Frequency and predictors of renal artery stenosis in patients with coronary artery disease

BackgroundRenal artery stenosis (RAS) remains underdiagnosed because of nonspecific clinical manifestations, including in patients with coronary artery disease (CAD).AimsTo estimate the prevalence and identify predictors of RAS in patients with CAD undergoing coronary angiography.SettingUniversity-based medical centre.MethodsWe enrolled 650 consecutive patients (mean age=67±10 years, 80% men) with confirmed CAD. All patients underwent selective renal arteriography in the same procedure.We estimated the prevalence of RAS, defined as a >50% lesion. Multiple variable analysis of factors associated with presence of RAS was carried out using a logistic regression model. Variables that emerged as predictors by single-variable analysis were included in the model, along with variables that were tentatively associated with RAS, based on a literature review.ResultsRAS was detected in 94 patients (14.5%, 95% CI: 11.8–17.2%), including 20 (3.1%) with bilateral lesions. By single-variable analysis and presence and number of coronary artery stenoses (P<.001), hypertension (P=.001), and creatinine clearance <90 ml/min (P<.001) were associated with an increased risk of RAS. By multiple variable analysis, male sex (P<.05), presence and number of coronary artery lesions (P<.01), hypertension (P=.001), and renal insufficiency (P<.001) predicted the presence of RAS.ConclusionsThe main clinical predictors of RAS in patients with CAD were hypertension, renal insufficiency, and multivessel CAD. These observations might help defining a high-risk subgroup of patients in need of meticulous investigations of both CAD and RAS.     

Injury control in Africa: getting governments to do more

Despite increasing recognition of injury as a major public health problem worldwide, it has received limited attention and resources. This lack of attention is most notable in low-income countries. As part of efforts to develop coordinated injury control activities in Africa, a round table session was held at the Third International Conference on Injury Prevention and Control in Melbourne, Australia. The aims of the forum were to provide injury control researchers from Africa the opportunity to come together and reflect on issues of injury control in Africa, to deliberate on strategies of getting African governments to show more interest in injury control, and to solicit more assistance from the international donor community. Participants from Ghana, Kenya, South Africa and Zimbabwe presented the magnitude of the injury burden in their respective countries, reflected on current research efforts and highlighted the preventive efforts being undertaken. The forum made many recommendations including several regarding specific actions required of African governments, individual researchers and donor agencies.     

Physical Leisure Participation and the Well-Being of Adults With Rheumatoid Arthritis: The Role of Sense of Belonging

Participation in physical leisure activities was tested as a coping resource among adults with rheumatoid arthritis. Drawing on sociological theory of social integration, sense of belonging was tested as a potential mediator to help explain any significant association found between physical leisure activity and well-being among a population-based sample of adults with rheumatoid arthritis. Greater frequency of physical leisure participation was associated with higher ratings of mental health and physical health, and these associations were partially explained by sense of belonging. Results highlight the potential role of sense of belonging as a component in how activity participation can enhance the well-being of adults coping with disability.     

Occupational injuries in Ghana

Household interviews were used to survey 21,105 persons living in 431 urban and rural sites in Ghana, to determine the nature and extent of their occupational injuries. Annual occupational injury rates were 11.5 injuries/1000 persons in the urban areas and 44.9/1000 in the rural areas. Occupational injuries had higher mortality, longer disability, and higher treatment costs than non-occupational injuries. There were substantial occupational injury rates among children, especially in rural areas. In the urban areas, the largest numbers of injuries were to drivers (12.7% of urban occupational injuries) and traders (19.4%), most of which were road-traffic-related. In the rural areas, most injuries (71.6%) were to farm workers. Occupational injuries are a substantial burden in Ghana. Priorities include improving road safety and improving the prevention and treatment of injuries from nonmechanized farming.