Change in cardiovascular risk factors in France, 1985–1997

The change in the main cardiovascular risk factors in France was assessed using the MONICA population surveys conducted in the Urban Community of Lille, Bas-Rhin and Haute-Garonne. Trends in obesity, tobacco smoking, hypertension, hypercholesterolaemia and self-reported diabetes were established for the first (1985-1988) and the last (1995-1997) survey. The results indicate that the prevalence of overweight and obesity remained stable in both genders; tobacco smoking decreased in men but increased in women. Prevalence of hypertension decreased, and preventive measures improved in both genders. Prevalence of hypercholesterolaemia remained stable, and preventive measures improved only in men. Prevalence of self-reported diabetes increased solely in women, and preventive measures improved in both genders. However, in 1995-1997 still 40% of the treated hypertensive and 30% of the treated hypercholesterolaemic subjects were not adequately controlled. We conclude that prevalence and prevention of the main cardiovascular risk factors have evolved favourably in France, but the management of hypercholesterolaemia and hypertension can still be improved.     

Tracking of cardiovascular risk factors: the Tromsø study, 1979-1995

Tracking of cardiovascular risk factors (blood pressure, body mass index (BMI), and serum lipids) has not been studied much in a general, adult population. No known study has compared tracking of these factors for both sexes. In the present study, 17,710 men and women aged 20-61 years at baseline attended two or three population-based health surveys in Troms?, Norway, over 16 years (between 1979-1980 and 1994-1995). Tracking coefficients were estimated by using different methods, and possible predictors of tracking were found. There was a high degree of tracking for BMI (overall tracking coefficients: 0.85 for men, 0.80 for women). Relatively high (or moderate) tracking was found for systolic blood pressure (respective sex-specific coefficients: 0.52, 0.54), diastolic blood pressure (0.48, 0.48), high density lipoprotein cholesterol (0.55, 0.64), and total cholesterol (0.77, 0.65). The lowest coefficients were for triglycerides (0.43, 0.39). Analysis of tracking in the upper sextile confirmed these results. Although some baseline predictors were associated with tracking, the effects were relatively weak. When predictors for tracking in the upper sextile were assessed, significant associations were found with relatively strong effects. No major sex differences were observed in tracking. However, women were more likely than men to remain in the upper sextile of systolic and diastolic blood pressures and of BMI.     

Are environmental exposures to selenium, heavy metals, and pesticides risk factors for amyotrophic lateral sclerosis?

The etiology of sporadic amyotrophic lateral sclerosis (ALS), the most common form of this degenerative disease of the motor neurons, is still unknown, despite extensive investigation of several genetic and environmental potential risk factors. We have reviewed laboratory and epidemiological studies assessing the role of exposure to neurotoxic chemicals (metalloid selenium; heavy metals mercury, cadmium, and lead; pesticides) in ALS etiology by summarizing the results of these investigations and examining their strengths and limitations. Despite limitations in the exposure assessment methodologies typically used in human studies, we found suggestive epidemiological evidence and biologic plausibility for an association between ALS and antecedent overexposure to environmental selenium and pesticides. The relation with mercury, cadmium, and lead appears weaker.     

Are psychosocial factors,risk factors for symptoms and signs of the shoulder,elbow, or hand/wrist?: A review of the epidemiological literature

BACKGROUND: In 1993, an extensive review on the role of psychosocial factors in the development of musculoskeletal problems was published by Bongers et al (1993). Since then, additional reviews on this topic have been published; however, none of these focussed on upper limb problems. METHODS: In this systematic review, the methodological quality of all studies was assessed and levels of evidence were apriori defined. RESULTS: The large majority of the studies reported an association between at least one work-related psychosocial factor and adverse upper extremity symptoms or signs. High-perceived job stress was consistently associated with all upper extremity problems (UEP) in high and lower quality studies. Although not often studied, non-work-related stress was also consistently associated with UEP. In addition, there was some evidence for a relationship between high job demands and UEP, although the results did not meet the pre-set criterion for consistency. CONCLUSIONS: High job stress and non-work-related stress reactions are consistently associated with UEP. In addition, high job demands is also in most studies associated with these disorders. Firm conclusions on the role of these factors in the etiology of UEP are not possible due to the cross-sectional nature of most studies.     

Is social participation associated with cardiovascular disease risk factors?

There is increasing interest in the idea that social participation (operationalised as taking part in formal groups and associations) is an important determinant of health and survival. However, although a large body of literature exists which supports the notion that social contact is associated with good health, few studies have examined whether participation in specific groups and associations is related to specific risk factors, which are in turn linked to a major cause of death. In this paper, we focus on risk markers (BMI, waist-hip ratio, blood pressure, resting heart rate, anxiety and depression) for cardiovascular disease (CVD), which contributes around a third to all cause mortality in the UK. Using survey data (n=2334 individuals) from the West of Scotland Twenty-07 Study, we examine, separately by sex, cross-sectional associations between participation in groups and associations and CVD risk markers. There is no consistent patterning in the results. For some types of groups, there is a relationship between participation and risk factors in one sex but not the other, or better functioning on one health measure but worse in another. The most consistent results are found for psychological distress where, with the exception of church-related activities, participation in groups and associations is related to less distress (although more strongly in men than in women). Our findings do not therefore lend unequivocal support to the notion of social participation having a strong relationship with CVD risk factors at a cross-sectional level.     

Hormonal factors and risk of lung cancer among women?

BACKGROUND: Gender differences in the histological distribution of lung carcinoma and a possibly greater susceptibility of women than men to tobacco carcinogens, suggest a possible influence of sex-specific hormones. This study examines endocrine factors and risk of lung cancer among women by smoking status and histology. METHODS: We used data of a case-control study on lung cancer conducted from 1990 to 1996 in Germany, including 811 histologically confirmed female cases and 912 female population controls. Information on various menstrual and reproductive factors, use of oral contraceptives (OC), hormone replacement therapy (HRT), and smoking was gathered through personal interviews using a structured questionnaire. Odds ratios (OR) and 95% CI adjusted for age, region, smoking, and education were calculated via logistic regression. RESULTS: A reduction in lung cancer risk was observed with the use of OC (OR = 0.69; 95% CI: 0.51-0.92), but no trend in risk with increasing duration of use, age at first use, or calendar year of first use was present. A history of HRT was associated with a reduced risk (OR = 0.83; 95% CI: 0.64-1.09), particularly after long duration (>/=7 years) (OR = 0.59; 95% CI: 0.37-0.93). No clear association was found with regard to age at menarche, length of menstrual cycle, number of live-births, and age at menopause. Overall results did not differ much by histological cell subtype. The reduction in lung cancer risk associated with the use of exogenous hormones was primarily seen among smoking women. CONCLUSIONS: Our data provide evidence for a possible role of hormonal factors in the aetiology of lung cancer in women.     

Are coalminers,with low "risk factors" for ischaemic heart disease at greater risk of developing progressive massive fibrosis?

Coalminers with "A" shadows (the first stage of progressive massive fibrosis (PMF)) have a similar standardised mortality ratio (SMR) to those without PMF, and those with A shadows have a much higher specific mortality from pneumoconiosis. It is therefore argued that either A shadows confer immunity against some other disease(s) or that those developing A shadows are selected on the basis of increased life expectancy. These two hypotheses were investigated and as the selection hypothesis appeared promising further studies were made to discover which specific cause of death might be associated with this selection. This, surprisingly, appeared to be ischaemic heart disease.     

Assessment of global cardiovascular risk and risk factors in Portugal according to the SCORE® model

Background/objective

Cardiovascular diseases (CVD) are the leading cause of mortality in European countries. This study aimed at estimating the 10-year risk of fatal CVD in Portuguese adults and to assess the prevalence of major cardiovascular risk factors, according to the SCORE® risk prediction system.

Subjects and methods

A cross-sectional survey was carried out in 60 community pharmacies (CP) from October 2005 to January 2006 in a sample of CP users (≥40 and ≤65 years). Data were collected by patient interviews using a structured questionnaire applied by a trained pharmacist.

Results

A total of 1,043 individuals were enrolled in the study (participation rate: 91%). The mean age was 53.7 years (SD: 7.1) with a ratio men/women of 0.68. The average risk in the sample was 1.94 (minimum 0, maximum 28, SD?=2.69). About 20% of the studied adults were at high risk, of which 39.4% were asymptomatic. CV risk was significantly higher in the oldest age group and in men (p?2): 28.0?±?4.5.

Conclusions

According to SCORE®, about one-fifth of the individuals was classified as high risk, and 7.7% was asymptomatic. CV risk was significantly higher in the oldest age group (55–65 years old) and in men (p?     

Health risk factors and mortality in Pécs City, Hungary in the 1990s

In the period of 1990-1994 an increase of all causes mortality for 35-74 years old males was observed both in Pécs and in all Hungary. From 1994 to 1997 the mortality decreased. Similar changes, but of smaller dimension, were observed in the female population. The increasing mortality of the early 1990s is attributed primarily to the extra psycho-social stress of this period. The data of the population survey at Pécs in 1995-96 were compared to the data of earlier surveys. The mean blood total cholesterol levels and the prevalence of smoking decreased from 1990 to 1996. The prevalence of hypertension and male obesity increased. Physical inactivity, unhealthy diet and lack of improvement of diet still represent significant health problems. High prevalence of increased gamma-glutamyl transferase indicate high prevalence of excess alcohol consumption. The risk factor profile of 18-25 year old males is very unfavourable. Smoking prevalence in females aged 26-35 years exceeds that of males of the same age group. Preventive efforts should be focused to young males and females.     

When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood

STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88. PARTICIPANTS: 4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances. MAIN RESULTS: Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent. CONCLUSIONS: Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood.     

Socioeconomic factors, nutritional risk, and enamel defects in children from João Pessoa, Paraíba State, Brazil

This study focused on factors related to nutritional risk in children over one year of age from low-income families in Jo?o Pessoa, Paraíba State, Northeast Brazil, and the frequency of related enamel defects. The study included 117 children, 56 at nutritional risk and 61 with normal growth. Nutritional evaluation, clinical dental examination, and interviews with mothers were conducted at the homes. Gestational and birth records were examined in the maternity hospital. Data were analyzed using the chi-square, Fisher's exact tests, and logistic regression. Enamel defects were associated with nutritional risk after the first year of life. Nutritional risk was associated with per capita family income, birth weight, and intrauterine growth index. These are relevant factors for individual nutritional planning and formation of dental enamel.     

Clarifying questions about “risk factors”: predictors versus explanation

Background

In biomedical research much effort is thought to be wasted. Recommendations for improvement have largely focused on processes and procedures. Here, we additionally suggest less ambiguity concerning the questions addressed.

Methods

We clarify the distinction between two conflated concepts, prediction and explanation, both encompassed by the term “risk factor”, and give methods and presentation appropriate for each.

Results

Risk prediction studies use statistical techniques to generate contextually specific data-driven models requiring a representative sample that identify people at risk of health conditions efficiently (target populations for interventions). Risk prediction studies do not necessarily include causes (targets of intervention), but may include cheap and easy to measure surrogates or biomarkers of causes. Explanatory studies, ideally embedded within an informative model of reality, assess the role of causal factors which if targeted for interventions, are likely to improve outcomes. Predictive models allow identification of people or populations at elevated disease risk enabling targeting of proven interventions acting on causal factors. Explanatory models allow identification of causal factors to target across populations to prevent disease.

Conclusion

Ensuring a clear match of question to methods and interpretation will reduce research waste due to misinterpretation.

     

Asthma prevalence and risk factors in schoolchildren of the city of São Paulo, Brazil

OBJECTIVE: To assess asthma prevalence and potential risk factors associated. METHODS: Cross-sectional study part of the International Study of Asthma and Allergies in Childhood. A total of 561 schoolchildren aged 6-7 years from 35 public schools in the city of S?o Paulo (Southeastern Brazil) were drawn to participate in the study, in 2002. The sample consisted of 168 asthmatic and 393 non-asthmatic children who answered a questionnaire comprising 33 questions on personal, family and environmental information. The association between asthma and the risk factors studied was assessed by logistic regression analysis at a 5% statistical significance. RESULTS: Among the schoolchildren studied, 31.2% reported wheezing in the 12 months preceding the interview. The following risk factors were significantly associated with asthma: male gender (OR=2.4; 95% CI: 1.4;4.2), maternal smoking in the child's first year of life (OR=2.0; 95% CI: 1.1;3.8), eczema on characteristic body areas (OR=3.0; 95% CI: 1.2;7.6) and rhinoconjunctivitis (OR=2.4; 95% CI: 1.2;4.8). CONCLUSIONS: Asthma prevalence in the study area was high and the risk factors identified were male gender, rhinoconjunctivitis in last year, maternal smoking in the child's first year of life and eczema on characteristic body areas.     

Clinical inquiry: what risk factors contribute to C difficile diarrhea?

Certain antibiotics and using 3 or more antibiotics at one time are associated with Clostridium difficile-associated diarrhea. Hospital risk factors include proximity to other patients with C difficile and longer length of stay. Patient risk factors include advanced age and comorbid conditions. Acid suppression medication is also a risk factor for CDAD.