Beliefs about the causes of weight change in the Australian population.

OBJECTIVE: To describe self-reported weight change and beliefs about the causes of weight change and to examine whether these vary by sex and weight status. DESIGN: This cross-sectional population study examined data from the 1995 Australian National Health and Nutrition Surveys. SUBJECTS: A total of 10 624 randomly-selected adults provided data. MEASURES: Objectively measured height and weight, perceptions of current weight status, self-reported weight change over the past year, and reasons for weight change. RESULTS: Thirty-five percent of participants reported a weight gain in the last 12 months, with females, and those already overweight more likely to report a recent increase in weight. Approximately one in five participants reported a recent weight loss. Those who had recently gained weight were more likely to perceive themselves as overweight regardless of actual weight status. Commonly reported reasons for weight gain included a change in physical activity level (52% males and 35% females) and a change in the amount of food/drink consumed (30% males, 27% females). Similar reasons were given for weight loss. CONCLUSIONS:: Findings of widespread reported weight gain, particularly among those already overweight, suggest Australia's obesity epidemic may be worsening. Strategies are urgently required to better inform individuals about the factors impacting on their weight in order to prevent further weight gain.     

Beliefs about memory changes across the adult life span.

Beliefs about age-related differences in memory were examined with an adaptation of the Short Inventory of Memory Experiences. In Experiment 1, 142 adults (mean age = 36 years) reported significantly more positive expectations for memory in everyday life for persons aged 25 years than for those aged 70 years. In Experiment 2, a between-subjects design with 189 adults (mean age = 34 years) was employed to examine the generality of memory beliefs about age-related change and the anticipated slope. Beliefs about the memory of 25-year-olds were significantly more positive than for 45- and 65-year-olds, which were correspondingly higher than for 85-year-olds. Secondary regression analyses revealed that participants with good memory self-perceptions anticipated better memory performance for others overall. In addition, older respondents exhibited more differentiated memory beliefs across age groups than younger respondents, especially at the two younger target ages. Examination of age-based memory beliefs with this type of instrument provides a new opportunity to integrate cognitive and social psychological approaches to the study of memory in aging.     

Beliefs about fact retrieval and inferential reasoning across the adult lifespan

This study deals with beliefs about question-answering processes involving "world knowledge" utilized by young, middle aged, and older adults. Questions intended to induce either fact retrieval or inferential reasoning were shown to younger (n = 37), middle aged (n = 37) and older (n = 37) adults in both a multiple choice and true/false format. Increasing age level was not related to decreased confidence in either fact retrieval or inferential reasoning. Global assessments about these question-answering processes involving "people in general" and self evaluations were taken from the same individuals. In contrast to personal confidence ratings, adults of all ages generally believed in declining fact retrieval abilities in old age. Inferential reasoning, however, often was believed to remain stable or even increase in ability level with increasing age. This was especially true in the assessments generated by older adults and in self evaluations. Thus, negative global beliefs about memory and aging may be present even when such global beliefs contradict item-specific judgments and personal beliefs about one's own cognition.     

Beliefs about control in the physician-patient relationship

OBJECTIVES: Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant). DESIGN: Stratified case-controlled study. PATIENTS/PARTICIPANTS: Twenty family medicine and internal medicine physicians and 135 patients. MEASUREMENTS: Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation. MAIN RESULTS: Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation. CONCLUSIONS: Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that increases in one often lead to increases in the other.     

Differences in HbA1C at the time of diabetes diagnosis in the adult population of Ontario,Canada

AimsTo determine the proportion of adults with HbA_1c ≥ 8.0% (64 mmol/mol) at diabetes diagnosis, as an indicator of delayed diagnosis or less intensive screening.MethodsWe conducted a cross-sectional population-level study using clinical, administrative and immigration data from Ontario, Canada. We identified all individuals diagnosed with diabetes between June 2012 and June 2015, and determined the HbA_1c between 60 days prior to and 30 days after diagnosis. Individuals were stratified based on many sociodemographic, clinical and primary care characteristics, and the proportion with HbA_1c ≥ 8.0% (64 mmol/mol) was determined.ResultsMean HbA_1c at diabetes diagnosis in the population was 7.3 ± 1.9% (56 ± 21 mmol/mol), and 21.1% had HbA_1c ≥ 8.0% (64 mmol/mol) at diagnosis. Factors for which there were important differences in the proportion with HbA_1c ≥ 8.0% (64 mmol/mol) included age, sex, ethnicity, comorbidities, frequency of primary care and primary care rostering.ConclusionsIn a real-world population-level setting, more than one-fifth of individuals diagnosed with diabetes have HbA_1c levels ≥8.0% (64 mmol/mol), suggesting a delay in diagnosis due to inadequate screening. Differences were found based on age, sex and clinical factors, but not based on socioeconomic or immigration factors.     

Validity of the obsessive compulsive drinking scale in a heavy drinking population

Background:  The Obsessive Compulsive Drinking Scale [OCDS; Anton et al., Alcohol Clin Exp Res 19 (1995), 92 ] is the most widely used measure of alcohol craving. There are no studies which comprehensively investigate the construct and concurrent validity of the OCDS in a severe alcohol dependent population.
Methods:  Three hundred and seventy alcohol-dependent patients were referred to a hospital-based alcohol treatment program. All participants completed the OCDS, the Alcohol Use Disorders Identification Test [AUDIT; Saunders et al., Addiction 88 (1993), 791 ] and provided demographic and alcohol consumption data.
Results:  The sample was randomly split into 2. Exploratory factor analysis and confirmatory factor analysis were conducted on these subsamples. Both analyses identified a 4-factor solution (compulsions, interference, obsessions and resisting obsessions). All factors showed sound internal consistency. Neither the factor scores nor the total OCDS score was related to baseline alcohol problems (AUDIT) or consumption.
Conclusions:  There was some support for the construct validity of the OCDS in this clinical group. Concurrent validity of the scale was not supported by these cross-sectional data. Future research should examine the predictive utility of the OCDS over time.     

Situational norms for drinking and drunkenness: trends in the US adult population, 1979-1990

Drinking depends on time, place, situation and personal characteristics. Patterns and trends in situational drinking norms (subjective levels of acceptable consumption for various situations) for US adults are reported. Results are based on eight comparable normative questions from national household surveys conducted in 1979 (n=1772), 1984 (n=5221 including Hispanic and black oversamples) and 1990 (n=2058). Across years and population subgroups, a correspondence in ordering of situations on acceptability of drinking and of drunkenness was found. There were contrasting secular trends in the acceptability of drunkenness in different situations: drinking "enough to feel the effects" became more acceptable when at home but less acceptable in several other situations, particularly for men at a bar. For a decreasing percentage of respondents of both genders, it remains more acceptable for men than women to drink in bars, but gender norms in such "wetter" situations were converging by 1990. Men remain more accepting of drinking (but not drunkenness) for "dryer" situations such as when driving, but the trend is towards reduced acceptance. Multiple regression models predicting "acceptance of drinking" and "acceptance of drunkenness" scores showed fair stability in explanatory variables over time, with drinking level and conservative Protestant affiliation (drinking) or age (drunkenness) the major contributors.     

Reassessing the cardiovascular risks and benefits of thiazolidinediones

This article is designed for the general cardiologist, endocrinologist, and internist caring for patients with diabetes and coronary artery disease. Despite the burden of coronary disease in diabetics, little is known about the impact of commonly used oral hypoglycemic agents on cardiovascular outcomes. As the untoward effects of insulin resistance (IR) are increasingly recognized, there is interest in targeting this defect. Insulin resistance contributes to dyslipidemia, hypertension, inflammation, hypercoagulability, and endothelial dysfunction. The aggregate impact of this process is progression of systemic atherosclerosis and an increased risk of adverse cardiovascular outcomes. As such, much attention has been paid to the peroxisome-proliferator-activated receptor gamma (PPARg) agonists rosiglitazone and pioglitazone (thiazolidinediones [TZDs]). Many studies have demonstrated a beneficial effect on the atherosclerotic process; specifically, these agents have been shown to reduce markers of inflammation, retard progression of carotid intimal thickness, prevent restenosis after coronary stenting, and prevent cardiovascular death and myocardial infarction in 1 large trial. Such benefits come at the risk of fluid retention and heart failure (HF) exacerbation, and the net effect on plasma lipids is still poorly understood. Thus, the aggregate risk-benefit ratio is poorly defined. A recent meta-analysis has raised significant concerns regarding the overall cardiovascular safety of 1 particular PPARg agonist (rosiglitazone), prompting international debate and regulatory changes. This review scrutinizes the clinical evidence regarding the cardiovascular risks and benefits of PPARg agonists. Future studies of PPARg agonists, and other emerging drugs that treat IR and diabetes, must be designed to look at cardiovascular outcomes. Copyright (c) 2008 Wiley Periodicals, Inc.     

我国中年人群QT间期与出生体重及心血管危险因素的相关性研究

目的:探讨中国中年人群QT间期与出生体重及心血管危险因素的关系。方法:对974例“宫内发育与成人疾病”队列人群进行流行病学调查、身体测量、血生化指标检测,记录标准12导联心电图,用Bazett公式计算校正的QT间期(QTc),设定QTc>0.41s为QT延长,采用Logisiti回归方法分析中年人群QT间期与出生体重及心血管危险因素的关系。结果:人群QT间期延长者262例(27.0%),男女QT间期延长检出率分别为21.6%,32.6%,心血管危险因素聚集的总检出率分别为64.85%,36.33%(均P<0.01),且男性随着出生体重的增加其检出率和患病危险度呈下降趋势。单项TG升高或心血管危险因素异常聚集与QT间期延长检出率有显著相关关系(均P<0.05)。结论:在中年期,男性心血管危险因素聚集检出率明显高于女性;心血管危险因素聚集与QT间期延长有明显相关性;中年女性的QT间期延长检出率明显高于男性,且可能与出生体重低有关。     

Palm wine drinking in a Balinese village: environmental influences

The present study reports observations of drinking patterns and life-style of Bali-Hindu men in a Balinese village, Pemuteran, who have a relatively high prevalence (about 40%) of excessive consumption of locally produced palm wine. Patterns of drinking were defined. They are rooted in the customs of the inhabitants prior to mass displacement to a "new" land area following a volcanic catastrophe in their old village location in 1963. Excessive drinking appeared to be causally related to identified sociocultural factors and to a physically impoverished environment that greatly reduced work opportunities during much of this year. A similar village in the area which underwent important social and drinking pattern changes consequent to government provision of irrigation water and greater work opportunities suggests that alcohol drinking in Pemuteran may decline under similar social-environmental changes.     

Prevalence of diabetes mellitus and associated cardiovascular risk factors in an adult urban population in Paraguay

A cross-sectional study was conducted on a 20–74-year-old population in an urban white-Hispanic population in Paraguay to determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT), and associated cardiovascular disease (CVD) risk factors. In total 1606 subjects completed the study (response rate 80.3%; 1094 women, 512 men). The overall prevalences were: DM 6.5 %, IGT 11.3 %, hypertension 17.1 %, and obesity 31.6% with more obesity in women (35.7 % vs 22.8 %, p < 0.05). Age-standardized prevalences were: DM 6.5 %, IGT 13.5 % in females and DM 5.5 %, IGT 7.2 % in males. DM and IGT subjects had two or more CV risk factors significantly more often than the normal population. In conclusion, DM, IGT, hypertension, and obesity are common in this South American Hispanic urban population, particularly in women. Public health measures, such as lifestyle education, are required to decrease these non-communicable diseases. © 1998 John Wiley & Sons, Ltd.     

Extending the cardiovascular benefits of omega-3 fatty acids

The cardiovascular benefits of omega (n)-3 fatty acids (FA) become clearer with each passing year. Although useful in large doses for lowering serum triglyceride levels, the primary benefits are likely to arise from smaller, nutritional intakes of eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). Doses of less than 1 g/d appear to reduce risk for fatal coronary heart disease events, perhaps by stabilizing the myocardium and reducing risk for fatal arrhythmias. New evidence points to a possible benefit on atrial fibrillation, particularly in the immediate post-cardiac surgery setting. Studies in women with coronary heart disease now suggest that plaque progression may be slowed by increased intakes of oily fish, even in women with diabetes. The relative importance of the n-6 FA linoleic acid (LA), the short-chain n-3 FA alpha linolenic acid (ALA), and the long-chain n-3 FAs EPA and DHA is becoming clearer. If intakes of the latter are adequate (perhaps over 250 mg/d), then there appears to be little need to consume more ALA or less LA.     

Potential cardiovascular benefits of insulin sensitizers.

A multiple risk factor approach is needed in patients who have type 2 diabetes. Because many risk factors are linked with IR, treatment with insulin sensitizers has the potential to modulate these risk factors favorably. TZDs 'have many important effects beyond lowering blood glucose. By targeting IR, they improve many cardiovascular risk factors that are associated with the IR syndrome. In particular, they increase HDL-C, have anti-inflammatory effects, improve endothelial function and fibrinolysis, and decrease carotid intimal thickness; however, no evidence-based studies on cardiovascular outcomes are available to substantiate the potential cardioprotective effects of TZDs. Several clinical trials that were designed to investigate the effect that these agents have on reducing cardiovascular events are well under way.     

Red wine polyphenols prevent cardiovascular alterations in L-NAME-induced hypertension

OBJECTIVE: Red wine polyphenols have been reported to possess beneficial properties for preventing cardiovascular diseases but their effects on hemodynamic and functional cardiovascular changes during inhibition of nitric oxide (NO) synthesis have not been elucidated. DESIGN: The effects of the red wine polyphenols, Provinols, on arterial hypertension as well as left ventricular (LV) hypertrophy, myocardial fibrosis and vascular remodeling were investigated in rats during chronic inhibition of nitric oxide synthase (NOS) activity. Rats were divided into four groups: a control group, a group treated with N-nitro-L-arginine methyl ester (L-NAME) (40 mg/kg per day), a group receiving Provinols (40 mg/kg per day) alone or Provinols plus L-NAME. RESULTS: Provinols markedly reduced the increase in both blood pressure and protein synthesis in the heart and aorta caused by chronic inhibition of NO synthesis. Provinols reduced myocardial fibrosis even though it did not affect LV hypertrophy. In addition, Provinols prevented aortic thickening and corrected the augmented reactivity of the aorta to norepinephrine and the attenuated endothelium-dependent relaxation to acetylcholine in NO-deficient rats. These alterations were associated with an increase of NOS activity, a moderate enhancement of endothelial NOS expression and a reduction of oxidative stress in the LV and aorta. CONCLUSION: Our results provide evidence that Provinols partially prevents L-NAME-induced hypertension, cardiovascular remodeling and vascular dysfunction via the increase of NO-synthase activity and prevention of oxidative stress. Thus, the beneficial effects of plant polyphenols in prevention of hypertension may result from their complex influence on the NO balance in the cardiovascular system.