Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children

OBJECTIVE: Our primary objective was to determine whether a novel 'active school' model--Action Schools! BC--improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors. METHODS: We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across 1 school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total:high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77). RESULTS: INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables. CONCLUSION: Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis.     

Adult family members and their resemblance of coronary heart disease risk factors: The Cardiovascular Disease Study in Finnmark

Coronary heart disease tends to run in families, and the familial resemblance of major risk factors for the disease was examined among various types of adult family members. Family units were assembled from a total of 4,738 men and women who took part in a cross sectional health survey in four Norwegian municipalities where all inhabitants between 20 and 52 years of age were invited. After adjusting for age and other confounders, correlation coefficients were derived as a measure of the degree of resemblance. Viewed across all types of investigated familial relationships, similarity was found to be stronger for total cholesterol than for high-density lipoprotein cholesterol and triglycerides, and also stronger for systolic than for diastolic blood pressure. Between husbands and wives (3,060 subjects), correlations were small (between 0.02 and 0.06), except for 0.11 for total cholesterol. Lipid and blood pressure correlations ranged from 0.13 to 0.27 for parents and their offspring (471 subjects, p < 0.05) and from 0.11 to 0.22 among siblings (2,166 subjects, p < 0.01). Sibling correlations were consistent across age groups. Furthermore, reports from each individual on daily smoking (yes or no) revealed that husbands and wives had similar habits in 63.5% of all marriages as compared with the expected 49.4% had no smoking similarity at all been present. Smoking concordance was also demonstrated among siblings (p < 0.01). The persistent pattern of lipid and blood pressure aggregation among genetically related individuals from 20 to 52 years of age and the much weaker such similarity between husbands and wives, point towards genes or commonly shared environment at early ages as a major reason why coronary heart disease runs in families.     

Functional somatic symptoms and associated impairment in 5–7-year-old children: the Copenhagen Child Cohort 2000

Research on somatisation or functional disorders, characterised by the subjective report of physical symptoms in the absence of clear physical pathology, in young children is limited. This study investigates the distribution, types and co-occurrence of parent-reported functional somatic symptoms (FSS) and their impairment in a population-based sample of Danish 5–7-year-old children. Data were obtained from a 5–7-year follow-up of the Copenhagen Child Cohort 2000. The entire study population included 3,000 randomly sampled children from the cohort. Among these FSS measures were obtained for 1,327 children. The newly introduced parent interview, the soma assessment interview, was used to assess the child’s FSS. Impairing symptoms were defined as FSS that caused substantial discomfort, impairment of everyday life, absence from day-care or school and/or help-seeking in the health care system. The 1-year prevalence of any FSS was 23.2% (N = 308) and higher in girls than boys (27.6 vs. 18.8%, P < 0.0001). Impairing FSS were found in 4.4% (N = 58). Pain complaints, i.e. limb pain, headache and abdominal pain, were the most frequently reported FSS. Among the 308 children with FSS, 66 (21.4%) presented with two or more of these functional pain complaints, while 15 (4.9%) had all three types. The findings indicate that FSS are common health complaints in 5–7-year-old children. A subgroup with impairing FSS with a likely need of clinical intervention was identified. This suggests that a somatisation pattern may start early in life and call for future studies to include associated impairment in the investigation of childhood FSS.     

Mean levels and distribution of some risk factors for atherosclerosis in Sardinia: The ATS-Sardegna survey

Six population samples of randomly chosen men and women aged 20–59 years in the four provinces of the island of Sardinia, for a total of 5,697 individuals (overall partecipation 55%), were examined to determine the mean levels and distribution of some risk factors for atherosclerosis. A remarkable uniformity of such levels, with some minor exceptions, was found throughout the island. The overall, age-standardized mean levels for the factors considered are as follows (men and women, respectively): total cholesterol (TC) (mg/dl) 204 and 196; LDL-cholesterol (LDL-C) (mg/dl) 131 and 125; apolipoprotein B (ApoB) (mg/dl) (five out of six areas) 112 and 104; HDL-cholesterol (HDL-C) (mg/dl) 48 and 53; triglyceride (TG) (mg/dl) 117 and 89; systolic blood pressure (mmHg) 129 and 128; diastolic blood pressure (mmHg) 81 and 80; body mass index (BMI) [kg/(m)²] 26 and 25; prevalence of smokers (%) 48 and 15; cigarettes per day among smokers 19 and 11. A regular increase with increasing age exists for TC, LDL-C, ApoB, blood pressure (systolic and diastolic) and BMI. Compared to the results of a previous survey eight years earlier, an unfavorable trend is in progress, particularly for TC levels in both sexes and smoking among women.Corresponding author.     

Participation and cardiovascular risk reduction in a voluntary worksite nutrition and physical activity program

Objective

In a cohort of employees participating in a worksite nutrition and physical activity program, we compared program completion and changes in cardiovascular risk factors by baseline body mass index.

Methods

In 2007, 774 employees enrolled in a 10 week program at a hospital in Boston, Massachusetts. Program completion and change in weight, cholesterol, and blood pressure were compared between obese (body mass index ≥ 30), overweight (body mass index = 25-29.9), and normal weight (body mass index < 25) participants.

Results

At baseline, 63% were obese or overweight and had higher blood pressure and cholesterol compared to normal weight participants. Program completion was 82% and did not differ by body mass index. Mean weight loss was 1.9 kg at end of program (p < 0.001) and 0.4 kg at 1 year (p = 0.002). At end of program, participants with body mass index ≥ 30 lost 3.0% body weight vs. 2.7% for body mass index = 25-29.9 and 1.7% for body mass index < 25 (p < 0.001), but weight loss at 1 year did not differ by body mass index. Mean cholesterol and blood pressure were lower at end of program and 1 year (all, p < 0.005) but did not differ by body mass index.

Conclusions

Worksite programs can successfully initiate cardiovascular risk reduction among employees, but more intensive interventions are needed to make significant improvements in the health of higher risk obese employees.     

Diabetes and modifiable risk factors for cardiovascular disease: the prospective Million Women Study

To compare the effect of potentially modifiable lifestyle factors on the incidence of vascular disease in women with and without diabetes. In 1996–2001 over one million middle-aged women in the UK joined a prospective study, providing medical history, lifestyle and socio-demographic information. All participants were followed for hospital admissions and deaths using electronic record-linkage. Adjusted relative risks (RRs) and incidence rates were calculated to compare the incidence of coronary heart disease and stroke in women with and without diabetes and by lifestyle factors. At recruitment 25,915 women (2.1% of 1,242,338) reported current treatment for diabetes. During a mean follow-up of 6.1 years per woman, 21,928 had a first hospital admission or death from coronary heart disease (RR for women with versus without diabetes = 3.30, 95% CI 3.14–3.47) and 7,087 had a first stroke (RR = 2.47, 95% CI 2.24–2.74). Adjusted incidence rates of these conditions in women with diabetes increased with duration of diabetes, obesity, inactivity and smoking. The 5-year adjusted incidence rates for cardiovascular disease were 4.6 (95% CI 4.4–4.9) per 100 women aged 50–69 in non-smokers with diabetes, 5.9 (95% CI 4.6–7.6) in smokers with diabetes not using insulin and 11.0 (95% CI 8.3–14.7) in smokers with diabetes using insulin. Non-smoking women with diabetes who were not overweight or inactive still had threefold increased rate for coronary disease or stroke compared with women without diabetes. Of the modifiable factors examined in middle aged women with diabetes, smoking causes the greatest increase in cardiovascular disease, especially in those with insulin treated diabetes.     

中国九省居民膳食、体力活动与血压水平关系的纵向分析研究

目的 通过构建多水平模型,对中国九省居民饮食、体力活动与血压水平之间的关系进行纵向分析.方法 以"中国健康与营养调查"追踪调查项目中参加1997、2000、2004和2006年四轮调查中至少一次调查的18岁及以上成年人(男性6706名,女性7140名)为研究对象,分性别拟合包括个体和调查时间两个水平的发展模型,分析膳食中盐、蔬菜、水果、脂肪和蛋白质摄入量以及中重度体力活动时间对SBP和DBP的影响.结果 在调整年龄、教育程度、BMI、饮酒和能量摄入量等因素之后,四轮调查女性个体平均盐摄入量与SBP呈正相关(β=0.0481,s-x=0.0178,P＜0.01);男女性个体平均蔬菜摄入量与SBP呈负相关(P＜0.01),其回归系数估计值分别为-0.0063、-0.0068,即个体四次调查日均蔬菜摄入量每增加100 g,其SBP会降低0.6mm Hg(1 mm Hg=0.133kPa)以上,另外,男女性个体平均蔬菜摄入量同DBP亦呈负相关(P＜0.01).对同一调查时间的不同个体或不同调查时间的同一个体来说,男女性水果摄入量和SBP呈负相关,其回归系数估计值分别为-0.0029、-0.0031.中重度体力活动时间与男女性SBP和女性DBP均呈负相关(P＜0.05).不过,膳食总脂肪和蛋白质摄入量与血压水平之间并无关联.结论 膳食中盐、蔬菜和水果摄入量以及中重度体力活动时间与血压水平有关.限盐、增加蔬菜和水果摄入量、提高各项体力活动水平、积极控制体重等生活方式的转变是控制血压水平的重要方法.     

Non-response in a survey of cardiovascular risk factors in the Dutch population: determinants and resulting biases

BACKGROUND: The aim of the research was to study the determinants of participation in a health examination survey (HES) which was carried out in a population that previously participated in a health interview survey (HIS) of Statistics Netherlands, and to estimate the effect of non-participation on both the prevalence of the main HES outcomes (risk factors for cardiovascular disease) and on relationships between variables. METHODS: Logistic regression was used to study the determinants of participation in the HES (n=3699) by those who had previously participated in the HIS (n=12,786). Linear models were used to predict the main outcomes in non-participants of the HES. Item non-response was handled by multiple imputation. RESULTS: HES participants had a higher socio-economic status and comprised more 'worried well', while the rural population were less likely to participate in the HES. Most predicted values of outcomes in HES non-participants differed from those in HES participants, but much of this was due to differences in the age and gender composition of both groups. Taking age and gender differences into account, most predicted values of outcomes in the entire HIS population were within the 95% confidence intervals of the HES values, with the exception of body height in men and high-density lipoprotein cholesterol, fasting glucose and body weight in women. These differences are most likely to be due to the higher socio-economic status of HES participants. Relationships between HIS variables did not change significantly when using HES participants alone compared with all HIS participants. CONCLUSIONS: Despite a high rate of non-participation, some bias, mostly small, was seen in the prevalence rates of the main outcome variables. Bias in the relationships between variables was negligible.     

中国15城市儿童血铅水平及影响因素现况调查

目的调查中国城市0～6岁儿童血铅水平，为制定防止环境铅污染，保护儿童健康政策提供科学依据。方法采用分层整群随机抽样的方法在全国15个中心城市中采集0～6岁儿童末梢血17141份，采用原子吸收光谱法测定血铅水平，同时进行问卷调查。采用多元回归分析方法进行结果分析。结果中国城市儿童血铅总体均值为59．52μg/L，血铅水平≥100μg／L占10．45％，血铅水平≥200μg／L仅有0．62％。血铅水平有随着年龄增大而升高的趋势，男童的血铅水平均值（59．50μg／L）高于女童血铅水平均值（54．95μg／L）。多元回归分析表明：①儿童生活居住环境会影响儿童的血铅水平。②父母的文化程度和职业以及儿童生活或卫生习惯对儿童血铅有影响。③饮食以及营养状况也与儿童血铅水平有关。结论中国儿童血铅水平已有所下降，但仍高于发达国家儿童血铅水平，需要引起政府和全社会的重视。     

北京市0～6岁儿童血铅水平与相关影响因素的研究

目的　了解近期北京市 0～ 6岁儿童血铅水平及其影响因素。方法　采取分层整群随机抽样的方法。 2 0 0 1年 5～ 7月调查北京市常住人口中 0～ 6岁儿童 2 2 62名。采用石墨炉原子吸收法进行微量血中铅含量的测定 ,并做相关因素问卷调查。结果　北京市 0～ 6岁儿童血铅水平均值为96.8μg L,血铅值≥ 10 0 μg L为 3 5.7% ,血铅值≥ 2 0 0 μg L为 2 .5%。农村儿童铅中毒为 43 % ,明显高于城区和郊区儿童。 2岁组铅中毒为 45.1%高于其他年龄组。男童血铅平均值 10 0 .2 μg L明显高于女童血铅平均值 93 .0 μg L(P <0 .0 1)。不喝或偶喝牛奶、居室距繁华马路≤ 50m、家庭居住 1层楼房或平房为儿童高血铅的主要危险因素。结论　目前北京市儿童血铅水平≥ 10 0 μg L的比例不容忽视 ,应对重点人群采取行之有效的干预措施     

Associations between overall physical activity level and cardiovascular risk factors in an adult population

Background It is well established that physical activity level is inversely associated with cardiovascular morbidity and mortality, and with all-cause mortality. However, the dose–response relationship between physical activity and other cardiovascular disease risk factors is not fully understood. The aim of the present study was to explore the dose–response relationship between daily physical activity, as measured by a metabolic equivalent score, and BMI, waist circumference, waist hip ratio, total cholesterol, HDL, LDL, triglycerides, systolic and diastolic blood pressure. Methods A total of 1693 men and women, 33–64 years of age, from the 3 year follow-up of a population-based intervention study, were included in this cross-sectional study. Information on physical activity and other lifestyle factors was obtained by self-report questionnaire. Associations between activity level and biological variables were explored by general linear regression. Results Data from 835 (51%) men and 805 (49%) women were included. Mean age was 50.8 years (33–64). A significant inverse association between average 24-hour physical activity level ≤45 METs and waist circumference (men p = 0.012, women p = 0.011), BMI (p = 0.0004), waist-hip-ratio (p = 0.002) and triglycerides (p = 0.0001) was found as well as a positive association with HDL (p = <0.0001). In those with an activity level above 45 METs there were no associations. No association was found with total cholesterol, LDL, systolic or diastolic blood pressure. Conclusion This study suggests a linear dose–response relationship between activity level and certain biological cardiovascular risk factors up to a threshold of a daily 24 h MET-score of 45, which corresponds to a moderate physical activity level. Electronic Supplementary Material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

宁夏农村地区7～12岁儿童虐待现状及其影响因素分析

目的 了解宁夏农村地区7～12岁儿童虐待的现状,并探讨其影响因素。方法 采用多阶段抽样法抽取宁夏西吉县和隆德县农村地区7～12岁的儿童及其监护人,采用百分比描述儿童虐待现状,采用logistic回归模型筛选儿童虐待的相关影响因素。结果 共调查西吉县和隆德县15个村的704名7～12岁儿童。最近一年内经历过任何类型的虐待（包括躯体虐待、忽视、情感虐待、性虐待）的儿童有359人（50.2%）,其中以躯体虐待为主（44.6%）。仅有10名（1.4%）儿童能正确全面理解儿童虐待问题,经历虐待时,55.5%的儿童会通过上报的形式寻求帮助。男童（OR=1.37,95%CI：1.01～1.85）、汉族人群（OR=1.49,95%CI：1.06～2.08）、低年龄 （OR=1.16,95%CI：1.05～1.28）、父母一方在家（OR=2.05,95%CI：1.16～3.64）、家庭经济相对富裕（OR=1.55,95%CI：1.03～2.33）的儿童更易经历虐待。 结论 宁夏农村地区7～12岁儿童虐待严重,儿童自身对虐待问题的认知水平较低。应关注男童、汉族人群、低年龄、父母一方在家的儿童,促进儿童身心健康发展。     

Biological cardiovascular risk factors cluster in Danish children and adolescents: the European Youth Heart Study

BACKGROUND: The aim of this study was to determine whether the number of participants with multiple coronary heart disease (CHD) risk factors exceeded the number expected from a random distribution. METHODS: A cross-sectional study of 1020 randomly selected boys and girls, 9 and 15 years old, was conducted. Risk factors were total cholesterol, HDL-cholesterol, triglyceride, serum insulin, and blood pressure. Physical fitness was assessed from a maximal cycle test and body fat from the sum of four skinfolds. Risk factors selected in the analysis were those related to the metabolic syndrome. RESULTS: More participants than expected had four or five CHD risk factors. Four risk factors were found in 3.03 (95% confidence interval (CI): 2.24-4.10) times as many participants as expected from a random distribution and five risk factors were found in 8.70 (95% CI: 4.35-17.4) times as many participants as expected. Fifty (5.4%) had four or five risk factors and in these individuals physical fitness was 1.2 standard deviation (SD) lower and body mass index (BMI) 1.6 SD higher than mean values for the population. CONCLUSION: Clustering of risk factors for the metabolic syndrome was found in children and adolescents. Low levels of physical fitness and raised BMI in these individuals indicate that lifestyle factors such as physical activity and diet may influence the development of these unhealthy risk profiles.     

Association of neighborhood physical activity opportunities with incident cardiovascular disease in the Cardiovascular Health Study

We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age = 73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5 km of home was associated with a respective 7% (95% confidence interval (CI) = 0.87–0.99) and 12% (95% CI = 0.73–1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.     

The ischemic electrocardiogram: A harbinger for ischemic heart disease independent of the blood pressure level. The Copenhagen City Heart Study

Information is limited on the co-existence and prognostic association of the ischemic electrocardiogram (ECG) and blood pressure. Prospectively collected data sets from 28,118 examinations in the Copenhagen City Heart Study were analyzed for cardiac morbidity and mortality for a 5.9-year follow-up. The prognosis of the ECG, independently of blood pressure, was examined. The Cox proportional hazard model was employed to evaluate the prognostic implications of ECG findings and relative risk was adjusted for age and multivariately adjusted for traditional cardiovascular risk factors. End-points were (1) fatal and non-fatal ischemic heart disease (IHD) events and (2) cardiovascular disease (CVD) mortality. During a total follow-up period of 166,471 person years (mean: 5.9 years) 1.481 IHD events were recorded and 1.051 CVD deaths. The relative risk of an ischemic ECG was independent of the blood pressure level. The multivariately adjusted relative risk for fatal and non-fatal IHD for the ischemic ECG was 1.70 (95 CI: 1.39–2.09, p < 0.001) in women, and 1.96 (95 CI: 1.67–2.30, p < 0.001) in men, and for CVD mortality 1.71 (95 CI: 1.34–2.17, p < 0.001) in women and 2.08 (95 CI: 1.74–2.49, p < 0.001) in men. An ECG with left ventricular hypertrophy (LVH) and ST-depression was the finding with the highest risk for future events. LVH by ECG voltage-only was associated with no statistically increased risk, except for men treated for arterial hypertension.     

我国成年人血压水平与心脑血管疾病行为危险因素及其聚集关系分析

目的 探讨中国成年人血压水平与心脑血管疾病主要行为危险因素流行及聚集的关系。方法 采用2013年中国慢性病及其危险因素监测数据。源自31个省（自治区、直辖市）298个监测点,采用面对面询问调查和身体测量收集心脑血管疾病行为危险因素及高血压患病等信息,将其中179 347名≥18岁成年人作为研究对象。血压水平分为理想血压、正常血压、正常高值及高血压Ⅰ、Ⅱ、Ⅲ期6个水平,分析不同血压水平人群心脑血管疾病行为危险因素的流行及聚集情况。结果 样本人群中血压6个水平分别占36.14%、22.77%、16.22%、16.43%、5.97%、2.48%。不同人口学特征亚组间血压水平比较,以男性、汉族、有伴侣者血压水平更高;年龄越大、经济收入越低、文化程度越低者血压水平越高,差异均有统计学意义（P<0.05）。无论是否服用降压药,不分性别人群血压水平均随危险因素聚集数量增加而升高（P<0.05）,其中未服药组血压水平受危险因素数量聚集影响更大。经多因素logistic分析发现,具有1、2、≥3个危险因素者血压水平升高的风险分别是具有0个危险因素者的1.36、1.79、2.38倍。结论 我国成年人心脑血管疾病行为危险因素聚集越多,血压水平越高;采用≥2种的行为危险因素联合干预可更好控制人群血压水平。     

中国7～12岁儿童血压与年龄身高的关系

目的探讨中国7～12岁儿童血压受年龄和身高的影响及其作用规律,为儿童青少年血压评价和相关标准制定提供科学依据。方法运用1985年全国学生体质与健康调研7～12岁汉族学生数据,从每个省中随机抽取相同数量的同年龄、同性别、同身高学生,分别控制年龄、身高后,分析身高和年龄对儿童青少年血压的影响。结果在未控制身高、年龄时,男、女生收缩压、舒张压随年龄增长而上升;控制年龄后,男、女生7～12岁收缩压、舒张压总体呈随身高增长而升高的趋势(P值均<0.05);控制身高后,男、女生各年龄组间血压水平差异无统计学意义(P值均>0.05)。结论 7～12岁儿童血压水平随身高增长而升高,受年龄影响较小。     

Traditional and novel cardiovascular risk factors in school-aged children: A call for the further development of public health strategies with emphasis on fitness

The purpose of this study was to improve the understanding of the relationship between cardiorespiratory fitness (CRF) and the early aetiology of cardiovascular disease. We examined if the levels of traditional and novel cardiovascular disease risk factors were influenced by the levels of CRF in children. A total of 339 randomly selected children aged 9–10 years participated in the Swedish part of the European Youth Heart Study (EYHS). CRF was estimated by a maximal ergometer bike test and dichotomized into low and high categories. Additional measured outcomes included fasting triglycerides, high density lipoprotein cholesterol (HDLc), C-reactive protein, homocysteine, blood pressure, body mass index, sum of five skinfolds and waist circumference. Homeostasis model assessment (HOMA) was computed from insulin and glucose measurements. Body mass index, skinfold thickness, waist circumference and insulin resistance (HOMA) levels were lower both in girls and boys with high CRF compared to those with low CRF. In girls, the levels of C-reactive protein were significantly lower in those with high CRF compared with those with low CRF, while HDLc levels showed the opposite pattern. The levels of triglycerides and homocysteine showed a tendency to be lower in girls having low CRF compared to those with high CRF. The results indicate that the levels of several traditional and novel cardiovascular disease risk factors are positively influenced by the levels of CRF in school-aged children. The data call for the development, testing and implementation of preventive strategies with stronger emphasis on CRF, especially for those children with low CRF. They also reinforce the need to include CRF testing in pan-European Health Monitoring Systems, also among younger individuals.     

儿童青少年血压偏高和高血压与心理行为因素关系的研究

目的 了解心理行为因素对儿童青少年血压偏高及高血压的影响,为儿童青少年高血压病心理行为干预提供依据.方法 采用分层整群抽样的方法,对江苏省宿豫区和沭阳县的1 928名5～ 15岁学生进行体格检查,应用Conners问卷等量表对学生的学习压力和常见行为问题倾向进行调查.分析主要采用x2检验和多因素Logistic回归分析.结果 血压偏高或高血压总检出率为18.0％.除年龄(OR =0.75)、性别(女性OR=1.64)、地区(城区OR=2.93)、学习阶段(小学1～3年级OR=0.44,小学4～5年级OR=0.26)和体重(OR=1.07)是主要影响因素外,品行问题(OR=2.34)是儿童青少年血压偏高或高血压的重要心理行为危险因素.结论 研究地区高血压检出率高于国内外平均水平.建议加强心理因素的研究,制定对未成年人品行问题为重点的心理干预策略,以降低儿童青少年罹患心脑血管疾病的风险.     

Quantifying the dose-response of walking in reducing coronary heart disease risk: meta-analysis

The evidence for the efficacy of walking in reducing the risk of and preventing coronary heart disease (CHD) is not completely understood. This meta-analysis aimed to quantify the dose-response relationship between walking and CHD risk reduction for both men and women in the general population. Studies on walking and CHD primary prevention between 1954 and 2007 were identified through Medline, SportDiscus and the Cochrane Database of Systematic Reviews. Random-effect meta-regression models were used to pool the relative risks from individual studies. A total of 11 prospective cohort studies and one randomized control trial study met the inclusion criteria, with 295,177 participants free of CHD at baseline and 7,094 cases at follow-up. The meta-analysis indicated that an increment of approximately 30 min of normal walking a day for 5 days a week was associated with 19% CHD risk reduction (95% CI = 14–23%; P-heterogeneity = 0.56; I ² = 0%). We found no evidence of heterogeneity between subgroups of studies defined by gender (P = 0.67); age of the study population (P = 0.52); or follow-up duration (P = 0.77). The meta-analysis showed that the risk for developing CHD decreases as walking dose increases. Walking should be prescribed as an evidence-based effective exercise modality for CHD prevention in the general population.