RESUMEN

This study was conducted in three tertiary hospitals in Dhaka city at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH) and National Institute of Cardiovascular Disease (NICVD) as a part of Inter-Heart Study. Secondary data was obtained from the standard questionnaires to determine door to needle time (DNT) following thrombolytic therapy in patients with Acute Myocardial Infarction (AMI) in coronary care units at three large tertiary referral hospitals in Dhaka city. Of total 192 patients studied in three centres, 156 (81.2%) received thrombolytic therapy. In BSMMU, 33 out of 45 (73.33%) patients received thrombolysis. Mean DNT was 147 minutes. Eighteen (55%) patients received thrombolysis within 90 minutes and 9 patients (27%) received with in 91-180 minutes, 6 patients (18%) received thrombolysis after 180 minutes. In DMCH, 44 out of 57 patients (77.1%) received thrombolysis. Mean DNT was 210 minutes. Five patients (11%) received within 90 minutes, 19 (43%) received thrombolysis between 91 to 180 minutes and 20 patients (46%) received thrombolysis outside the range of 180 minutes. In the NICVD, 79 out of total 90 (87.7%) patients received thrombolysis. Mean DTN was 64 minutes. Sixty seven (82%) patients received therapy within 90 minutes, 6 patients (9%) received between thrombolysis 91-180 minutes and 6 (9%) patients received after 180 minutes of reaching hospital. Inspite of overall improvement in the management of patients with AMI in coronary care units of major teaching hospitals, there seem to remain certain difficulty in our system which causes delay in thrombolysing patients with AMI. In this study, the mean DNT for thrombolysis was quickest (64 minutes) at NICVD and slowest (210 minutes) at DMCH. Although the study was conducted almost four years ago, it gives some insight regarding strength and weaknesses in the infrastructure of public sector hospitals in our country.

Asunto(s)

Asunto(s)

RESUMEN

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiological transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Asunto(s)

RESUMEN

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Although declines in mortality rates have occurred in most developed countries, increases are being seen in developing countries. Our knowledge of risk factors for acute myocardial infarction (AMI) is largely derived from studies in the former. Applicability of these results to other populations is unknown. The objectives of INTER-HEART are to determine the association between risk factors and AMI within populations defined by ethnicity and/or geographic region and to assess the relative importance of risk factors across these populations. METHODS: INTER-HEART is a study of 14,000 cases of AMI and 16,000 matched control patients from 46 countries, which was conducted with a standardized protocol. Questionnaires were translated into 11 languages; physical measurements were obtained, and 20 mL of blood was drawn and shipped frozen to a central laboratory in Canada. The study will evaluate the importance of conventional and emerging risk factors within each geographic region and whether their impact varies by region. RESULTS: INTER-HEART is sponsored by the World Health Organization and the World Heart Federation and has received funding from several peer-reviewed agencies and many different pharmaceutical companies. A vanguard phase (February 1999 to 2000) enrolled 4000 subjects from 41 countries. Full data collection started in April 2000 and is expected to be completed by October 2002. CONCLUSIONS: Several years of targeted work have allowed the development of the concepts that were tested in the pilot studies. This has ensured the feasibility of INTER-HEART. This study has the potential to have a major impact in developing a worldwide strategy for cardiovascular disease prevention, especially in developing countries and nonwhite populations.

Asunto(s)

RESUMEN

Investigators at the Centers for Disease Control and Prevention in the US have developed a brief survey tool to measure health-related quality of life (HRQOL-4). In order to support use of such tools in surveillance, it is important to assess their validity in different groups. Subjects were 926 non-institutionalized men and women (age > or = 65 years) who completed a health exam and questionnaire. Results indicated that physical and mental health and physical activity limitation were each related to self-perceived health. Compared with subjects who reported excellent health, those with poor self-rated health reported a more than 17-fold increase in the number of unhealthy days in the previous 30. While responses to questions addressing psychosocial factors were most consistently associated with the HRQOL item relating to mental health, responses to health and health behaviour questions were more consistently associated with items related to physical health. This study demonstrated that the HRQOL-4 is not only accepted by older adults in a self-administered format, but also stands up to tests of its validity.

Asunto(s)

RESUMEN

In this retrospective study, 37 patients with myelomeningocele who had undergone gait analysis were examined. Patients were divided into groups based on the level of involvement (29 sides: L4; 26 sides: L5; 19 sides: S1-2). Results showed increased knee flexion and associated knee extensor moments with increasing level of neurologic involvement. The mean coronal plane knee position in stance was normal in all groups and not related to coronal plane knee moment. However, there was an increased incidence of a net knee adductor moment in stance with increasing involvement (mean, 0.02 +/-0.18 N.m/kg for the L4 group). The presence of a visual valgus thrust based on video records was not reliable in predicting an abnormal knee coronal plane moment. An abnormal knee adductor moment in stance was most highly related to coronal plane trunk motion (r = -0.62) and not tibial torsion (r = -0.340). Increased transverse plane range of motion of the knee was most highly related to transverse plane trunk motion (r = 0.67).

Asunto(s)

RESUMEN

OBJECTIVE: To test the validity of staging methodology for dietary fat reduction by examining cognitive profiles of persons classified in these groups: precontemplation, lowerfat maintenance (< or = 30% of energy as fat), and higher-fat maintenance (> 30% of energy as fat). DESIGN: Cross-sectional survey of a random sample of 491 women residing in Guelph, Ontario, Canada, recruited by telephone. SETTING/SUBJECTS: Mean age of subjects was 43.7 +/- 12.2 years. The majority (58%) lived with a spouse or partner and had completed high school (68%). STATISTICAL ANALYSES: Multivariate analysis of variance was used to compare the pros and cons of lower-fat eating, level of self-efficacy in avoiding high-fat foods, and use of 9 processes of change to support lower-fat eating habits in women assigned to the precontemplation, higher-fat, and lower-fat maintenance stages. RESULTS: When compared with subjects classified in the precontemplation stage, the 2 groups of subjects in the maintenance stage had higher ratings of the pros (49.7 +/- 9.5 vs 43.7 +/- 7.2, P < .05), lower ratings of the cons (47.2 +/- 8.2 vs 51.9 +/- 11.8, P < .05), higher self-efficacy scores, and more frequent use of processes of change than subjects classified in the precontemplation stage. No differences between women in the 2 maintenance groups were observed in self-efficacy; however, those in the lower-fat maintenance group reported lower cons than those in the higher-fat maintenance group (46.2 +/- 7.2 vs 48.2 +/- 9.1, P < .05) and more frequent use of all processes of change. CONCLUSIONS/APPLICATIONS: Stage of change for dietary fat reduction is a cognitive variable that provides insights into attitudes about and motivations to consume lower-fat foods.

Asunto(s)

Asunto(s)

RESUMEN

As responsibility for health funding shifts from central to local governments, providers find themselves in decision-making roles or asked to give guidance in allocation of resources. To develop a picture of a population's health, data are needed about the effects that illness and disability have on a person's ability to function and thus on quality of life. This study assessed the validity in a Canadian city, of a Health-related Quality of Life (HRQoL) instrument developed by the US Centers for Disease Control and used in the US Behavioral Risk Factor Surveillance System. The HRQoL was administered to a random sample of 1,042 adults. The patterns of association among the HRQoL questions, and the direction of the relationships among independent variables and HRQoL were consistent with those hypothesized. The accumulating evidence for validity of the HRQoL support its use in monitoring the performance of local health initiatives in Canada.

Asunto(s)

RESUMEN

The purpose of this study was to determine the effects of the ankle-foot orthosis (AFO) on gait patterns in patients with low-level myelomeningocele and to identify any abnormal gait patterns that may lead to future knee instability and pain. A total of 28 children (26 L4-level sides, 18 L5-level sides, and 10 S1-2-level sides) underwent a three-dimensional gait analysis when ambulating barefoot and with AFOs. Results show significant improvements in sagittal plane function with reductions in excessive ankle dorsiflexion, increases in peak plantar flexor moment, and reductions in crouch and knee extensor moment in the L4 and L5 groups. The only improvement in the S1-2 group was a reduction in excessive dorsiflexion, but there was a reduction in power generation at the ankle. The S1-2 group had normal transverse plane knee motion in stance during barefoot walking that increased significantly (p < 0.01) with the AFO. Both the L5 and L4 groups showed greater-than-normal transverse plane knee motion in stance during barefoot walking that also increased significantly (p < 0.01) with the AFO. The results suggest that excessive knee transverse plane rotation may contribute to knee instability more than coronal plane abnormalities. The AFO in S1-2-level patients may be more detrimental for the knee than barefoot walking.

Asunto(s)

RESUMEN

The purpose of this study was to evaluate the effects of hamstring lengthenings and psoas recessions over the brim of the pelvis (OTB) on pelvic function in the gait of patients with spastic cerebral palsy. Seventy-three patients were divided into four groups based on surgical intervention: medial hamstrings (n = 37), medial and lateral hamstrings (n = 12), medial hamstrings with psoas OTB (n = 9), and medial and lateral hamstrings with psoas OTB (n = 15). Three-dimensional gait analysis was completed both before and approximately 1 year after surgery. When pelvic position in gait was normal or posterior of normal preoperatively, there was a significant increase in pelvic tilt (p < 0.05) when medial and lateral hamstrings were lengthened, irrespective of simultaneous psoas OTB surgery. Medial hamstrings alone, with or without simultaneous psoas OTB, did not result in a significant change in pelvic position, irrespective of preoperative pelvic position. The only surgical combination that caused a reduction in excessive preoperative anterior pelvic tilt was medial and lateral hamstrings with psoas OTB, a 4 degrees change of limited clinical significance. In general, psoas and medial hamstring surgery have minimal effect on the pelvic position during gait. Medial and lateral hamstring lengthening will increase pelvic tilt if preoperative pelvic position is normal or slightly posteriorly tilted. The results of this study suggest that the fundamental determinants of pelvic position during gait postoperatively are the extent of hamstring surgery (medial only vs. both medial and lateral hamstring lengthening) and the preoperative position of the pelvis.

Asunto(s)

RESUMEN

The purpose of this study was to compare surgical recommendations made by clinicians experienced in gait analysis when using information provided from the clinical examination and videotape, with recommendations made after the addition of kinematic, kinetic, and electromyographic (EMG) data. Ninety-one patients with a diagnosis of cerebral palsy were seen in the gait laboratory as part of the surgical decision-making process. Experienced clinicians reviewed video and clinical examination data for each patient and made surgical recommendations. Joint kinematics and kinetics and EMG data were then reviewed, and a second set of surgical recommendations was made. Comparisons between these recommendations showed that the addition of gait-analysis data resulted in changes in surgical recommendations in 52% of the patients, with an associated reduction in cost of surgery, not to mention the human impact of an inappropriate surgical decision, which is more likely without gait analysis. When changes in recommendations were made, an increase in surgical recommendations was observed for the gastrocnemius (59%) and rectus femoris (65%), whereas decreases were observed for the hamstrings (61%), psoas (78%), hip adductors (83%), femur (86%), and tibia (64%).

Asunto(s)

RESUMEN

There are significant changes in gait across the life span, but particularly after the age of 70 years. This article reviews the physiology of gait and the motor control challenges during gait. The kinematics (motion) and the kinetics (moment and power) of normal gait of a database of healthy young and older adults are compared. Older subjects generate significantly lower peak ankle plantar flexor power during gait. The clinical significance of the reduction in ankle plantar flexion power is discussed.

Asunto(s)

RESUMEN

BACKGROUND: Aging is associated with a reduction in gait velocity, which is due to a shortened step length. This study investigated the relationship between joint kinetics and step length. METHODS: Three-dimensional gait kinematics and kinetics were measured during usual pace gait in 26 older subjects (average age 79) and in 32 young subjects (average age 26). Gait measures were obtained at maximal velocity in five older subjects. Lower extremity strength was measured in the older subjects on an isokinetic dynamometer. RESULTS: Older persons had a 10% shorter step length during usual gait, when corrected for leg length (.65 +/- .07, .74 +/- .04/leg length, respectively, p < .001). Older persons had reduced ankle plantarflexion during late stance (13 +/- 5 degrees, 17 +/- 5 degrees, p = .02) and lower ankle plantarflexor power (2.9 +/- 0.9 W kg-1, 3.5 +/- 0.9 W kg-1, respectively, p = .007). Ankle strength was associated with plantarflexor power developed during late stance (r = .49, p < .001). When gait kinetics were corrected for step length, the older subjects developed 16% greater hip flexor power during late stance than younger subjects (estimate of effect: .15 W kg-1, p = .002). Older subjects were unable to increase ankle plantarflexor power at maximal pace, but increased hip flexor power 72% (1.1 +/- 0.3 W kg-1 to 1.9 +/- 1.0 W kg-1, p = .02). CONCLUSIONS: Older subjects had lower ankle plantarflexor power during the late stance phase of gait and appeared to compensate for reductions in plantarflexor power by increasing hip flexor power. Appropriate training of ankle plantarflexor muscles may be important in maintaining step length in advanced age.

Asunto(s)

RESUMEN

The primary function of the posterior leaf spring orthosis (PLS) is to prevent excessive equinus or drop foot in swing. The name of the orthosis, posterior leaf "spring," suggests that it also mechanically augments push-off in stance. The purpose of this study was to determine the effect of the PLS on ankle function by using computerized gait-analysis techniques. Multiple barefoot versus brace walks were compared in 31 children with cerebral palsy. Results indicate that the PLS reduces excessive equinus in swing and is sufficiently flexible to allow ankle dorsiflexion in midstance. In terminal stance, the peak power-generating capabilities of the ankle were reduced when the child was wearing the PLS. Energy results indicate that more mechanical energy was absorbed during midstance and less produced during terminal stance with the PLS. Therefore, the PLS improved ankle function but did not augment ankle function through storage and return of mechanical, or spring, energy.

Asunto(s)

RESUMEN

An increased knowledge of the biomechanics of normal walking and running will improve our understanding of the possible mechanisms of pathology and ultimately improve the treatment of pathology and injury. Running, a natural extension of walking, involves increased velocities, joint range of motion, forces, muscle activity, joint moments, and joint powers as compared with walking. These differences not only stress the mechanics of the body to a greater extent but also contribute to the development of injury due to overuse. With the use of modern computerized gait analysis techniques that provide objective information, comprehension of normal and also pathologic walking and running patterns can be improved.

Asunto(s)

RESUMEN

The effect of surgical lengthening of the gastrocnemius fascia on ankle joint kinematics and kinetics during gait in patients with cerebral palsy (CP) was evaluated. Twenty independent ambulators (24 sides) were included in this retrospective study. The evaluation included clinical examination, calculation of joint kinematics and kinetics, and collection of surface electromyography (EMG) during gait. Postoperative improvements were noted in static heelcord range of motion (ROM), with an associated increase in dorsiflexion in stance and swing. Kinetic analysis showed a decrease in the abnormal energy generated around the ankle in midstance and a statistically significant increase in the energy generated in late stance for push-off.

Asunto(s)

RESUMEN

The zinc nutrition of rural Malawian children (24 females, 33 males; age 62 +/- 10 mo) consuming cereal-based diets was compared with that of rural Ghanaian children (43 females, 33 males; age 59 +/- 10 mo) consuming cereals or starchy staples, using hair zinc concentrations, growth and body composition indices, and dietary intakes. Intakes of energy, protein, Ca, Zn, dietary fiber and phytate at two seasons of the year were estimated from 3-d weighed food records, using analyzed and literature food composition values. The mean annual intakes of energy (5419 +/- 1081 vs. 4698 +/- 885 kJ), protein (31.8 +/- 7.0 vs. 24.1 +/- 6.8 g), Zn (7.4 +/- 1.9 vs. 5.1 +/- 1.1 mg) and phytate (1899 +/- 590 vs. 604 +/- 151 mg), and the mean molar ratios of [phytate]/[Zn] and [Ca] x [phytate]/[Zn] mmol per MJ (25 +/- 4 vs. 12 +/- 2 and 44 +/- 13 vs 20 +/- 8 mmol/MJ), were higher for Malawian than for Ghanaian children. More Malawian than Ghanaian children had [phytate]/[Zn] > or = 15 (72% vs. 0%) and were severely stunted (57 vs. 28%). Ninety-four percent of children in Malawi and 83% in the Ghanaian village of Slepor had low hair Zn concentrations (< 1.68 mumol/g) compared with 39% in Gidantuba, Ghana. In Gidantuba, children with low hair Zn concentrations had low upper-arm-muscle-area-for-age and upper-arm-muscle-area-for-height Z-scores. The high intakes of phytic acid relative to zinc in Malawi suggest that these children were at greater risk for inadequate zinc nutriture than their Ghanaian counterparts.

PIP: A study of 57 children aged 44-78 months living in Chilunga village in Zomba District, Malawi, and of 76 children aged 42-80 months living in the villages of Slepor and Gidantuba in Greater Accra in Ghana aimed to determine intakes of zinc and other dietary components influencing zinc bioavailability. Children from Malawi had higher mean annual intakes of energy (5419 kJ vs. 4698 kJ; p .05), and phytate (1899 mg vs. 604 mg; p .05) and higher mean molar rations of [phytate]/[zinc] and [calcium] x [phytate]/[zinc] mmol per megajoule (25 mmol/MJ vs. 12 mmol/MJ and 44 mmol/MJ vs. 20 mmol/MJ, respectively; p .05) than the children from Ghana. A higher proportion of children from Malawi had a molar ratio of [phytate]/[zinc] of at least 15 (72% vs. 0; p .05). Malawian children were more likely to be severely stunted than the Ghanaian children (57% vs. 28%; p .05). The median hair zinc concentration of children living in Gidantuba was significantly higher than that of children living in Slepor and in Malawi (1.99 mcmol/g vs. 1.42 mcmol/g, respectively; p .05). Further, a higher percentage of children in Slepor and Malawi had lower hair zinc concentrations than those in Gidantuba (83% and 94%, respectively vs. 39%; p .05). The children in GIdantuba with low hair zinc concentrations exhibited low upper-arm-muscle-area-for-age (-0.71) and upper-arm-muscle-are-for-height Z scores (-0.10). The diets in Malawi were cereal-based while those in Ghana consisted of starch staples with relatively low nutrient and phytate densities and fermented cereals with relatively low densities of phytate relative to zinc. The high intakes of phytic acid relative to zinc in Malawian children indicated that they faced a greater risk for insufficient zinc nutrition status than Ghanaian children. The researchers called for a study to determine whether zinc supplementation would improve zinc nutrition status in children in Ghana and Malawi

Asunto(s)