The prevalence of high blood cholesterol levels among adults in the United States

Using the National Cholesterol Education Program's Guidelines for the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the most recent nationally representative serum total cholesterol and lipoprotein data for adults (ages 20 to 74 years) from the second National Health and Nutrition Examination Survey (1976 to 1980), it is estimated that 41% of adults should have lipoprotein analysis after an initial measurement of serum total cholesterol. Furthermore, it is estimated that 88% of those who need lipoprotein analysis, or 36% of all adults aged 20 to 74 years, are candidates for medical advice and intervention for high blood cholesterol levels. We estimate, based on 1986 population data, that approximately 40 million Americans between the ages of 20 and 59 years are candidates for medical advice and intervention. An additional 24 million Americans aged 60 years and older are candidates. Overall, we estimate that about 60 million Americans aged 20 years and older are candidates for medical advice and intervention for high levels of blood cholesterol, although a less intensive approach might be appropriate for elderly patients.     

Experience with measles in Canada and the United States.

The United States is attempting to eliminate indigenous measles by October 1982. Progress in this effort appears to be related largely to the fact that all children must now be vaccinated before starting school and that unvaccinated children are not allowed to attend school during epidemics. Canada has not yet made a similar concerted effort to eliminate measles. The epidemiologic features of the disease in Canada and the United states have generally been similar, but some differences have emerged in recent years: Canadian rates are currently about 10 times higher, and the highest incidence in Canada is still in children 5 to 9 years of age, whereas in the United States the highest incidence is now in children aged 10 to 14 years, the result of intensive vaccination programs for preschool and early school-aged children.     

Sexual dysfunction in the United States: prevalence and predictors

CONTEXT: While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. OBJECTIVE: To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. DESIGN: Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. PARTICIPANTS: A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. MAIN OUTCOME MEASURES: Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. RESULTS: Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. CONCLUSIONS: The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.     

动态血压监测揭示高血压病患者的血压模式及昼夜节律

目的研究高血压患者血压模式及昼夜规律。方法选择50例高血压病患者(EH)24小时动态血压(ABPM)记录资料，得到日间6AM～10PM，夜间10PM～6AM两个时间段的平均血压及每小时的血压均值，比较昼夜间的血压差异，了解夜间血压下降水平。并描记24小时动态血压的趋势图，收缩压与舒张压相关图，收缩压与心率的相关图，血压分布直方图等。结果夜间血压明显低于日间。轻度高血压患者血压模式呈“杓型”，具有昼夜节律性，重度高血压患者血压模式呈“非杓型”，昼夜节律消失。结论24小时动态血压监测对高血压病的诊断有重要意义，血压模式的改变及昼夜节律的消失见于重度高血压或心、脑、肾靶器官受损害者。     

Declining prevalence of anemia among low-income children in the United States

To determine the anemia trends among low-income US children, hematologic measurements obtained from children aged 6 to 60 months who were enrolled in public health programs in six states that were consistently monitored by the Centers for Disease Control Pediatric Nutrition Surveillance System were studied. Overall, the prevalence of anemia has declined steadily from 7.8% in 1975 to 2.9% in 1985. The prevalence of anemia declined significantly among children seen at preenrollment screening visits, as well as those seen at follow-up visits, suggesting a generalized improvement in childhood iron nutritional status in the United States, as well as a positive impact of public health programs. To ensure that the declining trend of anemia was not a function of a change in the population of children enrolled in the surveillance system, Tennessee nutrition surveillance records were further analyzed; these records were linked with birth records to obtain detailed socioeconomic status (SES) information. Even though the SES composition remained stable from 1975 to 1984, the prevalence of anemia has declined significantly within each SES group. These findings indicate a true decline in the prevalence of anemia among low-income children that is likely the result of improvements in childhood iron nutrition.     

Time required for approval of new drugs in Canada, Australia, Sweden, the United Kingdom and the United States in 1996-1998

BACKGROUND: The timeliness with which national regulatory agencies approve new drugs for marketing affects health care professionals and patients. An unnecessarily long approval process delays access to new medications that may improve patients' health status. The author compared drug approval times in Canada, Australia, Sweden, the United Kingdom and the United States. METHODS: Application and approval dates of new chemical or biological substances (excluding diagnostic products, and new salts, esters, dosage forms and combinations of previously approved substances) approved for marketing in the 5 countries from January 1996 to December 1998 were requested from the relevant pharmaceutical companies. Data on new drug approvals during the study period were also obtained from the national drug regulatory agencies in Canada, Australia and Sweden and from publications of the US Food and Drug Administration. RESULTS: A total of 219 new drugs were identified as being approved in at least one of the countries during the study period: 23 (10.5%) in all 5 countries, 23 (10.5%) in 4, 27 (12.3%) in 3, 42 (19.2%) in 2, and 104 (47.5%) in 1 country. By individual nation, 97 drugs were identified as being approved in Canada, 94 in Australia, 107 in Sweden, 55 in the UK and 123 in the US. Approval times in Canada and Australia were similar (medians 518 and 526 days respectively), but both countries had significantly longer approval times than Sweden (median 371 days), the UK (median 308 days) and the US (median 369 days). This pattern was consistent across all 3 years and for the 23 new drugs approved in all 5 countries during the 3-year period. Median approval times in Canada were similar in all of the reviewing divisions of Health Canada's Therapeutic Product Program (539-574 days) except the Central Nervous System Division (428 days) and the Bureau of Biologics and Radiopharmaceuticals (698 days). INTERPRETATION: Median drug approval times during 1996-1998 decreased by varying amounts from the 1995 values in all 5 countries. However, the median approval time in Canada continues to be significantly longer than the times achieved in Sweden, the UK and the US, and it remains considerably longer than Canada's own target of 355 days for all new drugs.     

Hypertension in India--definition, prevalence and evaluation

High blood pressure (BP) is an important cardiovascular risk factor. Hypertension experts still debate on the level of BP considered abnormal. The currently accepted dividing line is systolic BP > or = 140 mm Hg and/or diastolic BP > or = 90 mm Hg based on epidemiological and intervention studies. In India, hypertension has become a major health problem. Epidemiological studies show a steadily increasing trend in hypertension prevalence over the last 40 years, more in urban than in the rural areas. This is converse to findings reported from developed countries where there is a significant decrease in its prevalence. Objectives of clinical evaluation of hypertensive individual are: To establish that BP is elevated, to seek evidence for a causal or contributory factor which may influence management, to assess target organ involvement and to assess relevant factors which will influence the particular mode of treatment to be adopted. Proper measurement techniques are important for diagnosis of hypertension. Canadian Coalition Guidelines are important in this regard. A basic, simple screening programme is the most appropriate policy for investigating the majority of hypertensive patients. Assessment of target organ involvement is important and can be obtained from history, physical examination or investigations. Studies of hypertension in general population have shown that secondary hypertension with high BP is present in 1.1% to 5.7% of subjects. Investigating all the hypertensive patients for secondary hypertension is not cost-effective and should be guided by history and clinical examination.     

Trends in prevalence,awareness, treatment,and control of hypertension in the United States, 1988-2000

Context  Prior analyses of National Health and Nutrition Examination Survey (NHANES) data through 1991 have suggested that hypertension prevalence is declining, but more recent self-reported rates of hypertension suggest that the rate is increasing. Objective  To describe trends in the prevalence, awareness, treatment, and control of hypertension in the United States using NHANES data. Design, Setting, and Participants  Survey using a stratified multistage probability sample of the civilian noninstitutionalized population. The most recent NHANES survey, conducted in 1999-2000 (n = 5448), was compared with the 2 phases of NHANES III conducted in 1988-1991 (n = 9901) and 1991-1994 (n = 9717). Individuals aged 18 years or older were included in this analysis. Main Outcome Measures  Hypertension, defined as a measured blood pressure of 140/90 mm Hg or greater or reported use of antihypertensive medications. Hypertension awareness and treatment were assessed with standardized questions. Hypertension control was defined as treatment with antihypertensive medication and a measured blood pressure of less than 140/90 mm Hg. Results  In 1999-2000, 28.7% of NHANES participants had hypertension, an increase of 3.7% (95% confidence interval [CI], 0%-8.3%) from 1988-1991. Hypertension prevalence was highest in non-Hispanic blacks (33.5%), increased with age (65.4% among those aged =" BORDER="0">60 years), and tended to be higher in women (30.1%). In a multiple regression analysis, increasing age, increasing body mass index, and non-Hispanic black race/ethnicity were independently associated with increased rates of hypertension. Overall, in 1999-2000, 68.9% were aware of their hypertension (nonsignificant decline of -0.3%; 95% CI, -4.2% to 3.6%), 58.4% were treated (increase of 6.0%; 95% CI, 1.2%-10.8%), and hypertension was controlled in 31.0% (increase of 6.4%; 95% CI, 1.6%-11.2%). Women, Mexican Americans, and those aged 60 years or older had significantly lower rates of control compared with men, younger individuals, and non-Hispanic whites. Conclusions  Contrary to earlier reports, hypertension prevalence is increasing in the United States. Hypertension control rates, although improving, continue to be low. Programs targeting hypertension prevention and treatment are of utmost importance.      

Differences and Similarities in Explanatory Models of Hypertension in the United States of America,Tanzania and Jamaica

Background:

Misperceptions detract from effective disease management in a number of conditions but the nature of underlying illness beliefs and their relative consistency in patients with chronic hypertension (cHTN) who present to the Emergency Department (ED) with poor blood pressure control is not known.

Objectives:

1) To explore disease knowledge in ED patients with cHTN using explanatory modelling; and 2) to compare gaps in cHTN knowledge across racially similar but geographically divergent ED patients.

Methods:

Emergency department patients of African origin with cHTN were recruited from three sites: Detroit Receiving Hospital (DRH - Detroit, MI, USA), the Tanzanian Training Center for International Health (TTCIH – Ifakara, TZ) and the University Hospital of the West Indies (UHWI – Kingston, JA). Demographic and baseline data were collected along with open-ended responses to a series of questions related to cHTN. Qualitative responses were coded into predefined, disease-relevant quantitative domains by two separate, blinded reviewers and multilevel comparisons were performed using Kruskal-Wallis or analysis of variance (ANOVA) tests, where appropriate.

Results:

One hundred and ninety-seven patients were enrolled; mean age (50.5 years vs 51.6 years vs 50.8 years; p = 0.86) and gender distribution (% male: 49.5 vs 44 vs 40; p = 0.53) were similar across sites but patients at DRH (vs TTCIH vs UHWI) were more hypertensive at presentation (mean systolic BP in mmHg: 166.8 vs 153 vs 152.7; p = 0.003), had a longer mean duration of cHTN (12.1 years vs 4.6 years vs 9.1; p < 0.0001), and were less likely to be on antihypertensive therapy (84.5% vs 92% vs 100%, p = 0.001). Explanatory models revealed limited recognition of cHTN as a "disease" (19.6% vs 28% vs 16%; p = 0.31) and consistency in the belief that cHTN was curable (44.3% vs 36% vs 42%; p = 0.62). Stress (48.4% vs 60% vs 50%; p = 0.31) and, especially at DRH, diet (62.2% vs 22% vs 36%; p < 0.0001) were identified most frequently as causes of cHTN and an association with symptoms was common (83.5% vs 98% vs 78%; p = 0.15). Clear differences existed for perceived benefits of treatment and consequences of poor control by site, but in general, both were under-appreciated.

Conclusions:

Misperceptions related to cHTN are common in ED patients. While specific areas of disconnect exist by geographic region, failure to recognize cHTN as a dire and fixed disease state is consistent, suggesting that a uniform educational intervention may be of benefit in this setting.     

Diazepam and drug-associated deaths. A survey in the United States and Canada.

This study describes a population of deceased persons in which death was generally caused by ingestion of numerous drugs, of which diazepam was only one agent. This drug occurred with high frequency relative to the total case load at each site, but its toxicological importance was often of a low order, and its role in the fatal cases was judged as minimal.     

Trends in pulmonary embolism death rates for Canada and the United States, 1962-87.

To investigate the effect of advances in the prevention and treatment of pulmonary embolism, we examined the rates of death from pulmonary embolism in Canada for 1965-87 and compared them with those for the United States for 1962-84. The direct method of age standardization was used on sex-specific and age-specific death rates, with the 1960 US population as the standard. In both countries the death rates increased then decreased, although the changes in the Canadian rates occurred later and were less pronounced than those in the US rates. Men and elderly people were at higher risk of death from pulmonary embolism than women and younger people. Prevention strategies, possibly including encouraging a more active lifestyle and targetting high-risk groups, may further reduce pulmonary embolism death rates in both countries.