Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database

BACKGROUND: Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment results of this severe and long-lasting pain syndrome are often disappointing. From the point of view of possible prevention and early treatment, it is important to identify HZ patients who have an increased risk of developing PHN. OBJECTIVES: Our goals were to determine the incidence of HZ and PHN in a primary care population and to identify risk indicators for the occurrence of PHN. METHODS: A search for HZ and PHN was conducted in a general practice research database, comprising 22 general practices and representing 49 000 people, over a 5-year period. Potential risk indicators were analysed using multivariate logistic regression. RESULTS: A total of 837 patients had been diagnosed with HZ [incidence 3.4/1000 patients/year, 95% confidence interval (CI) 2.9-3.9]. The risk of developing PHN 1 month after the start of the zoster rash was 6.5% (95% CI 4.9-8.3). This risk was 11.7% (95% CI 8.5-14.9) for patients aged > or =55 years. Independent risk indicators for the occurrence of PHN were age [55-74 years, adjusted odds ratio (OR) 4.2, 95% CI 1.8-9.7; >75 years, OR 10.7, 95% CI 4.6-25.1] and ophthalmic localization (OR 2.3, 95% CI 1.0-4.6). CONCLUSIONS: The risk of developing PHN increases with age. Preventive strategies should focus on patients with herpes zoster aged >55 years and with ophthalmic localization.     

Incidence and outcome of first syncope in primary care: A retrospective cohort study

ABSTRACT: BACKGROUND: Assessment of risk for serious cardiovascular outcome after syncope is difficult. OBJECTIVES: To determine the incidence of first syncope in primary care. To investigate the relation between syncope and serious cardiovascular (CV) outcome and serious injury. METHODS: Retrospective cohort study using data from the Intego general practice-based registration network, collecting data from 55 general practices (90 GP's). All patients with a first syncope from 1994 to 2008 were included; five participants without syncope were matched for age and gender for every patient with syncope. The main outcome measures were incidence of first syncope by age and gender and one year risk of serious CV outcome or injury after syncope. RESULTS: 2785 patients with syncope and 13909 matched patients without syncope were included. The overall incidence of a first syncope was 1.91 per 1000 person-years (95% CI 1.83-1.98). The incidence was higher in females (2.42 (95% CI 2.32-2.55) per 1000 person-years) compared to males (1.4 (95% CI 1.32-1.49) per 1000 person-years) and follows a biphasic pattern according to age: a first peak at the age of 15-24 years is followed by a sharp rise above the age of 45. One year serious outcome after syncope was recorded in 12.3% of patients. Increasing age (HR 1.04 (1.03-1.04)), CV comorbidity (HR 3.48 (95% CI 2.48-4.90) and CV risk factors (HR 1.65 (95% CI 1.24-2.18) are associated with serious outcome. Cox regression, adjusting for age, gender, CV comorbidity and risk factors, showed that syncope was an independent risk factor for serious CV outcome or injury (HR 3.99 (95% CI 3.44-4.63)). The other independent risk factors were CV comorbidity (HR 1.81 (95% CI 1.51-2.17)) and age (HR 1.03 (95% CI 1.03-1.04)). CONCLUSIONS: Incidence rate of first syncope in primary care was 1.91 per 1000 person-years. One year risk of serious outcome after syncope was 12.3%. Increasing age, CV comorbidity and risk factors are associated with serious outcome. Compared to a control group, syncope on itself is an independent risk factor for serious outcome (adjusted for age, gender, CV comorbidity and risk factors).     

交通警察高脂血症患病情况及其影响因素分析

目的 分析某市交通警察高脂血症患病情况及其相关影响因素, 为减少该职业人群高脂血症的发生提供参考。
方法 选择某市2015年参加体检的2 228名交通警察作为研究对象, 通过问卷调查方式完成现场调查, 对高脂血症的相关危险因素进行非条件logistic回归分析。
结果 研究人群以男性为主(占89.10%), 平均年龄为(41.33±7.51)岁, 高脂血症粗患病率为39.67%。高脂血症粗患病率有随年龄增长而增高的趋势(P < 0.01);不同年龄段人群甘油三酯、总胆固醇、高密度脂蛋白胆固醇平均水平差异均有统计学意义(P < 0.05)。同体质量指数正常相比, 超重(OR=2.25, 95% CI:1.85~2.72)、肥胖(OR=3.12, 95% CI:2.18~4.42)可能是患高脂血症的危险因素; 同女性、无高尿酸血症及空腹血糖 < 5.6 mmol/L分别相比, 男性(OR=2.55, 95% CI:1.77~3.67)、高尿酸血症(OR=1.64, 95% CI:1.36~1.99)以及空腹血糖≥ 7.0 mmol/L (OR=2.80, 95% CI:1.81~4.33)均可能是患高脂血症的危险因素; 同20~29岁相比, 30~39岁(OR=1.86, 95% CI:1.25~2.76)、40~49岁(OR=2.34, 95% CI:1.60~3.42)、≥ 50岁(OR=3.06, 95% CI:1.99~4.71)均可能是患高脂血症的危险因素。
结论 某市交通警察高脂血症患病率较高, 应加强对他们的健康教育, 以减少高脂血症的发生。
     

Prevalence of dementia in the City of Zurich

OBJECTIVES: The purpose of the study was to estimate the prevalence rate of dementia (PRD) in relation to age, gender, and ApoE-genotype. METHODS: The random sample consisted of 465 subjects aged 65 and more. The interview was conducted by means of the Canberra Interview for the Elderly. The genotyping of ApoE has been performed by a combination of the polymerase chain reaction and a gel electrophoresis separation. RESULTS: The overall PRD amounted to 10.1% (95% CI 6.8-13.3%) and was higher among females (12.2%) than among males (4.9%). The gender difference was of borderline statistical significance (OR 2.17; 95% CI 0.97-4.84 adjusted for age, education level). PRD rose significantly with age. In contrast, the possession of one copy of ApoE-epsilon 4-allele was not associated with a higher risk of having dementia (OR 1.48; 95% CI 0.60-3.63 adjusted for age, gender, education level). CONCLUSIONS: These results are consistent with the finding from other authors.     

Work-related risk factors for the incidence and recurrence of shoulder and neck complaints among nursing-home and elderly-care workers

OBJECTIVES: This study assessed the differences and similarities in the incidence and recurrence of shoulder and neck complaints with respect to work-related physical, psychosocial, and personal risk factors. METHODS: A prospective cohort study was carried out among 769 workers of nursing homes and homes for the elderly. At baseline, a questionnaire was used to collect data on personal characteristics, physical workload, psychosocial workload, and the presence of shoulder and neck complaints. After 1 and 2 years, follow-up data were collected on shoulder and neck complaints. Generalized estimation equations were used for analyzing risk factors for the participants with at least one follow-up measurement available (N=556, 72%). RESULTS: In the multivariate model, adjusted for age and gender, obesity [odds ratio (OR) 2.12, 95% confidence interval (95%CI) 1.23-3.65] was related to the incidence of shoulder complaints. The incidence of neck complaints was increased for obesity (OR 1.81, 95% CI 1.07-3.05), work in awkward postures (OR 1.76, 95% CI 1.11-2.78), and poor or fair general health (OR 1.53, 95% CI 1.02-2.31). The recurrence of both shoulder and neck complaints was associated with chronic complaints at baseline (shoulder: OR 1.91, 95% 1.36-2.67; neck: OR 1.71, 95% 1.14-2.55) but not with work-related risk factors. CONCLUSIONS: The results suggest that there are differences in risk factors for the incidence and recurrence of shoulder and neck complaints.     

某随访人群颈动脉硬化发生影响因素及风险预测能力研究

  目的  探讨不同性别人群颈动脉硬化发生影响因素，为疾病针对性预防提供参考。  方法  对金昌队列人群按年龄分层随机抽样后进行随访，采用巢式病例对照研究，分析不同性别人群颈动脉硬化发生的影响因素，并建立发病风险预测模型，以受试者工作特征曲线(receiver operator characteristic curve，ROC) 下面积评价模型拟合优度。  结果  该随访人群颈动脉硬化标化发病率为12.32%，男性发病率(13.65%)高于女性(11.29%)，差异有统计学意义(χ2=4.267，P < 0.001)。年龄、文化程度、收缩压升高、低密度脂蛋白升高是男性和女性发病的共同危险因素，空腹血糖升高(OR=2.556，95% CI:1.618~4.038)和甘油三酯升高(OR=1.535，95% CI:1.058~2.227)仅与男性发病有关；腹型肥胖(OR=1.414，95% CI:1.013~1.974)仅与女性发病有关。男性和女性预测模型曲线下面积分别为0.835(95% CI:0.815~0.856)、0.809(95% CI:0.788~0.831)，灵敏度分别为78.0%、78.9%，特异度分别为78.8%、73.1%，诊断一致率分别为91.3%、82.4%。  结论  影响男性和女性颈动脉硬化发生的危险因素不同，应分性别采取针对性防控措施，运用Logistic回归建立的发病风险预测模型有一定的指导价值。     

Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett's esophagus

Barrett's esophagus is thought to be a disease occurring predominantly in White Caucasian males of higher socioeconomic status. There are no published studies simultaneously examining risk of Barrett's esophagus according to ethnicity, gender, and socioeconomic status within a single data set. The authors conducted a retrospective case-control analysis within a cross-sectional study to determine risk of Barrett's esophagus in relation to sociodemographic variables in a large United Kingdom population. All patients undergoing upper gastrointestinal endoscopy at two clinical centers between January 2000 and January 2003 were evaluated. Data on ethnicity, age, gender, socioeconomic status, and the presence of Barrett's esophagus and esophagitis at endoscopy were collected. A total of 20,310 patients were analyzed. Barrett's esophagus was more common in White Caucasians (401/14,095 (2.8%)) than in South Asians (16/5,190 (0.3%)) (adjusted odds ratio (OR)=6.03, 95% confidence interval (CI): 3.56, 10.22), as was esophagitis (2,500/14,095 (17.7%) vs. 557/5,190 (10.7%); adjusted OR=1.76, 95% CI: 1.57, 1.97). Patients with Barrett's esophagus were also more likely to be male (adjusted OR=2.70, 95% CI: 2.18, 3.35) and of higher socioeconomic status (adjusted OR=1.58, 95% CI: 1.16, 2.15 (top tertile vs. bottom tertile)). White Caucasian ethnicity, male gender, and higher socioeconomic status are independent risk factors for Barrett's esophagus.     

Characteristics of tuberculosis patients with positive sputum smear in Catalonia, Spain

BACKGROUND: Patients with positive sputum smears are those with the capacity to spread infection. The objective of this study was to describe the incidence of tuberculosis in Catalonia (an autonomous community in the northeast of Spain which includes Barcelona) and to determine risk factors associated to patients with positive sputum smear test. METHODS: New cases of tuberculosis detected by active surveillance between May 1996 and April 1997 were studied. The study was analysed as a coincident cases and controls study. The rate of incidence was calculated per 100,000 persons-year. The association of the dependent variable--case of tuberculosis with positive sputum smear--with the remainder of independent variables was determined by odds ratio (OR) with a 95% confidence interval (CI). RESULTS: A total of 2508 cases of tuberculosis were detected. The rate of incidence was 41.4 per 100,000 persons-year. Of these 19.4% (487/2508) were coinfected with HIV and 35.6% (893/2508) presented a positive sputum smear, which implies a rate of 14.7 per 100,000 persons-year. In an adjusted multivariate analysis, cases with positive smears were positively associated with the 15-24 (OR=1.9; 95% CI: 1.4-2.4), 25-34 (OR=2.1; 95% CI: 1.7-2.7) and 35-44 years (OR=1.7; 95% CI: 1.3-2.2) age compared with persons 45 years old and above; with males (OR=1.8; 95% CI: 1.5-2.2) and consumers of alcohol (OR=2.1; 95% CI: 1.7-2.7) and negatively with those under 15 years of age (OR=0.1; 95% CI: 0.1-0.2) and coinfection with HIV (OR=0.5; 95% CI: 0.3-0.7). CONCLUSIONS: Measures to control tuberculosis transmission (prompt diagnosis, study of contacts and directly observed treatments) should be reinforced for male adults with excessive consumption of alcohol.     

Risk factors for and influence of bloodstream infections on mortality: a 1-year prospective study in a Greek intensive-care unit

To determine the incidence, risk factors for, and the influence of bloodstream infections (BSIs) on mortality of patients in intensive-care units (ICUs), prospectively collected data from all patients with a stay in an ICU >48 h, during a 1-year period, were analysed. Of 572 patients, 148 developed a total of 232 BSI episodes (incidence 16.3 episodes/1000 patient-days). Gram-negative organisms with high level of resistance to antibiotics were the most frequently isolated pathogens (157 strains, 67.8%). The severity of illness on admission, as estimated by APACHE II score (OR 1.07, 95% CI 1.04-1.1, P<0.001), the presence of acute respiratory distress syndrome (OR 3.57, 95% CI 1.92-6.64, P<0.001), and a history of diabetes mellitus (OR 2.37, 95% CI 1.36-4.11, P=0.002) were risk factors for the occurrence of BSI whereas the development of an ICU-acquired BSI was an independent risk factor for death (OR 1.76, 95% CI 1.11-2.78, P=0.015). Finally, the severity of organ dysfunction on the day of the first BSI episode, as estimated by SOFA score, and the level of serum albumin, independently affected the outcome (OR 1.44, 95% CI 1.22-1.7, P<0.001 and OR 0.47, 95% CI 0.23-0.97, P=0.04 respectively).     

Socioeconomic status and lung cancer risk in Canada

BACKGROUND: Several epidemiological studies have found that lung cancer is inversely related to socioeconomic status (SES) and suggest it as a possible risk factor for lung cancer. This study examines SES and lung cancer risk in Canada. METHODS: Mailed questionnaires with telephone follow-up were used to obtain data on 3280 newly diagnosed, histologically confirmed lung cancer cases and 5073 population controls, between 1994 and 1997, in eight Canadian provinces. Measurement included information on SES, smoking habits, alcohol use, diet, residential and occupational histories and both residential and occupational exposure to environmental tobacco smoke (ETS). Odds ratios (OR) and 95% CI were derived from unconditional logistic regression analysis. RESULTS: Compared with high income adequacy, an increased risk was found among low income males and females, with adjusted OR of 1.7 (95% CI : 1.3-2.2) and 1.5 (95% CI : 1.1-2.0), respectively. Compared with < or = 8 years of education, the adjusted OR were 0.6 (95% CI : 0.5-0.7) and 0.6 (95% CI : 0.5-0.8) for > or = 14 years education among males and females, respectively. Lung cancer risk was significantly increased for males of some social classes. The population attributable risk for income adequacy, education and social class was 24%, 25% and 21% among males, respectively, and 14% and 19% for income adequacy and education among females, respectively, in this Canadian population. CONCLUSIONS: A statistically significant association between income adequacy, education social class and lung cancer risk was found.     

Mortality, disability, and falls in older persons: the role of underlying disease and disability.

BACKGROUND. Falls are prevalent in older persons and can have serious consequences. METHODS. Data from the Longitudinal Study on Aging were analyzed to study the relationship between falls and both mortality and functional status in 4270 respondents age 70 and over. The effects of demographic traits, chronic conditions, and disability present at baseline were controlled for by means of multivariable analyses. RESULTS. Risk of death within 2 years was greater for both single fallers (crude odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.0) and multiple fallers (crude OR, 2.2; 95% CI, 1.7-2.8). This excess risk was dissipated when selected covariates were added to the model. No crude or adjusted association was evident between single falls and functional impairment; however, multiple falls were an independent risk factor (adjusted OR, 1.6; 95% CI, 1.2-2.0). CONCLUSIONS. Multiple falls in older persons increase risk of functional impairment and may indicate underlying conditions that increase risk of death.     

基于Joinpoint回归和年龄-时期-队列模型分析中国皮肤癌的长期发病趋势

  目的  分析中国皮肤癌的发病趋势并分别估计其年龄、时期、队列效应。  方法  从2019年全球疾病负担研究中估计中国皮肤癌发病率的变化趋势。采用Joinpoint回归分析模型分析年度变化百分比和平均年度变化百分比(average annual percentage change, AAPC);利用年龄-时期-队列模型评估年龄、时期和出生队列效应对皮肤癌发病率的影响。  结果  1990―2019年中国皮肤癌男性和女性年龄标准化发病率均上升。Joinpoint回归分析模型分析显示皮肤恶性黑色素瘤男性AAPC为2.8%(95% CI: 2.6~3.0),女性AAPC为3.0%(95% CI: 2.8~3.2);基底细胞癌男性AAPC为4.2%(95% CI: 3.9~4.4),女性AAPC为4.0%(95% CI: 3.7~4.3);鳞状细胞癌男性AAPC为3.7%(95% CI: 3.5~3.9),女性AAPC为2.9%(95% CI: 2.7~3.0)。此外,年龄-时期-队列模型表明无论男女,皮肤癌的发病风险均随年龄增长和年份推移而增加,且较晚出生的队列的发病风险均低于之前出生的队列。  结论  1990―2019年中国皮肤癌的发病率呈上升趋势,年龄越大、出生越早且生活在当代的人其发病风险更高。应重视皮肤癌的防治工作。     

The relationships of gender, cigarette smoking, and hypertension with the risk of aneurysmal subarachnoid hemorrhage: a case-control study in Nagoya, Japan

PURPOSE: To examine the relationship of gender, cigarette smoking, and a history of hypertension to the risk of aneurysmal subarachnoid hemorrhage (SAH), using a case-control study. METHODS: Case subjects consisted of a consecutive series of 201 patients with spontaneous SAH with aneurysm(s) confirmed by angiography and/or CT scan. One hospital and one community control subject was matched to each case by gender and age (+/- 2 years). Multiple conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) adjusted for potential confounders. RESULTS: Current smoking and a history of hypertension were each significantly associated with an increased risk of subarachnoid hemorrhage for men and women combined. There was also a non-significant trend towards synergism between these two factors with respect to an increased risk of subarachnoid hemorrhage for each gender separately and both combined. A significantly increased risk was observed for a history of hypertension (adjusted OR, 3.5; 95% CI, 1.2-14.7) among men, for current smoking alone (adjusted OR, 2.9; 95% CI, 1.1-7.7), and a history of hypertension alone (adjusted OR, 2.6; 95% CI, 1.4-5.1) among women. CONCLUSIONS: Trends towards gender differences and synergism emerged in the relationship of cigarette smoking and a history of hypertension of the risk of SAH provides useful information for targeting individuals/populations in programs for the primary prevention of SAH by gender.     

Occupation and gastric cancer in Spain

The association between occupational exposure and stomach cancer was investigated in a multicenter case-referent study conducted in Spain on 354 histologically confirmed cases and 354 hospital referents, matched by age, gender, and residence. An increased risk of gastric cancer was found for coal mining workers [odds ratio (OR) 11.8], but the number of workers was small, and therefore the 95% confidence interval (95% CI) was wide (95% CI 1.36-103). An increased risk was observed for wood and furniture workers (OR 1.76), construction workers (OR 1.68), and glass and ceramic workers (OR 2.18), but none of these risks were statistically significant. According to an occupation-exposure linkage system an increased risk was found for occupations associated with exposure to silica and mineral dust (OR 1.80, 95% CI 0.90-3.59). All of the OR estimates were adjusted for the confounding factors socioprofessional status and dietary habits. The possibility of a causal association between stomach cancer and coal and mineral dust is supported by the results.     

Risk factors associated to tuberculosis patients with positive sputum microscopy

OBJECTIVE: The main factor responsible for producing new cases of tuberculosis by exogen transmission is the existence of Mycobacterium tuberculosis in the sputum of tuberculosis patients. The objective of this study was to determine the risk factors associated to positive smear tuberculosis cases in Lleida (Spain). METHODS: We studied new cases of tuberculosis over the period 1992-1998. The variables considered were: age, gender, coinfection with HIV, injection drug use (IDU), consumption of alcohol, existence of caverns in thorax X-ray, and laboratory results of direct smear examination. We calculated the incidence rates for 100,000 persons-year. The association between the dependent variable case of tuberculosis with positive Mycobacterium tuberculosis smear and the remaining independent variables were assessed obtaining odds ratios (OR) and 95% confidence intervals (CI) (crude cOR and adjusted aOR by non conditional logistic regression). RESULTS: We detected 905 new cases of tuberculosis. The rates in the period 1992-1998 decreased from 38.8 to 30.8. 44.9% of cases (n = 406) presented a positive direct smear. There was a positive association between the risk of being a positive smear patient and having caverns in thorax x-ray (aOR = 6.8; 95% CI, 4.8-95), being male (aOR = 1.8; 95% CI, 1.3-2.6) and consuming alcohol (aOR = 1.6; 95% CI,1.1-2.3) and this risk was significant lower in those under 15 years old (aOR = 0.2; 95% CI, 0.1-0.5), and coinfection with HIV (aOR = 0.5; 95% CI, 0.3-0.9). CONCLUSIONS: HIV infection implies a reduced impact in endemecity of tuberculosis. Study of contacts and the implementation of directly observed treatment must be considered not only for coinfected HIV cases and IDU but also for adult males, especially those who consume alcohol, particularly when they have caverns.     

Time of adhesion to the Family Health Strategy protects elderly against cardiovascular and cerebrovascular accidents in Florianópolis, 2003 to 2007

The Family Health Strategy (FHS) provides longitudinal follow-up and integrated healthcare. This study evaluated the influence of the time of adhesion to the FHS upon the incidence of cardiovascular and cerebral vascular accidents among the elderly enrolled in the CASSI-Florianópolis. The events were selected because of their high incidence, good notification and association with risk factors the FHS is able to modify. The longer the time of adhesion to the strategy the lower the incidence of these events, demonstrating the effectiveness of the FHS. A historical cohort study was conducted with 674 senior participants (60 or more years), registered between November/2003 and March/2007. The analysis used Student's T test, bivariate and multivariate analysis with logistic regression. The independent risk factors were: age over 80 years, (OR=3,44; CI 95%: 1,8-6,2), diabetes (OR=2,62; CI 95%: 1,4-4,7), hypertension (OR=1,68; CI 95%: 1,0-2,6) and physical inactivity (OR=2,06; CI 95%: 1,2-3,2). The study found no significant association between gender, dislipidemia, obesity, smoking, alcoholism and the studied events. The long time of adhesion to the FHS showed independent protective effect (OR=0,43; CI 95%: 0,2-0,8) after adjustment to earlier covariates, being effective in reducing the incidence of cardiovascular and cerebral vascular accidents among the enrolled population of elderly.     

胸苷酸合成酶基因多态和生活习惯及亚甲基四氢叶酸还原酶基因协同作用与胃癌的易感性

目的　研究胸苷酸合成酶 (TS) 3’ UTR基因多态和生活习惯及亚甲基还原酶基因相互作用与胃癌易感性的关系。方法　在上消化道癌高发区淮安市进行病例对照研究 (胃癌患者 1 0 7例 ,人群对照 2 0 0名 ) ,调查研究对象的生活习惯 ,采用聚合酶链反应 限制性片段长度多态性 (PCR RFLP)技术检测研究对象的TS 3’ UTR基因型。结果　 (1 )胃癌组中TS +6bp +6bp、+6bp - 6bp、- 6bp - 6bp基因型频度分别为5 .6 %、47.7%和 46 .7% ,与对照组的 9.0 %、54 .0 %和 37.0 %相比 ,差异无显著性 (χ2 =3 .1 90 ,P =0 .2 0 3)。与携带 +6bp等位基因者相比 ,携带TS - 6bp - 6bp基因型者胃癌发生的危险性有所升高 (调整OR =1 .36 ,95 %CI:1 .0 0～ 1 .78,P =0 .0 4 7)。 (2 )TS - 6bp - 6bp基因型对吸烟、饮酒及不饮茶的习惯在胃癌发生中的作用有放大效应。与携带 +6bp等位基因且不吸烟者或不经常饮酒者或饮茶者相比 ,携带 - 6bp - 6bp基因型且有吸烟习惯者或经常饮酒者或不饮茶者发生胃癌的调整OR分别为 2 .79(95 %CI :1 .51～ 5 .1 8)、1 .76(95 %CI:1 .0 7～ 2 .90 )和 2 .34(95 %CI :1 .43～ 3 .82 )。 (3)TS - 6bp - 6bp基因型与亚甲基四氢叶酸还原酶 (MTHFR)C T或T T基因型有协同作用。携带TS - 6bp - 6bp基因型同时     

Excess cardiac mortality on Monday: the importance of gender,age and hospitalisation

Background: Available evidence suggests a peak in the incidence of cardiovascular events on Mondays compared to other days of the week. The underlying mechanism may be summarised as naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour. Change in these rhythms may lead to attenuation of the peak on Mondays. Objective: To quantify the excess risk associated with the Monday peak in cardiovascular mortality and to explore the role of age, gender and hospitalisation. Methods: Details on time and cause of all deaths which occurred in the city of Rotterdam between November 21, 1988 and November 21, 1990 were obtained by sending a questionnaire to the physician who signed the death certificate. We studied the weekly distribution of 1828 confirmed cases of sudden cardiac death, for the group as a whole and in subgroups according to gender, age (<65 years/≥65 years) and hospitalisation. Results: The odds ratio (OR) of sudden cardiac death on Monday compared to other days of the week was 1.20 (95% CI: 1.06–1.36). The excess mortality due to the Monday peak amounted to 4.9 per 1000 deaths. The Monday peak was more pronounced in non-hospitalised (OR: 1.25; 95% CI: 1.08–1.44) than in hospitalised patients (OR: 1.06; 95% CI: 0.83–1.37), in men (OR: 1.25; 95% CI: 1.06–1.48) than in women (OR: 1.14; 95% CI: 0.95–1.36), and in those younger than 65 (OR: 1.29; 95% CI: 0.95–1.74) compared to those aged 65 years or over (OR: 1.18; 95% CI: 1.03–1.35). Yet, the confidence limits overlap. Conclusion: The incidence of sudden cardiac death is markedly increased on Monday, more pronounced in non-hospitalised patients. Our results may point to the relevance of naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour as underlying mechanism.     

Prevalence and risk factors associated with dyslipidaemia in children and adolescents among ethnic groups in Taiwan

BACKGROUND: The mortality rates of cerebral and cardiovascular diseases are higher for aborigines than non-aborigines in Taiwan. Hypertriglyceridaemia and hypercholestolaemia are risk factors for cardiovascular diseases. OBJECTIVES: To investigate the prevalence of dyslipidaemia and its associated risk factors in aborigine (Atayal, Paiwan and Bunun tribes) and non-aborigine (Fukein and Hakka Chinese) children and adolescents in Taiwan. STUDY DESIGN: This was a cross-sectional study. METHODS: In total, 718 males and 721 females, below 20 years of age, were recruited. Our study defined dyslipidaemia as serum triglyceride and cholesterol levels greater than 200 and 240 mg/dl, respectively. RESULTS: The serum triglyceride level and the prevalence of hypertriglyceridaemia were similar in both aborigines and non-aborigines and both sexes, but the Bunun and Paiwan tribes had the highest prevalence of hypertriglyceridaemia in males (11.8-29.4%) and females (10.9-22.8%) compared with other aboriginal tribes (5.1-10.8% for males and 7.8-9.2% for females). Serum cholesterol concentrations and the prevalence of hypercholesterolaemia were lower in the aborigines than non-aborigines for both sexes (P<0.05), with the Atayal tribe having the lowest prevalence in males (1.1%) and females (2.1%) compared with other aboriginal tribes (2.4-4.5% for males and 5.7-8.0% for females). Using multivariate-adjusted logistic regression modelling, hypertriglyceridaemia was significantly associated with the Bunun tribe (odds ratio (OR)=3.2, 95% confidence intervals (CI) 1.6-6.1), hyperuricaemia (OR=1.8, 95% CI 1.2-2.6), hypercholesterolaemia (OR=3.3, 95% CI 1.7-6.4) and alcohol use (OR=2.8, 95% CI 1.2-6.6). Hypercholesterolaemia, after controlling for age and sex, was significantly associated with the Atayal tribe (OR=0.2, 95% CI 0.1-0.5), hypertriglyceridaemia (OR=3.5, 95% CI 1.8-6.7) and hyperuricaemia (OR=3.2, 95% CI=1.7-6.0). CONCLUSIONS: For the young people of Taiwan, hypertriglyceridaemia is associated with hyperuricaemia, hypercholesterolaemia and alcohol use, and hypercholesterolaemia is associated with hypertriglyceridaemia and hyperuricaemia. Compared with non-aborigines, the young aborigines of some tribes have a higher prevalence of hypertriglyceridaemia and a lower serum cholesterol level.