Life-course socioeconomic positions and subclinical atherosclerosis in the multi-ethnic study of atherosclerosis

A major limitation of past work on the social patterning of atherosclerosis has been the reliance on measures of neighborhood or individual-level socioeconomic position (SEP) assessed at a single point in time in adulthood. Risk of chronic disease is thought to accumulate throughout the life-course, so the use of a measure for a single point in time may result in inaccurate estimates of the social patterning of subclinical disease. Using data from the US Multi-Ethnic Study of Atherosclerosis (MESA), we examined the relation between childhood SEP [CSEP] (father or caretaker's education), adulthood SEP [ASEP] (a summary score of income, education, and wealth), and 20-year average exposure to neighborhood poverty [NSEP] (residential addresses geocoded and linked to census data) and the prevalence of subclinical atherosclerosis, as assessed by common carotid intimal-medial thickness (IMT) in mid to late adulthood. Participants were 45-84 years of age at baseline and were sampled from six study sites in the United States. After adjustment for age, CSEP and ASEP were both inversely and independently associated with IMT in men. All three indicators CSEP, ASEP, and NSEP were inversely and independently associated with IMT in women. Associations were somewhat reduced after adjustment for cardiovascular risk factors, suggesting that these factors may play a mediating role. There was evidence of heterogeneity in effects of NSEP by gender, and in the effects of ASEP and NSEP by race/ethnicity. Our results contribute to the growing body of work that shows that SEP at multiple points in the life-course, and at the individual and neighborhood level, contributes to the development of atherosclerosis.http://deepblue.lib.umich.edu/bitstream/2027.42/61830/1/Lifecourse socioeconomic positions and subclinical atherosclerosis in the multi-ethnic study of atherosclerosis.pd

Designing a multifaceted quality improvement intervention in primary care in a country where general practice is seeking recognition: the case of Cyprus

<p>Abstract</p> <p>Background</p> <p>Quality Improvement Interventions require significant financial investments, and therefore demand careful consideration in their design in order to maximize potential benefits. In this correspondence we present the methodological approach of a multifaceted quality improvement intervention aiming to improve quality of care in primary care, properly tailored for a country such as Cyprus where general practice is currently seeking recognition.</p> <p>Methods</p> <p>Our methodological approach was focused on the design of an open label, community-based intervention controlled trial using all patients from two urban and two rural public primary care centers diagnosed with hypertension and type II diabetes mellitus. The design of our intervention was grounded on a strong theoretical framework that included the Unified Theory of Acceptance and Use of Technology, and the Chronic Care Model, which synthesize evidence-based system changes in accordance with the Theory of Planned Behavior and the Theory of Reasoned Action. The primary outcome measure was improvement in the quality of care for two chronic diseases evaluated through specific clinical indicators, as well as the patient satisfaction assessed by the EUROPEP questionnaire and additional personal interviews.</p> <p>Results</p> <p>We designed a multifaceted quality improvement intervention model, supported by a varying degree of scientific evidence, tailored to local needs and specific country characteristics. Overall, the main components of the intervention were the development and adoption of an electronic medical record and the introduction of clinical guidelines for the management of the targeted chronic diseases facilitated by the necessary model of organizational changes.</p> <p>Conclusion</p> <p>Health planners and policy makers need to be aware of the potential use of certain theoretical models and applied methodology as well as inexpensive tools that may be suitably tailored to the local needs, in order to effectively design quality improvement interventions in primary care settings.</p

Do neighborhood socioeconomic deprivation and low social cohesion predict coronary calcification?: the CARDIA study

Growing evidence suggests that neighborhood characteristics may influence the risk of coronary heart disease. No studies have yet explored associations of neighborhood attributes with subclinical atherosclerosis in younger adult populations. Using data on 2,974 adults (1,699 women, 1,275 men) aged 32-50 years in 2000 from the Coronary Artery Disease Risk Development in Young Adults (CARDIA) Study and 2000 US Census block-group-level data, the authors estimated multivariable-adjusted associations of neighborhood socioeconomic deprivation and perceived neighborhood cohesion with odds of coronary artery calcification (CAC) 5 years later. Among women, the quartiles of highest neighborhood deprivation and lowest cohesion were associated with higher odds of CAC after adjustment for individual-level demographic and socioeconomic factors (for deprivation, odds ratio = 2.49, 95% confidence interval: 1.22, 5.08 (P for trend = 0.03); for cohesion, odds ratio = 1.87, 95% confidence interval: 1.10, 3.16 (P for trend = 0.02)). Associations changed only slightly after adjustment for behavioral, psychosocial, and biologic factors. Among men, neither neighborhood deprivation nor cohesion was related to CAC. However, among men in deprived neighborhoods, low cohesion predicted higher CAC odds (for interaction between neighborhood deprivation and cohesion, P = 0.03). This study provides evidence on associations of neighborhood deprivation and cohesion with CAC in younger, asymptomatic adults. Neighborhood attributes may contribute to subclinical atherosclerosis.http://deepblue.lib.umich.edu/bitstream/2027.42/78332/1/KimDiezRoux2010_AJE.pd

Breadmaking stability of wheat flours: Relation between mixing properties and molecular weight distribution of polymeric glutenins

International audienceABSTRACT The use of multi‐angle laser light scattering (MALLS) in conjunction with asymmetrical flow field‐flow fractionation (A‐FFFF) was investigated for the determination of the molecular weight distribution (MWD) of wheat proteins. The wheat flour proteins were dissolved by sonication in 0.1 M sodium phosphate (pH 6.9) containing 2% SDS. The results presented make it evident that efficient separation and size characterization of monomeric ( M < 10 5 g/mol) and polymeric protein (10 5 ≤ M < 10 8 g/mol) wheat proteins can be achieved with A‐FFFF/MALLS/UV in a single run. Therefore, this method appears to be able to detect significant modifications of MWD of wheat protein, whatever the factor inducing these alterations (i.e., genetic or environmental) and whatever the nature of these alterations (i.e., monomeric‐to‐polymeric ratio or MWD of polymeric protein). In the present study, we have indeed demonstrated that the MWD of wheat proteins can be altered from one cultivar to another in three main ways: by changing the relative amounts of monomeric and polymeric proteins, by changing the MWD of polymeric protein, and then by changing both the monomeric‐to‐polymeric ratio and the MWD of polymeric protein

Impact of Cultivar and Environment on Size Characteristics of Wheat Proteins Using Asymmetrical Flow Field‐Flow Fractionation and Multi‐Angle Laser Light Scattering

ABSTRACT The use of multi‐angle laser light scattering (MALLS) in conjunction with asymmetrical flow field‐flow fractionation (A‐FFFF) was investigated for the determination of the molecular weight distribution (MWD) of wheat proteins. The wheat flour proteins were dissolved by sonication in 0.1 M sodium phosphate (pH 6.9) containing 2% SDS. The results presented make it evident that efficient separation and size characterization of monomeric ( M < 10 5 g/mol) and polymeric protein (10 5 ≤ M < 10 8 g/mol) wheat proteins can be achieved with A‐FFFF/MALLS/UV in a single run. Therefore, this method appears to be able to detect significant modifications of MWD of wheat protein, whatever the factor inducing these alterations (i.e., genetic or environmental) and whatever the nature of these alterations (i.e., monomeric‐to‐polymeric ratio or MWD of polymeric protein). In the present study, we have indeed demonstrated that the MWD of wheat proteins can be altered from one cultivar to another in three main ways: by changing the relative amounts of monomeric and polymeric proteins, by changing the MWD of polymeric protein, and then by changing both the monomeric‐to‐polymeric ratio and the MWD of polymeric protein

Breadmaking stability of wheat flours: Relation between mixing properties and molecular weight distribution of polymeric glutenins

The environmental stability of breadmaking quality of wheat flours i.e. the absence of fluctuation across environments and genotype X environment interactions is as important as their performance in milling and baking. Many statistical approaches have been used to assess cultivar stability parameters across environments. Quality stability parameters were studied using a set of eleven bread wheat cultivars and five hybrid wheats grown in France at eight locations in two consecutive years. Three different statistical variances: ecovalence Wi, environmental variance S-Xi(2) and genotypic stability were used to assess the stability of quality parameters measured on wheat kernels at harvest, on the technological properties of their flours and on the molecular weight distribution of total endosperm proteins extracted using 2% SDS in phosphate buffer with sonication. Asymmetrical flow field-flow fractionation coupled with a multi-angle laser light scattering photometer allowed the molar masses of polymeric glutenins to be measured without size limits. Marked variation in the quality parameters was observed due to genetic and environmental effects. The three stability values calculated for protein content were not significantly correlated to the stability of the polymeric fraction, the bread loaf volume (LV) or the bread quality score (BQS). The three stability values of LV and BQS were significantly correlated to the stability of the weight-average ( w) molecular weight of the polymeric fraction. Multiple regressions showed that 60-84% of the stability values of LV and BQS were explained by the stability of only few quality parameters among which the (M)w of polymers played the major role