RESUMEN
Botswana, with its estimated HIV prevalence of 37%, instituted a policy of universal access to antiretroviral therapy (ART) in 2002. Initial enrolment lagged behind expectations, with a shortfall in voluntary testing that observers have attributed to HIV-related stigma - although there are no published data on stigma among HIV-positive individuals in Botswana. We interviewed 112 patients receiving ART in 2000, finding evidence of pervasive stigma in patterns of disclosure, social sequelae, and delays in HIV testing. Ninety-four percent of patients reported keeping their HIV status secret from their community, while 69% withheld this information even from their family. Twenty-seven percent of patients said that they feared loss of employment as a result of their HIV status. Forty percent of patients reported that they delayed getting tested for HIV; of these, 51% cited fear of a positive test result as the primary reason for delay in seeking treatment, which was often due to HIV-related stigma. These findings suggest that success of large-scale national ART programmes will require initiatives targeting stigma and its social, economic and political correlates.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/psicología , Estereotipo , Adulto , Botswana/epidemiología , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: We sought to compare 10-year survival in patients after mitral valve replacement with biologic or mechanical valve prostheses. METHODS: Retrospective survival analysis was performed on data from 1139 consecutive patients older than 18 years of age undergoing mitral valve replacement with Carpentier-Edwards (n = 495; Baxter Healthcare Corp, Irvine, Calif) or St Jude Medical (n = 644; St Jude Medical, Inc, St Paul, Minn) prostheses. RESULTS: The 10-year survival was not statistically different between the patients receiving Carpentier-Edwards valves and those receiving St Jude Medical valves (P =.16). Adjusted survival estimates at 2, 5, and 10 years were 82% +/- 2% (95% confidence intervals, 79%-85%), 69% +/- 2% (95% confidence intervals, 64%-73%), and 42% +/- 3% (95% confidence intervals, 37%-48%), respectively, for the Carpentier-Edwards group and 83% +/- 2% (95% confidence intervals, 80%-86%), 72% +/- 2% (95% confidence intervals, 69%-76%), and 51% +/- 3% (95% confidence intervals, 45%-58%), respectively, for the St Jude Medical group. Predictors of worse survival after mitral valve replacement are older age, lower ejection fraction, presence of class IV congestive heart failure, coronary artery disease, renal disease, smoking history, hypertension, concurrent other valve surgery, and redo heart surgery. CONCLUSION: Choice of biologic or mechanical prosthesis does not significantly affect long-term patient survival after mitral valve replacement.
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Bioprótesis/normas , Prótesis Valvulares Cardíacas/normas , Insuficiencia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/mortalidad , Prolapso de la Válvula Mitral/cirugía , Factores de Edad , Anciano , Análisis de Varianza , Comorbilidad , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/complicaciones , Selección de Paciente , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Volumen Sistólico , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) are being applied to high-risk populations, but previous randomized trials comparing revascularization methods have excluded a number of important high-risk groups. OBJECTIVES: This five-year, multicenter, randomized clinical trial was designed to compare long-term survival among patients with medically refractory myocardial ischemia and a high risk of adverse outcomes assigned to either a CABG or a PCI strategy, which could include stents. METHODS: Patients from 16 Veterans Affairs Medical Centers were screened to identify myocardial ischemia refractory to medical management and the presence of one or more risk factors for adverse outcome with CABG, including prior open-heart surgery, age >70 years, left ventricular ejection fraction <0.35, myocardial infarction within seven days or intraaortic balloon pump required. Clinically eligible patients (n = 2,431) underwent coronary angiography; 781 were angiographically acceptable; 454 (58% of eligible) patients consented to random assignment between CABG and PCI. RESULTS: A total of 232 patients was randomized to CABG and 222 to PCI. The 30-day survivals for CABG and PCI were 95% and 97%, respectively. Survival rates for CABG and PCI were 90% versus 94% at six months and 79% versus 80% at 36 months (log-rank test, p = 0.46). CONCLUSIONS: Percutaneous coronary intervention is an alternative to CABG for patients with medically refractory myocardial ischemia and a high risk of adverse outcomes with CABG.
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Angioplastia Coronaria con Balón , Puente de Arteria Coronaria , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/terapia , Anciano , Angina de Pecho/mortalidad , Angina de Pecho/cirugía , Angina de Pecho/terapia , Humanos , Isquemia Miocárdica/cirugía , Factores de Riesgo , StentsRESUMEN
We investigated the use of flue-gas-desulfurization (FGD) by-products from electric power plant wet scrubbers as liners in wetlands constructed to improve water quality. Mesocosm experiments were conducted over two consecutive growing seasons with different phosphorus loadings. Wetland mesocosms using FGD liners retained more total and soluble reactive phosphorus, with lower concentrations in the leachate (first year) and higher concentrations in the surface water (second year). Leachate was higher in conductivity (second year) and pH (both years) in lined mesocosms. Surface outflow did not reveal any significant difference in physicochemical characteristics between lined and unlined mesocosms. There was no significant difference in total biomass production of wetland plants between lined and unlined mesocosms although lower average stem lengths and fewer stems bearing flowers were observed in mesocosms with FGD liners. Potentially phytotoxic boron was significantly higher in the belowground biomass of plants grown in lined mesocosms with low phosphorus loading. A larger-scale, long-term wetland experiment close to full scale is recommended from this two-year mesocosm study to better predict the potentially positive and negative effects of using FGD by-products in constructed wetlands.
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Conservación de los Recursos Naturales , Administración de Residuos/instrumentación , Administración de Residuos/métodos , Contaminación del Agua/prevención & control , Abastecimiento de Agua , Ecosistema , AzufreRESUMEN
To evaluate whether items from 3 brief measures of fruit and vegetable consumption were understood and interpreted as intended, cognitive testing was conducted in a purposive sample of 31 white, African-American and Hispanic persons. The measurement instruments tested were the fruit and vegetable module from the Behavioral Risk Factor Surveillance System (to measure frequency), and 1 fruit and 1 vegetable variety measurement instrument developed by the investigators. The cognitive testing interviews were analyzed qualitatively to identify interpretation difficulties and other measurement issues. The testing identified a number of measurement issues, including issues related to time frame, wording, interpretation, grouping of items, and serving size. Recommendations based on the findings were incorporated into revised versions of each instrument, which were further tested in a small sample. As revised and presented in this article, these instruments for assessing fruit and vegetable frequency and variety appear to be understood and interpreted as intended across different racial and ethnic groups, and may be useful in situations requiring brief dietary assessment, although further testing is needed.
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Negro o Afroamericano/psicología , Frutas , Hispánicos o Latinos/psicología , Encuestas y Cuestionarios/normas , Verduras , Población Blanca/psicología , Conducta Alimentaria , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Entrevistas como Asunto , Recuerdo Mental , Evaluación Nutricional , Reproducibilidad de los ResultadosRESUMEN
This article takes a critical look at the much-touted cultural tolerance explanation of obesity among African-American women with the hope of stimulating a re-examination of its relative merits. After reviewing evidence that runs contrary to the cultural tolerance explanation, the focus turns to an examination of some of the explanation's inherent risks and limitations. Among those discussed is that an overstated cultural tolerance explanation seems to have had a tendency of polarizing thinking in this area of public health, in that if a population group is not pre-occupied with the ideal of thinness, there has been a proclivity to assume they are indifferent about their weight. A corollary risk and limitation also discussed is that factors, which adversely affect the less extreme weight reduction behavior of African-American women but are outside the cultural realm, have tended to be neglected. The factor identified that has been most conspicuously neglected in recent years, but which can profoundly affect the weight management behavior of African-American women on many different levels, is the enduring socioeconomic disparity compared with European-American women.
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Negro o Afroamericano/psicología , Características Culturales , Obesidad/etnología , Femenino , Conductas Relacionadas con la Salud/etnología , Humanos , Estados Unidos/epidemiologíaRESUMEN
As part of an international nutrition project sponsored by the International Atomic Energy Agency (see footnote), Vienna, Austria, a number of bench-mark mixed total diet composites from the United States were collected and analyzed for minor and trace elements. In this segment of the project, the daily dietary intakes of the minor elements Ca, Cl, K, Mg, N and P and the trace elements Al, As, Au, Br, Cd, Co, Cr, Cs, Cu, Fe, Hg, I, Mn, Mo, Ni, Pb, Rb, Sb, Sc, Se, Sn, Sr, V, Zn and W were determined in mixed total diet composites of foods collected in the FDA Total Diet Study (FDA-TDS). These diets are representative of foods consumed by 25-30-year-old males (representing the mixed population groups in the United States), the highest of eight intake groups in the TDS scheme. In order to link the US mixed diet composite results from this study group to the more comprehensive information generated by the FDA-TDS, the results are compared with the same age-sex group published by the FDA-TDS scheme. The FDA-TDS scheme is based on individual analysis of the 201 food items, with resultant calculation of the daily intake representative of various age-sex groups. The comparison shows excellent agreement for 21 elements which have been investigated by both approaches. Additional elements are reported in the US mixed diet composites from the present study which demonstrate a valuable supplement to the data obtained by FDA-TDS scheme. Further the mixed total diet composite approach has also proven useful for the assessment of dietary intake of proximates (protein, fat, carbohydrates), fiber and phytate. In addition, vitamins thiamin, riboflavin, niacin, B6, B12, pantothenic acid, folic acid and biotin were also assayed in these composites.
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Dieta , Oligoelementos/análisis , Adulto , Humanos , Masculino , Valor Nutritivo , Salud Pública , Valores de Referencia , Estados UnidosRESUMEN
The frequent comorbidity of eating disorders and substance use has been demonstrated consistently by research. Less is known about the basis of this relationship. A review of the literature indicates that the hypotheses proposed to clarify the etiological relationship between eating disorders and substance use have not been supported sufficiently or consistently by empirical evidence. General criticisms include: a lack of well developed models, a reliance on co-prevalence data, and a lack of integration of knowledge from eating disorder and substance use research. It is suggested that an understanding of the etiological relationship between eating disorders and substance use will be arrived at only after fundamental inquiries into the functional relationship between eating disorders symptomatology and substance use patterns have been conducted. A behavioral assessment approach is offered as a means of evaluating the functional relationship between eating disorder symptomatology and substance use.
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Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Comorbilidad , Estudios Transversales , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Humanos , Determinación de la Personalidad , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
The effect of self-discrepancy magnitude and salience on alcohol consumption was examined in an ad lib drinking study in order to evaluate the utility of the self-inflation component of the myopia model for better understanding drinking practices. Participants were 33 males and 27 females recruited on a university campus. It was predicted that participants with relatively large real self/ideal self discrepancies on dimensions important to their self-concept would consume the greatest amount of alcohol in a wine tasting test. Moreover, this effect was expected to be enhanced when self-discrepancies were made salient. The results of hierarchical regression analyses showed a main effect of gender and a significant interaction between self-discrepancy magnitude and salience condition. However, the interaction was such that wine consumption tended to decrease as discrepancy magnitude increased in the condition in which self-discrepancies were made salient, with the opposite relationship in the control condition. Three possible reasons for the unexpected findings are discussed: (a) The salience manipulation did not perform as expected: (b) the sample had little to gain from self-inflation: and (c) typically, self-inflation does not significantly motivate alcohol consumption.
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Consumo de Bebidas Alcohólicas/psicología , Conflicto Psicológico , Autoimagen , Adolescente , Afecto , Disonancia Cognitiva , Mecanismos de Defensa , Femenino , Humanos , Masculino , Inventario de Personalidad , Estudiantes/psicologíaRESUMEN
BACKGROUND: While internal mammary artery (IMA) use predicts improved survival after coronary bypass grafting (CABG), it remains unknown whether patients undergoing concomitant aortic valve replacement (AVR) realize a similar benefit. METHODS: All patients at a single teaching institution, undergoing combined AVR-CABG, which included a graft to the left anterior descending coronary artery (LAD) from 1984 to 1994 (n = 227) were examined retrospectively. RESULTS: Patients receiving an IMA graft (yesIMA, n = 135) and patients receiving only saphenous vein grafts (nonIMA, n = 92) were not different in their presenting symptoms, or in their incidence of preoperative risk factors. The patients with IMA were more likely to be male, have a later year of operation, be younger, and have a greater body surface. Morbidity was not different between groups. IMA use did not affect 30-day mortality. Long-term actuarial survival was greater in the group with IMA (63% +/- 7% vs 42% +/- 6% at 5 years, p < 0.01). A multivariate Cox proportional hazards model demonstrated that use of an IMA graft improved survival, while recent myocardial infarction, diabetes, earlier year of operation, and lower ejection fraction diminished long-term survival. The relative risk of IMA grafting was 0.570. CONCLUSIONS: Within the limits of a retrospective analysis, patients in a modern era of cardiac operation, who undergo combined AVR-CABG, do not suffer increased morbidity from IMA use, and may realize a survival benefit from use of the IMA as a conduit for bypass of the LAD coronary artery.
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Válvula Aórtica/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedad Coronaria/cirugía , Anastomosis Interna Mamario-Coronaria , Anciano , Comorbilidad , Enfermedad Coronaria/complicaciones , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Anastomosis Interna Mamario-Coronaria/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios RetrospectivosAsunto(s)
Defectos del Tabique Interatrial/complicaciones , Accidente Cerebrovascular/etiología , Anticoagulantes/uso terapéutico , Diagnóstico Diferencial , Diagnóstico por Imagen , Defectos del Tabique Interatrial/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/prevención & controlRESUMEN
BACKGROUND: Patients presenting for coronary artery bypass graft (CABG) surgery may have concurrent asymptomatic aortic stenosis (AS) or aortic insufficiency (AI). This retrospective study was performed to evaluate outcomes in patients with aortic valve disease undergoing CABG with or without aortic valve replacement (AVR). METHODS: Study groups included 414 patients undergoing combined AVR and CABG (AVR-CABG group) and 62 patients with asymptomatic mild-to-moderate AS, AI, or both undergoing CABG but not AVR (CABG group). End points included 30-day mortality rate, time to cardiac mortality, time to all-cause mortality, and time to aortic valve reoperation. Reoperation refers to surgery for replacement of the native aortic valve in the CABG group or replacement of the prosthetic aortic valve in the AVR-CABG group. Important patient characteristics affecting outcomes were determined by using Cox proportional-hazard analysis. These variables were then included in multivariable analyses by using logistic regression analysis and Cox proportional-hazard modeling to compare outcomes between each patient group. RESULTS: No difference was seen in any of the mortality end points between the CABG group and the AVR-CABG group after controlling for significant differences between the groups. However, the need for reoperation for AVR was significantly higher for the CABG group than the AVR-CABG group. For patients followed for up to 6 years, the estimated need for aortic valve reoperation was 24.3% in the CABG group versus 3% in the AVR-CABG group. CONCLUSION: On the basis of these results, patients with asymptomatic AS or AI should be considered for AVR at the time of CABG.
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Insuficiencia de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/epidemiología , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Anciano , Válvula Aórtica , Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Estudios de Casos y Controles , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/mortalidad , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Modelos Logísticos , Modelos de Riesgos Proporcionales , Reoperación , Tasa de SupervivenciaRESUMEN
BACKGROUND: Pectoralis flaps are frequently used to treat poststernotomy mediastinitis. We compared the outcomes of omental transfer, an alternative treatment for mediastinitis, with those of pectoralis flaps. METHODS: Patients treated for poststernotomy mediastinitis with isolated omental flaps (n = 21) were compared with a group of consecutive patients treated with pectoralis flaps (n = 38). Baseline characteristics were equivalent for the two groups, and both early and late outcomes were compared. RESULTS: Length of procedure and length of postoperative hospitalization were reduced significantly and there were significantly fewer early complications in the group treated with omental flaps. Furthermore, there were no early or late flap failures or abscesses in the omental flap group. CONCLUSIONS: This study found that omental flaps had improved early outcomes and are a more effective therapy relative to pectoralis flaps for poststernotomy mediastinitis. Technical considerations for omental transfer that could optimize results are given.
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Mediastinitis/cirugía , Esternón/cirugía , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica/cirugía , Anciano , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Mediastinitis/mortalidad , Persona de Mediana Edad , Reoperación , Infección de la Herida Quirúrgica/mortalidad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement. METHODS: Retrospective analysis was performed for 841 patients undergoing isolated, first-time aortic valve replacement with Carpentier-Edwards (n = 429) or St Jude Medical (n = 412) prostheses. RESULTS: Patients with Carpentier-Edwards and St Jude Medical valves had similar characteristics. Ten-year survival was similar in each group (Carpentier-Edwards 54% 3% versus St Jude Medical 50% 6%; P =.4). Independent predictors of worse survival were older age, renal or lung disease, ejection fraction less than 40%, diabetes, and coronary disease. Carpentier-Edwards versus St Jude Medical prostheses did not affect survival (P =.4). Independent predictors of aortic valve reoperation were younger age and Carpentier-Edwards prosthesis. The linearized rates of thromboembolism were similar, but the linearized rate of hemorrhage was lower with Carpentier-Edwards prostheses (P <.01). Perivalvular leak within 6 months of operation was more likely with St Jude Medical than with Carpentier-Edwards prostheses (P =.02). Estimated 10-year survival free from valve-related morbidity was better for the St Jude Medical valve in patients aged less than 65 years and was better for the Carpentier-Edwards valve in patients aged more than 65 years. Patients with renal disease, lung disease (in patients more than age 60 years), ejection fraction less than 40%, or coronary disease had a life expectancy of less than 10 years. CONCLUSIONS: For first-time, isolated aortic valve replacement, mechanical prostheses should be considered in patients under age 65 years with a life expectancy of at least 10 years. Bioprostheses should be considered in patients over age 65 years or with lung disease (in patients over age 60 years), renal disease, coronary disease, ejection fraction less than 40%, or a life expectancy less than 10 years.
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Materiales Biocompatibles , Bioprótesis , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Adolescente , Adulto , Anciano , Válvula Aórtica , Puente Cardiopulmonar , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/fisiopatología , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Volumen Sistólico , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To examine how life-course experiences and events are associated with current fruit and vegetable consumption in 3 ethnic groups. DESIGN: A theoretic model developed from previous qualitative research guided the development of a telephone survey. Data were collected on fruit and vegetable consumption, sociodemographic characteristics, ethnic identity, and life-course events and experiences, including food upbringing, social roles, food skills, dietary changes for health, and practice of food traditions. SUBJECTS/SETTING: Low- to moderate-income adults living in a northeastern US city were selected randomly from 3 ethnic groups: black (n = 201), Hispanic (n = 191), and white (n = 200). STATISTICAL ANALYSES: Bivariate and multiple linear regression analysis of associations between life-course variables and fruit and vegetable consumption. RESULTS: Black, Hispanic, and white respondents differed significantly in life-course experiences, family roles, socio-demographic characteristics, and place of birth. Explanatory models for fruit and vegetable consumption differed among ethnic groups and between fruits and vegetables. Among black respondents, a college education was positively associated with fruit consumption; education and family roles contributed most to differences in fruit (R2 = .16) and vegetable (R2 = .09) consumption. Among Hispanic respondents, life-course experiences such as liking fruits and vegetables in youth, making dietary changes for health, and food skills were positively associated with fruit (R2 = .25) and vegetable (R2 = .35) consumption. Among white respondents, socio-demographic characteristics, such as being married with a young child or single with no child and having a garden as an adult, were positively associated with fruit (R2 = .20) and vegetable (R2 = .22) consumption. APPLICATIONS/CONCLUSIONS: An understanding of the determinants of food choice in different subcultural groups can be used to design effective nutrition interventions to increase fruit and vegetable consumption. Experiences such as eating fresh-picked fruits and vegetables while growing up or vegetable gardening as an adult may enhance fruit and vegetable consumption among members of some ethnic groups.
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Negro o Afroamericano , Preferencias Alimentarias/etnología , Frutas , Hispánicos o Latinos , Acontecimientos que Cambian la Vida , Verduras , Población Blanca , Adolescente , Adulto , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Teléfono , Población UrbanaRESUMEN
BACKGROUND: Percutaneous balloon mitral valvuloplasty and durable mitral prostheses have made the role of open mitral commissurotomy (OMC) uncertain. METHODS AND RESULTS: Results from the use of St Jude mitral valve replacement (SJMVR) were compared with those of the use of OMC in 312 consecutive patients with mitral stenosis between 1983 and the present. OMC and SJMVR patients were well matched for age, sex, and comorbidity except that SJMVR patients had more severe stenosis and were more likely to undergo concurrent aortic valve replacement. Compared with OMC, SJMVR without chordal preservation involved a longer pump time (158 +/- 81 versus 87 +/- 41 min, P < 0.05), more frequent in-hospital complications or death (57 of 219 [26%] versus 4 of 52 [8%], P < 0.01), and longer hospital stay (13 +/- 11 versus 10 +/- 6 days, P = 0.001). Preservation of chordae to at least 1 mitral valve leaflet decreased early morbidity and mortality rates of SJMVR to values comparable to those of OMC (3 of 41 [7%]). Survival was greater at 10 years for OMC versus SJMVR (86 +/- 5% versus 67 +/- 4%, P = 0.03). Ten-year freedom from cardiac events was not different between groups (49 +/- 9% for OMC versus 55 +/- 4% for SJMVR, P = 0.7). Freedom from subsequent mitral procedures at 10 years was better for SJMVR (96 +/- 2% versus 58 +/- 8%, P < 0.001). CONCLUSIONS: In the modern era, SJMVR offers significantly greater durability than does OMC. Chordal preservation at the time of SJMVR may reduce perioperative complications to levels comparable to those of OMC.
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Cuerdas Tendinosas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Adulto , Anciano , Análisis Discriminante , Femenino , Cardiopatías/epidemiología , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Modelos de Riesgos Proporcionales , Análisis de SupervivenciaRESUMEN
OBJECTIVES: To examine the prevalence of overweight and associated characteristics in a representative sample of children from schools in New York City (NYC). DESIGN: A cross-sectional survey with an in-person interview (including measurements of height and weight) and a household questionnaire. SUBJECTS: Second and fifth grade students from schools in NYC participated. A total of 1,396, including 692 second and 704 fifth grade, children were included in the analysis. MEASUREMENTS: Prevalence of overweight based on the body mass index (BMI) and the 85th or 95th percentile cutoff points from Cycles II and III of the National Health Examination Survey reference recently developed by the Centers for Disease Control and Prevention (CDC). The characteristics of overweight examined were: age, gender, socio-economic status, Hispanic origin, family structure, number of children in the household, meal preparation by children, food diversity and participation in the National School Lunch Program. RESULTS: Overweight based on the 85th percentile of BMI was 37.5% among second grade and 31.7% among fifth grade children. Based on the 95th percentile, overweight was 19.9% and 17.8%, respectively. Overweight was associated with Hispanic origin, fewer children in the household, family structure and meal preparation by children. CONCLUSIONS: Overweight is prevalent among elementary school children in NYC. Studies in diverse geographically defined areas with diverse populations, are necessary to design effective prevention efforts. Primary prevention efforts in NYC should target Hispanics and take into consideration individual behaviour and family characteristics.
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Obesidad/epidemiología , Índice de Masa Corporal , Niño , Intervalos de Confianza , Estudios Transversales , Recolección de Datos , Etnicidad , Femenino , Humanos , Modelos Logísticos , Masculino , Ciudad de Nueva York/epidemiología , Obesidad/etnología , Oportunidad Relativa , Prevalencia , Factores Sexuales , Factores SocioeconómicosRESUMEN
BACKGROUND: The determinants of long-term outcome 15 years or more after porcine valve replacement are poorly documented. METHODS: A retrospective review was performed of patients undergoing valve replacement with standard Carpentier-Edwards aortic (n = 531), mitral (n = 492), and tricuspid (n = 96) valves. RESULTS: Patient survival was 26%+/-3%, 23%+/-2%, and 31%+/-8% 15 years after aortic, mitral, and tricuspid valve replacements, respectively. Independent determinants of impaired long-term survival for aortic or mitral valve replacement were multiple valve replacement, older age, renal disease, lung disease, or coronary disease. Actual (versus actuarial) freedom from reoperation at 15 years was 86%+/-2%, 76%+/-2%, and 95%+/-2% after aortic, mitral, and tricuspid valve replacement, respectively. Risk factors for reoperation were young age for aortic or mitral valve replacement, previous operation for aortic valve replacement, and large valve size for mitral valve replacement. Freedom from thromboembolism was 77%+/-4%, 62%+/-9%, and 80%+/-5%; from hemorrhage, 95%+/-5%, 87%+/-4%, and 82%+/-6%; and from endocarditis, 94%+/-1%, 96%+/-1%, and 89%+/-5% 15 years after aortic, mitral, and tricuspid valve replacement, respectively. Risk factors for thromboembolism or hemorrhage were multiple valve replacement and age. CONCLUSIONS: The standard Carpentier-Edwards bioprosthesis continues to provide relatively low complication rates at 15 years, especially in the aortic and tricuspid positions, and especially in patients older than 60 years or with significant comorbdity.
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Bioprótesis , Prótesis Valvulares Cardíacas , Análisis Actuarial , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Válvula Aórtica/cirugía , Bioprótesis/efectos adversos , Niño , Enfermedad Coronaria/complicaciones , Endocarditis/etiología , Femenino , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Enfermedades Renales/complicaciones , Estudios Longitudinales , Enfermedades Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Hemorragia Posoperatoria/etiología , Diseño de Prótesis , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Tromboembolia/etiología , Resultado del Tratamiento , Válvula Tricúspide/cirugíaRESUMEN
To better understand the nature of food insecurity in the elderly and to improve its measurement, in-depth interviews were conducted with 41 urban Black and rural White elderly in 35 households, followed by telephone administration of commonly used measures of food insecurity in 24 of these elderly. Elderly food insecurity appears to follow a progression of severity, beginning with compromised diet quality, followed by food anxiety, socially unacceptable meals, use of emergency food strategies, and finally actual hunger. The five quantitative measures tested were compared to each elderly person's food insecurity status based on the in-depth interview. All measures had reasonable specificity, and good sensitivity for those experiencing severe food insecurity. However, the Cornell-Radimer, Community Childhood Hunger Identification Project (CCHIP) and Nutrition Screening Initiative (NSI) measures appeared more sensitive than the USDA food sufficiency or Urban Institute measures in correctly identifying those in the lesser stages of food insecurity.
Asunto(s)
Anciano/psicología , Hambre , Inanición/epidemiología , Anciano/estadística & datos numéricos , Anciano de 80 o más Años , Femenino , Humanos , Masculino , New York/epidemiología , Encuestas Nutricionales , Salud Rural/estadística & datos numéricos , Población Rural , Salud Urbana/estadística & datos numéricos , Población UrbanaRESUMEN
OBJECTIVE: To examine food consumption patterns and related characteristics of schoolchildren. DESIGN: A representative survey involving a household questionnaire and child interview to conduct a nonquantitative 24-hour dietary recall. Indexes were developed to score the diets based on the Food Guide Pyramid and 5 A Day for Better Health recommendations. SUBJECTS/SETTING: Six hundred ninety-three 2nd-grade students and 704 5th-grade students from public and private schools in New York City. STATISTICAL ANALYSES PERFORMED: Weighted means and gender-adjusted analysis of covariance models were used to account for a complex survey design in calculating variance estimates. RESULTS: Compared with a maximum of 50, the mean Food Guide Pyramid index score was 29.2 for 2nd-grade students and 30.4 for 5th-grade students. The mean 5 A Day consumption score was 3.4 and 3.6 servings of fruits and vegetables daily for 2nd and 5th graders, respectively. Measures of food consumption were significantly related to socioeconomic status, race/ethnicity, skipping meals, and participating in school lunch for both grades, and with meal preparation for 5th graders. APPLICATIONS/CONCLUSIONS: The Food Guide Pyramid and 5 A Day recommendations provide guidelines for food selection beginning in childhood. Knowledge and skills training are needed to improve food consumption patterns as children consume foods away from home and as they take on greater responsibility for meal preparation and food selection.