The prevalence and distribution of coronary artery calcium in asymptomatic Korean population

Coronary artery calcium score (CACS) is a strong predictor of coronary heart disease and provides incremental prognostic information beyond traditional risk factors. The difference in prevalence and distribution of CACS in different ethnic groups has been reported with conflicting results. We aimed to investigate the prevalence and distribution of CACS in asymptomatic Korean population. A total of 5,239 asymptomatic patients free of known coronary artery disease who had coronary artery calcium scoring computed tomography during comprehensive medical examinations were included in the analysis. Coronary calcium was present in 33.1% of overall population, 40.5% of males and 19.3% of females. In all age groups, CACS was higher in males. The pattern of increase in CACS appeared in different patterns, with earlier and gradual increase in males. In females, there was a time-lag, behind that observed in males by about 10 years. Multivariate analysis showed that male gender (OR 3.759, 95% CI 3.120-4.529, P < 0.001), older age (OR 1.095, 95% CI 1.085-1.106, P < 0.001), pulse pressure (OR 1.142, 95% CI 1.063-1.227, P < 0.001), HbA1C (OR 1.390, 95% CI 1.255-1.540, P < 0.001), and obesity defined by body mass index (BMI) ≥ 25 kg/m(2) (OR 1.042, 95% CI 1.011-1.073, P = 0.007) were related to the presence of coronary artery calcification (CACS > 0). This study provides a healthy reference value of coronary artery calcification in Korean subjects, based on sex and age percentiles. Similar age and gender associations and distributions of coronary artery calcification are found, compared to the previous studies in western populations, but median CACS tend to be lower in Koreans.     

Frequency distribution of human platelet antigens in the Indian population

This study was undertaken with an aim of establishing the frequency distribution of various human platelet antigens (HPA) in Indian populations by means of DNA-based technology. A total of 1164 people belonging to various population groups were studied for the frequency distribution of HPA. DNA extraction was performed from peripheral venous blood samples. Polymerase chain reaction allele-specific amplification technique was used for HPA genotyping. The HPA bands were visualized by using ethidium bromide-stained agarose gel, after electrophoresis. The homozygosity of the HPA-1b/1b genotype was found to be significantly higher (P < 0.05) in the Parsi population group and Vatalia Prajapati population group, compared to Maharashtrians. Frequency distribution of HPA-1b in our populations was found to be slightly lower than that reported in some western populations. This study has established a DNA technique to diagnose cases of NAITP definitively and to treat these cases during the neonatal period, and also gives the frequency distribution of HPA in some of the Indian population.     

The prevalence of pain complaints in a general population

The authors argue that the study of the complaint of pain falls within the purview of epidemiological study. An analytic survey of 500 randomly selected households on the roster of a group family practice clinic was undertaken. The purpose was to determine the self-reported prevalence rates of any pain complaint and to determine the distribution of pain rates according to selected demographic and socioeconomic variables. Sixteen percent of the individuals sampled from a family practice (H.S.O.) had experienced pain within the 2 weeks preceding the survey. The prevalence rate of those with persistent pain was approximately twice that of those with temporary pain. More women than men reported temporary and persistent pain. The age specific morbidity rate for persistent pain increased with age. The back, lower extremities, and head and face were the most frequently identified sites of pain in both subgroups. Persons with persistent pain used health services, both community physicians and hospital care, more frequently than did those with temporary pain. No significant differences between the two groups were reported for physical, social or emotional function although the persistent pain group characterized their general health status more poorly.     

The prevalence of hereditary haemochromatosis in a diabetic population

Hereditary haemochromatosis is an under-diagnosed and treatable cause of chronic liver disease. Its prevalence indicates that selective population screening may be worthwhile, but opinion differs as to whether diabetic patients constitute such a group. We studied 727 patients attending a teaching hospital diabetic clinic. On first testing, 7.4% had abnormally high iron indices, but only 3% remained abnormal on retesting. Of these patients, those at high risk were offered liver biopsy for histological assessment and iron assay. Only one had hereditary haemochromatosis, but all had abnormal liver histology--largely steatosis but some with fibrosis. These findings raise questions regarding the true prevalence of this disorder in North- East England, do not indicate that targeted screening of diabetic patients is worthwhile, and incidentally highlight the potential importance of diabetes as a cause of liver disease.      

The prevalence of bowel problems reported in a palliative care population

ContextConstipation and other disturbances of bowel function are distressing problems for people with specialist palliative care needs. Recent observations suggest that such problems may worsen as people become more unwell, but the changes in intensity over time are not well documented.ObjectivesThe objectives of this work were to understand the prevalence, intensity, and progression of self-reported bowel disturbances across a community palliative care population, which included people with cancer and noncancer diagnoses.MethodsAll people referred to a community-based palliative care service over a period of 6.3 years had their bowel problem scores reported, using a numerical rating score at every clinical encounter until their death, at four discrete time points, namely, 90, 60, 30, and seven days before death. This allowed change over three time periods to be considered. At the same time, other symptom scores were collected including nausea, fatigue, pain, appetite problems, and breathing problems. Patients were categorized according to the underlying disease that accounted for their referral to palliative care, namely, cancer diagnoses (upper gastrointestinal cancers, lower gastrointestinal cancers, cancers of the associated digestive organs, and other cancers) and nonmalignant diagnoses. Group differences over the time periods were assessed using analysis of variance. Bivariate analysis was used to explore the relationship between bowel disturbances and other symptoms using Spearman's Rho correlation.ResultsFor 7772 patients, data were collected an average of 22.5 times, generating 174,783 data collection points over an average of 98.6 days on the service. At the time of referral to the service, 3248 (42.4%) people had disturbed bowel scores, 548 (7.2%) of whom described these as severe. Only 1020 (13.1%) people never described disturbed bowel function over their time in palliative care. At each time point, approximately one-third were experiencing disturbed bowel function, with proportionally greater numbers of people experiencing more significant problems as death approached (Χ² (9) = 119.3; P < 0.001). Most referrals to the service were because of cancer diagnoses, with no significant differences noted between the bowel disturbance scores of those with cancer diagnoses compared with those with nonmalignant disease. Associations between bowel problem score and appetite problems, nausea, breathing problems, fatigue, and pain were explored. Although weak, there were statistically significant associations between all symptoms and bowel problem scores except for breathing problems.ConclusionIn conclusion, disturbed bowel function consistently remains a problem for people under the care of palliative care services, with the proportion of people with severe problems increasing as death approaches. This is despite the time and number of interventions currently used to palliate these problems.     

The prevalence of red cell antigens and antibodies in Malawi

As there were no reliable data in Malawi for the prevalence of red cell alloantibodies or antigens in the population, a study was conducted to screen 1000 patients for the presence of antibodies and to type them for ABO, RhD, C, c, E, e and K antigens and to test 500 donors for these antigens plus Fy^a, Fy^b, Jk^a, Jk^b, S and s. Red cell antibodies were identified in 11 patients [1.1%]; 2 were anti‐D, 2 anti‐S, 1 anti‐Le^a+b and 6 anti‐M, 4 of which were found in non‐transfused males suggesting they might be naturally acquired. The antigen frequencies found were similar to those previously published for Central Africa but 98.2% of donors were found to be Fy(a‐b‐). All patients tested were K negative and only three donors were found to be K positive, one being a Caucasian. Approximately 3.5% of Malawians are D negative, lower than the usual 8% quoted for Black Africans. These data confirm the assumption that pre‐transfusion antibody screening is not currently required but that use of the indirect antiglobulin test in the cross‐match is necessary. Haemolytic disease of the newborn (HDN) appears to be rare, or under reported, in Malawi, and more work is needed to find the real incidence of this condition.     

The prevalence of pain in a pediatric and young adult cancer population

The prevalence and nature of pain in the population of children and young adults with malignancy treated by the Pediatric Branch of the National Cancer Institute were assessed over a 6 month period. One hundred and thirty-nine patients were evaluated during 161 in-patient days and 195 out-patient clinic visits. Approximately 50% of the patients assessed in the hospital and 25% of the patients assessed in the out-patient clinic were found to be experiencing some degree of pain at the time of assessment. Therapy-related pain predominated in both in-patients and out-patients; only one-third of the pain experienced by in-patients and less than 20% of the pain experienced by out-patients was due to tumor. Tumor pain was due primarily to bony invasion. In order to control pain in those individuals experiencing pain, narcotic analgesics were being used by one-half of the in-patients and one-third of the out-patients. Overall pain control was good, with the medium visual analogue scale score being 26 mm on a 0-100 mm scale. During the study period 7 patients were identified to have chronic pain for greater than 1 year following eradication of all known tumor from the site of pain. One was receiving massive doses of narcotics (120 mg/day of methadone) apparently out of proportion to his underlying pain.     

The reliability of balance, mobility and self-care measures in a population of adults with a learning disability known to a physiotherapy service

OBJECTIVE: To estimate the reliability of three measures of balance, mobility and activity for use in clinical and research physiotherapy, with adults with a learning disability. DESIGN: Prospective study to investigate test-retest and inter-rater reliability. SETTING: Participants' homes and day centres. MEASURES: The Berg Balance Scale (BBS), the Rivermead Mobility Index (RMI) and the Barthel Activities of Daily Living Index (BI). PARTICIPANTS: Of the 181 adults known to the Nottingham Community Physiotherapy Service for Adults with Learning Disabilities, 64 with a known Rivermead Mobility score of less than three were excluded. Of 117 randomized, a further 21 were found to fail this criteria, 27 had acute medical, social or behavioural problems, 22 were unable to participate or refused: therefore 47 entered the study. METHODS: Participants were visited in their own homes by two researchers on two occasions, one week apart and rated independently by each rater. Agreement was assessed with the kappa statistic (kappa) and percentage agreement for each item in each scale, and described using standard classification. Intraclass correlation coefficients for inter-rater and test-retest total scores and average differences of total scores, their standard deviations and limits of agreement, were calculated. RESULTS: For inter-rater observations, the Barthel Index and the Rivermead Mobility Index had almost perfect agreement (kappa = 0.86-1.00 and 0.89-1.00 respectively), with the Berg Balance Scale having substantial to almost perfect agreement (kappa = 0.74-1.00). For test-retest comparisons, both the Barthel Index and the Rivermead Mobility Index demonstrated moderate to almost perfect agreement (kappa = 0.57-1.00 and 0.45-1.00 respectively). Kappa scores for the Berg Balance Scale varied from low to almost perfect agreement (kappa = 0.37-1.00). CONCLUSIONS: The Berg Balance Scale, Rivermead Mobility Index and Barthel Activities of Daily Living Index are all reliable clinical and research tools for physiotherapists working with adults with learning disabilities.     

The spectrum of meningitis in a population with high prevalence of HIV disease

We studied the spectrum of meningitis and impact of HIV infection retrospectively (8 months) and prospectively (5 months) in 284 adult patients with meningitis hospitalized in Soweto, South Africa. Tuberculous meningitis (TBM) was the most common cause of meningitis (25.4%) followed by acute bacterial meningitis (ABM; 22.5%), acute viral meningitis (14.1%) and cryptococcal meningitis (13%). The in-hospital mortality was &gt;40% in TBM, ABM, cryptococcal meningitis, the neurosurgery and the parameningeal/parenchymal groups. At least 37.3% of all patients were HIV-seropositive (only 67% of patients were tested). In at least 27% of the study group the meningitis was an AIDS-defining illness (TBM, cryptococcal meningitis). Only 56.2% of patients with ABM has positive cultures (CSF or blood), of which <it>Streptococcus pneumoniae</it> was by far the most frequently found organism (35.8%). The spectrum of meningitis in HIV-affected communities in Africa can be expected to change towards a predominance of TBM and cryptococcal meningitis.      

The use of a hospital laboratory cohort to estimate the prevalence of dyslipidemia in an adult Brazilian population

BACKGROUND: Dyslipidemia is diagnosed through the determination of plasma lipid profiles. This study is aimed at establishing the prevalence of dyslipidemia in a Brazilian out-patient population by using a hospital laboratory cohort. METHODS: Lipid profiles of 22,542 individuals from both sexes, aged 20 to 124 years, and registered at the University Hospital of the State University of Campinas, a standard of reference for hospital treatment in the state of S?o Paulo, Brazil, were retrospectively analyzed from 2000 to 2003. The cut-off values for cholesterol (C), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) were determined as recommended by the National Cholesterol Education Program. Statistical analyses were carried out using the SPSS program. RESULTS: Altered C, LDL-C and TG were found in 44%, 38% and 37% of adults and in 55%, 48% and 41% of the elderly, respectively; 35% of adults and 32% of the elderly presented undesirable low HDL-C. Combined dyslipidemia was very prevalent. CONCLUSION: Dyslipidemia was a serious public health problem in the studied population, especially among women and the elderly. The mixed phenotype of hypercholesterolemia and hypertriglyceridemia was the most prevalent. The results of this study were validated by their agreement with previously studied non-hospital Brazilian populations.     

SNaPshot技术应用于西藏高原人群Duffy血型基因分型

目的应用SNaPshot技术对Duffy血型进行基因型检测,对西藏高原人群Duffy血型的分布进行研究,为临床输血工作提供指导依据。方法采集725份西藏高原人群静脉血,提取DNA,进行引物合成与PCR扩增,再通过SNaPshot检测技术对Duffy血型第125位的SNP位点进行检测,计算遗传学相关参数,并与文献公布的各地区人群及千人基因组计划公布的非洲、东亚、欧洲、南亚、美国等人群和遗传基因组数据库公布的非洲、东亚、其他、美国以及犹太人的基因频率数据进行比较。结果 725份血液标本中Fya+b-、Fya-b+和Fya+b+的表型分别为629例(86.76%)、16例(2.21%)和80例(11.03%),FYa和FYb的基因频率分别为92.28%和7.72%。与各人群基因频率相比,在国内各地区不同民族之间的血型等位基因频率没有明显差异,在亚洲人群中的差异不明显,但与非洲、欧洲、南亚、美国、犹太人相比有显著差异。结论西藏高原人群的Duffy血型分布与国内各地区人群分布一致,但与其他种族人群有明显差异。     

Erythrocyte antigens on human platelets. Absence of Rh, Duffy, Kell, Kidd, and Lutheran antigens

There is considerable controversy as to whether antigens of the Rh, Duffy, Kidd, Kell, or Lutheran red cell systems are present on human platelets. The majority of previous investigators of this topic have reported them to be present. We have used a sensitive two-stage radioimmunoassay to examine human platelets for the presence of antigens of these five red cell systems. Platelets from donors of appropriate red cell phenotype were incubated with monospecific anti-erythrocyte IgG, followed by a second-stage incubation with 125I-labeled mouse IgG monoclonal anti-human IgG (Fc). Analysis of ligand bound per cell demonstrated no significant difference in binding of erythrocyte antibodies to platelets from donors homozygous, heterozygous, or negative for D, C, c, E, e, Fya, Fyb, Jka, Jkb , K, k, and Lub antigens. These findings indicate that major antigens of the Rh, Duffy, Kidd, Kell, and Lutheran systems are not expressed on the surface of human platelets.     

Diabetic retinopathy: contemporary prevalence in a well-controlled population

OBJECTIVE: To measure the extent to which modern intensified risk factor control has lessened the duration-specific prevalence of diabetic retinopathy and, therefore, has decreased the risk of blindness in Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: Intensified control of blood glucose and blood pressure has prevented diabetic retinopathy in randomized controlled trials. There is as yet no confirmation that subsequent treatment intensification in the community has had the same result. We identified all 6993 members of a health maintenance organization, Kaiser Permanente Northwest (KPNW), who, in 1997-1998, had dilated retinal examinations and verifiable data of diagnosis of type 2 diabetes. We plotted prevalence by time since diagnosis for background diabetic retinopathy (BDR) and proliferative diabetic retinopathy (PDR) and compared these results to identically derived 1980-1982 results from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). We estimated multivariate predictive models. RESULTS: Mean (+/- SD) HbA(1c) in KPNW was 7.84 +/- 1.26% versus 10.37% (standardized) in the WESDR. KPNW blood pressure averaged 138.6 +/- 13.8/79.5 +/- 7.4 mmHg compared with 147.0/79.0 in the WESDR. BDR was much less prevalent in KPNW, but PDR prevalence appeared unchanged. BDR preceded diagnosis in 20.8% of the WESDR subjects but only 2.0% of KPNW subjects. However, in both populations, the first cases of PDR appeared similarly, soon after diagnosis. CONCLUSIONS: Earlier diagnosis and more aggressive control of blood glucose and blood pressure decreased the duration-adjusted prevalence of background, but not of sight-threatening proliferative retinopathy. More population-based research is needed to replicate and explain this unexpected finding. Detecting and treating PDR should not be neglected on the assumption that risk-factor control has minimized its prevalence.     

南宁地区人群血小板抗原HPA1—16bw基因分布频率的研究

目的研究南宁地区人类血小板抗原基因分布频率,为临床同种免疫血小板减少症患者提供诊断依据和HPA相容的成分血。方法采用序列特异性引物聚合酶链反应(PCR-SSP)对南宁地区1 500名无血缘关系的成年人做HPA1—16bw基因分型研究。在包含引物混合液的96孔反应板中,按照相同的循环条件扩增PCR产物。结果每份血液标本均可在4 h内获得分型结果。在16个HPA系统中,HPA-15基因型杂合频率最高,HPA15a/15a,HPA15a/15b和HPA15b/15b的频率分别为0.252 7,0.500 7和0.246 7。HPA-3的杂合程度仅次之,HPA3a/3a,HPA3a/3b和HPA3b/3b的频率分别为0.284 0,0.508 0和0.208 0。其余14个HPA系统均以a/a纯合子为主,其a基因频率范围为0.916 7—0.999 3。除了HPA-3b/3b和HPA-15b/15b的纯合子以外,还检测出了HPA-2b/2b5例和HPA-1b/1b1例。HPA-7bw至-14bw,-16bw的a/a等位基因纯合率为1.000 0。结论在临床工作中我们仍须警惕可能由HPA-1,-2,-3,-5,-6和-15同种抗体引起的疾病,HPA基因分型将有助于更好地诊断同种免疫血小板减少症和建立相容的HPA血小板供者库,提供更有效的血小板输注方法。     

The prevalence of pain in a general population. The results of a postal survey in a county of Sweden

In a postal survey, we asked 1009 randomly chosen individuals, age 18-84, about their pain problems. The pain prevalence depended on what types of questions were asked. Any pain or discomfort, including even a problem of short duration, was reported by 66% of those questioned. Forty percent reported 'obvious pain' (pain which affected them 'to quite a high degree' or more and was 'like being stiff after exercise' or worse) lasting more than 6 months. Pain problems of more than 6 months duration were reported far more often than short-lasting problems. Continuous or nearly continuous pain problems were reported as frequently as problems recurring regularly or irregularly. Pains in the neck, shoulders, arms, lower back and legs were most frequent. The prevalence of 'obvious pain' in these localizations was 15-20%. Pain was reported most frequently in the age group 45-64, where the prevalence of 'obvious pain' was 50% among males as well as females. Over 65 years of age the prevalence was less.