建立国家服务框架后老年患者的冠心病二级预防:基于人群的研究

Objective: To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before(1998- 2001) and after(2003) the implementation of the national service framework. Design: Two population based, longitudinal studies of men and women aged 60- 79 in 1998- 2001, based in one general practice in each of 24 British towns. Participants: Men and women with established coronary heart disease at the two time points(respectively 817 and 465 in 1998- 2001, 857 and 548 in 2003), aged 60- 79 in 1998- 2001. Main outcome measures : Prevalence of use of antiplatelet medication, statins, β blockers, angiotensin converting enzyme(ACE) inhibitors, and other blood pressure lowering treatments(individually and in combination) assessed in 1998- 2001 and 2003. Results: Between 1998- 2001 and 2003, the use of all individual drugs had increased in both men and women, especially for statins(from 34% to 65% in men and from 48% to 67% in women with myocardial infarction). However, less than half received β blockers and ACE inhibitors, even by 2003. Prevalences of medication use were lower in patients with angina than in those with myocardial infarction. The proportions of patients receiving more than one drug increased over time; by 2003 about half of patients with myocardial infarction and a third of those with angina were receiving antiplatelet medication, statins, and blood pressure lowering treatments. Conclusions: Between 1998- 2001 and 2003, statin uptake and the use of combined drug treatment in elderly men and women increased markedly. Further potential exists, however, for reducing the risk of recurrent coronary heart disease in older patients, particularly by improving the uptake of medication among angina patients, and by more extensive use of blood pressure lowering treatment(particularly with β blockers and ACE inhibitors).

婴儿喂养方式与代谢综合征代谢异常间的关系:欧洲青少年心脏病研究的结果

Aims: To assess the associations of type and duration of infant feeding with c omponents of the metabolic syndrome in children aged 9 and 15. Methods: A total of 2192 randomly selected schoolchildren aged 9 and 15 years from Estonia (n = 1 174) and Denmark (n = 1018) were studied. Insulin resistance (homoeostasis model assessment), triglyceride levels, high density lipoprotein cholesterol, and sys tolic blood pressure were measured. Results: Children who had ever been exclusiv ely breast fed had lower systolic blood pressures than those who were not. With full adjustment for age, sex, country, birth weight, pubertal stage, body mass i ndex, height, maternal and paternal education, income, smoking, and body mass in dex the mean systolic blood pressure of children who had ever been breast fed wa s 1.7 mm Hg (95%CI -3.0 to -0.5) lower than those who had never been exclusiv ely breast fed. There was a dose-response in this association with decreasing m ean systolic blood pressure across categories from never exclusively breast fed to breast fed for more than six months. Exclusive breast feeding was not associa ted with other components of the metabolic syndrome. Results were similar when e xamined separately in each country. Conclusions: The magnitude of the associatio n, its independence of important confounding factors, and the dose-response sug gest that exclusive breast feeding is causally associated with reduced systolic blood pressure. The magnitude of the effect we found with blood pressure is comp arable to the published effects of salt restriction and physical activity on blo od pressure in adult populations, suggesting that it is of public health importa nce.

横断面研究:丹麦、爱沙尼亚和葡萄牙儿童胰岛素耐受性与社会经济状况间的关系

To examine the association between socioeconomic position and insulin resistance in children from three countries in northern Europe (Denmark), eastern Europe (Estonia), and southern Europe (Portugal) that have different physical, economic, and cultural environments. Design: Cross sectional study. Participants: 3189 randomly selected schoolchildren aged 9 and 15 years from Denmark (n = 933), Estonia (n = 1103), and Portugal (n = 1153). Main outcome measure: Insulin resistance (homoeostasis model assessment). Results: Family income and pare ntal education were inversely associated with insulin resistance in Danish children but were positively associated with insulin resistance in Estonian and Portuguese children. Among Danish children, insulin resistance was 24% lower (95% confidence interval - 38% to - 10% ) in those whose fathers had the most education compared with those with the least education. The equivalent results were 15% (2% to 28% ) higher for Estonia and 19% (2% to 36% ) higher for Portugal. These associations remained after adjustment for a range of covariates: - 20% (- 36% to - 5% ) for Denmark, 10% (- 4% to 24% ) for Estonia, and 18% (- 1% to 31% ) for Portugal. Strong statistical evidence supported differences between the associations in Denmark and those in the other two countries in both unadjusted and adjusted models (all P < 0.03). Conclusions: Among Danish children, those with the most educated and highest earning parents had least insulin resistance, whereas the opposite was true for children from Estonia and Portugal.

儿童和青少年的超重与行为问题是否有关:来自Mater大学有关妊娠及其转归研究的结果

Aims: To examine the associations between being overweight and behavioural pro blems at ages 5 and 14. Methods: Birth cohort study of 2875 individuals who were born in Brisbane between 1981 and 1984 and who were followed up at ages 5 and 1 4 years. Behavioural problems were defined as scoring above the 90th centile on Achenbach’s child behavioural checklist. Results: In cross-sectional analyses there was no association between being overweight and behavioural problems in ei ther females at age 5. At age 14 females who were overweight were more likely th an those who were normal weight to experience behavioural problems. However, the re was no association between being overweight and behavioural problems at age 1 4 among males. The prevalence of behavioural problems increased linearly across the di stribution of body mass index in females at age 14. In prospective analyses, amo ng participants who had no behavioural problems at age 5, there was no associati on between being overweight at age 5 and behavioural problems at age 14 in eithe r sex. Females who were overweight at age 5 and normal weight at age 14 had redu ced odds of behavioural problems at age 14. Conclusions: Among adolescent female s there is a positive linear association between body size and behavioural probl ems. However, no such association was found in adolescent males, or in either se x at age 5 years, and in prospective analyses being overweight at age 5 was not associated with behavioural problems in either sex at age 14.