for exposed compared to shaded samples was 20 and 9 times higher for the S and C strains, respectively. Site did not affect the survival of the C strain, but for the S strain, the hazard of death was 2.3 times higher at the two arid zone sites (Broken Hill and Condobolin) than at the two temperate zone sites (Bathurst and Armidale). Temperature measurements revealed maximum temperatures exceeding 60°C and large daily temperature ranges at the soil surface, particularly in exposed boxes.This work was supported by the NSW sheep industry through the NSW Ovine Johne's Disease Industry Fund and the NSW Rural Assistance Authority

Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior

Annemiek J Linn,1 Julia CM van Weert,1 Barbara C Schouten,1 Edith G Smit,1 Ad A van Bodegraven,2 Liset van Dijk31Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands; 2VU University Medical Center, Amsterdam, The Netherlands; 3Netherlands Institute for Health Services Research, Utrecht, The NetherlandsPurpose: The barriers to patients&amp;rsquo; successful medication intake behavior could be reduced through tailored communication about these barriers. The aim of this study is therefore (1) to develop a new communication typology to address these barriers to successful medication intake behavior, and (2) to examine the relationship between the use of the typology and the reduction of the barriers to successful medication intake behavior.Patients and methods: Based on a literature review, the practical and perceptual barriers to successful medication intake behavior typology (PPB-typology) was developed. The PPB-typology addresses four potential types of barriers that can be either practical (memory and daily routine barriers) or perceptual (concern and necessity barriers). The typology describes tailored communication strategies that are organized according to barriers and communication strategies that are organized according to provider and patient roles. Eighty consultations concerning first-time medication use between nurses and inflammatory bowel disease patients were videotaped. The verbal content of the consultations was analyzed using a coding system based on the PPB-typology. The Medication Understanding and Use Self-efficacy Scale and the Beliefs about Medicine Questionnaire Scale were used as indicators of patients&amp;rsquo; barriers and correlated with PPB-related scores.Results: The results showed that nurses generally did not communicate with patients according to the typology. However, when they did, fewer barriers to successful medication intake behavior were identified. A significant association was found between nurses who encouraged question-asking behavior and memory barriers (r = &amp;minus;0.228, P = 0.042) and between nurses who summarized information (r = &amp;minus;0.254, P = 0.023) or used cartoons or pictures (r = &amp;minus;0.249, P = 0.026) and concern barriers. Moreover, a significant relationship between patients&amp;rsquo; emotional cues about side effects and perceived concern barriers (r = 0.244, P = 0.029) was found as well.Conclusion: The PPB-typology provides communication recommendations that are designed to meet patients&amp;rsquo; needs and assist providers in the promotion of successful medication intake behavior, and it can be a useful tool for developing effective communication skills training programs.Keywords: interpersonal communication, tailoring, adherence, coding provider-patient interaction, beliefs, self-efficac