Multifactorial trial in the prevention of coronary heart disease: 3. Incidence and mortality results

Incidence and mortality results are presented from an internationalcontrolled trial of multifactorial prevention of coronary heartdisease, involving randomization of 66 factories (49 781 men)in U.K., Belgium, Italy and Poland (Cracow). Results for Poland(Warsaw) are not yet complete. Net average reductions in riskfactors (all subjects) were 1.2% for plasma cholesterol, 8.9%for daily cigarettes, 0.4% for weight, 2.0% for systolic bloodpressure, and 11.1% for a combined risk estimate. Greater reductionsoccurred in high-risk subjects (19.4% for the combined estimate). The net overall reduction in CHD rates was 7.4% (95% confidenceinterval –29 to +15%) for deaths (722 cases), and 3.9%(95% confidence interval –10 to + 2%) for fatal CHD +non-fatal myocardial infarction (1502 cases). Among men aged40–49 the reduction for this end-point was 15%; at ages50–59 there was a small net increase. All-causes deathsafter an early adverse trend showed 2.7% reduction overall.There were large differences between centres, ranging from a5% net increase in CHD for U.K. to a decrease of 24% in Belgium.In Belgium the decrease both in CHD and in all deaths was significantat the 5% level. The effect on CHD in the different centrescorrelated broadly with their changes in risk factors. It isconcluded that reduction in major coronary risk factors in industrialpopulations is possible, but it depends on adequate resources;the results support the hypotheses that CHD risk in middle-agedmen is reversible and that community intervention can be beneficial.     

特里杨甙对过敏性慢反应物质和组胺的拮抗作用

采用离体豚鼠回肠标本法及荧光分光光度法研究了从毛白杨叶中分离得到的特里杨甙(tremulacin,TRC)与组胺(histamine,His)及过敏性慢反应物质(SRS-A)的关系。结果表明:TRC能明显抑制His和SRS-A所致离体豚鼠回肠收缩,且成剂量相关性,IC₅₀分别为1.78X10-4mol·L^-1 2.51X10-4mol·L^-1。亦明显抑制致敏豚鼠肺释放SRS-A及致敏大鼠腹腔肥大细胞释放His。提示:TRC的抗炎作用与其对His及SRS-A的受体拮抗作用及对His和SRS-A释放的阻滞作用有关。     

The risk of first venous thromboembolism during pregnancy and puerperium in double heterozygotes for factor V Leiden and prothrombin G20210A

Background : The risk of venous thromboembolism (VTE) during pregnancy in double heterozygous carriers of factor (F) V Leiden and prothrombin G20210A is not established. Hence, whether or not these women deserve antithrombotic prophylaxis when pregnant is unknown. Patients and methods : In the frame of a multicenter family study, 52 double heterozygous carriers of FV Leiden and prothrombin G20210A who had remained pregnant at least once before knowledge of thrombophilia, were retrospectively investigated with respect to the occurrence of first VTE during pregnancy and puerperium. They were compared with 104 heterozygous carriers of FV Leiden, 104 of prothrombin G20210A and 104 women without thrombophilia. Results : Double heterozygotes were similar to single heterozygous carriers and non-carriers for the age at first pregnancy, age at testing and rate of full-term pregnancies. No VTE during pregnancy was observed in the four groups of women, whereas in the puerperium it occurred in two double carriers (1.8% of pregnancies, 95% CI: 0.5–6.3), three single FV Leiden carriers (1.5%, 0.5–4.3), two single prothrombin G20210A carriers (1%, 0.2–3.6) and one non-carrier (0.4%, 0–2.5). Conclusions : The risk of first VTE during pregnancy and puerperium in double heterozygous carriers of FV Leiden and prothrombin G20210A is low and similar to that of single carriers. As for single heterozygotes, antithrombotic prophylaxis in asymptomatic double heterozygous carriers appears to be justified only in puerperium.     

Dispensing medications at the hospital upon discharge from an emergency department

Although most health care services can and should be provided by their medical home, children will be referred or require visits to the emergency department (ED) for emergent clinical conditions or injuries. Continuation of medical care after discharge from an ED is dependent on parents or caregivers' understanding of and compliance with follow-up instructions and on adherence to medication recommendations. ED visits often occur at times when the majority of pharmacies are not open and caregivers are concerned with getting their ill or injured child directly home. Approximately one-third of patients fail to obtain priority medications from a pharmacy after discharge from an ED. The option of judiciously dispensing ED discharge medications from the ED's outpatient pharmacy within the facility is a major convenience that overcomes this obstacle, improving the likelihood of medication adherence. Emergency care encounters should be routinely followed up with primary care provider medical homes to ensure complete and comprehensive care.     

Biracial couples and adverse birth outcomes: a systematic review and meta-analyses

Background. Differences in birth outcomes such as low birthweight (LBW), preterm births (PTB), stillbirth, differences in birthweight in Black vs. White race are well known. Infants born to biracial parents (mother and father from either Black or White races) also experience higher adverse birth outcomes. Objective. To systematically review and meta-analyze birth outcomes among parents of mixed racial background compared to parents of same race. Search strategy. Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies. Selection criteria. Studies reporting association between parental mixed racial status and LBW, PTB, or small-for-gestational age (SGA) outcomes were included. Data collection and analyses. After exclusion of duplicate cohorts in different publications, data from White mother-Black father (WMBF), Black mother-White father (BMWF) and Black mother-Black father (BMBF) groups were compared with the White mother-White father (WMWF) group. Results. Eight English language studies from of 26?335?596 singleton births were included and reviewed. Compared to the WMWF group, the adjusted odds ratio (95% confidence intervals) were: (a) low birthweight; 1.21 (1.10-1.33) for WMBF, 1.75(1.64-1.87) for BMWF, and 2.08 (1.81-2.38) for BMBF; (b) preterm births; 1.17 (1.05-1.31) for WMBF, 1.37 (1.18-1.59) for BMWF, and 1.78 (1.59-2.00) for BMBF; and (c) stillbirths; 1.43 (0.92-2.21) for WMBF, 1.51 (1.09-2.08) for BMWF, and 1.85 (1.47-2.32) for BMBF. Conclusion. Biracial status of parents was associated with higher risk for adverse pregnancy outcomes than both White parents but lower than both Black parents, with maternal race having a greater influence than paternal race on pregnancy outcomes.