RESUMO
Overweight clusters with high blood pressure (BP), but the independent contribution of both risk factors remains insufficiently documented. In a prospective population study involving 8467 participants (mean age 54.6 years; 47.0% women) randomly recruited from 10 populations, we studied the contribution of body mass index (BMI) to risk over and beyond BP, taking advantage of the superiority of ambulatory over conventional BP. Over 10.6 years (median), 1271 participants (15.0%) died and 1092 (12.9%), 637 (7.5%) and 443 (5.2%) experienced a fatal or nonfatal cardiovascular, cardiac or cerebrovascular event. Adjusted for sex and age, low BMI (<20.7 kg m(-2)) predicted death (hazard ratio (HR) vs average risk, 1.52; P<0.0001) and high BMI (> or = 30.9 kg m(-2)) predicted the cardiovascular end point (HR, 1.27; P=0.006). With adjustments including 24-h systolic BP, these HRs were 1.50 (P<0.001) and 0.98 (P=0.91), respectively. Across quartiles of the BMI distribution, 24-h and nighttime systolic BP predicted every end point (1.13 < or = standardized HR < or = 1.67; 0.046 < or = P<0.0001). The interaction between systolic BP and BMI was nonsignificant (P > or = .22). Excluding smokers removed the contribution of BMI categories to the prediction of mortality. In conclusion, BMI only adds to BP in risk stratification for mortality but not for cardiovascular outcomes. Smoking probably explains the association between increased mortality and low BMI.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Índice de Massa Corporal , Hipertensão/diagnóstico , Hipertensão/etnologia , Obesidade/diagnóstico , Obesidade/etnologia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Ásia/epidemiologia , Pressão Sanguínea/efeitos dos fármacos , Europa (Continente)/epidemiologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Obesidade/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/mortalidade , América do Sul/epidemiologia , Fatores de TempoRESUMO
Compared to the well-characterized health threats associated with contamination of fish and shellfish by algal toxins in marine fisheries, the toxicological relevance of the bioaccumulation of toxins from cyanobacteria (blue-green algae), as the primary toxigenic algae in freshwater systems, remains relatively unknown. Lake Catemaco (Veracruz, Mexico) is a small, tropical lake system specifically characterized by a year-round dominance of the known toxigenic cyanobacterial genus, Cylindrospermopsis, and by low, but detectable, levels of both a cyanobacterial hepatotoxin, cylindrospermopsin (CYN), and paralytic shellfish toxins (PSTs). In the present study, we evaluated, using enzyme-linked immunoassay (ELISA), levels of both toxins in several species of finfish caught and consumed locally in the region to investigate the bioaccumulation of, and possible health threats associated with, these toxins as potential foodborne contaminants. ELISA detected levels of both CYN and PSTs in fish tissues from the lake. Levels were generally low (≤ 1 ng g(-1) tissue); however, calculated bioaccumulation factors (BAFs) indicate that toxin levels exceed the rather low levels in the water column and, consequently, indicated bioaccumulation (BAF >1). A reasonable correlation was observed between measured bioaccumulation of CYN and PSTs, possibly indicating a mutual source of both toxins, and most likely cells of Cylindrospermopsis, the dominant cyanobacteria in the lake, and a known producer of both metabolites. The potential roles of trophic transport in the system, as well as possible implications for human health with regards to bioaccumulation, are discussed.
Assuntos
Peixes/metabolismo , Lagos/química , Uracila/análogos & derivados , Alcaloides , Animais , Toxinas Bacterianas , Cianobactérias , Toxinas de Cianobactérias , Monitoramento Ambiental/métodos , Monitoramento Epidemiológico , Cadeia Alimentar , Invertebrados , México/epidemiologia , Intoxicação por Frutos do Mar/epidemiologia , Uracila/metabolismo , Uracila/toxicidade , Microbiologia da Água , Poluentes Químicos da Água/metabolismoRESUMO
In a double-blind, placebo-controlled efficacy trial of a monocomponent pertussis toxoid vaccine, 3450 infants were randomly assigned to vaccination with diphtheria-tetanus toxoids with or without pertussis toxoid at 3, 5, and 12 months of age. Study children and family members were investigated for possible pertussis with cultures, serology, and polymerase chain reaction. Efficacy was 71% after 3 dose when the World Health Organization case definition of pertussis (which includes paroxysmal cough for 21 days or longer) was used. We report the efficacy in the subgroup of children who were exposed to pertussis in the household. Among study children exposed to pertussis in the household from the day of the third vaccination, 20 of 99 (20%) recipients of diphtheria-tetanus-pertussis toxoids vaccine and 64 of 79 (81%) recipients of diphtheria-tetanus toxoids vaccine had pertussis fulfilling criteria of the World Health Organization. The vaccine efficacy was 75% (95% confidence intervals 64% to 84%). In children who had received only two doses at the time of household exposure, vaccine efficacy was 66% (95% confidence intervals 15% to 90%) based on 4 cases among 32 household-exposed recipients of diphtheria-tetanus-pertussis toxoids vaccine and 13 cases among 35 household-exposed recipients of diphtheria-tetanus toxoids vaccine. In conclusion, the pertussis toxoid vaccine provides protection against pertussis both after household and community exposure.