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High Burden (high + burden)
Selected AbstractsDisproportionately High Risk of Left Ventricular Hypertrophy in Indo-Asian Women: A Call for More StudiesECHOCARDIOGRAPHY, Issue 8 2008F.A.C.C., Fahim H. Jafary M.D. Objective: Indo-Asians have one of the highest rates of cardiovascular disease worldwide. Estimates and determinants of left ventricular hypertrophy (LVH) in this population are not known. We sought to determine the prevalence of and risk factors for LVH in Karachi, Pakistan.Methods: We conducted a population-based cross-sectional study on 320 randomly selected adults from the general population aged 40 years or above. LVH was defined as increased left ventricular mass index (LVMI) on echocardiogram (>115 g/m2 in men and >95 g/m2 in women) employing the adjusted Devereux equation. Multivariable models were built and logistic regression analysis was done for the primary outcome of LVH.Results: Mean age of subjects was 52.7 (10.4) years, 50% were women. Mean LVMI (SD) was 72.0 (19.2) [median 71.1] g/m2 in men and 75.7 (25.9) [median 72.9] g/m2 in women. The overall prevalence of LVH was 21.9% in women and 2.5% in men (P < 0.001). The factors (odds ratio, 95% CI) independently associated with LVH were women versus men (11.35, 3.79,34.02), systolic blood pressure > versus < 140 mmHg (2.70, 1.23,5.93), waist circumference (1.05, 1.02,1.08 for each cm increase) and illiteracy (2.43, 1.07,5.52).Conclusions: Urban Pakistani women appear to have a disproportionately high risk of LVH compared to men using standard echocardiographic criteria. Further research is needed to verify these results by establishing population-specific reference values for LVH and correlating cut-points for increased LVMI with prognosis. Concerted efforts are needed to reduce the high burden of risk factors in Indo-Asian women. [source] Screening of domestic violence against women in the perinatal setting: A systematic reviewJAPAN JOURNAL OF NURSING SCIENCE, Issue 2 2004Yaeko KATAOKA Abstract Aim:, To review published studies focusing on the screening of domestic violence (DV) against women, in particular, the instruments, the screening methods and the interventions used to help abused women after screening. Based on the results of the review, the suitability of introducing routine screening for DV in the perinatal setting in Japan would be assessed. Methods:, National Guideline Clearinghouse database, HSTAT, PubMed, CINAHL, the Cochrane Library and the Ichushi-Web were all used to searched from when records were first held until February 2003 for eligible primary studies and systematic reviews for this literature review. Each selected article was independently read and appraised by two reviewers who finally selected 12 primary studies and three systematic reviews that fulfilled the criteria for inclusion. Results:, Three studies evaluated screening instruments for DV (i.e. Abuse Assessment Screen, Partner Violence Screen and Violence Against Women Screen) and of these, the Violence Against Women Screen was the most valid, reliable and suitable for use in the clinical setting in Japan. The three studies that examined the screening method had differing results, but the one conducted in Japan showed a significantly higher rate of identification in the self-administered questionnaire group compared with the interview group. The six studies that tested the effectiveness of interventions for abused women showed that counseling sessions after screening and the advocacy program for postsheltered women were effective in reducing DV. Conclusion:, Routine screening of all pregnant women in Japan for DV should be introduced, considering the high burden of suffering that women expose to DV experience, and the existence of both acceptable screening instruments and effective interventions. [source] Depressive Symptoms and Self-Rated Health in Community-Dwelling Older Adults: A Longitudinal StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Beth Han MD OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. DESIGN: A 2-year prospective cohort study. SETTING: Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26,1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50,0.65). CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health. [source] Health Beliefs toward Cardiovascular Risk Reduction in Patients Admitted to Chest Pain Observation UnitsACADEMIC EMERGENCY MEDICINE, Issue 5 2009David A. Katz MD Abstract Objectives:, Even after acute coronary syndrome (ACS) is ruled out, observational studies have suggested that many patients with nonspecific chest pain have a high burden of cardiovascular risk factors (CRFs) and are at increased long-term risk of ischemic heart disease (IHD)-related mortality. The aim of this study was to evaluate the premise that evaluation in an observation unit for symptoms of possible ACS is a "teachable moment" with regard to modification of CRFs. Methods:, The authors conducted a baseline face-to-face interview and a 3-month telephone interview of 83 adult patients with at least one modifiable CRF who presented with symptoms of possible ACS to an academic medical center. Existing questionnaires were adapted to measure Health Belief Model (HBM) constructs for IHD. Stage of change and self-reported CRF-related behaviors (diet, exercise, and smoking) were assessed using previously validated measures. The paired t-test or signed rank test was used to compare baseline and 3-month measures of health behavior within the analysis sample. Results:, Of the 83 study patients, 45 and 40% reported having received clinician advice regarding diet and physical activity during the observation unit encounter, respectively; 69% of current smokers received advice to quit smoking. Patients reported lower susceptibility to IHD (13.3 vs. 14.0, p = 0.06) and greater perceived benefit of healthy lifestyles (27.5 vs. 26.4, p = 0.0003) at 3-month follow-up compared to baseline. Patients also reported greater readiness to change and improved self-reported behaviors at follow-up (vs. baseline): decreased intake of saturated fat (10.1% vs. 10.5% of total calories, p = 0.005), increased fruit and vegetable intake (4.0 servings/day vs. 3.6 servings/day, p = 0.01), and fewer cigarettes (13 vs. 18, p = 0.002). Conclusions:, Observed changes in IHD health beliefs and CRF-related behaviors during follow-up support the idea that observation unit admission is a teachable moment. Patients with modifiable risk factors may benefit from systematic interventions to deliver CRF-related counseling during observation unit evaluation. [source] Public Health Conditions and Policies in the Asia Pacific regionASIAN-PACIFIC ECONOMIC LITERATURE, Issue 2 2001Dennis A. Ahlburg Health has improved dramatically in Asia over the last 40 years. Infant mortality dropped over 60 per cent and life expectancy increased by 40 per cent. Despite these gains, health outcomes remain relatively low in many Asian countries, and vary tremendously by region, income level and demographic group. Little progress has been made, for example, in decreasing maternal mortality. Asia is experiencing an epidemiological transition from a high burden of communicable diseases to a high burden of non-communicable diseases. The pace of this transition varies across countries, and some countries will experience increasing incidence of non-communicable diseases before the level of communicable diseases has decreased. Ill-health imposes a heavy economic cost: HIV/AIDS may reduce economic growth in some countries. As incomes and expectations rise, the demand for health care also rises and one of the greatest challenges facing Asia is how to provide and finance this care. [source] Reducing alcohol related harm experienced by Indigenous Australians: identifying opportunities for Indigenous primary health care servicesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Anthony Shakeshaft Abstract Objective: Identify key issues and opportunities relating to the dissemination of cost-effective interventions for alcohol in Indigenous-specific settings. Methods: Update previous reviews of the Indigenous alcohol literature, particularly in relation to intervention and dissemination studies aimed at identifying and integrating into routine clinical care those strategies that are most cost-effective in reducing alcohol-related harm. Results: The harmful use of alcohol has been identified as a major public health issue, which has a disproportionately high negative impact on Indigenous Australians. While the disproportionately high burden of harm borne by Indigenous Australian communities is well documented in descriptive studies, attempts to redress this imbalance through well controlled intervention and dissemination studies appear to have been inadequate to date. There is compelling evidence from the non-Indigenous community that brief intervention is an effective treatment for harmful alcohol use, compared to the relatively lower levels of evidence for primary and tertiary level interventions. The effectiveness of brief intervention for alcohol in Indigenous Australian communities should, therefore, be examined. Conclusions and Implications: An opportunity exists to implement brief intervention into Indigenous primary health care settings, as an evidence-based strategy using established resources. There is the possibility that such Indigenous-specific health services research will lead the dissemination field in demonstrating how the implementation process can be successfully tailored to specific and defined clinical settings. [source] Detrimental deletions: mitochondria, aging and Parkinson's diseaseBIOESSAYS, Issue 10 2006Saskia Biskup As individuals enter their 80s, they are inevitably confronted with the problem of neuronal loss in the brain. The incidence of the common movement disorder ,mild parkinsonian signs' (MPS) is approximately 50% over the age of 85 years. It has long been known that the loss of dopaminergic neurons in the substantia nigra pars compacta is a neuropathological hallmark of Parkinson's disease (PD). Recently, two papers1,2 present clear evidence for a high burden of mitochondrial DNA deletions within substantia nigra neurons in aged individuals and individuals with PD, pointing towards a common pathway inevitably leading to neuronal dysfunction and death. BioEssays 28: 963,967, 2006. © 2006 Wiley Periodicals, Inc. [source] Continent catheterizable conduits: which stoma, which conduit and which reservoir?BJU INTERNATIONAL, Issue 1 2002H.F. McAndrew Objective To assess the outcome of the various methods used in creating continent catheterizable conduits. Patients and methods The case notes were reviewed from 89 patients who underwent the formation of 112 continent catheterizable conduits. Results Sixty-five conduits were Mitrofanoff and 47 were antegrade colonic enema (ACE); 21 patients had both. At a mean follow-up of 34 months, 95 (85%) conduits were still in use. There was no difference in complications between the Mitrofanoff and ACE conduits; 109 (97%) conduits were continent and stomal stenosis occurred 35 (31%). There was no significant difference relating to the conduit used, the reservoir, the stoma type or the stoma site. Only 39% of patients required no revisional surgery. Conclusion Although urinary and fecal continence can be achieved in most patients there is a high burden of complications and revisional surgery. All patients should be counselled accordingly. [source] Transcriptional control and gene silencing in Plasmodium falciparumCELLULAR MICROBIOLOGY, Issue 10 2008Bradley I. Coleman Summary Infection with the apicomplexan parasite Plasmodium falciparum is associated with a high burden of morbidity and mortality across the developing world, yet the mechanisms of transcriptional control in this organism are poorly understood. While P. falciparum possesses many of the characteristics common to eukaryotic transcription, including much of the canonical machinery, it also demonstrates unique patterns of gene expression and possesses unusually AT-rich intergenic sequences. Importantly, several biological processes that are critical to parasite virulence involve highly regulated patterns of gene expression and silencing. The relative scarcity of transcription-associated proteins and specific cis -regulatory motifs recognized in the P. falciparum genome have been thought to reflect a reduced role for transcription factors in transcriptional control in these parasites. New approaches and technologies, however, have led to the discovery of many more of these elements, including an expanded family of DNA-binding proteins, and a re-assessment of this hypothesis is required. We review the current understanding of transcriptional control in P. falciparum, specifically highlighting promoter-driven and epigenetic mechanisms involved in the control of transcription initiation. [source] | |||||||||||||