Experience with cardiac valve operations in Cape York Peninsula and the Torres Strait Islands, Australia

OBJECTIVE: To describe the outcome of valve surgery, for rheumatic heart disease (RHD) and non-RHD, in residents of Cape York Peninsula and the Torres Strait Islands referred to the Cairns Base Hospital specialist outreach service. DESIGN AND PARTICIPANTS: Retrospective review of medical records on all patients residing in the outreach area who had surgery for valvular heart disease between 1 January 1992 and 31 December 2004. MAIN OUTCOME MEASURES: Operation type and perioperative characteristics; 5- and 10-year survival rates; reoperation rates; complications. RESULTS: Forty-seven patients met the selection criteria; the median age was 40 years (range, 4-76 years); and 39 patients were Indigenous. RHD was the predominant cause of valve dysfunction (30/47 patients). Thirty-seven patients had valve replacements, six had valve repair and four had balloon valvotomy as the initial procedure. There were three bleeding complications, two episodes of operated valve endocarditis, and six embolic complications. There were nine valve-related deaths (six in the first 5 years). At 5 years, all seven patients who had had valve repair or balloon valvotomy were alive. Seven of the 47 patients required reoperation. Survival analysis showed freedom from valve-related deaths to be 83% (95% CI, 66%-92%) at 5 years and 61% (95% CI, 33%-80%) at 10 years. Freedom from reoperation at 5 years was 88% (95% CI, 71%-95%). Among the 30 patients with RHD, freedom from valve-related death was 80% (95% CI, 60%-92%) at 5 years and 52% (95% CI, 21%-75%) at 10 years. In patients with RHD, freedom from reoperation at 5 years was 87% (95% CI, 65%-96%). CONCLUSION: Valvular heart disease results in substantial morbidity and mortality, despite intervention. Efforts need to focus on prevention of rheumatic fever and closer follow-up.     

Untreated hypertension among Australian adults: the 1999-2000 Australian Diabetes,Obesity and Lifestyle Study (AusDiab)

OBJECTIVE: To measure the prevalence of untreated hypertension in Australian adults, and examine the associations with clinical and lifestyle factors. DESIGN: AusDiab, a cross-sectional survey conducted between May 1999 and December 2000, involved participants from 42 randomly selected census districts throughout Australia. PARTICIPANTS: Of 20 347 eligible people aged >or= 25 years who completed a household interview, 11 247 attended a physical examination (response rate, 55%). MAIN OUTCOME MEASURES: The prevalence of hypertension (blood pressure >or= 140/90 mmHg or self-reported use of antihypertensive drugs) and its treatment; associations of clinical and lifestyle factors with the treatment of hypertension; and adequacy of treatment for primary and secondary prevention of cardiovascular disease. RESULTS: The prevalence of hypertension was 28.6 per 100 (95% CI, 25.0-32.3), and the prevalence of untreated hypertension was 15.2 per 100 (95% CI, 13.2-17.2). Of those with untreated hypertension, 80.8% (95% CI, 74.7%-85.0%) had had a blood pressure check within the preceding 12 months. At least one modifiable lifestyle factor was present in 71.7% (95% CI, 68.5%-74.8%) of participants with untreated hypertension. Although lower risk clinical characteristics of younger age and lack of hyperlipidaemia were independently associated with untreated hypertension, 53.5% warranted treatment based on current cardiovascular disease prevention guidelines and multivariable absolute risk assessment. CONCLUSIONS: Considerable scope remains for reducing the burden of cardiovascular disease through lifestyle modification and rational treatment of hypertension.     

Prevalence and trends in obesity among US adults, 1999-2000

Context  The prevalence of obesity and overweight increased in the United States between 1978 and 1991. More recent reports have suggested continued increases but are based on self-reported data. Objective  To examine trends and prevalences of overweight (body mass index [BMI] 25) and obesity (BMI 30), using measured height and weight data. Design, Setting, and Participants  Survey of 4115 adult men and women conducted in 1999 and 2000 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Main Outcome Measure  Age-adjusted prevalence of overweight, obesity, and extreme obesity compared with prior surveys, and sex-, age-, and race/ethnicity–specific estimates. Results  The age-adjusted prevalence of obesity was 30.5% in 1999-2000 compared with 22.9% in NHANES III (1988-1994; P<.001). The prevalence of overweight also increased during this period from 55.9% to 64.5% (P<.001). Extreme obesity (BMI 40) also increased significantly in the population, from 2.9% to 4.7% (P = .002). Although not all changes were statistically significant, increases occurred for both men and women in all age groups and for non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Racial/ethnic groups did not differ significantly in the prevalence of obesity or overweight for men. Among women, obesity and overweight prevalences were highest among non-Hispanic black women. More than half of non-Hispanic black women aged 40 years or older were obese and more than 80% were overweight. Conclusions  The increases in the prevalences of obesity and overweight previously observed continued in 1999-2000. The potential health benefits from reduction in overweight and obesity are of considerable public health importance.      

Overweight and obesity in Australia: the 1999-2000 Australian Diabetes,Obesity and Lifestyle Study (AusDiab)

OBJECTIVE: To measure the prevalence of obesity in Australian adults and to examine the associations of obesity with socioeconomic and lifestyle factors. DESIGN: AusDiab, a cross-sectional study conducted between May 1999 and December 2000, involved participants from 42 randomly selected districts throughout Australia. PARTICIPANTS: Of 20,347 eligible people aged > or = 25 years who completed a household interview, 11,247 attended the physical examination at local survey sites (response rate, 55%). MAIN OUTCOME MEASURES: Overweight and obesity defined by body mass index (BMI; kg/m(2)) and waist circumference (cm); sociodemographic factors (including smoking, physical activity and television viewing time). RESULTS: The prevalence of overweight and obesity (BMI > or = 25.0 kg/m(2); waist circumference > 80.0 cm [women] or > or = 94.0 cm [men]) in both sexes was almost 60%, defined by either BMI or waist circumference. The prevalence of obesity was 2.5 times higher than in 1980. Using waist circumference, the prevalence of obesity was higher in women than men (34.1% v 26.8%; P < 0.01). Lower educational status, higher television viewing time and lower physical activity time were each strongly associated with obesity, with television viewing time showing a stronger relationship than physical activity time. CONCLUSIONS: The prevalence of obesity in Australia has more than doubled in the past 20 years. Strong positive associations between obesity and each of television viewing time and lower physical activity time confirm the influence of sedentary lifestyles on obesity, and underline the potential benefits of reducing sedentary behaviour, as well as increasing physical activity, to curb the obesity epidemic.     

State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s

Context  Monitoring trends is essential for evaluating past activities and guiding current preventive health program and policy efforts. Although tracking progress toward national health goals is helpful, use of national estimates is limited because most preventive health care activities, policies, and other efforts occur at the state or community level. There may be important state trends that are obscured by national data. Objective  To estimate state-specific trends for 5 health risk factors and 6 clinical preventive services. Design  Telephone surveys were conducted from 1991 through 2000 as part of the Behavioral Risk Factor Surveillance System. Setting and Participants  Randomly selected adults aged 18 years or older from 49 US states. Annual state sample sizes ranged from 1188 to 7543. Main Outcome Measures  Statistically significant changes (P<.01) in state prevalences of cigarette smoking, binge alcohol use, physical inactivity, obesity, safety belt use, and mammography; screening for cervical cancer, colorectal cancer, and cholesterol levels; and receipt of influenza and pneumococcal disease vaccination. Results  There were statistically significant increases in safety belt use for 39 of 47 states and receipt of mammography in the past 2 years for women aged 40 years or older for 43 of 47 states. For persons aged 65 years or older, there were increases in receipt of influenza vaccination for 44 of 49 states and ever receiving pneumococcal vaccination for 48 of 49 states. State trends were mixed for binge alcohol use (increasing in 19 of 47 states and declining in 3), physical inactivity (increasing in 3 of 48 states and declining in 11), and cholesterol screening (increasing in 13 of 47 states and decreasing in 5). Obesity increased in all states and smoking increased in 14 of 47 states (declining only in Minnesota). Cervical cancer screening increased in 8 of 48 states and colorectal cancer screening increased in 13 of 49 states. New York experienced improvements for 8 of 11 measures, while 7 of 11 measures improved in Delaware, Kentucky, and Maryland; in contrast, Alaska experienced improvements for no measures and at least 4 of 11 measures worsened in Iowa, North Dakota, and South Dakota. Conclusions  Most states experienced increases in safety belt use, mammography, and adult vaccinations. Trends for smoking and binge alcohol use are disturbing, and obesity data support previous findings. Trend data are useful for targeting state preventive health efforts.      

Ethnic variation in cardiovascular disease risk factors among children and young adults: findings from the Third National Health and Nutrition Examination Survey, 1988-1994

Context  Knowledge about ethnic differences in cardiovascular disease (CVD) risk factors among children and young adults from national samples is limited. Objective  To evaluate ethnic differences in CVD risk factors, the age at which differences were first apparent, and whether differences remained after accounting for socioeconomic status (SES). Design  Third National Health and Nutrition Examination Survey, 1988-1994. Setting  Eighty-nine mobile examination centers. Participants  A total of 2769 black, 2854 Mexican American, and 2063 white (non-Hispanic) children and young adults aged 6 to 24 years. Main Outcome Measures  Ethnicity and household level of education (SES) in relation to body mass index (BMI), percentage of energy from dietary fat, cigarette smoking, systolic blood pressure, glycosylated hemoglobin (HbA_1c), and non–high-density lipoprotein cholesterol (non–HDL-C [the difference between total cholesterol and HDL-C]). Results  The BMI levels were significantly higher for black and Mexican American girls than for white girls, with ethnic differences evident by the age of 6 to 9 years (a difference of approximately 0.5 BMI units) and widening thereafter (a difference of >2 BMI units among 18- to 24-year-olds). Percentages of energy from dietary fat paralleled these findings and were also significantly higher for black than for white boys. Blood pressure levels were higher for black girls than for white girls in every age group, and glycosylated hemoglobin levels were highest for black and Mexican American girls and boys in every age group. In contrast, smoking prevalence was highest for white girls and boys, especially for those from low-SES homes (77% of young men and 61% of young women, aged 18-24 years, from low-SES homes were current smokers). All ethnic differences remained significant after accounting for SES and age. Conclusion  These findings show strong ethnic differences in CVD risk factors among youths of comparable age and SES from a large national sample. The differences highlight the need for heart disease prevention programs to begin early in childhood and continue throughout young adulthood to reduce the risk of atherosclerosis.      

体重变化及相关因素与老年原发性高血压发病的关系

目的：研究老年原发性高血压与体重变化及其相关因素的关系。方法：利用天津市滨江医院内科门诊高血压抽样调查资料进行病例对照研究。病例为调查前2年内或调查时新诊断的127例年龄≥60岁高血压病人，对照则为无心血管病史的其他门诊病人。二者按年龄和性别1：1配比。应用条件Logistic回归模型分析资料。结果：与老年高血压发病相关的因素有：低文化水平，职业，同胞高血压史，调查时体重或体重指数（kg/m^2)、体重增加程度和体重增加的开始年龄，未显示吸烟和饮酒与老年高血压有关。结论：控制体重或尽量减低肥胖程度和推迟发胖年龄，可降低老年人发生高血压的危险性，是老年高血压防治的有效措施。     

Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial

Context  Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately. Objective  To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. Design, Setting, and Participants  Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. Intervention  Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Main Outcome Measures  Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non–high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing. Results  Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, –4.7 kg (95% confidence interval [CI], –6.3 to –3.1 kg), Zone, –1.6 kg (95% CI, –2.8 to –0.4 kg), LEARN, –2.6 kg (–3.8 to –1.3 kg), and Ornish, –2.2 kg (–3.6 to –0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Conclusions  In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss. Trial Registration  clinicaltrials.gov Identifier: NCT00079573      

Infant homicide and accidental death in the United States, 1940-2005: ethics and epidemiological classification

Potential ethical issues can arise during the process of epidemiological classification. For example, unnatural infant deaths are classified as accidental deaths or homicides. Societal sensitivity to the physical abuse and neglect of children has increased over recent decades. This enhanced sensitivity could impact reported infant homicide rates. Infant homicide and accident mortality rates in boys and girls in the USA from 1940 to 2005 were analysed. In 1940, infant accident mortality rates were over 20 times greater than infant homicide rates in both boys and girls. After about 1980, when the ratio of infant accident mortality rates to infant homicide rates decreased to less than five, and the sum of infant accident and homicide rates became relatively constant, further decreases in infant accident mortality rates were associated with increases in reported infant homicide rates. These findings suggest that the dramatic decline of accidental infant mortality and recent increased societal sensitivity to child abuse may be related to the increased infant homicide rates observed in the USA since 1980 rather than an actual increase in societal violence directed against infants. Ethical consequences of epidemiological classification, involving the principles of beneficence, non-maleficence and justice, are suggested by observed patterns in infant accidental deaths and homicides in the USA from 1940 to 2005.     

美国成年慢性肾脏病患者高磷血症患病率：1999-2018年国家健康与营养抽样调查

目的：描述美国成年慢性肾脏病(CKD)患者血磷水平及高磷血症的患病率,分析临床特征与高磷血症的关联。方法：基于美国国家健康与营养检查调查( NHANES) 1999年至-2018年的数据,描述不同年份、不同阶段成年CKD患者血磷水平及高磷血症患病率。使用多因素逻辑回归分析CKD患者临床特征与血磷水平的关联。结果：研究纳入9311名CKD1-5期研究对象,高磷血症的加权患病率为9.8%。高磷血症的加权患病率随着CKD分期的进展而显著增加,从CKD1-2期的7.99%增加到CKD5期的54.66%。男性、老年人、肥胖、低蛋白血症患者更倾向于较低的高磷血症发病率。结论：CKD患者在肾功能受损的早期(即CKD3a期)高磷血症患病率即显著升高,应受到更多关注。不同临床特征人群,血磷水平存在差异。