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Heart transplant programs were surveyed regarding psychosocial evaluation process, criteria, and outcomes. There was considerable disagreement among programs when a patient is rejected on psychosocial grounds with regard to the use of second opinions and how often patients are informed of the reasons. Wide discrepancies in criteria used and rates of patients refused on psychosocial grounds were discovered. More than 70% of all programs excluded patients for transplantation on the grounds of dementia, active schizophrenia, current suicidal ideation, history of multiple suicide attempts, severe mental retardation, current heavy alcohol use, and current use of addictive drugs. Lack of consensus was found for some exclusion criteria (cigarette smoking, obesity, noncompliance, recent alcohol or drug abuse, criminality, personality disorder, mild mental retardation, controlled schizophrenia, and affective disorder). The proportion of patients rejected for transplantation on psychosocial grounds ranged from 0% to 37%, with an average rate of 5.6% in the United States and 2.5% in non-U.S. programs. This survey thus supports the need for research on the validity and reliability of psychosocial selection criteria.
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PMID:Psychosocial evaluation of heart transplant candidates: an international survey of process, criteria, and outcomes. 175 61

To determine if a history of snoring is a risk factor for brain infarction, I conducted a case-control study of risk factors for ischemic stroke using 177 consecutive male patients aged 16-60 (mean 49) years with acute brain infarction. For each patient I chose an age-matched (+/- 6 years) male control. Arterial hypertension, coronary heart disease, snoring (habitually or often), and heavy drinking (greater than 300 g/wk) were risk factors in the stepwise multiple logistic regression analysis. The odds ratio of snoring for brain infarction was 2.13. By McNemar's test this association increased strongly if a history of sleep apnea, excessive daytime sleepiness, and obesity were all present with snoring (odds ratio 8.00). My study indicates that snoring may be a risk factor for ischemic stroke, possibly because of the higher prevalence of an obstructive sleep apnea syndrome among snorers than nonsnorers.
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PMID:Snoring and the risk of ischemic brain infarction. 186 48

We report the association between hostility and the incidence of ischemic heart disease (IHD) in 3,750 Finnish men aged 40-59. Hostility was assessed from self-ratings on irritability, ease of anger-arousal, and argumentativeness, and four groups were formed from the summed hostility ratings. At baseline, the age-adjusted relative risk (RR) of the prevalence of angina pectoris between the highest and lowest hostility groups was 2.88 (95% confidence limits (CL), range 1.71-4.77). A three-year follow-up yielded 65 deaths and 109 IHD-incident cases. Hostility did not predict IHD among healthy men, but among men with previous IHD and hypertension (N = 104), the age-adjusted RR of IHD between the highest and lowest hostility groups was 12.9 (95% CL, 3.92-42.6). After standardization for smoking, obesity, heavy alcohol use, and snoring, the RR was 14.6 (95% CL, 1.94-110). When the degree of dyspnea at baseline was also standardized, the RR was 21.1 (95% CL, 1.59-282). Our data suggest that extreme hostility is not a consequence of symptom severity; rather, hostility is a strong determinant of coronary attack among hypertensive men with IHD.
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PMID:Hostility as a risk factor for mortality and ischemic heart disease in men. 341 67

The association of snoring with some cardiovascular risk factors was studied cross-sectionally by a postal survey among 3750 males aged 40-59 years. In univariate analyses, snoring associated statistically significantly (P < 0.01) with hypertension, smoking, obesity, heavy alcohol use, physical inactivity, dyspnoea, hostility and morning tiredness. In a multiple logistic regression model adjusted by age, snoring associated significantly with smoking, obesity, physical inactivity, hostility and morning tiredness. When smoking was excluded from the multivariate model, alcohol use was also associated significantly with snoring. The association of snoring with smoking, and with obesity seemed to be almost independent from other studied correlates of snoring. Our results indicate that in further studies on predictive value of snoring with regard to coronary heart disease and stroke, the associations of snoring with hypertension, smoking, obesity, heavy alcohol use, physical inactivity and hostility have to be considered, as these risk characteristics may cause confounding effects.
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PMID:Snoring and cardiovascular risk factors. 782 98

We use econometric techniques to consider whether the statistical association between drinking and blood pressure among men may be due, in part, to the constitutional hypothesis. The constitutional hypothesis holds that the same unobserved genetic or personality factors that affect blood pressure will affect the amount of alcohol consumed. Our sample is restricted to men because most investigations for women have revealed a weak to nonexistent positive, and sometimes a negative, association. Data are drawn from the National Health and Nutrition Examination Survey, 1971-1975. The econometric technique requires fitting three equations using two-stage least squares or multiple regressions. The first equation explains how much people drink. The second and third equations explain fluctuations in systolic and diastolic blood pressures using information on the predicted values of the drinking variable from the first equation. Our results suggest that, after accounting for unobserved constitutional factors as well as other observed covariates such as obesity, salt intake, schooling and so on, the strength of the statistical association between high blood pressure and heavy drinking in men drops only slightly by 8% (diastolic) and 23% (systolic). Thus, a strong statistically significant result remains after removing the unobserved variables bias.
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PMID:An econometric technique to remove unobserved variables that bias the relationship between alcohol and blood pressure. 845 17

The Mamre Hypertension Project was initiated in response to studies indicating that hypertension and cardiovascular disease were prevalent in a rural community of Mamre, located in the Western Cape, South Africa. A survey was done to collect baseline information on the prevalence of hypertension and other cardiovascular disease risk factors. The age-adjusted prevalence of hypertension in people aged 15 years or more was 13.9% in men and 16.3% in women. Of the hypertensive subjects, 27% were not aware of their hypertension, a further 14.4% were not on treatment, and only 16.8% had their blood pressure (BP) controlled at under 140/90 mm Hg. There was a high prevalence of smoking, heavy alcohol use (in men), obesity (in women) and physical inactivity. The survey results will be used to assess the impact of the intervention programme using a before and after design, and are being used to direct interventions. The intervention programme comprises a BP station catering primarily for people with hypertension, and a health education and promotion programme directed at the general community. The BP station screens for hypertension, monitors BP and compliance with medication in hypertensives, and encourages risk factor modification. Health promotion activities include a smoking cessation group and a weight reduction and exercise group. These are run by community volunteers with support from outside consultants. The effects of the programme will be assessed after 4-5 years.
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PMID:Design and baseline characteristics of a hypertension intervention program in a South African village. 888 May 68

The role of the microsomal ethanol-oxidizing system (MEOS) in hepatic ethanol metabolism is reviewed, with focus on its constitutive, ethanol-inducible cytochrome P-4502E1 (2E1). The MEOS was purified and reconstituted using 2E1, phospholipids, and cytochrome P-450 reductase and shown to oxidize ethanol to acetaldehyde, mainly as a monooxygenase and secondarily via hydroxyl radicals, with transcriptional and posttranscriptional regulation. Polymorphism of 2E1 was recognized, and enzymology (including cofactors, role of lipids, inducers, and inhibitors) as well as cellular and tissue distribution were chartered. Physiological functions involve lipid metabolism and ketone utilization in starvation, obesity, and diabetes. The most significant role of 2E1 is its adaptive response to high blood ethanol levels with a corresponding acceleration of ethanol metabolism. The associated free radical production, however, contributes to liver injury in the alcoholic. Most importantly, 2E1 has a unique capacity to activate many xenobiotics (85 of which are listed) to hepatotoxic or carcinogenic products. Induction of 2E1 also results in enhanced production of acetaldehyde, a highly reactive and toxic metabolite. The proliferation of the endoplasmic reticulum associated with 2E1 induction is also accompanied by enhanced activity of other cytochrome P-450s, resulting in accelerated metabolism of, and tolerance to, other drugs, as well as increased degradation of retinol and its hepatic depletion. Some substrates and metabolites, however, are innocuous and may eventually be used as markers of heavy drinking. Recently discovered effective 2E1 inhibitors also have great therapeutic potential.
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PMID:Cytochrome P-4502E1: its physiological and pathological role. 911 22

The amount of alcohol intake has been increasing in Japan. We investigated whether this might affect dietary habits in middle-aged men. In 1989, we conducted a health examination of 809 Japanese males aged 40-69. Food and nutrient intakes were estimated from 24-hour dietary recall. Mean values of total energy, protein, fat, and carbohydrate were evaluated according to alcohol intake. Consumption of total calories and proteins, especially animal proteins, increased and carbohydrate intake decreased proportionately with the amount of alcohol intake. Meat, fish, and soybean intake were increased in heavy drinker, along with niacin, sodium, and phosphorus intake. Despite their higher caloric intake, moderate and heavy drinkers were not more obese than non- or light-drinkers. Japanese heavy drinkers took more animal protein and sodium instead of carbohydrate compared to non- and light- drinkers. In our series, heavy drinking was not related to obesity.
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PMID:[Effect of alcohol intake on dietary habits and obesity in Japanese middle-aged men]. 1114 57

A number of risk factors of cancer diseases can be identified in the diet of the Hungarian population, and also one may infer the presence of these risk factors from statistics on food purchasing, the results of household budget surveys and those of earlier nutrition surveys. These risk factors are: overweight and obesity involving two thirds of the male and half of the female population, insufficient vegetable and fruit consumption, insufficient wholemeal cereal consumption, inadequate dietary fibre intake, high sugar intake, regular heavy drinking, as well as high fat, animal fat, cholesterol and salt intakes. The messages for decreasing the risks of cancer diseases--as presented herein--have been included in the recommendations for healthy nutrition aimed at eliminating the risk factors of diet-related diseases.
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PMID:[Healthy nutrition and the prevention of cancer]. 1268 35

A population-based health interview and examination survey of 8 Inuit communities in the Kivalliq region of Nunavut, Canada, during the early 1990s has resulted in an increased understanding of the burden and extent of cardiovascular diseases and diabetes and their risk factors such as genetics, obesity, lipids, blood pressure and fatty acids. A recent national health interview survey which included a sample from Nunavut indicates that the Inuit still enjoy some advantages relative to other Canadians (lower level of self-reported diabetes and hypertension) and disadvantages (higher level of smoking, obesity, and heavy drinking). The pattern of health and disease among the Inuit is rapidly evolving, as the traditional lifestyle becomes further eroded. A long-term prospective cohort study that monitors this trend, investigates the etiology, and identifies potential interventions is urgently needed.
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PMID:Contributions to chronic disease prevention and control: studies among the Kivalliq Inuit since 1990. 1496 61


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