Prevalence of heart disease in school children in rural Kenya using colour-flow echocardiography

In a survey using colour-flow echocardiography and a portable generator, of one thousand one hundred fifteen children, three had clinical and echocardiographic evidence of rheumatic heart disease giving a prevalence rate of 27/1000. Sixty nine (6.2%) of the children examined had trivial mitral regurgitation (TMR). Of these, three had associated trivial aortic regurgitation. Isolated trivial aortic regurgitation was not seen. Four children had isolated mild-moderate regurgitation of the pulmonary valve. Congenital heart disease (CHD) was found in two children-one with secundum atrial septal defect and one with a ventricular septal defect and pulmonary stenosis, giving a prevalence of 1.8/1000. One child had a bicuspid aortic valve and two persistent left superior vena cava. It is feasible to carry out an echocardiographic survey using a portable generator in schools where electricity is not available. The prevalence of rheumatic heart disease (RHD) is higher than previously found in Kenya. The prevalence of TMR is surprisingly high. This was associated with familial clustering reminiscent of RHD. The importance of these findings must await the results of further investigation.     

The prevalence of diabetes and associated coronary risk factors in urban and rural older Mexican populations

OBJECTIVE: To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations. DESIGN: A cross-sectional study. SETTING: Three Mexican communities (urban areas of medium and low income and a rural area). PARTICIPANTS: A total of 121 men and 223 women aged 60 years and older and 93 men and 180 women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study (Cross-Cultural Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community. MEASUREMENTS: A personal interview assessed demographic information, personal medical history, and functional status, and a 24-hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and glucose. RESULTS: Diabetes prevalence was higher in men than in women for all age groups: 16.7% versus 9.5% in younger adults and 30.8% versus 22.8% in older adults. For all age groups, diabetes was more highly prevalent in urban communities. Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: gender (male sex: OR = 2.1; P < .009); diminished carbohydrate intake in the diet (OR = 0.77; P < .03); central distribution of adiposity (OR = 1.9; P < .03); and functional disability (OR = 2.3; P < .01). This relationship was not observed with living area, income, education, fiber and alcohol intake, body mass index, or age. Individuals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceridemia, and a proportionally higher fat intake. CONCLUSION: This survey confirms the high prevalence of diabetes in the older Mexican population - particularly in men and in individuals living in urban areas - associated with an increased prevalence of other coronary risk factors. Diabetes was associated with higher fat, low carbohydrate, low fiber diets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertriglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a survivorship effect must be considered in studies of older individuals. The health situation in the older Mexican population presents a complex problem that needs correct diagnosis and better strategies to benefit those segments of the population at increased risk.     

Prevalence of heart disease in older women in a nursing home

The prevalence of coronary artery disease (CAD) and the incidence of new coronary events are similar in older men and women. Independent risk factors for new coronary events in older women include age, prior CAD, cigarette smoking, hypertension, diabetes mellitus, high serum total cholesterol and triglycerides, and low serum high-density lipoprotein cholesterol. Older women have a higher prevalence of hypertension than older men. In older women with hypertension, echocardiographic left ventricular hypertrophy is a powerful independent predictor of new coronary events, atherothrombotic brain infarction, and congestive heart failure (CHF). Older women have a higher prevalence of rheumatic mitral stenosis and of mitral annular calcium than older men. Older women and men have a similar prevalence of valvular aortic stenosis, aortic regurgitation, mitral regurgitation, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy. The prevalence and incidence of CHF increase with age. The prevalence of normal left ventricular ejection fraction associated with CHF increases with age and is higher in older women than in older men. The prevalence of chronic atrial fibrillation increases with age and is similar in older men and women. Atrial fibrillation is an independent predictor of new coronary events and thromboembolic stroke in older women. Older women with unexplained syncope should have 24-hour ambulatory electrocardiograms to determine whether pauses > 3 seconds are present, requiring permanent pacemaker implantation.     

Ultrastructure of the taste disc in the red-bellied toad Bombina orientalis (Discoglossidae, Salientia)

To establish the prevalence, with 95% confidence limits, of some of the indicators of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala state, India, we did a field survey on a cluster sample with probability proportionate to size (PPS sample) of 500 households from five villages. Altogether the sample consisted of 1253 individuals who were more than 25 years of age, of which 1130 responded (90%). The survey instruments included the Malayalam translation of the Rose questionnaire, a standard 12-lead electrocardiogram with a battery operated portable electrocardiograph machine, blood pressure measurements using a mercury sphygmomanometer, and routine anthropometric measurements. The prevalence rates estimated were: (a) ECG changes suggestive of coronary heart disease, 36/1000 (95% C.L., 18, 55), (b) Rose questionnaire angina, 48/1000 (95% C.L. 35, 62), (c) definitive evidence of coronary heart disease, 14/1000 (95% C.L., 7, 21), (d) possible evidence of coronary heart disease, 74/1000 (95% C.L., 55, 93). Prevalence of major risk factors were, (a) hypertension by the WHO criteria, 179/1000 (95% C.L., 137, 221), (b) smoking, 219/1000 (95% C.L., 151, 287), (c) diabetes, 40/1000 (95% C.L., 17, 63), (d) obesity, 55/1000 (95% C.L., 6, 104). We have found that objective criteria indicate a lower prevalence of coronary heart disease in rural Thiruvananthapuram district when compared to studies from urban centres in India, but the prevalence of angina by Rose questionnaire is greater.     

Prevalence of dementia in a rural setting: A report from India

A study to estimate the prevalence of dementia in a rural population was conducted in a community located on the outskirts of Madras city in South India. Seven hundred and fifty elderly 60 years of age and older, selected using the cluster sampling technique, were interviewed using the Geriatric Mental State schedule (GMS). The prevalence of dementia was 3.5%, the percentage increasing with age. These rural prevalence estimates were higher than in urban settings (WHO multicentre study on cognitive impairment and dementia in developed and developing countries, unpublished) and male/female differences were negligible. The difficulties associated with the use of the GMS in a non-literature rural population are discussed. The implications of these findings for India's growing elderly population are highlighted.     

Predictors of major weight gain in adult Finns: stress, life satisfaction and personality traits

To study the epidemiology of rural populations in the context of contemporary issues in public health, a population laboratory (Health Census '89) was established in Otsego County, New York, by the Research Institute of the M.I. Bassett Hospital, affiliated with the Columbia University School of Public Health. Such a laboratory is needed because of an apparent lag in positive health indices in rural populations across the United States, resulting in rates of chronic diseases, such as coronary heart disease, for which rural areas now exceed urban ones. This was confirmed for Otsego County by the survey Health Census '89, the foundation of a rural population laboratory, in which all residents were enumerated and characterized as to their prevalent diseases, health behaviors, use of preventive services, and environmental exposures. Heart disease, cancer, and diabetes mellitus rates were found to exceed average rates for US urban areas, while the data on preventive health behaviors suggest this is a population of "late adopters." The survey, conducted in 1989, had an 86.6% response rate, and enumerated 17,147 households and 44,406 persons. The authors discuss adults aged 17-64 years, 58 percent of the total census (n=25,614). Sharp gradients in disease prevalence, risk factors, and utilization of preventive services were observed across educational strata. Data from Health Census '89 were used as the basis for a successful community intervention program, which targeted identified high risk groups. Rural populations are excellent settings for community interventions, offering laboratories where new strategies of risk reduction and provision of preventive services might be tested.     

Social networks and coronary heart disease among Japanese men in Hawaii

A group of 4653 men of Japanese ancestry living in Hawaii were studied for the association of measures of social networks with both the prevalence and incidence rates of coronary heart disease (Honolulu Heart Program, 1971-1979). Prevalence rates for myocardial infarction, angina, and total coronary heart disease were inversely associated with the social network scales in bivariate analyses with age, and in multivariate analyses including 12 other risk factors. With the incidence data, the associations were less evident. Bivariate analysis with age revealed inverse associations for nonfatal myocardial infarction and total coronary heart disease with only one of the social network scales. With multivariate analyses, there was no significant association of any subgroup of coronary heart disease with any scale, although there was a borderline association (p = 0.08) of nonfatal myocardial infarction with one scale. No individual question was significantly associated with either prevalence or incidence rates for coronary heart disease. There was also little evidence of reduced risk of incident coronary heart disease associated with the social network scale for men in high risk categories of serum cholesterol, blood pressure, and cigarette smoking.     

Incidence and prevalence of juvenile chronic arthritis in East Berlin 1980-88

OBJECTIVE: To estimate the incidence and prevalence rates of juvenile chronic arthritis (JCA). METHODS: The study population was children under 16 years of age living in the East Berlin area (part of the former German Democratic Republic). By admission order that was effective up to 1990, all children with symptoms of a rheumatic disease living in the East Berlin area had to be referred to the 2nd Children's Hospital at Berlin-Buch. This specific condition allowed us to ascertain cases from the clinical records and to calculate population rates. Based upon this data, the results of surveys with different methods of case ascertainment are compared. RESULTS: An incidence rate of 3.5 per 100,000 and a prevalence rate of 2.0 per 10,000 children were calculated. The frequency of JCA is higher for girls, with an incidence of 4.3 per 100,000 and a prevalence of 2.3 per 10,000. The figures for boys are 2.7 per 100,000 and 1.7 per 10,000, respectively. CONCLUSION: Because of the specific prerequisites, the population rates of prevalence and incidence that were based on clinical records can be regarded as valid in this study. Deviant results of other surveys can be explained by differences in the study design or in the diagnostic procedures used.     

Genetic-demographic structure and prevalence of congenital malformations in rural regions of the Kursk district

Investigation of the the genetics, demography, and epidemiology of congenital malformations (CMs) in Kursk oblast revealed statistically significant correlations between population parameters and the incidence of CM in the rural rations of the oblast. The general prevalence of CM and that of the separate CM forms ("guard" CM, multiple CM, hemangioma, congenital heart disease, congenital myelocele, talipes valgus, congenital femoral luxation, polydactyly, cryptorchism) increased with an increase in the average marital age of men and women of the reproductive part of the population and with an increase in the level of the populations homozygosity (an increase in the local consanguinity and ethnic marriage assortativeness, a decrease in the populations's migration activity, an increase in the proportion of genotypes homozygous for recessive genes, etc).     

Rheumatic diseases in China: ILAR-China study comparing the prevalence of rheumatic symptoms in northern and southern rural populations

OBJECTIVE: To determine the prevalence of rheumatic diseases in Han Chinese in north and south China. METHODS: Samples of 4192 adults in the Beijing (north) and 5057 in the Shantou (south) areas, based on village administration registers, were studied. The same questionnaire was administered by doctors who then examined those with rheumatic symptoms. One observer (QYZ) took part in both studies. RESULTS: The prevalence of definite rheumatoid arthritis (RA) was 0.34% (95% CI; 0.20-0.51) in the north and 0.32% (0.16-0.47) in the south. Ankylosing spondylitis (AS) was noted in 0.26% of both samples (95% CI; 0.11-0.42 north and 0.14-0.40 south). Only 3 cases of systemic lupus erythematosus (SLE) in the north and one in the south were identified. General rheumatic pain was reported more frequently in the north. Lumbar problems were recorded on examination 5 times more frequently in the north than in the south [men, 25%:5.3%; women 38%:6.5%] and knee problems 10 times more frequently [men, 24%:1.8%; women, 36%:3.4%] in the north. The difference was greatest in the 55 to 64 year age group. CONCLUSION: The prevalence of RA was similar to that in other rural populations and Japan, but only half that reported from other industrialized communities. The prevalence of AS was similar to that in most Caucasian populations. SLE was too infrequent to establish a prevalence with confidence, but did not differ from that in other populations. A study is planned in the south to assess the contribution of interobserver error and/or differences in cultural response to the north/south differences observed in the prevalence of general rheumatic symptoms and back pain.     

Localization of the somatostatin sst2(a) receptor in human cerebral cortex, hippocampus and cerebellum

AIMS: To quantify birth prevalence and spectrum of congenital heart disease in the Island population of Malta, and compare these rates with previous studies. METHODS: All patients diagnosed as having congenital heart disease by echocardiography, cardiac catheterization, surgery or post-mortem by 1 year of age between 1990-1994 were included. There were 231 cases of live born congenital heart disease with a birth prevalence of 8.8/1000 live births. The commonest lesions were ventricular septal defect, pulmonary stenosis and tetralogy of Fallot. The rates of individual lesions were compared with two recent epidemiological studies with similar methodologies. RESULTS: Although the overall birth prevalence of congenital heart disease was similar in three studies, significantly higher rates of pulmonary stenosis, tetralogy of Fallot and double outlet right ventricle were found in Malta, all of which predispose to right ventricular outflow tract obstruction. In contrast, there were lower rates of lesions causing left ventricular outflow tract obstruction. A higher rate of ventricular septal defect was also found. The Maltese gene pool may contain an inherent predisposition towards lesions causing right ventricular outflow tract obstruction.     

Nullification of a positive correlation between urinary contents of alpha1-microglobulin and ulinastatin with intracerebroventricularly administered 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 1-methyl-4-phenylpyridinium (MPP+) in mice

BACKGROUND: Wolff-Parkinson-White syndrome is thought to be a congenital disease, however, its exact prevalence is not known. This may be because of the intermittent activity of accessory pathways in some cases and fluctuations in autonomic tone. AIMS: To investigate the prevalence of ventricular preexcitation by electrocardiography and reported symptoms in each school age child in Yamanashi prefecture. METHODS: From 1994 to 1996, answers to a questionnaire, results of physical examination, and electrocardiography were obtained from all schoolchildren in Yamanashi prefecture (n = 92,161; total population 880,000) on admission to elementary school (age 6 to 7 years, n = 28,395), junior high school (age 12 to 13 years, n = 31,206), and high school (age 14 to 15 years, n = 32,837). RESULTS: Elementary and junior high school students had a significantly lower prevalence of preexcitation than high school students (0.073% and 0.070% v 0.174%, p < 0.001). The prevalence of left free wall pathway was highest in high school students (n = 27) compared with elementary (n = 6) and junior high school students (n = 5) (p < 0.005). The only symptom noted in the answers to the questionnaire was palpitations. The symptomatic cases were more frequent in high school (n = 13) than in elementary (n = 1) and junior high school (n = 2) children, but not significantly. No student with preexcitation had associated heart disease or family history of Wolff-Parkinson-White syndrome or sudden death. CONCLUSIONS: The prevalence of preexcitation in younger schoolchildren was less frequent than previously reported. The prevalence of preexcitation and left free wall pathways increased with age. The symptoms were few and there was no significant morbidity.     

Stent implantation in acute myocardial infarction

Analysis of the data from 7188 cases seen in the 1980s two general hospitals in Shanghai and comparison of the data with those in the 1950s, 1960s and 1970s revealed that the percentage of heart diseases among the inpatients in medical wards increased in each decades, from 9.89%, 15.69% 20.91% to 23.54% respectively. The constituent ratios of different etiologic types of heart diseases changed. Coronary heart disease constituted the largest proportion, next in number was rheumatic heart disease and congenital heart disease was in the third place. The incidence of congenital heart diseases, myocarditis, cardiac dysrhythmias without organic heart diseases, cardiomyopathy and endocarditis increased and that of rheumatic heart disease, pulmonary heart disease and hypertensive heart disease apparently decreased, syphilitic heart disease was rarely encountered.     

Extended-interval dosing of aminoglycosides

This study was carried out to determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in rural inhabitants of Durango, Mexico, and some of the risk factors for the disease. A random samples of 30,996 individuals aged 30 years and over was selected from 627 rural communities in Durango. These persons were interviewed between November 1993 and December 1994 to obtain information on several sociodemographic variables. A capillary blood sample was collected from each individual to determine his or her glucose level after 10-12 hours of fasting. Measures of central tendency and dispersion were calculated, and percentage distributions for the study variables were determined. Comparisons among proportions were made utilizing the chi-square test, and means were compared using Student's t test. The strength of associations was estimated with odds ratios, and 95% confidence intervals (CI 95%) were calculated for proportions. The final sample consisted of 31,028 persons, of whom 22,890 (73.8%) were women and 8,138 (26.2%) were men. A total of 1,004 cases of NIDDM were detected (3.2%; CI 95%:3.0 to 3.4), 767 in women and 237 in men. Only 9.2% of the study population was obese. The highest frequency of NIDDM was documented in persons 60 to 69 years of age. Family history of NIDDM was identified in 59.5% of the persons with the disease (CI 95%: 58.9 to 60.0) and in 26.3% of the healthy persons (CI 95%: 25.8 to 26.8). The low prevalence of NIDDM found in this study may be related to the low level of obesity in the population surveyed.     

Prevalence of pulmonary tuberculosis on the roof of the world

SETTING: The Shimshal Valley, a remote village in Northern Pakistan, is one of the seven Pamirs of Central Asia, widely known as the roof of the world. OBJECTIVE: To investigate the prevalence of pulmonary tuberculosis (TB) in the Shimshal Valley. DESIGN: The Rapid Village Survey Method (RVS) was used to investigate the prevalence of pulmonary tuberculosis. The selection criteria were chronic cough, hemoptysis, past history of TB and close contact with a tuberculous patient. After clinical examination, a chest radiograph was done and a single spot sputum sample was obtained for smear examination. RESULTS: The total population of the village was 1077, of whom 231 cases were studied. Overcrowding affected 75% of the study population. The prevalence of smear positive pulmonary TB in the village studied was 554 per 100000 population, and the prevalence of active smear-negative TB was estimated at 1949/100 000. The prevalence of active pulmonary TB increased with age and the only risk factor for active TB was age over 45 years. Of the 21 cases with a past history of pulmonary TB, only 38% had completed a full course of chemotherapy. CONCLUSION: Pulmonary TB is a very serious health issue in the rural community (Shimshal Valley) of Pakistan. This study highlights the lack of efficacy of national tuberculosis control programs in the country.     

Epidemiology and prevention of hypertension

At least 43 million (24%) adults in the general population of the United States have hypertension. The prevalence of hypertension increases with age and is higher among African-Americans compared to other ethnic groups. During the past several decades, the prevalence of hypertension in the general population of the United States has declined and the proportion of hypertensives who are aware of their high blood pressure, as well as the portion who are being treated and controlled has improved. Hypertension is the most important modifiable risk factor for coronary heart disease, stroke, congestive heart failure, and end-stage renal disease. To achieve the final goal of eliminating all blood pressure-related disease in the community, detection and treatment of hypertension must be complemented by equally energetic approaches directed at primary prevention of hypertension. A small downward shift in the entire distribution of blood pressure in the general population will not only reduce the incidence of hypertension, but substantially diminish the burden of blood pressure in the general population.     

Theory of evaluation of the single pneumatic resistor decompression computer

To our knowledge, no documented hemodynamic studies in larger series of young patients undergoing valve replacement for rheumatic valvular disease have been reported previously. It seems to us that the natural history of rheumatic heart disease in India often follows a rapid and fulminant course which makes an aggressive surgical approach mandatory. An operative mortality of 22 % was seen in this series. Pronounced cardiac disability together with the poor general condition and the low nutritional status contributed in no small measure to this figure. Patients have been followed for periods ranging from 6 months to 6 years following corrective surgery. A remarkable absence of thrombo-embolic phenomena was a striking feature in the follow-up. There has been no evidence of rheumatic reactivation in any of these patients. This communication reinforces the beneficial results of valve replacement even at this young age when severe mitral incompetence exists refractory to medical treatment.     

Improved exercise tolerance following enhanced external counterpulsation: cardiac or peripheral effect?

Tissue damage, inflammation and necrosis are hallmarks of myocardial infarction. In the present study significant elevations of serum alpha-1-antitrypsin were noted in coronary artery disease and angina cases. Interestingly chronic rheumatic heart disease which is also characterized by tissue injury. Inflammation revealed normal levels of serum alpha-1-antitrypsin. The level in chronic rheumatic heart disease was 3.37 +/- 0.57 mumol/mt/ml (control level was 3.37 +/- 0.54 mumol/mt/ml). The corollary of these observations is that in heart diseases acute phase response in terms of enhanced levels of alpha-1-antitrypsin differ depending on the causative factors. Except chronic rheumatic heart disease, in all other stressful states studied there is (to a certain degree) an altered systemic homeostasis and haemostasis. On the other hand chronic rheumatic heart disease encompass certain amount of acute phase status in terms of tissue damage and inflammation does exist unaccompanied by altered systemic homeostasis and haemostasis. However, bacteriological etiologies predominate the triggered immune responses. It is hypothesised that serum alpha-1-antitrypsin enhancement will not occur even though acute phase state exists if specific immune responses are also a part of the disease manifestation.     

Epidemiology and natural history of cardiac failure

Congestive heart failure is a major and growing public health problem. Its prevalence is 3-20 per 1,000, and increases steeply with age. Coronary heart disease is the underlying cause in 50% of the cases, idiopathic cardiomyopathy in 20%. Survival at 5 years after the onset of heart failure in the Framingham study was 25% in men and 38% in women; the mortality rate of heart failure patients was 6-7 times that of the general population. Three variables--functional class, natremia, left ventricular ejection fraction--are powerful prognostic factors. Quality of life of heart failure patients is severely impaired.     

Prognosis in men and women coming to the emergency room with chest pain or other symptoms suggestive of acute myocardial infarction

BACKGROUND: Previous studies suggest a gender-related difference in prognosis among patients with ischaemic heart disease. In the present study, we aimed to describe the characteristics and prognosis among patients with suspected ischaemic heart disease in relation to gender. METHODS: During the 21 months of the study, all patients who came to the medical emergency room of one single hospital as a result of chest pain or other symptoms suggestive of acute myocardial infarction were prospectively followed for 1 year. RESULTS: A total of 5362 patients were admitted on 7157 occasions; men accounted for 55% of the admissions. The 1-year mortality rate was 11% for men compared with 10% for women. The women were older and had a higher prevalence of known congestive heart failure and hypertension, whereas the prevalence of previous myocardial infarction was higher in men. When correcting for the dissimilarities in age and history of cardiovascular diseases, male gender appeared as an independent predictor of death. Development of myocardial infarction occurred in 25% of the men and 16% of the women (P < 0.001) during 1 year. The symptoms that brought patients to the emergency room were interpreted as being caused by myocardial infarction or myocardial ischemia in 29% of men compared with 21% of women (P < 0.001). CONCLUSIONS: In a consecutive series of patients with chest pain or other symptoms suggesting acute myocardial infarction in the emergency room, male gender was an independent risk indicator for death during 1 year. This might be explained by a higher occurrence of coronary artery disease in men than in women in this patient population.