Women and the media in South Asia.
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BACKGROUND: There is much interest in promoting healthy heart awareness among women. However, little is known about the reasons behind the lower rates of heart disease among women compared with men, and why this risk difference diminishes with age. Previous comparative studies have generally had insufficient numbers of women to quantify such differences reliably. METHODS: We carried out an individual participant data meta-analysis of 39 cohort studies (32 from Asian countries and 7 from Australia and New Zealand). Cox models were used to estimate hazard ratios (HR) for coronary death, comparing men to women. Further adjustments were made for several proven coronary risk factors to quantify their contributions to the sex differential. Sex interactions were tested for the same risk factors. RESULTS: During 4 million person-years of follow-up, there were 1989 (926 female) deaths from coronary heart disease (CHD). The age-adjusted and study-adjusted male/female HR (95% confidence interval [95% CI]) was 2.05 (1.89-2.22). At baseline, 54% of men vs. 7% of women were current smokers; hence, adjustment for smoking explained the largest component (20%) of this HR. A significant sex interaction was observed between systolic blood pressure (SBP) and CHD mortality such that a 10 mm Hg increase was associated with a 15% greater increase in the relative risk (RR) of coronary death in women compared with men (p = 0.002). CONCLUSIONS: Only a small amount of the sex differential in coronary death could be explained by differences in the prevalence of classic risk factors. Alternative explanations are required to explain the age-related attenuation of the sex difference in CHD risk.
The problems and prospects in the use of case-control studies to assess the effects of improvements in environmental sanitation on diarrhoea morbidity are discussed on the basis of two field studies. It is concluded that an adequate design is available for assessing the effects of a single improvement on diarrhoeal disease. The estimates of effect appear to be valid and sufficiently precise. For addressing more complex questions of interactions, sample sizes would have to be increased substantially. The experience with two field studies suggests that there is hope that a simpler protocol may be feasible, in which only limited information is collected, in which few home visits are made, and in which analytical techniques are simple. Until more field studies have been conducted definitive conclusions cannot be reached on the applicability of such a simple, rapid and inexpensive approach.
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Screening by culture of endocervical specimens revealed four cases of gonorrhea among 744 pregnant women attending the prenatal clinic at the University Hospital in Kuala Lumpur, Malaysia. The observed prevalence of gonorrhea (0.54%) in pregnant women is similar to that in Great Britain (0.2-0.7%), but lower than the prevalences reported for North America (2.5-7.5%) and Thailand (11.9%). The results indicate that routine screening of pregnant women attending prenatal clinics in Malaysia would aid in the control of gonorrhea in that country.
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Mental illnesses and mental health have, out of ignorance and fear, evoked a low priority in healthcare systems the world over. The concept that all mental illnesses were synonymous with madness has its origins in the beginnings of ignorance and fear. To a large extent, these have contributed to the marginalization of psychiatry and neglect of the mentally ill. The kings of old, seeing the ill-treatment of the mentally ill, built asylums for them, but again, the prejudice soon was overwhelming and care of the mentally ill was often given to those who were not the best administrators and carers. The long and controversial tradition of mental asylum care for the mentally ill was also brought about by the lack of specific treatments for mental illnesses. With the advent of chlorpromazine in the 1950s and other psychotropics afterwards, the need for incarceration in asylums became largely redundant. However, what also became obvious soon after was the fact that the psychotropics only helped to control symptoms and not to cure diseases of the mind. Although considerable research has gone into attempts at correcting supposed defects in neurotransmission, the cure of mental illness seems some way off. The need for rehabilitating or re-housing those with mental illnesses especially those needing long-term care and those whose cure seems difficult has been recognized for a long time. It was Phillipe Pinel who almost 200 years ago unchained the mental patients at an asylum in Paris and proposed work therapy and humane care. Psychosocial rehabilitation of the mentally ill is not, therefore, a new concept. The need for methods of changing the behavior, thinking and functioning of those with severe mental illnesses using psychological, social, occupational, behavioral and medical methods is called psychosocial rehabilitation. This method, although developed in stages over the past two centuries, has undergone changes and deterioration and development in different parts of the world with different priorities and emphasis.
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As a result of successful efforts to reduce fertility and mortality, East Asian populations are beginning to age, in some cases rapidly. Policies in response to population aging range from attempts in Singapore to reverse it by encouraging more births to efforts in Japan to accommodate it by increasing employment opportunities for older workers. The population of the United States, which had a longer postwar baby boom, is aging more slowly than these two countries and may be able to learn from the East Asian experience with aging policies.
This article aims to compare the importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) as risk factors for stroke and ischemic heart disease and to assess whether the patterns are consistent by age and gender. Cox proportional-hazards regression, adjusted for cholesterol and smoking, was used to assess the associations of the 4 BP indices with stroke and ischemic heart disease by age and gender. The relative importance of individual indices was assessed with a hazard ratios for a 1-SD change in BP and by likelihood-ratio chi2 tests. The influence of >1 BP index in the Cox model was also estimated. The analyses demonstrated similar associations of SBP, DBP, and MAP with both fatal stroke and ischemic heart diseases, which were stronger than those of PP. Both SBP and MAP tended to be more important in the regression model than DBP or PP. In Cox models including DBP, addition of SBP improved the goodness of fit at all ages and for both genders. However, in Cox models including SBP, addition of DBP typically resulted in little incremental benefit over and above that of SBP alone. These data suggest that if time or resources are highly constrained, such as in much-needed epidemiologic surveys in developing countries, very little is lost from only measuring SBP.
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OBJECTIVE: To assess the shape and strength of the association between usual blood glucose and cardiovascular disease (CVD) in Asian and Australasian cohorts and to determine the impact of adjusting for other determinants of CVD risk and excluding people with diabetes. RESEARCH DESIGN AND METHODS: Relative risk estimates and 95% CIs were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk on individual participant data from 17 cohort studies. Repeat measurements of blood glucose were used to adjust for regression dilution bias. RESULTS: Fasting blood glucose data were available for 237,468 participants, and during approximately 1.2 million person-years of follow-up, there were 1,661 stroke and 816 ischemic heart disease (IHD) events. Data were also available on 27,996 participants with nonfasting glucose measurements. Continuous positive associations were demonstrated between usual fasting glucose and the risks of CVD down to at least 4.9 mmol/l. Overall, each 1 mmol/l lower usual fasting glucose was associated with a 21% (95% CI 18-24%) lower risk of total stroke and a 23% (19-27%) lower risk of total IHD. The associations were similar in men and women, across age-groups, and in Asian compared with Australasian (Australia and New Zealand) populations. Adjusting for potential confounders or removing those with diabetes as baseline did not substantially affect the associations. Associations for nonfasting glucose were weaker than those with fasting glucose. CONCLUSIONS: Fasting blood glucose is an important determinant of CVD burden, with considerable potential benefit of usual blood glucose lowering down to levels of at least 4.9 mmol/l.