Impulsive behaviour induced by both NMDA receptor antagonism and GABA<Subscript>A</Subscript> receptor activation in rat ventromedial prefrontal cortex

Rationale  

Previous work has demonstrated a profound effect of N-methyl-d-aspartic acid receptor (NMDAR) antagonism in the infralimbic cortex (IL) to selectively elevate impulsive responding in a rodent reaction time paradigm. However, the mechanism underlying this effect is unclear.     

Ethnic differences in antenatal care use in a large multi-ethnic urban population in the Netherlands

Objective

to determine differences in antenatal care use between the native population and different ethnic minority groups in the Netherlands.

Design

the Generation R Study is a multi-ethnic population-based prospective cohort study.

Setting

seven midwife practices participating in the Generation R Study conducted in the city of Rotterdam.

Participants

in total 2093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese-Creole and Surinamese-Hindustani background were included in this study.

Measurements

to assess adequate antenatal care use, we constructed an index, including two indicators; gestational age at first visit and total number of antenatal care visits.Logistic regression analysis was used to assess differences in adequate antenatal care use between different ethnic groups and a Dutch reference group, taking into account differences in maternal age, gravidity and parity.

Findings

overall, the percentages of women making adequate use are higher in nulliparae than in multiparae, except in Dutch women where no differences are present.Except for the Surinamese-Hindustani, all women from ethnic minority groups make less adequate use as compared to the native Dutch women, especially because of late entry in antenatal care. When taking into account potential explanatory factors such as maternal age, gravidity and parity, differences remain significant, except for Cape-Verdian women. Dutch-Antillean, Moroccan and Surinamese-Creole women exhibit most inadequate use of antenatal care.

Key conclusions

this study shows that there are ethnic differences in the frequency of adequate use of antenatal care, which cannot be attributed to differences in maternal age, gravidity and parity. Future research is necessary to investigate whether these differences can be explained by socio-economic and cultural factors.

Implications for practise

clinicians should inform primiparous women, and especially those from ethnic minority groups, on the importance of timely antenatal care entry.     

Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy: Results of the ADVANCE study

OBJECTIVE

Although low HDL cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and the risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a cohort of patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazards models were used to assess the association between baseline HDL-C and the development of new or worsening microvascular disease, defined prospectively as a composite of renal and retinal events.

RESULTS

The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L [range 0.1–4.0]). During follow-up, 32% of patients developed new or worsening microvascular disease, with 28% experiencing a renal event and 6% a retinal event. Compared with patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted hazard ratio 1.17 [95% CI 1.06–1.28], P = 0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (1.19 [1.08–1.32], P = 0.0005). There was no association between thirds of HDL-C and retinal events (1.01 [0.82–1.25], P = 0.9).

CONCLUSIONS

In patients with type 2 diabetes, HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.Diabetes is the primary cause of end-stage kidney disease (1) and loss of vision (2) in developed nations. Microvascular disease is a common complication of type 2 diabetes and develops insidiously with few symptoms until irreversible damage has occurred. The two principal and reversible risk factors for the development and progression of nephropathy and retinopathy are blood glucose and blood pressure levels (1,2). However, despite the benefits seen with control of these two risk factors, considerable residual risk remains. Identifying additional risk factors for these common complications could aid the tailoring of risk assessment and development of novel therapeutic strategies.Reduced HDL cholesterol (HDL-C), characteristic of type 2 diabetic dyslipidaemia (3), is a well-recognized risk factor for macrovascular complications (4). We hypothesized that lower HDL-C levels also may predispose to the development and progression of diabetic microvascular disease. In subjects without diabetes, low HDL-C has been previously reported to be an independent risk factor for the development of chronic kidney disease (CKD) (5–7), but there are limited prospective data on the relationship between HDL-C and the risk of diabetic nephropathy (8–12). There are even fewer data on the relationship between HDL-C levels and retinopathy, with conflicting results in nondiabetic patients (13–15), and no significant association found in those with type 2 diabetes (16–20). Despite the paucity of epidemiological evidence, two large randomized trials have recently reported that fenofibrate, an HDL-C–modifying agent, reduces diabetes-related microvascular disease (21–23).The Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) Study is the largest trial to date of glycemic control and blood pressure lowering in patients with type 2 diabetes at high risk for vascular events (24). The ADVANCE study enrolled >11,000 patients with type 2 diabetes and followed them systematically for the development of microvascular complications. In these analyses, we evaluate baseline HDL-C level as a risk factor for the development of new or worsening microvascular disease, defined as a composite of new or worsening retinopathy and nephropathy.     

Associations between high-density lipoprotein cholesterol and both stroke and coronary heart disease in the Asia Pacific region.

BACKGROUND: The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL cholesterol and stroke, particularly for stroke subtypes. METHODS AND RESULTS: Cox survival models were applied to individual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After adjustment for age and regression dilution, hazard ratios (95% confidence intervals) for a 1 standard deviation (SD) lower level of HDL cholesterol (0.4 mmol/L) were: for CHD events, 1.39 (1.22-1.57); for ischaemic stroke, 0.90 (0.75-1.07), and for haemorrhagic stroke, 0.89 (0.74-1.07). As total cholesterol (TC) increased relative to HDL cholesterol, the risk of CHD increased, the risk of ischaemic stroke was unchanged but the risk of haemorrhagic stroke decreased. A 1 SD increase in TC/HDL cholesterol (1.63 units) was associated with a 27% decrease in the risk of haemorrhagic stroke (95% confidence interval, 7-44%). CONCLUSION: There is clear evidence of potential benefit for CHD of increases in HDL cholesterol and decreases in TC relative to HDL cholesterol, but no evidence of an association between either HDL cholesterol or TC/HDL cholesterol and ischaemic stroke. Increasing HDL cholesterol relative to TC may increase the risk of haemorrhagic stroke.     

Women's cardiovascular health in India

Cardiovascular diseases (CVDs) are the leading cause of death among adult women in many parts of India and a major cause of morbidity. In some parts of the world, gender inequities have been observed in cardiovascular healthcare and cardiovascular outcomes. The authors discuss the data for potential disparities in cardiovascular healthcare for women in India. Data on cardiovascular healthcare provision and CVD outcomes among women in India are generally lacking. The little available data suggest that women in rural areas, younger women and girl children with CVD are less likely to receive appropriate management than men, with this disparity most apparent in those of lower socioeconomic status and education. However, there is a particular lack of information about the prevention and management of atherosclerotic heart disease in women from a range of communities that comprise the extremely diverse population of India.