By official, mostly unvalidated statistics, mortality from subarachnoid hemorrhage (SAH) show large variations between countries. Using uniform criteria for case ascertainment and diagnosis, a ...multinational comparison of attack rates and case fatality rates of SAH has been performed within the framework of the WHO MONICA Project.
In 25- to 64-year-old men and women, a total of 3368 SAH events were recorded during 35.9 million person-years of observation in 11 populations in Europe and China. Strict MONICA criteria were used for case ascertainment and diagnosis of stroke subtype. Case fatality was based on follow-up at 28 days after onset.
Age-adjusted average annual SAH attack rates varied 10-fold among the 11 populations studied, from 2.0 (95% CI 1.6 to 2.4) per 100 000 population per year in China-Beijing to 22.5 (95% CI 20.9 to 24.1) per 100 000 population per year in Finland. No consistent pattern was observed in the sex ratio of attack rates in the different populations. The overall 28-day case fatality rate was 42%, with 2-fold differences in age-adjusted rates between populations but little difference between men and women. Case fatality rates were consistently higher in Eastern than in Western Europe.
Using a uniform methodology, the WHO MONICA Project has shown very large variations in attack rates of SAH across 11 populations in Europe and China. The generally accepted view that women have a higher risk of SAH than men does not apply to all populations. Marked differences in outcome of SAH add to the wide gap in the burden of stroke between East and West Europe.
The New Fiscal Sociology: Taxation in Comparative and Historical Perspective demonstrates that the study of taxation can illuminate fundamental dynamics of modern societies. The sixteen essays in ...this collection offer a state-of-the-art survey of the new fiscal sociology that is emerging at the intersection of sociology, history, political science, and law. The contributors include some of the foremost comparative historical scholars in these disciplines and others. They approach the institution of taxation as a window onto the changing social contract. Their chapters address the social and historical sources of tax policy, the problem of how taxes persist, and the social and cultural consequences of taxation. They trace fundamental connections between tax institutions and macrohistorical phenomena - wars, shifting racial boundaries, religious traditions, gender regimes, labor systems, and more.
BNP is a marker of systolic left ventricular dysfunction (LVSD) and heart failure. To assess BNP for the detection of diastolic dysfunction in the general population, we examined 1678 subjects within ...an age‐ and sex‐stratified survey (MONICA Augsburg). BNP was measured using a commercially available RIA (Shionogi).
BNP increased in subjects with diastolic dysfunction (mean 20.3±4.7 pg/ml vs. control 9.6±0.5 pg/ml, p<0.001), but to a lesser extent than in subjects with LV hypertrophy (LVH, mean 37.3±49.1 pg/ml, p<0.001 vs. control) or LVSD (mean 76.2±23.2 pg/ml, p<0.001 vs. control). Individuals with sole diastolic abnormality displayed BNP concentrations at the control level (mean 9.7±1.7 pg/ml). In univariate analysis, age, BMI, systolic blood pressure, left atrial size, LV mass index, diastolic dysfunction and EF displayed a significant correlation with BNP (p<0.001). However, LV mass index displaced diastolic dysfunction as a significant predictor of BNP in multivariate analysis. Upon ROC analysis, sensitivity and specificity for the detection of diastolic dysfunction by BNP were only 61% and 55%, respectively. Nevertheless, a normal BNP test virtually excluded the presence of diastolic dysfunction and concomitant LVH (NPV 99.9%).
Increased BNP concentrations in subjects with diastolic dysfunction are strongly related to LVH. Population‐wide screening for diastolic dysfunction with BNP cannot be recommended although a normal BNP test usually excludes diastolic dysfunction and LV hypertrophy.
Abstract Background The effects of smoking on central aortic pressures and the age-related increase in left ventricular mass (LVM) are largely unknown. We studied the relationship between smoking, ...arterial distensibility, central aortic pressures and left ventricular mass in two population-based studies. Methods Data was obtained from two German population-based studies (KORA and SHIP, participants' ages 25–84 years). We identified 114 normotensive current smokers and 185 normotensive all-time non-smokers in KORA as well as 400 and 588 such individuals in SHIP. Echocardiographic LVM was obtained at baseline (T0) and follow-up after ten years (T1) in KORA and at follow-up (T1) in SHIP. Additionally, pulse-wave analysis-based central aortic pressure and augmentation index (AIx) were measured at T1 in KORA. Results Cross-sectional analysis, using KORA T0 and SHIP T1, revealed in both studies a higher covariate-adjusted LVM and left ventricular mass index (LVMI) in smokers as compared with non-smokers. Moreover, in the KORA T1 examination, the smokers demonstrated a more pronounced increase, relative to baseline, of LVM (+ 13.5%) and LVMI (+ 13.4%) compared to non-smokers (+ 8.59% and + 8.65%; p = 0.036 and 0.042, respectively). Additionally, at KORA T1 smokers had a higher central systolic blood pressure and higher AIx than non-smokers (p = 0.012 and p = 0.001, respectively). Conclusions The difference in central aortic pressure due to enhanced and more prolonged wave reflection may explain our finding of a further pronounced increase in left ventricular wall thickness and mass over time in smokers.
This study assessed the consistency and magnitude of the association between educational level and relative body weight in populations with widely different prevalences of over-weight and ...investigated possible changes in the association over 10 years.
Differences in age-adjusted mean body mass index (BMI) between the highest and the lowest tertiles of years of schooling were calculated for 26 populations in the initial and final surveys of the World Health Organization (WHO) MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Project. The data are derived from random population samples, including more than 42,000 men and women aged 35 to 64 years in the initial survey (1979-1989) and almost 35,000 in the final survey (1989-1996).
For women, almost all populations showed a statistically significant inverse association between educational level and BMI; the difference between the highest and the lowest educational tertiles ranged from -3.3 to 0.4 kg/m2. For men, the difference ranged from -1.5 to 2.2 kg/m2. In about two thirds of the populations, the differences in BMI between the educational levels increased over the 10-year period.
Lower education was associated with higher BMI in about half of the male and in almost all of the female populations, and the differences in relative body weight between educational levels increased over the study period. Thus, socioeconomic inequality in health consequences of obesity may increase in many countries.
We studied the relationship between changes in body composition and changes in blood pressure levels.
The mechanisms underlying the frequently observed progression from pre-hypertension to ...hypertension are poorly understood.
We examined 1,145 subjects from a population-based survey at baseline in 1994/1995 and at follow-up in 2004/2005. First, we studied individuals pre-hypertensive at baseline who, during 10 years of follow-up, either had normalized blood pressure (PreNorm, n = 48), persistently had pre-hypertension (PrePre, n = 134), or showed progression to hypertension (PreHyp, n = 183). In parallel, we studied predictors for changes in blood pressure category in individuals hypertensive at baseline (n = 429).
After 10 years, the PreHyp group was characterized by a marked increase in body weight (+5.71% 95% confidence interval (CI): 4.60% to 6.83%) that was largely the result of an increase in fat mass (+17.8% 95% CI: 14.5% to 21.0%). In the PrePre group, both the increases in body weight (+1.95% 95% CI: 0.68% to 3.22%) and fat mass (+8.09% 95% CI: 4.42% to 11.7%) were significantly less pronounced than in the PreHyp group (p < 0.001 for both). The PreNorm group showed no significant change in body weight (-1.55% 95% CI: -3.70% to 0.61%) and fat mass (+0.20% 95% CI: -6.13% to 6.52%, p < 0.05 for both, vs. the PrePre group).
After 10 years of follow-up, hypertension developed in 50.1% of individuals with pre-hypertension and only 6.76% went from hypertensive to pre-hypertensive blood pressure levels. An increase in body weight and fat mass was a risk factor for the development of sustained hypertension, whereas a decrease was predictive of a decrease in blood pressure.
Measurements of longitudinal beam profile in non-relativistic hadron accelerators are usually performed with Bunch Shape Monitors that utilize secondary electron emission to reproduce the shape of a ...primary ion beam. The existing devices, however, have poor electron collection efficiency from the wire and are limited to one dimensional measurements of the phase coordinate. In this paper we present the performance improvements for a bunch shape monitor for proton beams used in the Spallation Neutron Source accelerator. These improvements were achieved by adding focusing optics between the wire and the entrance slit, which will also allow measurements over a much higher dynamic range. Here we present the design, simulation and experimental test results of the developed new electron beam guidance system for the existing SNS bunch shape monitor that allowed significant improvement in the collection efficiency.
The revolution in coronary care in the mid-1980s to mid-1990s corresponded with monitoring of coronary heart disease (CHD) in 31 populations of the WHO MONICA Project. We studied the impact of this ...revolution on coronary endpoints.
Case fatality, coronary-event rates, and CHD mortality were monitored in men and women aged 35–64 years in two separate 3–4-year periods. In each period, we recorded percentage use of eight treatments: coronary-artery reperfusion before, thrombolytics during, and β-blockers, antiplatelet drugs, and angiotensin-converting-enzyme (ACE) inhibitors before and during non-fatal myocardial infarction. Values were averaged to produce treatment scores. We correlated changes across populations, and regressed changes in coronary endpoints on changes in treatment scores.
Treatment changes correlated positively with each other but inversely with change in coronary endpoints. By regression, for the common average treatment change of 20, case fatality fell by 19% (95% Cl 12–26) in men and 16% (5–27) in women; coronary-event rates fell by 25% (16–35) and 23% (7–39); and CHD mortality rates fell by 42% (31–53) and 34% (17–50). The regression model explained an estimated 61% and 41% of variance for men and women in trends for case fatality, 52% and 30% for coronary-event rates, and 72% and 56% for CHD mortality.
Changes in coronary care and secondary prevention were strongly linked with declining coronary endpoints. Scores and benefits followed a geographical east-to-west gradient. The apparent effects of the treatment might be exaggerated by other changes in economically successful populations, so their specificity needs further assessment.
Quantum computing stands as a revolutionary frontier in information technology, with the potential to solve complex problems far beyond the capacity of classical computers. At the heart of this ...disruptive innovation are qubits, forming the fundamental backbone of quantum computing. A leading-edge solution for constructing robust, enduring qubits involves embedding a Josephson junction within a high Q-factor, superconducting three-dimensional cavity. Our recent innovation lies in developing a uniquely optimized, quarter-wave resonator-based superconducting cavity, functioning at 6 GHz, specifically tailored for quantum computers. In this work, we elucidate our advancement towards elevating the Q-factor tenfold, an achievement made possible through the enhancement of machining precision, the application of rigorous postprocessing techniques-including mechanical, chemical, and surface treatments-as well as the refinement of our testing methods.
Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As ...psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality.
Three cross-sectional MONICA surveys (conducted 1984-1995) including 11,282 subjects aged 25-74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables.
Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p=0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes.
The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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