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Mild hypercholesterolemia and premature heart disease: Do the national criteria underestimate disease risk?

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第5期35卷 1178-1184页

作者： Akosah, KO Gower, E Groon, L Rooney, BL Schaper, A Gundersen Lutheran Med Ctr La Crosse WI 54601 USA

OBJECTIVES To determine the frequency of hospital admissions for acute coronary syndrome In young adults and to examine the risk factors that predispose to the development of premature heart disease. BACKGROUND Significant coronary heart disease (CHD) is considered rare in the young adult. Current guidelines do not recommend treatment of mild cholesterol abnormalities fur primary prevention of CHD in the young. METHODS This is a large case series of 449 adults (less than or equal to 50 years) admitted to the hospital with acute coronary syndrome. A history of cardiovascular risk factors and lipid profile were recorded. The presence and extent of CHD were established. RESULTS Mean patient age was 44 +/- 6 years. Documented CHD was present in 61% of hospital admissions. Multivariate analysis revealed that history of hypercholesterolemia, history of smoking and diabetes were independently associated with premature CMD, The fasting lipid profiles were only borderline to mildly abnormal. Serum total cholesterol, low-density lipoprotein (LDL) and triglyceride levels were not different in cases compared with control subjects. Nearly half (49%) of those with LDL levels of greater than or equal to 160 mg/dl had only une additional risk factor or none. Despite this, a history of hypercholesterolemia had independent and incremental value on other risk factors for the likelihood of premature CHD. CONCLUSIONS The magnitude of hospital admissions relating to premature CHD is high. In tills population, the presence Df borderline or mild hypercholesterolemia has significant effects on the development of premature CHD. These observations have significant implications in the development of guidelines for primary prevention of premature CHD. (J Am Coll Cardiol 2000;35:1178-84) (C) 2000 by the American College of Cardiology.

关键词：年龄分布胆固醇/血液胆固醇 LDL/血液糖尿病并发症心脏病/诊断心脏病/流行病学心脏病/病因学心脏病/预防和控制高胆固醇血症/血液高胆固醇血症/分类高胆固醇血症/并发症高胆固醇血症/流行病学高胆固醇血症/预防和控制多元分析病人入院/统计学和数值数据诊疗准则(主题) 一级预防结果可重复性危险因素农村卫生/统计学和数值数据疾病严重程度指数吸烟/副作用甘油三酯类/血液威斯康星/流行病学成年人女(雌)性人类男(雄)性中年人

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Psychiatric morbidity of a rural Indian community - Changes over a 20-year interval

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BRITISH JOURNAL OF PSYCHIATRY 2000年第4期176卷 351-356页

作者： Nandi, DN Banerjee, G Mukherjee, SP Ghosh, A Nandi, PS Nandi, S Girindrasekhar Clin Calcutta W Bengal India Univ Calcutta Coll Sci & Technol Calcutta W Bengal India Peeless Hosp Calcutta W Bengal India Rankrishna Mission Seva Pratishthan Calcutta W Bengal India

Background Cross-sectional studies give no indication of the changes that may occur in the mental health status of a community in course of times. Studies should be designed to assess these changes. Aims To assess the changes, if any, in the prevalence of mental disorders in a rural community after an interval of 20 years in the context of its changing socio economic conditions. Method A door-to-door survey of the prevalence of psychiatric morbidity in two villages was conducted by a team of psychiatrists. The survey was repeated after 20 years by the same team and by the same method. Changes in the mental health status of the community were compared. Results Total morbidity per 1000 fell from 116.8 to 105.2. Morbidity in men fell from 86.9 to 73.5 per 1000 and in women from 146.8 to 138.3 per 1000. Rates of anxiety, hysteria and phobia had fallen dramatically and those of depression and mania had risen significantly. Conclusion The level of psychiatric morbidity showed no statistically significant change. The morbidity pattern (relative proportion of type of morbidity), however, showed some interesting changes. Similar studies should be done on a larger sample. Declaration of interest None.

关键词：年龄分布数据收集随访研究健康状况印度/流行病学精神障碍/流行病学精神卫生患病率农村卫生/统计学和数值数据性别分布社会经济因素青少年成年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Suicide in farmers

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BRITISH JOURNAL OF PSYCHIATRY 1999年第2期175卷 103-105页

作者： Malmberg, A Simkin, S Hawton, K Univ Oxford Warneford Hosp Dept Psychiat Oxford OX1 2JD England

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Trauma on rural roads: the role of a peripheral hospital

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 1999年第5期30卷 337-340页

作者： Street, JT Winter, D Buckley, S Nicholson, P Twomey, A Cork Univ Hosp Dept Orthopaed Surg Cork Ireland

Road accident trauma is a leading cause of death and serious morbidity among healthy young adults in the developed world. The Irish Republic has the third worst road safety record in the EU. In studying the unique demographics of rural road accidents, our aim was to provide information essential to the future development of trauma care in Ireland. Our figures highlight the inadequacies of data received by the National Roads Authority, illustrate the resource impact of road trauma on a peripheral hospital, and demonstrate the need for similar studies in the rationalisation of trauma care as we approach the next millennium. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：事故交通/统计学和数值数据年龄分布医院乡村/统计学和数值数据损伤严重度评分爱尔兰/流行病学转诊和会诊/统计学和数值数据回顾性研究农村卫生/统计学和数值数据季节创伤和损伤/流行病学创伤和损伤/病因学青少年成年人老年人老年人 80以上儿童儿童学龄前人类婴儿婴儿新生中年人

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Emergency medical care in rural America

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ANNALS OF EMERGENCY MEDICINE 2001年第3期38卷 323-327页

作者： Williams, JM Ehrlich, PF Prescott, JE W Virginia Univ Dept Emergency Med Morgantown WV 26506 USA W Virginia Univ Dept Surg Morgantown WV 26506 USA

The delivery of high-quality emergency care in a rural setting requires a conceptual framework quite different from that required in urban and suburban environments, given that available resources are limited in the rural setting. The intermittent and episodic nature of seriously ill and injured patients who present to rural emergency departments makes it difficult to plan, staff, and equip in order to provide emergency medical care at the same level seen at higher volume urban or suburban institutions. The objective of this article is to describe the distinctive nature and widely unrecognized features of emergency medicine in rural and remote areas, with a focus on clinical, workforce, and economic issues. We present recommendations for a shift in thinking and a call to action an behalf of all emergency medicine professionals that are based on a realistic assessment of the current status of emergency medicine and that are needed to develop and sustain high-quality emergency medical care in rural America.

关键词：急救医疗服务/利用急救医学/人力急诊室医院/利用卫生保健费用/统计学和数值数据需求估价/统计学和数值数据质量保证卫生保健/统计学和数值数据农村卫生/统计学和数值数据美国人类

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Analysis of prevalence and trends of dental caries in the Americas between the 1970s and 1990s

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INTERNATIONAL DENTAL JOURNAL 1999年第6期49卷 322-329页

作者： Beltrán-Aguilar, ED Estupiñáñ-Day, S Báez, R Ctr Dis Control & Prevent CDC Div Oral Hlth Atlanta GA 30341 USA

Data on the prevalence and severity of dental caries collected by country members of the Pan American Health Organisation (PAHO) were summarised to analyse current status and trends since the 1970s. The mean number of decayed, missing, and filled teeth (DMF-T) among 12-year-old children and the relative contribution of each DMF-T component were collected from official reports and publications in the scientific literature. Overall, a secular trend toward lower caries prevalence was observed in most countries, more notably among those with large prevention programmes using fluorides. Many countries have reached the World Health Organization (WHO) year 2000 goal of a mean DMF-T of less than or equal to 3 but others are still far from reaching that goal. Few countries have reached the status of having large proportions of disease prevalence localised in a small percentage of the population, a pattern observed as prevalence decreases. Since 1994, PAHO's Regional Oral Health Program has developed two strategies to address these issues: the introduction and reinforcement of national preventive programmes using fluorides and the introduction of the atraumatic restorative treatment (ART).

关键词：美洲/流行病学加勒比海地区/流行病学制龋药/治疗应用中美洲/流行病学龋失补指数龋齿/分类龋齿/流行病学龋齿/预防和控制牙修复永久/统计学和数值数据氟化物/治疗应用北美洲/流行病学患病率农村卫生/统计学和数值数据南美/流行病学牙缺失/流行病学城市卫生/统计学和数值数据世界卫生组织儿童人类

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Malocclusion and orthodontic treatment need of secondary school students in Nigeria according to the dental aesthetic index (DAI)

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INTERNATIONAL DENTAL JOURNAL 1999年第4期49卷 203-210页

作者： Otuyemi, OD Ogunyinka, A Dosumu, O Cons, NC Jenny, J lle-lfe Nigeria Ibadan Nigeria Davis USA [*]Faculty of Dentistry College of Health Sciences Obafemi Awolowo University Ile-Ife Nigeria

The aims of this study were to measure the distribution, prevalence and the severity of malocclusion and treatment need amongst randomly selected (n=703) rural and urban Nigerian children aged 12-18 years (mean 14.0+/-1.84) using the dental aesthetic index (DAI), and to assess whether malocclusion was affected by age, gender and socio-economic background. Data were collected according to the method recommended by WHO. Most of the children (77.4 per cent) had a dental appearance which required no orthodontic treatment. Over 13 per cent fell into the group where treatment for malocclusion is considered to be 'elective'. However, a substantial proportion (9.2 per cent) of the population had severe to handicapping malocclusion where treatment is 'highly desirable' or 'mandatory'. There were no statistically significant differences (P>0.05) in DAI scores between age groups, gender and socio-economic background. This study also found that Nigerian adolescents had better dental appearance and less orthodontic treatment need compared with the Caucasian and Oriental populations.

关键词：非洲大陆世系人群年龄因素亚洲大陆世系人群美学牙科欧洲大陆世系人群卫生服务需求/统计学和数值数据错|牙合|/分类错|牙合|/流行病学错|牙合|/治疗尼日利亚/流行病学正畸学矫正/统计学和数值数据患病率可重复性结果农村卫生/统计学和数值数据性别因素社会经济因素城市卫生/统计学和数值数据世界卫生组织青少年儿童女(雌)性人类男(雄)性

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Fever and acute brief psychosis in urban and rural settings in north India

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BRITISH JOURNAL OF PSYCHIATRY 1999年第6期174卷 520-524页

作者： Collins, PY Varma, VK Wig, NN Mojtabai, R Day, R Susser, E Columbia Univ Coll Phys & Surg Dept Psychiat New York NY 10032 USA New York State Psychiat Inst New York NY 10032 USA Postgrad Inst Med Educ & Res Chandigarh 160012 India Univ Pittsburgh Dept Biostat Pittsburgh PA 15261 USA Columbia Univ Joseph P Mailman Sch Publ Hlth Div Epidemiol New York NY 10027 USA

Background This case-control study used data from Chandigarh, North India to investigate the association between antecedent fever and acute brief psychosis. Aims To assess whether antecedent fever may be a biological correlate of acute brief psychosis, and contribute to the nosology of acute brief psychosis. Method The study was based in an incidence cohort from two catchment areas, an urban and a rural site, that were part of the World Health Organization Determinants of Outcome study. The cases (n = 17) met criteria for acute brief psychosis;controls (n = 40) were patients with other acute and subacute psychoses. The Lire Events Schedule was used to determine the presence of antecedent fever. Results The crude odds ratio for fever as a risk factor for acute brief psychosis was 6.2 (P = 0.004). The odds ratio in a logistic regression analysis - adjusted for site, gender and CATEGO classification - was 11.2 (P = 0.003). Conclusions Antecedent fever may be a biological correlate of acute brief psychosis. This finding supports the validity or this entity, and has implications for its aetiology and diagnosis. Declaration of interest Supported by the National institute of Mental Health, USA.

关键词：急性病病例对照研究队列研究发热/并发症发热/流行病学发病率印度/流行病学比值比精神病/并发症精神病/流行病学回归分析农村卫生/统计学和数值数据城市卫生/统计学和数值数据青少年成年人女(雌)性人类男(雄)性

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Electroencephalogram confirmatory rate in neonatal seizures

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PEDIATRIC NEUROLOGY 1999年第1期20卷 27-30页

作者： Sheth, RD Univ Wisconsin Dept Neurol Madison WI 53792 USA

The electroencephalogram (EEG) is confirmatory in 70% of children and adults with seizures, although gestation- and etiology-specific EEG confirmatory rates in neonates have not been well defined. All neonates treated for seizures and who underwent EEG were identified from 4,575 neonates admitted between 1985 and 1996 to a neonatal intensive care unit. The relationship between EEG findings (epileptiform discharges and background abnormalities) and gestation, mortality rate, and seizure etiology was examined using the Student t test. One hundred eighty-three neonates treated for seizures underwent a total of 352 EEGs: 144 of these neonates (79%) had an abnormal EEG (epileptiform discharges in 113 (60%) and non-epileptiform background abnormalities in 31). The EEG confirmatory rate increased with gestation (63% at 28 weeks vs 77% at term, P < 0.02). Etiology for seizures also influenced the EEG confirmatory rate: central nervous system (CNS) infection 95% (P < 0.05), hypoxic-ischemic encephalopathy 80% (P < 0.05), germinal matrix-intraventricular hemorrhage 65%, and CNS malformations 65%. The EEG confirmatory rate was predictive of neonatal mortality (19% vs 6%, P < 0.03). The EEG was directly confirmatory (epileptiform discharges) in 60% and supportive (non-epileptiform background abnormalities) in a further 17% of neonates with seizures. Gestation and etiology influence the EEG confirmatory rate in neonatal seizures. (C) 1999 by Elsevier Science Inc. All rights reserved.

关键词：脑疾病/并发症队列研究脑电描记术/统计学和数值数据孕龄发病率婴儿早产/生理学回顾性研究农村卫生/统计学和数值数据发作/流行病学发作/病理生理学人类婴儿新生

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The effectiveness of weekly iron supplementation in pregnant women of rural northern Malawi

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TROPICAL DOCTOR 2000年第2期30卷 84-88页

作者： Young, MW Lupafya, E Kapenda, E Bobrow, EA Ekwendeni Hosp Ekwendeni Malawi

A weekly iron/folate supplement was compared with a standard daily iron/folate supplement in pregnant women living in rural Malawi. Women were enrolled as they attended the local antenatal clinic, stratified by grade of anaemia and then randomized to receive either 60 mg iron/0.25 mg folate per day (n=211) or 120 mg iron/0.50 mg folate once a week (n=202). Supplementation was continued for a minimum of 8 weeks (10 weeks on average) and was self administered by the women at home. Initial haemoglobin values for the daily (mu=105.7 g/l) and weekly (mu=104.4 g/l) groups as well as final haemoglobin values (107.5 g/l and 105.6 g/l, respectively) did not differ significantly between the two groups, Haemoglobin values increased by similar levels in both groups with the subset of anaemic women increasing by an average of 6.3 g/l in the daily group (n=70) and 5.9 g/l in the weekly group (n=66) for all women. For compliant, anaemic women, the increases were 7.4 g/l and 6.6 g/l for the dairy and weekly groups, respectively. Compliance, as indicated by self reporting and by regular counts of remaining tablets, was significantly higher in the weekly group (76% compared with 60%, P < 0.05), however compliance was identical in both groups when assessed by a stool test for elemental iron. Reported side effects were significantly reduced in the weekly group (6% compared with 17%, P < 0.05). We conclude that a weekly iron supplement given to pregnant women in rural Malawi has similar haematologic effects, and an improved side effect profile, in comparison with a standard daily supplement when administered through an existing primary healthcare programme, although both regimens are relatively unsuccessful in the reduction of anaemia prevalence during pregnancy.

关键词：农村卫生/统计学和数值数据疾病严重程度指数

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