Ethnic variation in hypertension among premenopausal and perimenopausal women: Study of Women's Health Across the Nation

Data are sparse regarding hypertension prevalence, treatment, and control among some ethnic groups of American women. Furthermore, the effects of ethnicity on hypertension, independent of other factors that vary with ethnicity, are poorly understood. We examined the prevalence of hypertension (defined as systolic > or =140 or diastolic > or =90 mm Hg or receiving treatment), treatment, and control (to <140/<90 mm Hg) in a multiethnic study of premenopausal and perimenopausal women. Stepwise multivariable logistic regression was used to select covariates associated with hypertension. Among 3292 women, 46.9% were white, 28.3% were black, 8.7% were Hispanic, 7.6% were Chinese, and 8.5% were Japanese. Among these 5 ethnic groups, respectively, there was substantial variation in prevalence of normal blood pressure levels (<120/<80 mm Hg; 59.9%, 35.4%, 16.8%, 67.2%, and 63.7%) and hypertension (14.5%, 38.1%, 27.6%, 12.8%, and 11.0%). After multivariable adjustment, hypertension prevalence was 2 to 3x higher among black and Hispanic women but similar among Chinese and Japanese women compared with white women. Among hypertensive participants, prevalence of antihypertensive treatment was highest among blacks (58.9%) and whites (55.2%) and lowest among Chinese (34.4%). Prevalence of control to goal blood pressure levels was highest among whites (43.0%) and Japanese (38.7%) and markedly lower among Hispanic women (11.4%). Compared with whites, black and Hispanic women have significantly higher prevalence of hypertension independent of other factors, whereas Chinese and Japanese women have similar prevalence. Treatment and control rates vary considerably across ethnicities. Greater efforts must be made to improve hypertension awareness, treatment, and control in all middle-aged women, particularly those in ethnic minority groups.     

Inflammatory bowel disease, peptic ulcer and diverticular disease as certified causes of death in an English population 1979-2003

BACKGROUND: When gastrointestinal diseases are certified as causes of death, they are often not selected as the underlying cause. Until recently, only one underlying cause of death has been coded and analysed in official national statistics in England and many other countries. AIMS: To report on the total 'burden of mortality' from some common gastrointestinal diseases, and whether it has changed over time, including all certified causes of death as well as underlying causes, (i) in the Oxford region from 1979 to 2003, (ii) in England from 1996 to 2003; and to quantify the under-ascertainment of cause-specific mortality when based on underlying cause alone. METHODS: We searched death certificate data from the Oxford Record Linkage Study database, and from English national data, for specified gastrointestinal diseases certified as underlying or contributory causes of death. RESULTS: For all the conditions studied, underlying-cause-coded mortality missed a substantial percentage of all certified deaths. The extent of underestimation varied according to the periods in which different criteria were used for the selection of the underlying cause. For example, in Oxford, in the latest period 1993-2003, underlying-cause-coded mortality identified only 37% of all death certificates with ulcerative colitis, 47% of Crohn's disease, between 62 and 68% for the different types of peptic ulcer and 66% of diverticular disease. CONCLUSIONS: Studies of mortality for these diseases should take account of all certified causes as well as underlying-cause mortality. This is particularly important for analyses that go across periods of change to the rules for selecting the underlying cause of death.     

Shifting towards an Opt-Out System in Greece: A General Practice Based Pilot Study

New legislation in Greece towards presumed consent for organ donation, effective as of June 2013, has come at a critical moment. This pilot study aims to explore awareness, specific concerns and intentions about the new organ donation framework among patients attending Greek general practices in a rural and urban setting. Only 2.6% of respondents had a donor card, a mere 9.6% was aware of new legislation, whereas only 3.8% considered that the public had been adequately informed. Higher income respondents were more likely to be aware that they would be considered organ donors upon death, unless declared differently. Urban practice respondents were less likely to have previously discussed with a significant other their intentions in regards to presumed consent. One quarter of all respondents (22.4%) intended to carry out their right to prohibit organ removal upon death. Survey results reveal that organ donation reform has yet to be disseminated by the Greek society, underscoring the urgency for targeted information campaigns.     

Hierarchical self-assembly of a striped gyroid formed by threaded chiral mesoscale networks

Numerical simulations reveal a family of hierarchical and chiral multicontinuous network structures self-assembled from a melt blend of Y-shaped ABC and ABD three-miktoarm star terpolymers, constrained to have equal-sized A/B and C/D chains, respectively. The C and D majority domains within these patterns form a pair of chiral enantiomeric gyroid labyrinths (srs nets) over a broad range of compositions. The minority A and B components together define a hyperbolic film whose midsurface follows the gyroid minimal surface. A second level of assembly is found within the film, with the minority components also forming labyrinthine domains whose geometry and topology changes systematically as a function of composition. These smaller labyrinths are well described by a family of patterns that tile the hyperbolic plane by regular degree-three trees mapped onto the gyroid. The labyrinths within the gyroid film are densely packed and contain either graphitic hcb nets (chicken wire) or srs nets, forming convoluted intergrowths of multiple nets. Furthermore, each net is ideally a single chiral enantiomer, induced by the gyroid architecture. However, the numerical simulations result in defect-ridden achiral patterns, containing domains of either hand, due to the achiral terpolymeric starting molecules. These mesostructures are among the most topologically complex morphologies identified to date and represent an example of hierarchical ordering within a hyperbolic pattern, a unique mode of soft-matter self-assembly.Liquid crystals formed by molecular self-assembly provide fascinating examples of complicated space partitions in soft-material science. Relatively complex examples are the bicontinuous mesostructures found ubiquitously in both natural and synthetic soft matter, including lipid–water systems and block copolymer melts, namely the double diamond (symmetry ), the primitive , and, particularly, the gyroid mesophases. The structure of these mesophases can be described by a molecular membrane folded onto one of the three simplest triply periodic minimal surfaces (TPMS), namely the D, P, and G(yroid) surfaces, named by Schoen in the 1960s (1). From a 3D perspective, these structures are characterized by the nets describing the pair of mutually threaded labyrinths carved out of space by the convoluted hyperbolic architecture of the TPMS. For the gyroid, this is a racemic mixture of two chiral srs nets, one left- and the other right-handed [the three-letter nomenclature follows the Reticular Chemistry Structure Resource naming convention for 3D nets (2)]. This leads to an overall achiral structure when the two nets are chemically identical, which is the case in most experimentally identified gyroid liquid-crystal structures. One such structure recently reported is a gyroid assembly found in an ABC three-miktoarm star terpolymer melt (3). In this structure, the majority C component constitutes the two labyrinth nets while the A and B minority components together form the dividing membrane. Because of the connectivity of the star molecular architecture and because all components microphase separate, the A and B components segregate on the dividing hyperbolic interface. This structure is an experimental indication of a unique mode of self-assembly, namely “hierarchical assembly of a hyperbolic pattern.” Complementing this finding and further motivating our work reported here, a recent simulation study by one of us (J.J.K.K.) explored self-assembly of blends of equal amounts of two distinct three-miktoarm stars, namely ABC and ABD three-miktoarm star terpolymers (Fig. 1). Both molecules were assigned equal molecular weights, and the proportions of the equal volume C (green) and D (yellow) chains relative to the equal A (red) and B (blue) chains were varied (4). Despite these severe compositional constraints, a number of unique four-colored mesophases were revealed. The most striking feature of the predicted phase behavior in this system was the presence of interesting patterns whose general features are reminiscent of the gyroid, albeit far more complex in both geometric and topological aspects. In the system reported here, two ordering regimes form. At the larger length scale, ordering induces a gyroid-like membrane, which is itself also spontaneously ordered at a smaller length scale, giving unique microdomain patterning due to the membrane confinement to a hyperbolic curved interface. Each of these patterns contain distinct numbers and types of interwoven 2D and 3D A and B domains forming nets of equal hand, immersed within the hyperbolic interface between an enantiomeric pair of C and D srs nets. These structures are spectacularly convoluted in 3D space and correspond to special members of a sequence of chiral cubic patterns that emerge by local striping of the gyroid membrane. We demonstrate how this is performed systematically by mapping a particular family of tilings in the hyperbolic plane onto the gyroid in 3D euclidean space. Careful analysis of the morphologies formed in the simulations, described below, reveals the presence of up to three distinct chiral cubic mesophases within this striped gyroid region of the phase diagram. We explore the geometric and topological variety of these self-assemblies in detail and discuss how they emerge as a response to a hierarchy of frustrations imposed by the three-arm star molecular architecture, acting in both two and three dimensions.Open in a separate windowFig. 1.(A) Model ABC and ABD three-miktoarm star terpolymer molecules. All molecules contain equal-sized A (red) and B (blue) arms, and longer C (green) and D (yellow) arms, also of equal size. The parameter x (equal to in this image), corresponds to the number ratio of C to A beads. (B) C and D domain geometry, a pair of intertwined srs nets. (C–G) Single-unit cell snapshots illustrating the curved striped pattern formed by the minority components A and B for varying x. (C) x = 2, (D) x = 3.33, (E) x = 3.67, (F) x = 5, and (G) x = 6. Note the threefold branching of the stripes for all values of x.