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PubMed2000

Prevalence of migraine in Taipei, Taiwan: a population-based survey.

We conducted the first population-based migraine survey in Taipei, Taiwan, using a validated questionnaire administered by interviewers during the period from August 1997 to June 1998. Our target population comprised all individuals (age > or = 15 years) in 1400 randomly selected households. Migraine diagnoses were made according to the classification criteria of migraine without aura proposed by the International Headache Society, 1988, except that attacks with a duration of between 2 h and 4 h were also included. Of the 4434 eligible subjects in the 1211 respondent households, 3377 (76%) completed the questionnaire. After adjustment for age and sex distribution according to the population structure, the prevalence of migraine was 9.1% (F/M 14.4%/4.5%). Fifty-four percent of the subjects with migraine had consulted a physician about their headaches in the past year. However, only 18% of them reported that their migraine had been diagnosed by physicians. This study found that Taipei residents have the highest migraine prevalence of all Chinese populations studied, although it is still in the low range of prevalence compared with the results from Western countries.

Adolescent↗
PubMed1993

Gaucher disease as a paradigm of current issues regarding single gene mutations of humans.

Gaucher disease is a glycolytic storage disease caused by a deficiency in activity of the catabolic enzyme glucocerebrosidase. Over 35 different mutations have been documented, including missense and nonsense point mutations, splicing mutations, deletions and insertions, a fusion gene, and examples of gene conversion. Gaucher disease is most common in the Ashkenazi Jewish population, in which just five of the mutations in this population account for 98% of the disease-producing alleles. Each of these mutations is found in the context of a single haplotype, a finding consistent with a single origin of each mutation. Although it is clear that these mutations provide a selective advantage in the Jewish population and thus constitute a balanced polymorphism, the nature of the advantage is unknown. Gaucher disease can be treated symptomatically, by administration of the missing enzyme, by allogeneic bone marrow transplantation, and potentially by gene transfer into hematopoietic stem cells. Increasing understanding of this disease has, as in other genetic disorders, created a host of social and ethical dilemmas regarding matters such as the cost of treatment for rare diseases and the advantages and disadvantages of population-targeted genetic screening.

Amino Acid Sequence↗
PubMed2000

Nutritional status of Kuwaiti elementary school children aged 6-10 years: comparison with the NCHS/CDC reference population.

The objective of this cross-sectional sampling survey was to assess the nutritional status of Kuwaiti elementary school children aged 6-10 years in comparison with the NCHS/CDC American reference population. The study comprised a multistage stratified random sample of 8957 children (4401 males and 4556 females) which amounts to about 12% of the target population. Weights and heights of children were measured. Obesity was defined as weight-for-height (W/H) 2.00 to 5.00 standard deviation (SD) scores of the reference population. Underweight and short stature were defined as weight-for-height (W/H) and height-for-age (H/A) -4.00 to -2.00 and -5.00 to -2.00 SD scores, respectively. The results of this study showed that obesity was found to be significantly (P < 0.01) higher in males (15.7%) than in females (13.8%). Underweight was found to be almost equally prevalent among both genders (3.7% in males and 3.8% in females). Short stature (H/A) -5.00 to -2.00 SD scores) was found to be 7.1% (9.5% in males and 4.6% in females). When compared with an earlier study, changes in W/H were significant across most of the centile categories. However, significant changes in H/A were noted with less frequency than W/H; mostly in the upper centiles for both genders. More significant changes, however, were noted among males than females. In conclusion, Kuwaiti children were found to be heavier and shorter than American children. Moreover, the children were found to be fatter and slightly taller but nonetheless more nutritionally sound than a decade earlier.

Body Height↗
PubMed2006

Prevalence and determinants of lateral and medial epicondylitis: a population study.

Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study. The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001. Of the 5,871 subjects, 4,783 (81.5%) were included in this study. The prevalence of definite lateral epicondylitis was 1.3%, and that of medial epicondylitis was 0.4%. The prevalence did not differ between men and women and was highest in subjects aged 45-54 years. Current smoking (adjusted odds ratio (OR) = 3.4, 95% confidence interval (CI): 1.4, 8.3) and former smoking (OR = 3.0, 95% CI: 1.3, 6.6) were associated with definite lateral epicondylitis. An interaction (p = 0.002) was found between repetitive movements of the arms and forceful activities for the risk of possible or definite lateral epicondylitis (for both repetitive and forceful activities vs. no such activity: OR = 5.6, 95% CI: 1.9, 16.5). Smoking, obesity, repetitive movements, and forceful activities independently of each other showed significant associations with medial epicondylitis. Epicondylitis is relatively common among working-age individuals in the general population. Physical load factors, smoking, and obesity are strong determinants of epicondylitis.

Adult↗
PubMedDate not supplied

O-specific side-chain toxin-protein conjugates as parenteral vaccines for the prevention of shigellosis and related diseases.

Only indirect evidence has been cited to document that lipopolysaccharide-mediated virulence at the bacterial level and serum antibodies to the O-specific side chain of the lipopolysaccharide molecule may prevent shigellosis. Our proposed use of the B subunit of Shiga toxin as a carrier protein is based upon evidence (even more indirect) that serum antitoxin may reduce the severity of dysentery and diarrhea. Because animal models of disease may provide information inapplicable to the prediction of vaccine-induced protective immunity, we suggest that clinical trials in the population at risk should be started after successful completion of the safety and immunogenicity phases of vaccine development in laboratory animals and in the target population. Clinical studies of shigella vaccines are difficult because of the many causes of dysentery in a population with a high rate of intestinal disease.

Animals↗
PubMed2006

Incorporating known sources of uncertainty to determine precautionary harvests of saltwater crocodiles.

It has been demonstrated repeatedly that the degree to which regulation operates and the magnitude of environmental variation in an exploited population will together dictate the type of sustainable harvest achievable. Yet typically, harvest models fail to incorporate uncertainty in the underlying dynamics of the target population by assuming a particular (unknown) form of endogenous control. We use a novel approach to estimate the sustainable yield of saltwater crocodile (Crocodylus porosus) populations from major river systems in the Northern Territory, Australia, as an example of a system with high uncertainty. We used multimodel inference to incorporate three levels of uncertainty in yield estimation: (1) uncertainty in the choice of the underlying model(s) used to describe population dynamics, (2) the error associated with the precision and bias of model parameter estimation, and (3) environmental fluctuation (process error). We demonstrate varying strength of evidence for density regulation (1.3-96.7%) for crocodiles among 19 river systems by applying a continuum of five dynamical models (density-independent with and without drift and three alternative density-dependent models) to time series of density estimates. Evidence for density dependence increased with the number of yearly transitions over which each river system was monitored. Deterministic proportional maximum sustainable yield (PMSY) models varied widely among river systems (0.042-0.611), and there was strong evidence for an increasing PMSY as support for density dependence rose. However, there was also a large discrepancy between PMSY values and those produced by the full stochastic simulation projection incorporating all forms of uncertainty, which can be explained by the contribution of process error to estimates of sustainable harvest. We also determined that a fixed-quota harvest strategy (up to 0.2K, where K is the carrying capacity) reduces population size much more rapidly than proportional harvest (the latter strategy requiring temporal monitoring of population size to adjust harvest quotas) and greatly inflates the risk of resource depletion. Using an iconic species recovering from recent extreme overexploitation to examine the potential for renewed sustainable harvest, we have demonstrated that incorporating major forms of uncertainty into a single quantitative framework provides a robust approach to modeling the dynamics of exploited populations.

Alligators and Crocodiles↗
PubMed2001

Molecular biology of pancreatic cancer: potential clinical implications.

The development of cancer involves the accumulation of genetic changes. Over the past decade there has a been spectacular advance in the knowledge of the genetic basis of cancer, mainly as a result of the rapid progression of molecular technology. Pancreatic cancer is one of the most lethal cancers. Conventional therapeutic approaches have not had much impact on the course of this aggressive neoplasm. Knowledge of the molecular biology of pancreatic cancer has grown rapidly. Genetic alterations in pancreatic cancer include oncogene mutations (most commonly K-ras mutations), and tumour suppressor gene alterations (mainly p53, p16, DCC, etc.). These advances have potential implications for the management of this deadly disease. Identification of a hereditary genetic predisposition to pancreatic cancer has led to the formation of pancreatic cancer registries around the world, with voluntary screening of patients and siblings for the hereditary genetic defect. Asymptomatic population screening remains unrealistic, but the recognition of subpopulations at increased risk from pancreatic cancer, along with novel and sensitive detection techniques, means that targeted population screening is a step closer. Intensive research is performed in specialist laboratories to improve the diagnostic approach in patients with pancreatic cancer. The use of such molecular diagnostic methods is likely to expand. Molecular biology may also have a great impact on the treatment of pancreatic cancer, and many therapeutic approaches are being evaluated in clinical trials, including gene replacement therapy, genetic prodrug activation therapy, antisense immunology and peptide technology. The 'molecular age' has the promise of delivering still better results. This review summarises recent data relating to the molecular biology of pancreatic cancer, with emphasis on features that may be of clinical significance for diagnosis and/or therapy.

Genes, Tumor Suppressor↗
PubMedDate not supplied

Study of impact of nutrition & health day strategy on the coverage rates of supplementary nutrition and health interventions among the ICDS beneficiaries in a rural block of Madhya Pradesh.

To study the trends of beneficiary coverage (pregnant and lactating women and children less than two years of age) for utilization of supplementary nutrition and health services in a rural block before and after the launch of a strategy to converge Health & Integrated Child Development Services (ICDS) on a single day christened "Nutrition and Health Day" (NHD). It is a before and after intervention design in rural ICDS block Amarwada in district Chhindwada. As a part of intervention, NHD were organised on which convergent services of Health & ICDS were made available to the beneficiaries. On the weekly NHDs, uncooked supplementary nutrition for the week was distributed to pregnant and lactating mothers and children under two. The Health worker visited the Anganwadi Centre (AWC) and immunized children and pregnant women, distributed IFA, Vitamin A and provided health and nutrition education. The study assessed the impact of these interventions on the coverage rates of the services. Study was conducted between May 97 and March 98. The routine monitoring reports of the ICDS and Health System of the state government were used as study tools. The study sample comprised of AWC beneficiaries in the project area. The total population of the block was 89,476. Participation in the supplementary nutrition program (SNP) increased two to three folds in all categories of the target population. Immunization and Vitamin A coverage levels for children also showed an increase of about 3 and 5-8 times from baseline status respectively in a year's time. Among pregnant women, Tetanus Toxoid (TT) and Iron and Folic Acid (IFA) utilization rates have also shown two and five fold increase respectively.

Adolescent↗
PubMed1997

Action of thrombopoietin at the megakaryocyte progenitor level is critical for the subsequent proplatelet production.

Formation of proplatelets from megakaryocytes is believed to be the first step of platelet production in vitro. In this study, we evaluated the effects of recombinant human thrombopoietin (hTPO) on the development of proplatelets from a GpIIb/IIIa+ population of rat bone marrow cells highly enriched for late megakaryocyte progenitors (GpIIb/IIIa+ CFU-MK) that we recently found to be a primary target population of TPO. Quantitative measurement of hTPO-induced proplatelet formation was performed in liquid cultures. Proplatelet formation from megakaryocytes derived from GpIIb/IIIa+ CFU-MK in the presence of hTPO began on day 4 of culture and peaked the following day. On day 5 of culture, lower concentrations of hTPO expanded the number of megakaryocytes, increased the number of proplatelets and the percentage of proplatelet-developing megakaryocytes. Increasing hTPO concentrations resulted in a modest decrease in proplatelet development. We next used hTPO to derive immature or mature megakaryocytes from GpIIb/IIIa+ CFU-MK. These populations of cultured megakaryocytes spontaneously formed proplatelets when recultured in the absence of exogenous hTPO. The addition of hTPO at higher concentrations modestly augmented proplatelet production from immature megakaryocytes derived from 2-day liquid cultures. However, either murine interleukin-6 (IL-6) or human IL-11, but not rat IL-3, was more potent than hTPO in augmenting proplatelet formation from immature megakaryocytes. Each of these four cytokines had an inhibitory effect on proplatelet formation from more differentiated megakaryocytes derived from 3-day liquid cultures. These results indicate that TPO enhances proplatelet production primarily by stimulating CFU-MK to increase the number of proplatelet-forming megakaryocytes and that its action is clearly different from those of other cytokines that also stimulate megakaryocytopoiesis.

Animals↗
PubMed1999

The "Let's Get Alarmed!" initiative: a smoke alarm giveaway programme.

OBJECTIVES: To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households. SETTING: The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership. The target population included low income and rental households and households with elderly persons or young children. METHODS: Forty wards, averaging 4000 households each, were randomised to intervention or control status. Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods. Recipients provided data on household age distribution and housing tenure. Programme costs were documented from a societal perspective. Data are being collected on smoke alarm ownership and function, and on fires and related injuries and their costs. RESULTS: Community and paid workers distributed 20,050 smoke alarms, potentially sufficient to increase smoke alarm ownership by 50% in intervention wards. Compared with the total study population, recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older. Total programme costs were 145,087 Pounds. CONCLUSIONS: It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated, multicultural, materially deprived community. The programme's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries, and its cost effectiveness, are being evaluated as a randomized controlled trial.

Adolescent↗
PubMed2005

Is polygyny a risk factor for poor growth performance among Tanzanian agropastoralists?

Anthropologists and demographers have devoted considerable attention to testing the fertility-polygyny hypothesis, which posits that polygynously married women have lower fertility than their monogamously married counterparts. Much less attention has been paid to the potential impact of polygynous marriages on the health and well-being of children. The objective of this paper was to assess whether polygynous marital status is a risk factor for poor nutritional status and growth performance among a cohort of young Tanzanian children. Using data collected from both wet and dry season periods, we tested for an association from both cross-sectional and longitudinal perspectives. Despite relatively high nutritional status compared to other agropastoralists and horticultural populations, as well as the presence of various socioecological factors that were expected to mitigate any "costs" to polygynous marriage, we found that among our target population, polygynous marital status is a risk factor for poor growth performance. This association is most pronounced in the wet season, and maintains even after allowing for the potential influences of child age and sex, and household characteristics. These results counter our original expectation, and suggest that polygyny is costly to children in this population; this does not appear to be the result of difference in early child environment or household wealth.

Age Factors↗
PubMed2004

Projecting mental disorder prevalence from national surveys to populations-of-interest--an illustration using ECA data and the U. S. Army.

BACKGROUND: Psychiatric epidemiology can further public health practice and inform mental health policy through the development of methodologies that provide rapid and cost efficient estimation of the prevalence of mental disorders at the local, regional, and population levels. OBJECTIVE: The aim of this study was to illustrate an efficient method for the estimation of mental disorder prevalence in population groups where no direct prevalence data are available. This study demonstrated a new method to extrapolate prevalences from a national calibration survey to a target population where no observations are available and sociodemographic differences are prominent. METHOD: We restricted the ECA sample to full-time employed participants (approximately 10,500) and used the total active duty U. S. Army population (approximately 460,000) for illustration. Sociodemographic data for the Army came from the official military database (mid-year 2000). Our logistic regression projections represented an extension of sociodemographic-driven synthetic methods used among demographers. Outcomes were lifetime prevalences for 13 DIS/DSM disorders. RESULTS: Compared to the ECA employed population, extrapolations to the Army revealed lower/similar estimates for nine of 13 DIS/DSM disorders. Projections were twice as high for alcohol abuse/dependence and antisocial personality, and one-third higher for social phobia and schizophrenia in the Army. Estimates compared favorably to one other military prevalence study, and to results derived using traditional standardization/adjustment methods based on the ECA sample weighted to the working general population. CONCLUSIONS: The synthetic estimation technique using ECA data to project lifetime prevalences for the U. S. Army generated sound estimates while illustrating an attractive method to extrapolate national data to demographically diverse communities seeking policy-relevant data.

Adult↗
PubMed2006

Epidermal stem cells and cancer stem cells: insights into cancer and potential therapeutic strategies.

Epithelial keratinocyte regeneration has been exemplified as dependent on a population of cellular progenitors that have retained developmental pluripotency, a latent capacity for proliferation and differentiation with a prolonged lifespan. Recent evidence suggests that the cell populations that regulate the development of normal tissues, and which play vital roles in maintaining the overall homeostasis of the tissue, might be the key target population that is essential for malignant cancer development, thus giving rise to the notion of 'cancer stem cells'. This review examines the leading research into the relationship between adult stem cells in human skin marked by p63alphaDeltaN, their putative importance in cancer development, and how we might exploit our evolving knowledge of adult tissue stem cells to aid cancer treatments in the future. Furthermore, the review examines information regarding ataxia telangiectasia mutated (ATM) kinase and key regulatory events that take place on p53, only within putative keratinocyte stem cells that are transcriptionally regulated by p63alphaDeltaN.

Cell Proliferation↗
PubMedDate not supplied

[Prevalence of urinary incontinence in the population aged more than 64 years in Galicia, Spain].

OBJECTIVE: To determine the prevalence of urinary incontinence in the Galician population aged more than 64 years. METHODS: We performed a descriptive study, based on a personal interview with each individual from a sample of the target population. The sample was obtained through random sampling stratified into urban, semi-urban and rural of the Autonomous Community of Galicia. Subsequently, a random sample was extracted from the database of the individual health cards of selected localities. A total of 350 interviews in 12 sampling locations were performed. RESULTS: The prevalence of urinary incontinence in Galicia in 2002 was 35.14% (95% CI: 31-38%, 15-28 for men and 38-51% for women). CONCLUSIONS: One out of three Galicians aged more than 64 years presents urinary incontinence. The prevalence is almost double in women.

Aged↗
PubMed2003

Antiproliferative coatings for the treatment of coronary heart disease:. what are the targets and which are the tools?

Since the advent of percutaneous coronary intervention (PCI) for stenosing coronary disease, restenosis has remained a clinical problem. Despite the emergence and evolution of coronary stents, the rate of restenosis following PCI is still 10-20%, and above 50% in high risk subgroups. With increased understanding of the pathophysiology of this process, a number of potential therapeutic targets have been identified, allowing the development of novel therapies against restenosis, which can now be delivered locally using stent platforms. Some of the reported clinical trial data utilizing drug-eluting stents (DES) have produced such profound reductions in clinical and angiographic restenosis that we have been tempted to believe we are on the brink of eradicating this process completely. As the initial excitement subsides, however, there is a need to decide whether these tools will remain effective in real-world interventional practice. In this article we review the pathophysiology of the restenotic process, and the biological targets of the DES therapies currently available in clinical practice. We attempt to define clinical target populations for DES therapy, and assess the impact on outcomes thus far. We consider the advantages that newly emergent stent coatings might offer, and whether targeting specific patient subgroups with unique antiproliferative agents may provide the best chance of limiting restenosis in high risk subgroups. Finally, we consider future strategies to prevent restenosis, with a movement away from the antiproliferative approach, and toward accelerating endothelialization.

Antibiotics, Antineoplastic↗
PubMed1990

Childhood morbidity and adulthood ill health.

STUDY OBJECTIVE: The aim of the study was to investigate the relationship between the state of health in childhood and ill health in early adult life. DESIGN: The study used data collected as part of the National Child Development Study and related health at 7 years of age to that at 23. A wide range of information on child health in the cohort was available, which was used to construct a broader measure of health status than selected diagnostic categories. SETTING: The survey population was nationwide. PARTICIPANTS: The study population included all children born in the week 3-9 March 1958. They were followed up at 7, 11, 16, and 23 years. Of the target population of 17,733 births, 12,537 (76%) were retraced and interviewed at 23. MEASUREMENTS AND MAIN RESULTS: Children at age 7 were allocated to 13 morbidity groups; 20% of children had reported no ill-health apart from the common infectious diseases, but 10% were included in four or more of the morbidity groups. Children with no reported morbidity retained their health advantage into early adulthood: ratios of observed to expected ill health for four of the five indices examined at age 23 were all significantly below one (self rated health 0.81, asthma and/or wheezy bronchitis 0.63, allergies 0.79, emotional health 0.75). Children with more morbidity at age 7 had higher ratios of ill health in adulthood. A chronic condition in childhood was associated not only with excess morbidity in the short term but also with a poor health rating in early adult life (ratio = 1.38). Morbidity was significantly increased for most of the adulthood indices among children with asthma and/or wheezy bronchitis. However most ill health in young adulthood occurred in study members with a relatively healthy childhood. CONCLUSIONS: Although the state of health in childhood has long term implications, it does not form a substantial contribution to ill health in early adult life.

Acute Disease↗
PubMedDate not supplied

[Coverage and immune response to hepatitis B vaccine in adolescents of the Guadalajara province].

BACKGROUND: Hepatitis B comprises one of the major health problems worldwide. One of the measures for the prevention thereof is the massive vaccination of adolescents. The purpose of our study is that of assessing the degree of coverage of the systematic hepatitis B prevention campaign among the 8th-grade population in the province of Guadalajara in addition to studying the immune response of said population, relating said response to other variables. METHODS: Cross-sectional study. The degree of coverage of the vaccination campaign was studied throughout the entire target population in the province in question. For the study of the immune response, a sample of 338 students was taken by systematic random sampling. The titres of anti-HB's were quantified 6 months following the third dosage, levels of 10 mU/ml or above being considered as being levels providing protection. RESULTS: The percentage of students properly vaccinated totaled 82.7%. The overall serum protection rate was 97.5%, and 46.7% of the sample responded showing titres of over 100 mU/ml. A statistically significant inverse relationship (p < 0.001) existed between the level of anti-HB's and the Quetelet level, we not having found any significant differences between the two sexes on comparing the postvaccination titres of anti-HB's. CONCLUSIONS: We consider the degree of coverage provided to be satisfactory and the immunogenic aspect of the vaccine to be good. Obesity is a factor providing a prior indication of a minor response to the same. This response is not influenced by the subject's sex.

Adolescent↗
PubMed2005

A cost-effectiveness analysis of combination antiplatelet therapy for high-risk acute coronary syndromes: clopidogrel plus aspirin versus aspirin alone.

BACKGROUND: Although clopidogrel plus aspirin is more effective than aspirin alone in preventing subsequent vascular events in patients with unstable angina, the cost-effectiveness of this combination has yet to be examined in this high-risk population. OBJECTIVE: To determine the cost-effectiveness of clopidogrel plus aspirin compared with aspirin alone. DESIGN: Cost-utility analysis. DATA SOURCES: Published literature. TARGET POPULATION: Patients with unstable angina and electrocardiographic changes or non-Q-wave myocardial infarction. time horizon: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: Combination therapy with clopidogrel, 75 mg/d, plus aspirin, 325 mg/d, for 1 year, followed by aspirin monotherapy, was compared with lifelong aspirin therapy, 325 mg/d. OUTCOME MEASURES: Lifetime costs, life expectancy in quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. RESULTS OF BASE-CASE ANALYSIS: Patients treated with aspirin alone lived 9.51 QALYs after their initial event and incurred expenses of 127,700 dollars; the addition of clopidogrel increased life expectancy to 9.61 QALYs and costs to 129,300 dollars. The incremental cost-effectiveness ratio for clopidogrel plus aspirin compared with aspirin alone was 15,400 dollars per QALY. RESULTS OF SENSITIVITY ANALYSES: The analysis of 1 year of therapy was robust to all sensitivity analyses. In the probabilistic sensitivity analysis, fewer than 3% of simulations resulted in cost-effectiveness ratios over 50,000 dollars per QALY. The cost-effectiveness of longer combination therapy depends critically on the balance of thrombotic event rates, durable efficacy, and the increased bleeding rate in patients taking clopidogrel. LIMITATIONS: This analysis may not apply to patients with severe heart failure, those undergoing long-term anticoagulant therapy, those recently managed with revascularization, or those undergoing short-term treatment with glycoprotein IIb/IIIa inhibitors. CONCLUSIONS: In patients with high-risk acute coronary syndromes, 1 year of therapy with clopidogrel plus aspirin results in greater life expectancy than aspirin alone, at a cost within the traditional limits of cost-effectiveness. The durable efficacy of clopidogrel relative to the risk for hemorrhage should be further explored before more protracted therapy can be recommended.

Angina, Unstable↗