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PubMedDate not supplied

Risk factors for acute myocardial infarction in a rural population of central India: a hospital-based case-control study.

BACKGROUND: There is a paucity of data on the relative importance of various traditional risk factors for coronary artery disease among rural Indians. We conducted a prospective case-control study to determine the risk factors for acute myocardial infarction in a rural population of central India. METHODS: We recruited 111 consecutive patients admitted to our hospital with a first episode of acute myocardial infarction and 222 age- and sex-matched controls. Demographics, anthropometric measures, lipids, blood glucose, smoking and other lifestyle factors were compared among cases and controls. Multivariate analyses were used to identify the risk factors independently associated with acute myocardial infarction. RESULTS: Elevated fasting blood glucose (odds ratio [OR] 8.9; 95% confidence interval [CI] 4.5, 17.9), abnormal waist-hip ratio (OR 3.0; 95% CI 1.7, 5.4) and income (OR 4.0 and 5.9 for the high- and middle-income categories, compared to the lowest category) were independently associated with the first episode of acute myocardial infarction. Abnormal triglycerides (OR 1.7; 95% CI 0.9, 3.1) and current smoking (OR 1.9; 95% CI 0.9, 4.0) were risk factors but were not statistically significant. CONCLUSION: Reduction in blood glucose levels and truncal obesity may be important in controlling the burden of coronary artery disease in rural Indians.

Acute Disease↗
PubMed1993

Tutorial: using Microsoft Excel for health care CQI.

The transition from QA to CQI in health care calls for decentralized data collection and analysis in conjunction with the use of personal computers to support CQI team activities. In this article, we discuss recent advances in PC software and hardware technology that make possible revolutionary changes in health care quality data management. We also present detailed examples of how to use Microsoft Excel 4.0 as a single software platform to support commonly used CQI tools and analyses.

Computer Graphics↗
PubMedDate not supplied

An evidence-based curriculum to prepare students for global nursing practice.

This article describes a curriculum designed to prepare nurses for global public health practice. Designed to be adapted to meet the needs of either undergraduate or graduate students, the curriculum uses the Internet to provide the knowledge and skills needed by nurses to effectively practice in areas around the globe. This course offering integrates the disciplines of nursing and public health with state-of-the-art technology to teach nurses how to identify the health care needs of populations, prioritize national and international responses, and design health care delivery services to meet these needs.

Communicable Diseases, Emerging↗
PubMed2002

Modelling the costs and effects of leflunomide in rheumatoid arthritis.

This study investigated the cost-effectiveness of leflunomide (LEF) compared to methotrexate (MTX) and sulfasalazine (SSZ) in the United Kingdom. A Markov model was constructed using health states defined by Health Assessment Questionnaire score. The model is based on a cohort of patients with recently diagnosed definite RA who were followed for up to 15 years at nine rheumatology clinics in the UK. The treatment effect was calculated based on clinical trials comparing LEF to MTX (one international and one United States trial) and to SSZ (one international trial). Transitions between health states for the first 2 years of treatment were calculated from the clinical trials, while the extrapolation beyond the trial was based on the Early Rheumatoid Arthritis Study cohort, using an ordered probit model. This makes it possible to predict transitions for patients with similar characteristics (age, time since disease onset) as in the trials. Separate analyses were performed for each trial, and all analyses covered a 10-year timeframe. Using the US trial, LEF had slightly lower costs and better effects (44,017 and 4.307 pounds QALYs, compared to 44,988 and 4.158 pounds QALYs for MTX), while for the international trial this was reversed (34,070 and 4.487 pounds QALYs for MTX compared to 36,351 and 4.372 pounds QALYs for LEF). Compared to SSZ, the cost of using LEF was slightly lower, with an increase in QALYs (35,855 and 3.896 pounds QALYs compared to 36,731 and 3.721 pounds QALYs for SSZ). The two trials comparing LEF to MTX gave differing results. One possible reason for this is that MTX patients in the US trial were given folic acid, whereas in the international trial folate supplementation was not mandated. This may have reduced the effectiveness of MTX. In the UK it is standard practice to use folic acid with MTX, and therefore the results from the US trial may be more relevant for the UK. Compared to SSZ, the use of LEF appears to be cost-effective in the UK.

Journal Article↗
PubMed2002

Inequalities in the transition of cerebrovascular disease mortality in New South Wales, Australia 1969-1996.

With reference to epidemiological transition theory, this paper examines change in cerebrovascular disease mortality in Australia's most populous state in the 28 year period, 1969-1996. The hypotheses were that in the context of overall stroke mortality decline over the period, marital status, occupational status and spatial differences decreased. However, while overall mortality declined, differentials increased. The reasons for this are considered, with particular implications for epidemiological transition theory and for the targeting of populations at risk in policy terms.

Adult↗
PubMed2001

Developing sustainable studies on environmental health.

Toxicogenetics, toxicogenomics and proteomics are providing new biomarkers for use in human studies. These, coupled with the more traditional biological responses currently in use, provide a vast armamentarium for assessing exposures, effects and susceptibility factors relating to environmental pollutants. Biomarker availability, however, does not automatically translate to usefulness for studies directed at human health improvement. Transitional studies bridging the gap between laboratory and field, with the biomarker as dependent variable, are required for validation for intended applications. Prospective or cross-sectional studies are usually optimal for validating biomarkers of exposure, where the biomarker response follows the event (exposure) and the entire study population is affected. Biomarkers of effect, where the event (outcome) follows the biomarker response and may be infrequent in the study population, present more complex problems. Identification of genotypes as susceptibility factors requires that additional issues be addressed. Despite these difficulties, new data are emerging from transitional investigations that are providing validated biomarkers for sustainable human studies. It is now possible to envision schemes for integrating the results of molecular epidemiological investigations into the general toxicological evaluations of environmental agents. These will allow intermediate endpoints to be used for making realistic human health assessments and for elucidating pathogenic mechanisms that identify targets for intervention, all with the goal of preventing environmentally mediated human disease. Finally, select biomarker responses that predict the likelihood of disease occurrence will find application in the interpretation of individual medical diagnostic tests, with the goal of improving cancer detection and management.

Animals↗
PubMed2000

Transforming the exhausting to energizing process of being a good parent in the face of cancer.

The aim in this study was to gain a deeper understanding of the interaction between women who have been treated for breast cancer and their children. The focus was on how they deal with being a mother at the same time attending to their own needs. The main strategies of the grounded theory method were used to conceptualize the interactive process involved. Nine women, with children aged 4 to 23, living at home at the time of diagnosis, were interviewed. By the process of constant comparative analysis, the main theme that seemed to capture how the lives of these women had changed was transforming the exhausting-to-energizing process in being a good parent in the face of cancer. This theme is related to Meleis's concept of health-illness transition. The findings here indicate the need for family counseling, with special attention paid to the single parent with cancer.

Adult↗
PubMed1998

Demography and epidemiology of dying in the U.S. with emphasis on deaths of older persons.

As chronic disease continues to be the major cause of death and as the elderly population grows, it is important to evaluate the adequacy and completeness of health care strategies for the elderly. Two studies, the National Mortality Followback Survey and the National Institute on Aging Survey of the Last Days of Life, were designed to examine the circumstances of death for representative samples of decedents. Four areas of focus are location of death, transitions among health care settings, circumstances at the time of death, and changes in physical and cognitive function in the last year of life. Although the data are helpful for family planning, they are limited by a lack of data on costs.

Activities of Daily Living↗
PubMed2006

Educate, communicate, anticipate-practical recommendations for transitioning adolescents with IBD to adult health care.

The cyclical nature of chronic illness requires that children with inflammatory bowel disease be transitioned to the adult medical system with as much continuity of care as possible. Transition from pediatric to adult medical care continues to present significant barriers. The philosophy of transition centers on a process, with the actual transfer to adult care as a point along this clinical pathway. Concrete steps can be taken to help patients prepare for new responsibilities. The aim of this review is to propose a clinical and developmental timeline for both patients and their medical team, including specific responsibilities for both, so that the partnership can best promote a successful transition.

Adolescent↗
PubMed1999

Transitions between routes of heroin administration: a study of Caucasian and Indochinese heroin users in south-western Sydney, Australia.

AIM: To examine patterns and correlates of routes of heroin use among Caucasian and Indochinese heroin users. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: Two hundred heroin users resident in South West Sydney. The sample was divided between Caucasian and Indochinese users (each n = 100), with half of each group on methadone maintenance. MEASUREMENTS: A semi-structured interview was administered, based on previous studies of transitions between routes of administration. Measures included patterns of drug use, transitions, social, health and legal issues and cultural correlates of use. FINDINGS: Almost two-thirds (61%) had smoked heroin. Smoking was more common among the Indochinese (40% were predominantly or exclusively smokers), although injecting was the dominant route for both groups. More than one-quarter (29%) had made a transition from smoking to injecting, primarily due to drug effect and perceived cost-effectiveness. Reverse transitions were rare. Smoking appeared to be more culturally acceptable than injecting among Indochinese users. Among both groups, there was a small but significant risk for the transmission of HIV and other blood-borne viruses. Polydrug use and age were positively associated with having experienced a non-fatal overdose. CONCLUSIONS: This research documents the existence of smoking as a popular route of administration among both Indochinese and Caucasian heroin users in the study sample. There is an urgent need to provide smokers and injectors with information explaining the potential risks and ways to minimize harms associated with both routes of use.

Adult↗
PubMed2005

A life course approach to chronic disease epidemiology.

A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular way that time and timing in relation to physical growth, reproduction, infection, social mobility, and behavioral transitions, etc., influence various adult chronic diseases in different ways, and more ambitiously, by how these temporal processes are interconnected and manifested in population-level disease trends. In this review, we discuss some historical background to life course epidemiology and theoretical models of life course processes, and we review some of the empirical evidence linking life course processes to coronary heart disease, hemorrhagic stroke, type II diabetes, breast cancer, and chronic obstructive pulmonary disease. We also underscore that a life course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.

Age Distribution↗
PubMed2004

Body size and ethnicity are associated with menstrual cycle alterations in women in the early menopausal transition: The Study of Women's Health across the Nation (SWAN) Daily Hormone Study.

The dynamics of reproductive hormones that characterize the menopausal transition (perimenopause) are incompletely understood, particularly in non-Caucasian women. The Study of Women's Health across the Nation (SWAN) is a multiethnic cohort study of 3302 women at seven sites who were aged 42-52 yr at baseline. All participants are seen annually to assess a variety of endpoints. A subcohort of 848 women undergoes further investigation of their daily patterns of reproductive hormones in the Daily Hormone Study (DHS). DHS enrollees annually complete a daily collection of first morning voided urine for an entire menstrual cycle or up to 50 d (whichever comes first). Chemiluminescent assays measured urinary LH and FSH, as well as metabolites of estradiol [estrone conjugates (E1c)] and progesterone [pregnanediol glucuronide (Pdg)]. Cycles were assessed for evidence of luteal activity and day of luteal transition using previously developed algorithms. Midreproductive-aged women who underwent similar daily urinary analyses served as historical controls. Correlates of cycle features were identified. Eight hundred thirty-three cycles were evaluable and had complete data on covariates. Six hundred seventy-four (80.9%) cycles had evidence of luteal activity, and 159 (19.1%) did not. Women who were at least 49 yr old were less likely to have cycles with luteal activity and had more variable cycle length, higher total-cycle FSH, and lower total-cycle Pdg. Compared with heavier women, those with body mass index less than 25 kg/m2 had shorter cycles and higher total-cycle LH, FSH, and Pdg but not E1c. Chinese- and Japanese-American women had overall lower adjusted total-cycle E1c excretion. Smoking was not significantly associated with cycle length or hormones. When compared with cycles of younger control women, the cycles of the SWAN DHS participants had higher gonadotropins, lower total integrated Pdg, and E1c levels that were not different, which suggests that the ovary retains sensitivity to elevated FSH in the early menopausal transition. In this cross-sectional study of women over age 42 who are premenopausal or in the early menopausal transition, there were important differences in the characteristics of cycles related to age, body mass index, and ethnicity. Comparisons to younger women indirectly support the inhibin hypothesis, which proposes that the initiating event in the menopausal transition is the loss of inhibin negative feedback on FSH secondary to a diminished follicular reserve.

Adult↗
PubMed2002

ED utilization: the effect of changing demographics from 1992 to 2000.

To explore factors contributing to increased emergency department (ED) utilization, this retrospective chart review compared ED visits for a 2-week period in both 1992 and 2000 at a rural, tertiary medical center. Total ED visits increased 455 between the periods (% increase = 28.6%), whereas county population increased 18,253 (% increase = 16.1%) (P < 0.005). Average age increased from 35.2 +/- 23.8 years to 40.1 +/- 23.6 years (95% confidence interval, difference of means, 3.34 to 6.45). Patients over 80 years increased by 83%, whereas those over 90 years increased 138%. The admission rate, increased from 21.9% to 25.6% (P < 0.005). Patients with Medicare as primary insurance increased from 17.9% to 23.6% (P < 0.005). Increased age of the population, increased acuity as shown by 4 different measurements, and limited access to primary care physicians all contributed to increased ED demand in this study.

Adolescent↗
PubMed2002

Transitions in the concept of chronic pain.

Chronic pain is a worldwide problem with significant physical, psychological, and social impacts. Despite its prevalence and cost, the phenomenon is not well understood. An inductive method of concept analysis was used to study the concept of chronic, non-cancerous pain in adults. A random sample of nursing, psychology, and neurophysiology literature published over a 30-year period (1969 through 1999) was used to generate a consensual definition of chronic pain. The transition in the attributes, antecedents, consequences, related concepts, and surrogate terms of chronic pain is described, and the implications of the findings for practice and research are discussed.

Adaptation, Psychological↗
PubMed2006

Stress and social change in Poland.

The paper reports the findings of qualitative research carried out in Nowa Huta-Kraków, which sought to explore the influences perceived to contribute to the experience of stress. Stress was seen as the main danger to health in transition, and as such a socially produced phenomenon linked to the lack of security of employment and low income, as well as to changing social relations, where social inequalities were increasing, and the enrichment of some was seen to be occurring at society's expense. The paper outlines a framework for conceptualising psychosocial health influences, where these are represented in terms specific to social space/time, indicating the implications of the findings for public health discourse.

Aged↗
PubMed2003

Non-communicable diseases, political economy, and culture in Africa: anthropological applications in an emerging pandemic.

So-called 'diseases of lifestyle' are playing a major role in epidemiological transitions in many developing countries. Stratifying, urbanizing, and ageing African populations face rising levels of non-communicable diseases (NCDs). This article examines the need for anthropological perspectives on the causes, prevention, and control of NCDs, such as diabetes and hypertension, in Africa. Anthropologists have been silent on these topics in African public health for a decade or more. Community-oriented field studies on structural and socio-cultural aspects of NCDs are urgently needed. There can be little doubt of the benefits to be gained from a multi-disciplinary approach to NCD study and intervention for developing countries. However, key institutions setting the research agenda are doing so without the input of anthropologists or social epidemiologists, and without an emphasis on social science capacity strengthening in African countries.

Africa↗
PubMed2002

Nutrition transition in India.

OBJECTIVE: The primary objective of this review is to examine the demographic and nutrition transition in India in relation to its contribution to the emerging epidemic of chronic non-communicable diseases in this country. SETTING: India, the country as a whole and its different states with a population exceeding 1 billion in 2001. SUBJECTS: The review examines demographic changes in the population with consequent effects on the population pyramid, the rapidity and rates of urbanisation with striking variations in chronic disease patterns and the trends in obesity between rural and urban communities, attempting to relate their prevalence with the diet and lifestyle changes accompanying them. DESIGN: The review is based largely on representative large-scale surveys in the country and other reliable documented data on population characteristics. It also includes a review of the published literature. RESULTS: The results indicate that the demographic changes, rates of urbanisation and changes in dietary patterns are contributing to the changing trends in chronic disease in India. CONCLUSIONS: There is clear evidence of a demographic, epidemiological and nutrition transition in India that is fuelling the epidemic of chronic diseases and obesity, particularly in the urban areas.

Adolescent↗