Predictors of cardiovascular health knowledge among suburban cable TV subscribers and non-subscribers

This study focused on how social-psychological and demographicfactors combined to predict information-holding about cardiovasculardisease prevention among subscribers and non-subscribers toa suburban Midwest cable television system. Data come from oneof three education communities of the Minnesota Heart HealthProgram, a research and demonstration project to reduce communitylevels of heart attack and stroke. A principal component factoranalysis of the total sample (N = 635) extracted two factorsfrom variables operationalizing involvement, self-efficacy andsalience: ‘orientation to health behavior change’,and ‘orientation to disease consequences’. Separatefactor analyses for non-subscribers (N = 228) and subscribers(N = 407) showed a similar factor structure for the former,but the addition of a ‘transitional orientation’factor for the latter characterized by less orientation to healthbehavior change, but greater awareness of increasing informationabout heart disease prevention. These factors together withvariables of gender, age, education, occupation, family compositionand television use were entered into multiple regression analysesfor the total sample (P 0.001), and separately for subscribers(P 0.01) and non-subscribers (P 0.01). In general, gender,education and age emerged as significant predictors with healthorientation and television exposure marginally predictive amongcable-subscribers only.     

Patterns of physical activity among Russian youth: The Russian Longitudinal Monitoring Survey

Background: This paper describes physical activity the patternsof 2,101 Russian youth enrolled in the Russian LongitudinalMonitoring Survey (RLMS). The RLMS is a nationally representativehousehold sample survey. Methods: Youth 14–18 years andparents of youth 6–13 years responded to survey questionsabout hours per week of light (cooking and laundry), moderate(walking, bicycling and sports), and vigorous physical activities(karate, wrestling and gymnastics). Sedentary activities (e.g.watching TV, music, homework) were categorized separately. Subjectswere categorized for analyses by sex (boys n=1,072 and girlsn=1,029) and age was grouped by school year: 6–11 years(elementary school), 12–16 years (high school), and 17–18years. Mean hours per week by age and sex were computed fortime spent in sedentary (1 MET), light (1.1–2.9 METs),moderate (3–6 METs), and vigorous (6 METs) activities.The proportion of youth meeting International PA Guidelines1 (any intensity physical activity 30 mln/day, 5 days per week)and 2 (moderate to vigorous physical activity for three sessionsper week) was computed for each group. Results: Russian boysand girls spent approximately 28 h/week in sedentary activities.Boys spent more time than girls in moderate (5.2 versus 4.1h/week) and vigorous (2.5 versus 1.8 h/week) intensity activities;girls spent more time in household activities. Nearly 70% ofRussian youth met Guideline 1, and fewer than 45% met Guideline2. Conclusions: The results suggest that most Russian youthenrolled in the RLMS obtain sufficient amounts of any levelof physical activity per week, but that efforts may be neededto promote more regular moderate to vigorous physical activity.     

Waist circumference home measurement--a device to find out patients in cardiovascular risk

Background: New strategies are needed to prevent the globalepidemic of diabetes and subsequent rise in cardiovascular diseases.We describe a community-based, two-stage screening strategyusing home waist circumference measurement and a risk factorquestionnaire as a primary screening tool. Methods: We maileda tape for measurement of waist and a risk factor questionnaireto every inhabitant aged 45–70 years living in the ruraltown of Harjavalta in Finland. Thereafter we performed an oralglucose tolerance test, anthropometric variables and blood pressureof subjects having at least one risk factor for type 2 diabetesor cardiovascular disease. People with previously known diabetesor vascular disease were excluded. Results: Seventy-three percent(2085/2856) of the invited inhabitants participated, and 84%of the respondents had at least one pre-specified risk factor.Waist circumference 80 cm in women and 94 cm in men (n = 1168),positive metabolic syndrome criteria of the International DiabetesFederation (n = 681) or the Finnish Diabetes Risk Score questionnaire12 points (n = 697) identified 95, 92 and 63% of the new casesof type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively.Conclusion: The International Diabetes Federation criteria forelevated waist circumference are very sensitive but lack specificityin diagnosing glucose disorders. The criteria for metabolicsyndrome and the Finnish Diabetes Risk Score questionnaire aremore efficient tools for the selection of patients for furtherrisk stratification in general practise.     

Patients' perceptions of their clinical interactions: development of the multidimensional desire for control scales

Interventions oriented toward enhancing patient-provider communicationwill benefit from having a satisfactory measure of patients’desires for control in clinical interactions. Findings fromtwo studies are reported describing the development and validationof the Multidimensional Desire for Control (MDC) Scales. A totalof 160 patients with non-insulin-dependent diabetes (NIDDM)participated in the first study, which was designed to developand validate a measure of patients‘ desires for control.Factor analysis yielded three subscales reflecting patients’desires for: (i) personal, (ii) clinician, and (ii) shared controlin the interaction. Alphas for the three subscales were high( 0.75–0.86). Correlations with other measures of controlwere suggestive of good construct validity. The second investigationinvolves a replication study verifying the factorial compositionand validity of the scales. An independent sample of 109 patientswith NIDDM participated in this study. Findings support thereliability of the subscales (0.75–0.81). Furthermore,patients‘ desires for control were significantly associatedwith patient satisfaction, with desire for personal controlnegatively related to patient satisfaction (r = –0.30,–0.41, affective and behavioural dimensions, respectively)and desire for clinician control positively related to satisfaction(r = 0.44, 0.28, 0.31, affective, behavioral, and cognitivedimensions, respectively).     

EFFECTS OF THIAMINE DEFICIENCY ON BRAIN METABOLISM: IMPLICATIONS FOR THE PATHOGENESIS OF THE WERNICKE-KORSAKOFF SYNDROME

Chronic alcoholism results in thiamine deficiency as a consequenceof inadequate dietary intake and of impaired absorption of thevitamin. In addition, there is evidence to suggest that alcoholreduces thiamine phosphorylation to thiamine pyrophosphate (TPP)in brain. TPP is a cofactor for the pyruvate dehydrogenase complex(PDHC), -ketoglutarate dehydrogenase (KGDH) and transketolase(TK), three enzymes involved in cerebral glucose and energymetabolism. Pyrithiamine-induced thiamine deficiency in therat results in early, selective, reversible reductions of KGDHin brain; PDHC activities are unaffected. Reductions of KGDHare accompanied by decreased aspartate, glutamate and GABA andby concomitantly increased alanine in the brain of thiamine-deficientanimals. It is suggested that decreased KGDH, rather than decreasedPDHC constitutes ‘the biochemical lesion’ in thiaminedeficiency encephalopathy first enunciated by Peters in the1930s. If sufficiently prolonged and severe, thiamine deficiencyresults in brain cell death. Possible mechanisms involved includecompromised cerebral energy metabolism and focal accumulationof lactate, both of which could result from decreased activitiesof KGDH. In addition, it is proposed that brain cell death insevere thiamine deficiency may result from excessive releaseof excitotoxic amino acids. Comparable mechanisms could be involvedin the cell death and in the pathogenesis of the thiamine-unresponsivesymptoms of the Wernicke-Korsakoff Syndrome in humans     

Epidemiology and cost of treatment of genital warts in Spain

Background: Genital warts (GW) are common and increasing inyoung people. Ninety percent of GW are due to Human Papillomavirus(HPV) types 6 and 11. The objective of this study was to assessthe epidemiology and management costs associated with GW inSpain. Methods: A 1-year (2005) retrospective observational study wasperformed among a sample of gynaecologists, dermatologists andurologists in six autonomous regions in Spain. Men and womenwith newly diagnosed, recurrent or resistant GW were included.We estimated the incidence (new and recurrent cases) and prevalence(also including resistant cases) of GW. Healthcare resourceuse were collected and combined with unit costs to assess themean cost of GW management per patient. These figures were extrapolatedto the 14- to 64-year-old Spanish population to estimate thetotal cost of GW management from the Third Party Payer (TPP)and societal perspectives. Results: The overall annual incidence of GW was estimated at160.4 cases per 100 000. Overall prevalence was calculated as182.1 cases per 100 000, corresponding to 56 446 GW cases annually(14- to 64-year-old population). The mean management cost was833 and 1056 per patient from the TPP and societal perspective,respectively. The overall annual cost was estimated at 47 millionand 59.6 million, from the TPP and societal perspective, respectively. Conclusion: This study provides a first overview of the burdenof GW in Spain. A quadrivalent HPV vaccine that prevents HPV6, 11, 16, 18 related diseases will have the potential to significantlydecrease the socio-economic burden associated with GW in Spain.     

UROKINASE-LIKE PLASMINOGEN ACTIVATOR INCREASED IN PLASMA AFTER ALCOHOL DRINKING

After taking the local Japanese spirit ‘Shochu’,‘Sake’ and beer, increased plasma fibrinolysis wasconfirmed in normal persons at about 1 hr after for both thepyro-Glu-Gly-Arg-pNA amidolytic and Glu-plasminogen activatingactivities in eluates from [N-(-aminocaproyl)-DL-homoargiinehexlester;)]-Sepharose affinity column. The activity was highestin the Shochu group, followed by the Sake and beer groups withan approximately 2.1-, 1.7- and 1.5- fold increase in fibrinolyticactivity, respectively, compared to the control. The enzymecould be further purified using urokinase-IgG-Sepharose immunoadsorbentcolumn from the Shochu group and it reacted with and was inhibitedby urokinase specific antibody. The main molecular weight ofthe active enzyme was about 30,000, and those of minor componentswere about 50,000 and 100,000, as determined by zymography.These findings suggest that some of the enzymes appearing inthe plasma after drinking are related to ‘urokinase-likeplasminogen activator’, being endogenously produced.     

Alcohol and hypertension: an old relationship revisited

The American comedian Henny Youngman (1906–1998) oncesaid, ‘When I read about the evils of drinking, I gaveup reading.’ Ironic, but interestingly as though witha sense of foresight, he did not speak of giving up drinking!It is despite the fact that alcohol is responsible for increasedillness, being causally related to more than 60 different medicalconditions (Rehm et al., 2003). Around 4% of the global diseaseburden is also thought to be alcohol related, which is comparablewith that attributed to the effects of tobacco (4.1%) and highblood pressure (4.4%) (Ezzati et al., 2002; WHO, 2002). For most diseases related to alcohol consumption, a dose–responserelationship exists with risk of the disease increasing withgreater amounts of alcohol intake, with cardiovascular     

EFFECT OF ACUTE ETHANOL INGESTION ON HUMAN GASTRIC LUMINAL PROSTAGLANDIN E2, PROSTAGLANDIN F2{alpha} AND 6-KETO-PROSTAGLANDIN F1{alpha}

In healthy human volunteers we evaluated the effect of a singleoral dose of 1 g/kg of alcohol (12.5%, v/v) on the output ofprostaglandin E₂, prostaglandin F₂ and 6-ketoprostaglandin F₁in the gastric juice. In control experiments performed at intervalsof 5–8 days, the subjects received the identical volumeof water. Ninety minutes after the ingestion of alcohol, orwater, first the basal secretion and subsequently the secretionafter injection of pentagastrin (6 µg/kg, i.m.) were collectedover periods of 60 min. The concentrations of the three prostaglandinswere determined by radio-immunoassay. After ingestion of alcohol,the volume of gastric juice in response to pentagastrin stimulationwas reduced by 24.6%, as compared with the control period. Ingestionof alcohol led to a significant reduction in the concentrationof prostaglandin E₂ (–42.7%) after stimulation with pentagastrin.The prostaglandin E₂ output per hour was markedly inhibitedby the ingestion of alcohol, both in the basal period (–47%)and after stimulation with pentagastrin (–55%). Whilestimulation with pentagastrin did not influence the secretionof PGE₂ or PGF₂, the output of 6-keto-PGF₁ increased appreciably(+88%) after the administration of pentagastrin. Alcohol alsosignificantly (–28%) inhibited the secretion of 6-keto-PGF₁in the period following the administration of pentagastrin.It is supposed that the inhibition of the secretion of prostaglandinE₂ and 6-keto-prostaglandin F₁ by acute alcohol ingestion, mightbe of significance for the development of alcohol-induced mucosaldamage in the stomach.     

DETERMINATION OF PLASMA {alpha}-GLUTATHIONE-S-TRANSFERASES IN CHRONIC ALCOHOL ABUSERS: RELATIONSHIP WITH ALCOHOL INTAKE AND LIVER INVOLVEMENT

-Gluthathione-S-transferascs (-GSTs) are enzymes involved inthe cellular detoxifying processes; elevated circulating -GSTsactivity is considered to be an early index of liver damage.Glutathione (GSH) is the substrate for -GST action. The aimsof our study were: (1) to evaluate plasma GSH levels and -GSTactivity in chronic alcohol abusers with or without liver cirrhosis;(2) to define the relationship between these two biochemicalparameters; (3) to establish their clinical relevance in patientswith alcohol abuse and/or liver damage. We studied 69 subjects(18 healthy subjects and 51 chronic alcohol abusers: 29 withoutliver cirrhosis and 22 with). Plasma -GST activity was determinedon baseline samples and every following day for a total of 10days in five alcoholics by HEPKIT (Alpha-Biotech, Biotrin International,Dublin, Ireland). GSH was determined on all subjects' baselinesamples by fluorescent high-performance liquid chromatography.Alcohol intake was evaluated in all patients by determiningblood-alcohol concentrations. Significant increases in plasma-GSTs were observed in 9/29 (31%) alcoholics and 3/22 (13.6%)cirrhotics irrespective of their alcohol intake. GSH was significantlylower than normal values (P < 0.001) in all alcoholics withor without cirrhosis (controls 10.4 ± 4.8; alcoholicswithout cirrhosis 3.9 ± 1.4; alcoholics with cirrhosis3.3 ± 1.6). No correlation was observed between plasma-GST and GSH levels. Our data indicate that: (1) -GST activitydoes not correlate with GSH levels in the plasma; (2) -GSTsdo not have clinical relevance as markers of recent alcoholintake; (3) in cirrhotics, -GST does not provide more informationthan other liver function tests. However, plasma -GST determinationmay be useful in selecting a subgroup of alcoholics in whomroutine biochemical markers of liver damage are within referenceranges.     

Testing a conceptual model related to weight perceptions, physical activity and smoking in adolescents

The purpose of this study was to test a conceptual model basedon theoretical and empirically supported relationships relatedto the influences of weight perceptions, weight concerns, desiresto change weight, friends, age and location in relation to physicalactivity (PA) and smoking in adolescents. A total of 1242 malesand 1446 females (mean age = 15.6 ± 1.3) were recruitedfrom rural and urban Canadian schools. Study respondents providedself-reports of PA, ‘smoking’, ‘perceivedbody weight’, ‘desire to change weight’, ‘concernabout weight gain’ and ‘friends' smoking and PAbehaviors’. Results revealed an acceptable fitting model² (40) = 155.63, P < 0.05, root mean square error of approximation= 0.047 and comparative fit index = 0.98. Large effect sizesfor both genders were observed between friends' and adolescents'smoking behavior, and between perceived body weight and desireto change weight. Further, significant differences were identifiedbetween the male and female models [² difference (24) = 65.28,P < 0.05]. Several findings of this study point to the needto design programs to motivate adolescent females to adopt healthyweight-control practices and to target young peoples' socialnetworks to promote health behaviors, especially with regardto smoking. Received on December 22, 2005; accepted on June 15, 2006     

Physical Activity and Television Watching in Relation to Risk of Type 2 Diabetes: The Black Women's Health Study

Few modifiable risk factors for type 2 diabetes have been documentedin the high-risk population of US black women. The authors useddata from 45,668 black women aged 21–69 years, followedbiennially from 1995 to 2005 in the Black Women's Health Study,to estimate incidence rate ratios for type 2 diabetes comparingvarious levels of physical activity and television watching.Cox proportional hazards models were used to control confoundingfactors. During 10 years of follow-up, 2,928 incident casesof type 2 diabetes were identified. Vigorous activity was inverselyassociated with type 2 diabetes risk (P_trend < 0.0001); theincidence rate ratio for 7 hours per week was 0.43 (95% confidenceinterval (CI): 0.31, 0.59) relative to no activity. Brisk walkingfor 5 hours per week was associated with reduced type 2 diabetesrisk (incidence rate ratio = 0.67, 95% CI: 0.49, 0.92) relativeto no walking. Television watching was associated with an increasedtype 2 diabetes risk: The incidence rate ratio was 1.86 (95%CI: 1.54, 2.24) for 5 hours relative to <1 hour of televisionper day, independent of physical activity. These observationaldata suggest that black women might reduce their risk of developingtype 2 diabetes by increasing their time spent walking or engagedin vigorous physical activity and by limiting television watching. African continental ancestry group; diabetes mellitus, type 2; exercise; incidence; motor activity; television; walking; women's health     

Health Effects among Workers Involved in the Manufacture of Hexachlorocyclohexane

Forty-five male workers exposed to hexachlorocyclohexane (HCH)during its manufacture were studied and compared with 22 matchedcontrols. Twenty-one of the exposed workers worked in packagingand manual transport of HCH. Twenty-four other exposed workerswere plant operators. Exposure was mainly through skin. Results indicate that the neurological symptoms reported weredue to recent exposure to HCH and were related to the intensityof exposure. An increase in leucine aminopeptidase, ornithine carbamyl transaminase,5'nucleotides and immunoglobulin M levels among the exposedworkers is suggestive of some degree of liver damage. A significantincrease in total blood HCH and its , ß and isomerswas also observed in these workers. In spite of pronounced exposureto the , ß and isomers of HCH, signs of severe healthimpairment were not observed. Further biological monitoringneeds to be carried out among such workers exposed to HCH. Requests for reprints should be addressed to: Dr S. K. Nigam, National Institute of Occupational Health, Meghani Nagar, Ahmedabad-380 016, India     

Keeping the {heartsuit} Beat in Grampian--a case study in community participation and ownership

In the Grampian Region of Scotland, a new 10 year heart healthinitiative, ‘Keeping the Beat in Grampian’ waslaunched in October 1991. Although this programme is based ona number of well-tested health promotion principles it is uniquein a number of aspects. The concepts of community ownership,corporate identity and people empowerment have been extendedto a much greater degree. The programme is registered as a privatecompany with charitable status so that management, decision-makingand budgetary control are vested totally in the community.     

Ethanol Prevents Oxidant-Induced Mitochondrial Permeability Transition Pore Opening in Cardiac Cells

Aims: The purpose of this study was to determine if ethanolprevents the mitochondrial permeability transition pore (mPTP)opening via glycogen synthase kinase 3β (GSK-3β).Methods: Cardiac H9c2 cells were exposed to ethanol (10–1000µM) for 20 min. GSK-3β activity was determined bymeasuring its phosphorylation at Ser⁹. Mitochondrial membranepotential (_m) was assessed by imaging (confocal microscopy)H9c2 cells loaded with tetramethylrhodamine ethyl ester (TMRE).To activate GSK-3β, cells were transfected with constitutivelyactive GSK-3β (GSK-3β-S9A-HA) mutant plasmid. Results:Treatment of cardiac cells with low doses of ethanol (10–500µM) significantly enhanced GSK-3β phosphorylation,indicating that ethanol can inactivate GSK-3β in H9c2 cells.The effect of ethanol on GSK-3β activity was reversed bythe phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002and ethanol could enhance Akt phosphorylation, implying thatthe PI3K/Akt pathway accounts for the action of ethanol. Ethanolprevented oxidant (H₂O₂)-induced loss _m, an effect that wasreversed by LY294002, indicating that ethanol can modulate themPTP opening caused by oxidant stress through the PI3K/Akt pathway.Ethanol failed to preserve _m in cells transfected with the constitutivelyactive GSK-3β (GSK-3β-S9A-HA) mutant, suggesting thatethanol prevents the mPTP opening by inactivating GSK-3β.Conclusions: These data suggest that ethanol prevents the mPTPopening through inactivation of GSK-3β. The PI3K/Akt signalingpathway is responsible for inactivation of GSK-3β by ethanol.     

Prevention of fall injuries requiring hospital treatment among community-dwelling elderly

Background: To reduce the number of fall injuries requiringhospital treatment among community-dwelling elderly a community-basedintervention programme was set up. The study was designed asa prospective intervention study with the intervention consistingof information and home visits with follow-up, removing physicalhazards, treating somatic and psychiatric illnesses and dealingwith improper drug consumption, diet insufficiencies and physicaland mental inactivity. The setting was five municipalities ofthe county of Vejle, Denmark (intervention area) with 12,905community-dwelling elderly (65 years) and four other municipalitiesin the same county (control area) with 11,460 community-dwellingelderly (65 years) from 1 January 1986 to 31 March 1988. Method:A separate injury register at hospitals, with catchment areasfor the above study population, was established to collect informationon fall-related injuries among the community dwelling elderlywho were referred to out-patient treatment or hospitalization.The fall injuries requiring treatment were registered for ninemonths prior to the intervention and for 18 months during theimplementation of the intervention programme. Results: The preventedfraction was estimated for all fractures, lower extremity fracturesand hip fractures. A non-significant reduction of 14% in thenumber of all fractures was found in the intervention groupcompared with the control group. The reduction of lower extremityfractures in the intervention group was found to be significantlygreater: 33% (95% CI: 3–63%), due to a highly significantreduction among women: 46% (95% CI: 8–84%), but withoutreduction among men. Similarly a high, although non-significant,reduction of hip fractures among women was found: 43% (95% CI:-2 - 88%). The reductions appeared to be highest in the lastnine months of the intervention period and highest among womenliving alone. Conclusion: It is possible to reduce the numberof major fall-related fractures among elderly with a well-integrated,community-based intervention programme having information, homevisits and follow-up as major components and utilizing existinghealth personnel in a municipality.     

Doctors' drinking and fitness to practise

Rosta and Aasland's paper (2005) ‘Female surgeons’alcohol use: A Study of a Nation-wide Sample of Norwegian Doctorsadds to the evidence that doctors are at increased risk of becomingdependent at some point in their career. The finding that detrimental drinking by surgeons was more prevalentthan might be expected may point to important fitness-to-practiseconsiderations. The questions ‘Who cares about doctors as individuals?’and ‘Who cares for doctors apart from family and friends?’seem still to be difficult to answer. A doctor's independence and ability to become immersed in apatient's plight are key components for     

The harmful consequences of elevating the doctor-patient relationship to be a primary goal of the general practice consultation

Introduction In the UK, it has been estimated that an ‘average’GP will undertake 8000 face to face clinical interactions annually.¹The consultation has come to be identified as the cornerstoneof general practice,² and to be seen more than an occasion forthe medical work of diagnosis and treatment.³ Beginning withthe work of Balint,⁴ it has also come to be seen as a ‘meeting’of individuals in which (often undifferentiated) symptoms areexpected to be understood and accommodated in relation to theirsocial and psychological contexts. Much effort in educationand research has been invested in giving the consultation thisdeeper meaning and wider range of potential practice.⁵ Thus,whilst the doctor–patient relationship is a given in today'sprimary care, achieving a satisfactory doctor–patientrelationship has also been elevated to be an outcome or goalof every consultation. In many ways, exploring that     

Cost-Effectiveness of Acupuncture in Women and Men With Allergic Rhinitis: A Randomized Controlled Study in Usual Care

To assess quality of life and cost-effectiveness of additionalacupuncture treatment for allergic rhinitis, patients were randomlyallocated to 2 groups; both received usual care, but one groupreceived an additional 10 acupuncture sessions. Quality of life(according to the SF-36 Health Survey), and direct and indirectcosts, were assessed at baseline and after 3 months, and theincremental cost-effectiveness ratio of acupuncture treatmentwas calculated. This German study (December 2000–June2004) involved 981 patients (64% women, mean age 40.9 years(standard deviation, 11.2); 36% men, mean age 43.2 years (standarddeviation, 13.0)). At 3 months, quality of life was higher inthe acupuncture group than in the control group (mean PhysicalComponent Score 51.99 (standard error (SE), 0.33) vs. 48.25(SE, 0.33), P < 0.001; mean Mental Component Score 48.55(SE, 0.42) vs. 45.35 (SE, 0.42), respectively, P < 0.001).Overall costs in the acupuncture group were significantly higherthan those in the control group (Euro (; 1 = US $1.27)763, 95%confidence interval: 683, 844 vs. 332, 95% confidence interval:252, 412; mean difference 432, 95% confidence interval: 318,545). The incremental cost-effectiveness ratio was 17,377 perquality-adjusted life year (women, 10,155; men, 44,871) andwas robust in sensitivity analyses. Acupuncture, supplementaryto routine care, was beneficial and, according to internationalbenchmarks, cost-effective. However, because of the study design,it remains unclear whether the effects are acupuncture specific. acupuncture; cost-benefit analysis; economics; quality of life; rhinitis, allergic, perennial; rhinitis, allergic, seasonal