Analyzing Recent Coronary Heart Disease Mortality Trends in Tunisia between 1997 and 2009.

BACKGROUND: In Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing. OBJECTIVE: To explain recent CHD trends in Tunisia between 1997 and 2009. METHODS: DATA SOURCES: Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys. ANALYSIS: Data were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity). RESULTS: CHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (-0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75). CONCLUSIONS: Recent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive

Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model.

BACKGROUND: Most projections of type 2 diabetes (T2D) prevalence are simply based on demographic change (i.e. ageing). We developed a model to predict future trends in T2D prevalence in Tunisia, explicitly taking into account trends in major risk factors (obesity and smoking). This could improve assessment of policy options for prevention and health service planning. METHODS: The IMPACT T2D model uses a Markov approach to integrate population, obesity and smoking trends to estimate future T2D prevalence. We developed a model for the Tunisian population from 1997 to 2027, and validated the model outputs by comparing with a subsequent T2D prevalence survey conducted in 2005. RESULTS: The model estimated that the prevalence of T2D among Tunisians aged over 25 years was 12.0% in 1997 (95% confidence intervals 9.6%-14.4%), increasing to 15.1% (12.5%-17.4%) in 2005. Between 1997 and 2005, observed prevalence in men increased from 13.5% to 16.1% and in women from 12.9% to 14.1%. The model forecast for a dramatic rise in prevalence by 2027 (26.6% overall, 28.6% in men and 24.7% in women). However, if obesity prevalence declined by 20% in the 10 years from 2013, and if smoking decreased by 20% over 10 years from 2009, a 3.3% reduction in T2D prevalence could be achieved in 2027 (2.5% in men and 4.1% in women). CONCLUSIONS: This innovative model provides a reasonably close estimate of T2D prevalence for Tunisia over the 1997-2027 period. Diabetes burden is now a significant public health challenge. Our model predicts that this burden will increase significantly in the next two decades. Tackling obesity, smoking and other T2D risk factors thus needs urgent action. Tunisian decision makers have therefore defined two strategies: obesity reduction and tobacco control. Responses will be evaluated in future population surveys

Association Analysis of the Extended MHC Region in Celiac Disease Implicates Multiple Independent Susceptibility Loci

Celiac disease is a common autoimmune disease caused by sensitivity to the dietary protein gluten. Forty loci have been implicated in the disease. All disease loci have been characterized as low-penetrance, with the exception of the high-risk genotypes in the HLA-DQA1 and HLA-DQB1 genes, which are necessary but not sufficient to cause the disease. The very strong effects from the known HLA loci and the genetically complex nature of the major histocompatibility complex (MHC) have precluded a thorough investigation of the region. The purpose of this study was to test the hypothesis that additional celiac disease loci exist within the extended MHC (xMHC). A set of 1898 SNPs was analyzed for association across the 7.6 Mb xMHC region in 1668 confirmed celiac disease cases and 517 unaffected controls. Conditional recursive partitioning was used to create an informative indicator of the known HLA-DQA1 and HLA-DQB1 high-risk genotypes that was included in the association analysis to account for their effects. A linkage disequilibrium-based grouping procedure was utilized to estimate the number of independent celiac disease loci present in the xMHC after accounting for the known effects. There was significant statistical evidence for four new independent celiac disease loci within the classic MHC region. This study is the first comprehensive association analysis of the xMHC in celiac disease that specifically accounts for the known HLA disease genotypes and the genetic complexity of the region

The association of levels of physical activity with metabolic syndrome in rural Australian adults

Background:&nbsp; Physical activity (PA) reduces risk factors related to metabolic syndrome. Rurality influences the way people incorporate physical activity into daily life. The aim of this study is to determine the association of PA level with metabolic syndrome in a rural Australian population. The influence of adiposity on these associations is also investigated.Methods: Three cross-sectional population health surveys were conducted in south-east Australia during 2004&ndash;2006 using a random population sample (n = 1563, participation rate 49%) aged 25&ndash;74 years. PA was assessed via a self-administered questionnaire, and components of the metabolic syndrome via anthropometric measurements taken by specially trained nurses and laboratory tests.Results: Approximately one-fifth of participants were inactive in leisure-time and over one-third had metabolic syndrome (men 39%, women 33%; p = 0.022). There was an inverse association between level of PA and metabolic syndrome (p &lt; 0.001). Men who were inactive in leisure-time were more than twice as likely and women more than three times as likely to have metabolic syndrome compared with those having high PA. Body mass index (BMI) is a mediating factor in the association between level of PA and metabolic syndrome.Conclusion: Some PA is better than none if adults, particularly women, are to reduce their risk of metabolic syndrome and associated vascular diseases. Specialised interventions that take rurality into consideration are recommended for adults who are inactive.<br /

An Efficient ANN Interference Cancelation for High Order Modulation over Rayleigh Fading Channel

High order modulation (HOM) presents a key challenge in increasing spectrum efficiency in 4G and upcoming 5G communication systems. In this paper, two non-linear adaptive equalizer techniques based on multilayer perceptron (MLP) and radial basis function (RBF) are designed and applied on HOM to optimize its performance despite its high sensitivity to noise and channel distortions. The artificial neural network’s (ANN) adaptive equalizer architectures and learning methods are simplified to avoid more complexity and to ensure greater speed in symbol decision making. They will be compared with the following popular adaptive filters: least mean square (LMS) and recursive least squares (RLS), in terms of bit error rate (BER) and minimum square error (MSE) with 16, 64, 128, 256, 512 and 1024 quadrature amplitude modulation (QAM). By that, this work will show the advantage that the MLP equalizer has, in most cases, over RBF and traditional linear equalizers

Utilisation de Tlim (100 % de VMA) pour améliorer la performance en course de fond. Etude longitudinale.

National audienceno abstrac

The effect of time-of-day of training during Ramadan on physiological parameters in highly trained endurance athletes

International audienceWe investigated the effect of Ramadan fasting on maximal aerobic velocity (MAV), time to exhaustion (t(lim100)), performance in running 3000-m in runners who trained at 09:00, 14:00, and 22:00h. Twenty-four middle- and long-distance runners (28.5 +/- 10.6years) were assigned to 3 groups of 8 participants: an afternoon group (AG) (who trained between 14:00 and 16:00h), a morning group (MG) (who trained between 09:00 and 11:00h), and an evening group (EG) (who trained between 22:00 and 24:00h). Before, at mid-, and after Ramadan, MAV and maximal oxygen uptake were significantly higher (p<0.01) in the AG and MG groups compared to the EG group. Before and after Ramadan, the times recorded for the 3000-m running exercise were significantly higher (p<0.01) and t(lim100) was significantly lower (p<0.001) in the EG and MG groups compared to the AG groups. In conclusion, afternoon training during Ramadan might be more effective than morning or evening training for the enhancement of aerobic capacity

Drafting improves 3000 m running performance in elite athletes : is it a placebo effect ?

International audienceAbstract PURPOSE: To determine the effect of drafting on running time, physiological responseand rating of perceived exertion (RPE) during 3000-m track running. METHODS: Ten elite middle- and long-distance runners performed 3 track-running sessions. The 1st session determined maximal oxygen uptake and maximal aerobic speed using a lightweight ambulatory respiratory gas-exchange system (K4B2). The 2nd and the 3rd tests consisted of nondrafting 3000-m running (3000-mND) and 3000-m running with drafting for the 1st 2000 m (3000-mD) performed on the track in a randomized counterbalanced order. RESULTS: Performance during the 3000-mND (553.59 ± 22.15 s) was significantly slower (P < .05) than during the 3000-mD (544.74 ± 18.72 s). Cardiorespiratory responses were not significantly different between the trials. However, blood lactate concentration was significantly higher (P < .05) after the 3000-mND (16.4 ± 2.3 mmol/L) than after the 3000-mD (13.2 ± 5.6 mmol/L). Athletes perceived the 3000-mND as more strenuous than the 3000-mD (P < .05) (RPE = 16.1 ± 0.8 vs 13.1 ± 1.3). Results demonstrate that drafting has a significant effect on performance in highly trained runners. CONCLUSION: This effect could not be explained by a reduced energy expenditure or cardiorespiratory effort as a result of drafting. This raises the possibility that drafting may aid running performance by both physiological and nonphysiological (ie, psychological) effects