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In order to investigate the health and care of the urban elderly, self-administered anonymous questionnaires were sent to a sample randomly selected from the elderly 70 to 89 years of age, in 3 different areas (central, residential and suburban) in Wakabayashi-Ward in Sendai. Responses from 1,248 were returned by mail (response rate = 76.4%) and results were compared to the expected values estimated from the results of investigations conducted by the Ministry of Health and Welfare. 1) As for present addresses of the elderly, 94.2% were at home, 3.8% in hospitals, 0.7% in nursing homes, and 1.3% in other facilities. 2) Responses showed that 28.4% were suffering from hypertension, 5.6% from diabetes mellitus, 2.2% from strokes and liver diseases, with all of these percentages similar to the respective expected values. However, 12.7% were suffering from heart disease which was over twice the expected value. 3) Analysis of health habits showed that the percentages of the elderly who had "good sleep and rest", "nutritious meal", and "moderate exercise" were higher than expected. Only 2.3% did not practice good health habits, which was one sixth of the expected value. 4) As for meal habits of the elderly, 88.3% had three meals a day, and 33.7% made efforts to take less salty foods. 5) Dietary habits of the elderly indicated that 83.8% were frequent consumers of meat, fish and soybeans products, 62.3% vegetables, 51.0% sweet confectionery (significantly higher), 49.2% milk (significantly higher), 22.3% fried foods like tempura (significantly higher), and 22.3% salty vegetables (significantly lower).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Health status and care of the urban elderly]. 129 37

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional "Mediterranean diet", with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years. It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.
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PMID:Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968-1986. 129 80

In 1969, a Pacific Northwest American Indian community cohort (n = 100) was interviewed for the presence of physical and psychiatric illnesses. The same community was studied again in 1988. This study describes the outcome among the original 100 subjects. The schedule for Affective Disorders and Schizophrenia Lifetime Version (SADS-L) served as the basic interview instrument, supplemented by data from medical records, death certificates, and medical and community informants. Twenty-five subjects had died, 13 from cardiovascular disorders and seven from alcohol-related illnesses. Among the 46 subjects re-interviewed, hypertension, heart disease, and diabetes had become significant sources of medical morbidity. Alcoholism was the most significant cause of psychiatric morbidity, particularly among males. This study indicates that greater attention should be focused upon prevention and treatment of alcoholism, cardiovascular disorders, and diabetes in this community and in other American Indian populations.
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PMID:The natural history of medical and psychiatric disorders in an American Indian community. 130 32

Six patients with cardiac amyloidosis (four males, two females; age 27-60 years) were evaluated by us. Four patients presented with congestive heart failure, while one patient each presented with effort angina and giddiness. Extracardiac clues to the diagnosis in the form of involvement of other systems were present in only two patients. The electrocardiogram was abnormal in four patients while three exhibited roentgenographic evidence of cardiomegaly or pulmonary venous hypertension. Echocardiography suggested the diagnosis of amyloidosis in only two patients, restrictive cardiomyopathy in two other patients and dilated and hypertrophic cardiomyopathy in one patient each. Cardiac catheterisation and angiography suggested restrictive heart disease in four patients and hypertrophic cardiomyopathy in one. One patient, whose initial haemodynamic study was normal, had features of dilated cardiomyopathy at repeat study after 11 months. Endomyocardial biopsies showed amyloid deposits in all patients. We emphasise the varied clinical manifestation of cardiac amyloidosis and the need for a high index of suspicion. The diagnosis can be safely and reliably confirmed by endomyocardial biopsy.
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PMID:Cardiac amyloidosis: hemodynamic, echocardiographic and endomyocardial biopsy studies. 130 87

This study was based on a survey of the death certificates of Pu-Li Town in Taiwan, issued over the past 20 years from 1966 to 1985. Age-adjusted mortality trends as well as cause-specific mortality trends were analyzed and compared with nationwide Taiwan data. As a whole, Pu-Li had a higher age-adjusted mortality than that of the overall Taiwan area. This finding may result from a higher mortality from tuberculosis in Pu-Li. Based on these data, the five leading causes of death in Pu-Li were cerebro-vascular disease, accident, heart disease, cancer and tuberculosis. Hypertension and diabetes were the 5th and 6th leading causes of death in 1985 and ranked 12th and 13th, respectively, in 1966. This data point out the increasing importance of hypertension and diabetes rates in Pu-Li. Tuberculosis and pneumonia had been controlled, ranking from the 1st and 3rd in 1966 to the 10th and 12th, respectively, in 1985. Suicide, cancer, and accident were usually coded as the single cause of death without other co-existent causes of death noted, so that there was in most instances not much difference between analyses based on the underlying cause of death and multiple causes of death. However, this was not true for hypertension and diabetes. If multiple causes of death were analyzed, only 34.5% of hypertension and 66% of diabetes were coded as the underlying cause of death. 37.2% of cerebro-vascular diseases co-existed with hypertension, and 20.3% of diabetes co-existed with hypertension.
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PMID:Mortality trends in the past 20 years in Pu-Li, Taiwan. 132 83

Coronary heart disease is the most common cause of death in men and women in developed countries. Three primary risk factors--high serum cholesterol concentration, hypertension, and cigarette smoking--are known to increase the risk in both men and women more or less equally, although the latter two risk factors are a somewhat greater risk to men. This paper reviews two additional risk factors whose impact may be greater in women: diabetes and hypertriglyceridemia. Understanding how diabetes and hypertriglyceridemia act differently in women may explain some of the sex differences in the risk of heart disease.
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PMID:Diabetes mellitus, hypertriglyceridemia, and heart disease risk in women. 135 62

The strongest predictors of cardiovascular disease in women have been shown to be diabetes, high blood pressure, cigarette smoking, and, to a lesser degree, hypertriglyceridemia. The difference in risk between men and premenopausal women has been explained by the following widely held hypothesis: androgens lower plasma concentrations of high-density lipoprotein (HDL), particularly the HDL-2 subfraction, and increase plasma concentrations of low-density lipoprotein (LDL). In contrast, estrogens have the opposite effect, raising plasma concentrations of HDL, particularly HDL-2, and lowering plasma concentrations of LDL. After the menopause, it is believed that the protective effect of estrogens in women is lost and the incidence of heart disease rises to equal that in men. This paper provides a brief review of the effect of endogenous and exogenous androgens on lipoprotein metabolism in men and women, and considers the relevance of these findings to the choice of progestogens used in oral contraceptive preparations.
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PMID:Mechanism of action/effects of androgens on lipid metabolism. 135 63

We compared the self-reported illnesses (heart disease, back pain, rheumatoid arthritis, hypertension, and pulmonary disease) and smoking histories of 100 cases and 100 controls matched for age and sex with reports of this information from proxy informants from the same household in two areas in the city of Beirut. In addition, both cases and controls were given physical examinations to evaluate the accuracy of the responses. The level of agreement between the responses of subjects and of their informants varied from one condition to the other. Heart disease had the highest level of agreement, with the proportion of agreement greater than 93% for the cases and the controls and having chi values of 0.79 and 1.0, respectively. The report of back pain exhibited the lowest level of agreement, with responses showing a proportion of agreement of 74% for the cases and 90% for the controls, with chi values of 0.49 and 0.50, respectively. In comparing the responses of subjects and proxy informants with the results of physical examinations, heart disease had the highest level of agreement (J index ranged from 0.69 to 0.84), and back pain had the lowest level of agreement (J index ranged 0.42 to 0.48). These results show that proxy informants are good respondents for members of the same household and that health interview surveys are accurate for data collection of well defined chronic conditions.
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PMID:Reliability and validity of self and proxy reporting of morbidity data: a case study from Beirut, Lebanon. 138 64

Systolic blood pressure and heart rate measured at rest and during a standardized exercise test were analyzed in the cohort of middle-aged male employees followed-up an average of 17 years in the Paris Prospective Study I. The population sample selected for the analysis included 4,907 men who completed at least 5 minutes of bicycle ergometry, who had no heart disease at entry, and whose resting blood pressure was less than or equal to 180/105 mm Hg. Exercise-induced increase in systolic blood pressure was positively correlated with resting systolic blood pressure (r = 0.104, p less than 0.0001), whereas the correlation of exercise-induced heart rate increase with resting heart rate was negative (r = -0.169, p less than 0.001). Using Cox regression analysis with the inclusion of resting systolic blood pressure and heart rate; exercise-induced elevations of systolic blood pressure and heart rate; and controlling for age, smoking, total cholesterol, body mass index, electrical left ventricular hypertrophy, and sports activities, cardiovascular mortality was found to be associated with the systolic blood pressure increase (p less than 0.05), whereas no association with resting systolic blood pressure was found. Total mortality was predicted by resting systolic blood pressure and its elevation (p less than 0.01 for both) and by resting heart rate (p less than 0.0001). The heart rate increase did not contribute to death prediction. In conclusion, the magnitude of the exercise-induced increase of systolic blood pressure, but not of heart rate, may represent a risk factor for death from cardiovascular as well as noncardiovascular causes, independently of resting blood pressure and heart rate.
Hypertension 1992 Sep
PMID:Prognostic significance of exercise blood pressure and heart rate in middle-aged men. 138 30

The information explosion characteristic of recent years has presented a series of findings enabling a more effective prevention of ischemic heart disease by controlling low density lipoprotein (LDL) levels of cholesterol. The detection of LDL receptors has provided new information on the mechanisms regulating the level of plasma LDL. Data on competitive inhibitors of endogenous cholesterol synthesis have afforded new possibilities of pharmacological control of LDL levels. Studies of primary prevention of ischemic heart disease have yielded evidence showing that a 1% decrease of cholesterol level reduces coronary risk by 2%. A prospective study of the relationship between cholesterol levels and coronary mortality, absolutely unique as to its extent (368,000 middle-aged men followed up over a period of 6 years) has demonstrated that there is no borderline cholesterol level below which coronary risk would be absolutely excluded. Between total cholesterol level and coronary mortality there is a close, continual and graded relationship. In light of these findings, total cholesterol levels have been reclassified: desirable levels -5.2 x 10(-3) mol.l-1, borderline risk levels under 5.2-6.2 x 10(-3) mol.l-1, and high risk levels--above 6.2 x 10(-3) mol.l-1. In subjects with several risk factors (smoking, hypertension, familial occurrence of heart, heart disease, obesity, diabetes mellitus, HDL cholesterol below 0.9 x 10(-3) mol.l-1) the level of total cholesterol should be brought down below 4 x 10(-3) mol.l-1.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Plasma cholesterol levels and ischemic heart disease: new findings and new approaches]. 139 27


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