Trends in height and BMI of 6-year-old children during the nutrition transition in Chile

OBJECTIVE: We analyzed trends in height and BMI and their interaction in 6-year-old Chilean children over the last 15 years. RESEARCH METHODS AND PROCEDURES: We calculated height for age z-score (HAZ), BMI z-score, prevalence of obesity, underweight, and stunting from cross-sectional national school-based annual population surveys in 1987, 1990, 1993, 1996, 2000, and 2002. Using mixed model analysis, we determined the risk of obesity according to height over time as odds ratios (ORs) and 95% confidence interval and the potential influence of height and year of study on BMI z-score. RESULTS: Over the study period, height increased by 2.8 cm in boys and 2.6 cm in girls, whereas stunting declined from 5% to 2% in both. Tallness increased by approximately 2%, BMI z-score increased from +0.3 to +0.65 in boys and to +0.62 in girls, and HAZ increased from -0.47 in boys and -0.45 in girls to 0 in 2002. Underweight declined from 4% to 3%, whereas obesity rose from 5% to approximately 14%. The probability of obesity among tall children was significantly greater than that for normal height children (OR, 2.3 to 3.5). The lowest obesity risk was observed between -2 and -1 HAZ. The OR for obesity in the stunted relative to normal height children was variable, ranging from 1.23 to 0.65, whereas it was significant and consistently positive (1.1 to 1.7) for boys and girls when it was compared with the lowest obesity risk according to height. DISCUSSION: Tallness is significantly associated with increased obesity risk in children, while stunting is also associated, but to a lesser degree.     

Sun-protective behaviors of California farm workers

OBJECTIVE: Farm workers are exposed to long hours of solar ultraviolet radiation (UVR), placing them at higher risk for skin cancer. The goal of this study was to evaluate farm workers' sun exposure behaviors. METHODS: Farm workers (n=326) in the San Joaquin Valley of California were interviewed about their sun protective behaviors; these behaviors also were observed directly and these data were used to assess whether participants adequately protected against UVR exposure. RESULTS: All participants were Latino men with a mean age of 33 years. Although rates of wearing any hat and long-sleeved shirts were high, rates of wearing wide-brimmed hats and sunscreen were low. CONCLUSIONS: This study is important because there is limited research focused on farm workers' protective behaviors against UVR exposure. Interventions to improve sun protection behaviors of farm workers are needed.     

Cost-effectiveness of bupropion, nortriptyline, and psychological intervention in smoking cessation

Sustained-release bupropion and nortriptyline have been shown to be efficacious in treating cigarette smoking. Psychological intervention is also recognized as efficacious. The cost and cost-effectiveness of the 2 drug therapies have not been estimated. It was hypothesized that nortriptyline would be more cost-effective than bupropion. Hypotheses were not originally proposed concerning the cost-effectiveness of psychological versus drug treatment, but the 2 were compared using exploratory analyses. This was a 3 (bupropion versus nortriptyline versus placebo) by 2 (medical management alone versus medical management plus psychological intervention) randomized trial. Participants were 220 cigarette smokers. Outcome measures were cost and cost-effectiveness computed at week 52. Nortriptyline cost less than bupropion. Nortriptyline was more cost-effective than bupropion; the difference was not statistically significant. Psychological intervention cost less than the 2 drug treatments, and was more cost-effective, but not significantly so. Prospective investigations of the cost and cost-effectiveness of psychological and pharmacological intervention, using adequate sample sizes, are warranted.     

Characteristics of the poisoning mortality in the 1986-2001 period in the Autonomous Basque Community, Spain

BACKGROUND: Acute drug-related deaths are frequent, giving rise to high Potential Years of Life Lost figures. The objectives of this research are to ascertain the trend in the acute drug-related death rate in the Autonomous Basque Community and the variance thereof in terms of different variables. METHOD: The drug-related death rate data from the Autonomous Basque Community's Death Register for the 1986-2001 period was analyzed overall in terms of different demographic variables and by cause of death (ICD-9 and ICD-10). The analysis includes gross death rates and standardized rates by European population. The potential years of life lost are calculated. RESULTS: Acute drug-related deaths numbering 1,207 in all were recorded during the period under study, totaling 045% of all deaths, for a gross rate of 3.58 deaths/100,000 inhabitants. The mean Potential Years of Life Lost were 2,226.33/year, for a rate of 1.12/1000. A total of 75.97% of these deaths were males, the average age at time of death having been 40.29 years (36.09 for males and 52.64 for females). The etiology most often involved was: accidental (82.19%), followed by intentional (12.43%) and undetermined (5.38%)-. Accidental poisoning by other drugs (E-850 in ICD-9, X44 in ICD-10) was the leading cause of death (42.30% and 34.75% respectively). CONCLUSIONS: There has been an increase in the number of acute drug-related deaths throughout the period studied, the accidental prescribed drug overdose being the main cause, entailing statistically significant differences by sex and age.     

Use of proximal aortic cuffs as an adjunctive procedure during endovascular aortic aneurysm repair

The purpose of this study was to evaluate the incidence and durability of additional proximal cuffs during endovascular abdominal aortic aneurysm repair (EVAR). A retrospective review of 90 EVAR patients was conducted. Postoperative survival, proximal sealing zone-related complications, and secondary procedures were analyzed. Additional proximal cuffs were used in 11%. Their use did not affect postoperative survival (p = .58), type I endoleak rate (4.4%; p = .19), or the need for sealing zone-related secondary procedures (6.3%; p = .38) compared with patients without cuff placement but was related to a higher cumulative graft migration rate (2.2% overall p = .02). Two patients (2.5%; p = .79) underwent conversion to open surgery, both for proximal sealing zone-related complications. Application of proximal cuffs appears to be an effective intraoperative adjunctive procedure to achieve a proximal seal during EVAR, with favorable midterm results. However, the risk of late endograft migrations may be elevated in this group.     

Indications for revascularization in patients with internal carotid artery stenosis

Three different strategies should be associated for ischaemic stroke prevention in patients with internal carotid artery stenosis: vascular risk factors control, anti-thrombotic agents, and carotid revascularization. Patients are selected for carotid revascularization on the basis of the presence of clinical symptoms and degree of stenosis. The optimal indication for carotid surgery is a severe recently symptomatic stenosis, since the benefits are marginal in high-grade asymptomatic stenosis, and in moderate symptomatic stenosis. Angioplasty with endoprothesis is an alternative to surgery, but it must be restricted to symptomatic stenosis either in randomized trials, or in severe stenosis in patients in whom surgery is contra-indicated.