Monitoring, Cross Subsidies, and Universal Banking

We formalize the idea that a financial conglomerate may utilize commercial banking activities to cross-subsidize investment banking through bundled offers. The investment banking sector entails supra-normal profits due to incentive problems with security underwriting. Universal banks may aim to capture (some of) those profits by providing discounts on commercial loans. This practice has an adverse effect on commercial banks’ monitoring incentives, encouraging the pursuit of private rents by entrepreneurs. It also leads to lower underwriting fees and a lower probability of successful public offerings. The social welfare effects of universal banking can be either positive or negative

Epidemiology of leisure-time physical activity in socio-demographic, lifestyle and psychological characteristics of men and women in Greece: the ATTICA Study

BACKGROUND: We aimed to evaluate the prevalence, frequency and type of leisure-time physical activity (LTPA) among adults in Greece, as well as its relationship with socio-demographic, lifestyle and clinical characteristics of these people. METHODS: From May 2001 to December 2002 we randomly enrolled 1514 men and 1528 women, without any evidence of cardiovascular or any other chronic disease. The sampling was stratified by the age – gender distribution of (census 2001) of the greater area of Athens. Weekly energy expenditure assessed by considering frequency, duration (in minutes) and intensity of sports related physical activity during a usual week. RESULTS: 53% of men and 48% of women were classified as physically active. Men were more likely to be active as compared to women (p < 0.05), while the lowest activity rates were observed in 40 to 49 years old participants (p < 0.01). Physically active people had higher occupation skills, were more likely to live in rural areas, to be unmarried, non smokers and they were devoted to a healthier dietary pattern, as compared to sedentary, irrespective of age and sex (all p < 0.05). In addition, the cumulative risk factors score of obesity, hypertension, hypercholesterolemia and diabetes, was inversely associated with activity status (p < 0.001). Finally, physically active men and women were less likely to report depressive symptoms (p < 0.01), after various adjustments were made. CONCLUSION: Half of the studied population reported physically inactive, indicating that sedentary lifestyle becomes a serious epidemic in Greece. High occupation skills, non-smoking, devotion to a healthier dietary pattern and a better cardiovascular risk factors profile were some of the determinants of physically active people

Achievement of Right Ventricular Pacing by Use of a Long Guiding Catheter in a Hemodialysis Patient Presenting Significant Tortuosity of Vasculature

Increased vascular calcification and tortuosity are rather common in end-stage renal failure patients who are on hemodialysis. It renders manipulation of catheters and performance of percutaneous transluminal interventions more difficult than expected. Such vascular alterations may be evident in large veins and pose significant difficulties in placement of pacing leads as shown in our case. To overcome such difficulties, we demonstrated in this patient case that long guiding catheters may be of particular value

Ambulatory Blood Pressure Monitoring in Resistant Hypertension

ABPM constitutes a valuable tool in the diagnosis of RH. The identification of white coat RH and masked hypertension (which may fulfill or not the definition of RH) is of great importance in the clinical management of such patients. Moreover, the various ABPM components such as average BP values, circadian BP variability patterns, and ambulatory BP-derived indices, such as ambulatory arterial stiffness index (AASI), add significantly to the risk stratification of RH. Lastly, ABPM may indicate the need for implementation of specific therapeutic strategies, such as chronotherapy, that is, administration-time dependent therapy, and the evaluation of their efficacy

P Wave Dispersion: a valuable non-invasive marker of vulnerability to atrial arrhythmias

The prolongation of intraatrial and interatrial conduction time and the non-homogeneous propagation of sinus impulses are well known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation (AF). Previous studies have demonstrated that individuals with clinical history of paroxysmal AF show a significantly increased P wave duration in 12-lead surface electrocardiograms (ECG) and signal-averaged ECG recordings. The inhomogeneous and discontinuous atrial conduction in patients with atrial arrhythmias has been studied, during the last years, with a new ECG index, P wave dispersion. P wave dispersion is defined as the difference between the longest and the shortest P wave duration recorded from multiple different surface ECG leads. Extensive clinical evaluation of P wave dispersion has been performed in the assessment of the risk for AF in patients without apparent heart disease, in hypertensive patients, in patients with coronary artery disease, in patients undergoing coronary artery bypass surgery, in patients with congenital heart diseases, as well as in other groups of patients suffering from various cardiac or non-cardiac diseases. P wave dispersion has proven to be a sensitive and specific ECG predictor of AF in the various clinical settings. However, the methodology used for the calculation of P wave dispersion has not been standardized so far and more efforts to improve the reliability and reproducibility of P wave dispersion measurements are needed. In conclusion, P wave dispersion constitutes a significant contribution to the field of non-invasive electrocardiology and seems to be quite promising in the field of AF prediction

Advantages of Real-Time Three-Dimensional Echocardiography Over Two-Dimensional Echocardiography

Over the last fifty-years conventional two-dimensional (2D) echocardiography has served as a valuable clinical adjunct for the diagnosis and management of cardiovascular disease. However, the echocardiologist was expected to mentally reconstruct the complex structure of myocardium, resulting in geometrical assumptions which in turn could underestimate the validity of clinical findings

Hypertension: Renal Denervation: Hype After Initial Hope/Lessons to be Learned From its Fall/Other Methods Influencing the Autonomic Nervous System

The unexpected announcement of Symplicity HTN-3 trial by the sponsor company that renal sympathetic denervation (RDN) failed to meet its primary efficacy end-point at 6 months raised concerns regarding the extent of blood pressure (BP) lowering results of the procedure.1 But the answer to the “burning” question of whether we should stop research and clinical implementation of RDN based on the results of one trial needs a cautious approach

Five-year incidence of type 2 diabetes mellitus among cardiovascular disease-free Greek adults: Findings from the ATTICA study

Demosthenes B Panagiotakos1, Christos Pitsavos2, Yannis Skoumas2, Yannis Lentzas2, Christodoulos Stefanadis21Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece; 2First Cardiology Clinic, School of Medicine, University of Athens, Athens, GreeceObjective: We evaluated the 5-year incidence of diabetes in an adult population from Greece.Research design and methods: 3042 individuals (&gt;18 years), free of cardiovascular disease, participated in the baseline examination (during 2001&ndash;2002). Of this sample, 1012 men and 1035 women were found alive at the time of follow-up, while 32 (2.1%) men and 22 (1.4%) women died during this period. The rest were lost to follow-up. Incidence of type 2 diabetes mellitus was evaluated in 1806 participants who did not have diabetes at baseline.Results: The age-adjusted 5-year incidence of diabetes was 5.5% (men, 5.8%; women, 5.2%). A linear trend was observed between diabetes incidence and age (5.6% increases in incidence per 1-year difference in age, p &lt;&nbsp;0.001). Multiple logistic regression analysis revealed that age (OR per 1 yr = 1.04, 95% CI 1.02&ndash;1.06), waist (OR per 1 cm = 1.02, 95% CI 1.01&ndash;1.003), physical activity (OR = 0.62, 95% CI 0.35&ndash;1.02) and family history of diabetes (OR = 2.65, 95% CI 1.58&ndash;4.53), as well as fasting glucose levels (OR per 1 mg/dl = 1.05, 95% CI 1.03&ndash;1.07), were the most significant baseline predictors for diabetes, after adjusting for various potential confounders. Additionally, presence of metabolic syndrome at baseline evaluation 2.95-fold the risk of diabetes (95% CI 1.89&ndash;4.61), and showed better classification ability than the model that contained the components of the syndrome (ie, correct classification rate: 94.5% vs. 92.3%).Conclusion: Our findings show that a 5.5% incidence rate of diabetes within a 5-year period, which suggests that the prevalence of this disorder in Greece is rising. Aging, heredity, and metabolic syndrome were the most significant determinants of diabetes.Keywords: diabetes, incidence, metabolic syndrom