Visceral adiposity and subclinical coronary artery disease in elderly adults: Rancho Bernardo Study

OBJECTIVE

Despite growing attention to central obesity as a predictor of clinical coronary heart disease (CHD), there are few reports about the association between directly measured visceral obesity and subclinical coronary atherosclerosis in elderly adults. We examined this association in elderly, community-dwelling adults without clinically recognized CHD.

METHODS AND PROCEDURES

Elderly adults (190 men, BMI 27.2 +/- 3.6 kg/m(2); 220 women, BMI 25.8 +/- 4.6) aged 55-88 years (median 69 years) with no history of CHD or coronary revascularization had an electron beam computed tomography (EBCT) to measure coronary artery calcification score (CACS), an estimate of coronary plaque burden. Visceral and subcutaneous adiposity were assessed by a triple-slice EBCT scan at the lumbar 4-5 disc level and height, weight, and waist and hip circumferences were measured.

RESULTS

In sex-specific ordinal logistic regression analyses, no measure of obesity or body fat distribution, including BMI, waist-to-hip ratio, waist girth, and visceral and subcutaneous fat by EBCT, was significantly associated with CACS before or after adjusting for multiple covariates of CACS (age, smoking, alcohol intake, exercise, pulse pressure, low-density lipoprotein (LDL)/high-density lipoprotein (HDL)-cholesterol ratio, and fasting plasma glucose).

DISCUSSION

In elderly adults without clinically recognized CHD, body weight and fat distribution do not predict coronary artery plaque burden. These results raise questions about the value of weight reduction diets for preventing heart disease in elderly survivors without clinical heart disease.

Adaptation, migration or extirpation: climate change outcomes for tree populations

Species distribution models predict a wholesale redistribution of trees in the next century, yet migratory responses necessary to spatially track climates far exceed maximum post-glacial rates. The extent to which populations will adapt will depend upon phenotypic variation, strength of selection, fecundity, interspecific competition, and biotic interactions. Populations of temperate and boreal trees show moderate to strong clines in phenology and growth along temperature gradients, indicating substantial local adaptation. Traits involved in local adaptation appear to be the product of small effects of many genes, and the resulting genotypic redundancy combined with high fecundity may facilitate rapid local adaptation despite high gene flow. Gene flow with preadapted alleles from warmer climates may promote adaptation and migration at the leading edge, while populations at the rear will likely face extirpation. Widespread species with large populations and high fecundity are likely to persist and adapt, but will likely suffer adaptational lag for a few generations. As all tree species will be suffering lags, interspecific competition may weaken, facilitating persistence under suboptimal conditions. Species with small populations, fragmented ranges, low fecundity, or suffering declines due to introduced insects or diseases should be candidates for facilitated migration.

Adaptation, migration or extirpation: climate change outcomes for tree populations

Species distribution models predict a wholesale redistribution of trees in the next century, yet migratory responses necessary to spatially track climates far exceed maximum post-glacial rates. The extent to which populations will adapt will depend upon phenotypic variation, strength of selection, fecundity, interspecific competition, and biotic interactions. Populations of temperate and boreal trees show moderate to strong clines in phenology and growth along temperature gradients, indicating substantial local adaptation. Traits involved in local adaptation appear to be the product of small effects of many genes, and the resulting genotypic redundancy combined with high fecundity may facilitate rapid local adaptation despite high gene flow. Gene flow with preadapted alleles from warmer climates may promote adaptation and migration at the leading edge, while populations at the rear will likely face extirpation. Widespread species with large populations and high fecundity are likely to persist and adapt, but will likely suffer adaptational lag for a few generations. As all tree species will be suffering lags, interspecific competition may weaken, facilitating persistence under suboptimal conditions. Species with small populations, fragmented ranges, low fecundity, or suffering declines due to introduced insects or diseases should be candidates for facilitated migration.

Migration to the Maya Biosphere Reserve, Guatemala: Why place matters

Virtually all migration research examines international migration or urbanization. Yet understudied rural migrants are of critical concern for environmental conservation and rural sustainable development. Despite the fact that a relatively small number of all migrants settle remote rural frontiers, these are the agents responsible for perhaps most of the tropical deforestation on the planet. Further, rural migrants are among the most destitute people worldwide in terms of economic and human development. While a host of research has investigated deforestation resulting from frontier migration, and a modest literature has emerged on frontier development, this article explores the necessary antecedent to tropical deforestation and poverty along agricultural frontiers: out-migration from origin areas. The data come from a 2000 survey with community leaders and key informants in 16 municipios of migrant origin to the Maya Biosphere Reserve (MBR), Petén, Guatemala. A common denominator among communities of migration origin to the Petén frontier was unequal resource access, usually land. Nevertheless, the factors driving resource scarcity were widely variable. Land degradation, land consolidation, and population growth prevailed in some communities but not in others. Despite similar exposure to community and regional level push factors, most people in the sampled communities did not out-migrate, suggesting that any one or combination of factors is not necessarily sufficient for out-migration.

A community-based evaluation of sudden death associated with therapeutic levels of methadone

BACKGROUND

Published case reports have associated the therapeutic use of methadone with the occasional occurrence of sudden cardiac death. Because of the established utility of this drug and with the eventual goal of enhancing safety of use, we performed a community-based study to evaluate this association.

METHODS

During a 4-year period, we prospectively evaluated all patients who consecutively had sudden cardiac death and underwent investigation by the medical examiner in the metropolitan area of Portland, Ore. Case subjects of interest were those with a therapeutic blood level of methadone (<1 mg/L), and case comparison subjects were those with no methadone identified. Patients with recreational drug use or any drug overdose were excluded from either group. Detailed autopsies were conducted, including the detection and quantification of all substances in the blood.

RESULTS

A total of 22 sudden cardiac death cases with therapeutic levels of methadone (mean 0.48+/-0.22 mg/L; range 0.1-0.9 mg/L) were identified (mean age 37.0+/-10 years, 68% were male) and compared with 106 consecutive sudden cardiac death cases without evidence of methadone (mean age 42+/-13 years, 69% were male). The most common indication for methadone use was pain control (n=12, 55%). Among cases receiving methadone therapy, sudden death-associated cardiac abnormalities were identified in only 23% (n=5), with no clear cause of sudden cardiac death in the remaining 77% (n=17). Among cases with no methadone, sudden death-associated cardiac abnormalities were identified in 60% (n=64, P=.002).

CONCLUSION

The significantly lower prevalence of cardiac disease in the case group implicates methadone, even at therapeutic levels, as a likely cause of sudden death. These findings point toward an association between methadone and occurrence of sudden death in the community. Clinical safeguards and further prospective studies specifically designed to enhance safety of methadone use are warranted.

Development and poverty: a symbiotic relationship and its implication in Africa

Poverty is present everywhere but the kind in Africa is of great magnitude both in its spread and destitutive dimension. In other places any manifestation of poverty is a challenge to move forward but in Africa, the reverse is the case. Therefore the continent and international community are not happy about it, hence various programmes and strategies were put in place. Ironically there is little to show for it. For instance, about ten years before the end of millennium, the common slogan in Africa was 'water for all, food for all, education for all, health for all and so on by the year 2000'. The 'miracle' year 2000 has come and gone and water, food, education and health are not enjoyed by many citizens of the continent. Development is still illusive. In this paper I examine the issues of poverty and development in the context of deforestation/biodiversity a consequent effect of global warming being one of the major threats to humanity. Some questions are raised with a view to proffer recommendations that may move the continent forward. These are: What are the roots of poverty in Africa? Why should there be a symbiotic relationship between poverty and development in Africa? Can Africa really develop?

The profiles of adults who consult alternative health practitioners and/or general practitioners

OBJECTIVE

To compare the profiles of people visiting only a general practitioner (GP), those visiting only a practitioner of complementary and alternative medicine (CAM), and those visiting both (GP&CAM).

DESIGN

A comparative total population health survey in central Norway (HUNT 2).

SUBJECTS

A total of 54,448 persons 20 years of age and over who answered questions about their use of health services during the previous 12 months.

VARIABLES

Sociodemographic characteristics, self-perceived health, subjective health complaints, and a variety of common diseases.

RESULTS

Some 34,854 (64.0%) of those who answered the health service use question had visited only a GP, 837 (1.5%) only a CAM practitioner, and 4563 (8.4%) both during the last 12 months. The likelihood of being a CAM-only user as compared to a GP-only user was significantly increased (p < 0.005) if the participant was male; aged between 30 and 69; and without cardiovascular disease. The likelihood of being a GP&CAM user compared with a GP-only user was significantly increased (p < 0.005) for those who were female; aged between 30-59; had a higher education level; were non-smokers; had lower perceived global health; had a limiting chronic complaint; had experienced a health complaint during the last 12 months; had musculoskeletal disease; had a psychiatric complaint; and had hay fever.

CONCLUSION

There were few CAM-only users and they differ from GP-only users by being male, aged 30-69, and without cardiovascular disease. Users of both GP&CAM were less healthy with more complaints and poorer self-reported health than GP- and CAM-only users.

Cultural hitchhiking on the wave of advance of beneficial technologies

The wave-of-advance model was introduced to describe the spread of advantageous genes in a population. It can be adapted to model the uptake of any advantageous technology through a population, such as the arrival of neolithic farmers in Europe, the domestication of the horse, and the development of the wheel, iron tools, political organization, or advanced weaponry. Any trait that preexists alongside the advantageous one could be carried along with it, such as genetics or language, regardless of any intrinsic superiority. Decoupling of the advantageous trait from other "hitchhiking" traits depends on its adoption by the preexisting population. Here, we adopt a similar wave-of-advance model based on food production on a heterogeneous landscape with multiple populations. Two key results arise from geographic inhomogeneity: the "subsistence boundary," land so poor that the wave of advance is halted, and the temporary "diffusion boundary" where the wave cannot move into poorer areas until its gradient becomes sufficiently large. At diffusion boundaries, farming technology may pass to indigenous people already in those poorer lands, allowing their population to grow and resist encroachment by farmers. Ultimately, this adoption of technology leads to the halt in spread of the hitchhiking trait and establishment of a permanent "cultural boundary" between distinct cultures with equivalent technology.

Self-assembling plants and integration across ecological scales

BACKGROUND AND AIMS

Although individual plants exhibit much complex behaviour in response to environmental stimuli, they appear to do so without any identifiable centres of organization. We review a special class of model with the aim of testing whether plants can effectively be self-assembling, modular-driven organisms, in the sense that whole-plant organization and behaviour emerges solely from the interactions of much smaller structural elements. We also review evidence that still higher-level behaviour, at the population and community levels of organization, can emerge from this same source.

METHODS

In previous work we devised a special cellular automaton (CA) model of plant growth. This comprises a section depicting a two-dimensional plant in its above- and below-ground environments. The whole plant is represented by branching structures made up from identical 'modules'. The activity of these modules is driven by morphological, physiological and reproductive rulesets derived from comparative plant ecology, a feature which lends itself to experimentation at several ecological scales.

KEY RESULTS

From real experiments using virtual plants we show that the model can reproduce a very wide range of whole-plant-, population- and community-level behaviour. All of these properties emerge successfully from a ruleset acting only at the level of the CA module.

CONCLUSIONS

The CA model can, with advantage, be driven by C-S-R plant strategy theory. As this theory can ascribe a functional classification to any temperate angiosperm on the basis of a few simple tests, any community of such plants can be redescribed in terms of its 'functional signature' and the net environment that it experiences. To a valuable first approximation, therefore, a C-S-R version of the CA model can simulate the most essential properties both of natural vegetation and of its environment. We have thus achieved a position from which we can test a plethora of high-level community processes, such as diversity, vulnerability, resistance, resilience, stability, and habitat-community heterogeneity--processes which, if investigated on the scales truly required for a full understanding, would fall beyond the practical scope of even the largest real-life investigation.

Resource management and fertility in Mexico's Sian Ka'an Biosphere Reserve: Campos, cash, and contraception in the lobster-fishing village of Punta Allen

This case study examines the link between marine resource management, and the universal contraceptive use among married couples in the lobster- fishing village of Punta Allen, located in the Sian Ka'an Biosphere Reserve, Quintana Roo, Mexico. Several reasons appear to contribute to small desired and actual family sizes. Some of these include a medical clinic staff effective in promoting family planning, cooperative and private resource ownership, changing cultural attitudes, geographical limitations to population and economic growth, and a desire to conserve the environment for aesthetic and economic motives. Lastly, families desired to preserve a sustained balance between benefiting from lobster harvests today and safeguarding this marine resource for their children in the future.

Are population pharmacokinetic and/or pharmacodynamic models adequately evaluated? A survey of the literature from 2002 to 2004

Model evaluation is an important issue in population analyses. We aimed to perform a systematic review of all population pharmacokinetic and/or pharmacodynamic analyses published between 2002 and 2004 to survey the current methods used to evaluate models and to assess whether those models were adequately evaluated. We selected 324 articles in MEDLINE using defined key words and built a data abstraction form composed of a checklist of items to extract the relevant information from these articles with respect to model evaluation. In the data abstraction form, evaluation methods were divided into three subsections: basic internal methods (goodness-of-fit [GOF] plots, uncertainty in parameter estimates and model sensitivity), advanced internal methods (data splitting, resampling techniques and Monte Carlo simulations) and external model evaluation. Basic internal evaluation was the most frequently described method in the reports: 65% of the models involved GOF evaluation. Standard errors or confidence intervals were reported for 50% of fixed effects but only for 22% of random effects. Advanced internal methods were used in approximately 25% of models: data splitting was more often used than bootstrap and cross-validation; simulations were used in 6% of models to evaluate models by a visual predictive check or by a posterior predictive check. External evaluation was performed in only 7% of models. Using the subjective synthesis of model evaluation for each article, we judged the models to be adequately evaluated in 28% of pharmacokinetic models and 26% of pharmacodynamic models. Basic internal evaluation was preferred to more advanced methods, probably because the former is performed easily with most software. We also noticed that when the aim of modelling was predictive, advanced internal methods or more stringent methods were more often used.

Pharmacokinetics of ribavirin in patients with hepatitis C virus

AIM

A population pharmacokinetic analysis was performed using plasma concentration data (n = 7025) from 380 patients to examine the relationship between ribavirin dose and its pharmacokinetics.

METHODS

Ribavirin pharmacokinetics were described by a three-compartment model with sequential zero-order and a first-order absorption processes. Interoccasion variability and food effects were included.

RESULTS

Lean body weight (range 41-91 kg) was the only covariate with a clinically significant influence on ribavirin pharmacokinetics, affecting clearance (15.3-23.9 l h(-1)) and the volume of the larger peripheral compartment.

CONCLUSION

The model provided a good description of the available data, confirmed by accurate estimates of parameter values and low residual variability (17%).

Declining fertility on the frontier: the Ecuadorian Amazon

This paper examines farm and household characteristics associated with a rapid fertility decline in a forest frontier of the Ecuadorian Amazon. The Amazon basin and other rainforests in the tropics are among the last frontiers in the ongoing global fertility transition. The pace of this transition along agricultural frontiers will likely have major implications for future forest transitions, rural development, and ultimately urbanization in frontier areas. The study here is based upon data from a probability sample of 172 women who lived on the same farm in 1990 and 1999. These data are from perhaps the first region-wide longitudinal survey of fertility in an agricultural frontier. Descriptive analyses indicate that fertility has plummeted in the region, which is surprising since it had remained high and unchanging among migrant colonists up to 1990. Thus only half of the women in our sample reported having a birth during the 1990-1999 time period, and most women report in 1999 that they do not want to have any more children. Analyses, controlling for women's age, corroborate hypotheses about land-fertility relations. For example, women from households with a legal land title had fewer than half as many children as those from households without a title. Large cattle (pasture) holdings and hiring laborers to work on the farm (which may replace household labor) are both related to socio-economic status that is traditionally associated with lower fertility. Similarly, distance to the nearest community center is positively related to fertility. Factors negatively related to fertility include increasing temporary out-migration of adult men or women from the household, asset accumulation, and access to electricity.

Effect of Rotation Crops on Heterodera glycines Population Density in a Greenhouse Screening Study

Crop rotation is a common means of reducing pathogen populations in soil. Several rotation crops have been shown to reduce soybean cyst nematode (Heterodera glycines) populations, but a comprehensive study of the optimal crops is needed. A greenhouse study was conducted to determine the effect of growth and decomposition of 46 crops on population density of H. glycines. Crops were sown in soil infested with H. glycines. Plants were maintained until 75 days after planting, when the soil was mixed, a sample of the soil removed to determine egg density, and shoots and roots chopped and mixed into the soil. After 56 days, soil samples were again taken for egg counts, and a susceptible soybean ('Sturdy') was planted in the soil as a bioassay to determine egg viability. Sunn hemp (Crotalaria juncea), forage pea (Pisum sativum), lab-lab bean (Lablab purpureus), Illinois bundleflower (Desman-thus illinoensis), and alfalfa (Medicago sativa) generally resulted in smaller egg population density in soil or number of cysts formed on soybean in the bioassay than the fallow control. Sunn hemp most consistently showed the lowest numbers of eggs and cysts. As a group, legumes resulted in lower egg population densities than monocots, Brassica species, and other dicots.

Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches

STUDY OBJECTIVES

There are contradictory perspectives on the importance of conventional coronary heart disease (CHD) risk factors in explaining population levels and social gradients in CHD. This study examined the contribution of conventional CHD risk factors (smoking, hypertension, dyslipidaemia, and diabetes) to explaining population levels and to absolute and relative social inequalities in CHD. This was investigated in an entire population and by creating a low risk sub-population with no smoking, dyslipidaemia, diabetes, and hypertension to simulate what would happen to relative and social inequalities in CHD if conventional risk factors were removed.

DESIGN, SETTING, AND PARTICIPANTS

Population based study of 2682 eastern Finnish men aged 42, 48, 54, 60 at baseline with 10.5 years average follow up of fatal (ICD9 codes 410-414) and non-fatal (MONICA criteria) CHD events.

MAIN RESULTS

In the whole population, 94.6% of events occurred among men exposed to at least one conventional risk factor, with a PAR of 68%. Adjustment for conventional risk factors reduced relative social inequality by 24%. However, in a low risk population free from conventional risk factors, absolute social inequality reduced by 72%.

CONCLUSIONS

Conventional risk factors explain the majority of absolute social inequality in CHD because conventional risk factors explain the vast majority of CHD cases in the population. However, the role of conventional risk factors in explaining relative social inequality was modest. This apparent paradox may arise in populations where inequalities in conventional risk factors between social groups are low, relative to the high levels of conventional risk factors within every social group. If the concern is to reduce the overall population health burden of CHD and the disproportionate population health burden associated with the social inequalities in CHD, then reducing conventional risk factors will do the job.

Variable host-pathogen compatibility in Mycobacterium tuberculosis

Mycobacterium tuberculosis remains a major cause of morbidity and mortality worldwide. Studies have reported human pathogens to have geographically structured population genetics, some of which have been linked to ancient human migrations. However, no study has addressed the potential evolutionary consequences of such longstanding human-pathogen associations. Here, we demonstrate that the global population structure of M. tuberculosis is defined by six phylogeographical lineages, each associated with specific, sympatric human populations. In an urban cosmopolitan environment, mycobacterial lineages were much more likely to spread in sympatric than in allopatric patient populations. Tuberculosis cases that did occur in allopatric hosts disproportionately involved high-risk individuals with impaired host resistance. These observations suggest that mycobacterial lineages are adapted to particular human populations. If confirmed, our findings have important implications for tuberculosis control and vaccine development.

Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993-2001

BACKGROUND

Rates of invasive testing and treatment for coronary artery disease have increased over time. Less is known about trends in the utilization of noninvasive cardiac testing for coronary artery disease. The objective of this study was 2-fold: to explore temporal trends in the utilization of noninvasive and invasive cardiac services in relation to changes in the prevalence of cardiac disease, and to examine whether temporal increases have been targeted to potentially underserved populations.

METHODS AND RESULTS

We performed an annual cross-sectional population-based study of Medicare patients from 1993 to 2001. We identified stress testing, cardiac catheterization, and revascularization procedures, as well as hospitalizations for acute myocardial infarction, during each year and calculated population-based rates for each using the total fee-for-service Medicare population as the denominator and adjusting for age, gender, and race. We observed marked growth in the utilization rates of cardiac services over time, with relative rates nearly doubling for most services. Acute myocardial infarction hospitalization rates have remained stable over the study period. Although rates of all procedures except coronary artery bypass increased in all subgroups, differences in rates of cardiac testing and treatment between nonblack men and other subgroups persisted over time.

CONCLUSIONS

Temporal increases in the use of noninvasive and invasive cardiac services are not explained by changes in disease prevalence and have not succeeded in narrowing preexisting treatment differences by gender and race. Such increases, although conferring benefit for some, may expose others to risk and cost without benefit.

A predictive model for exemestane pharmacokinetics/pharmacodynamics incorporating the effect of food and formulation

AIMS

Exemestane (Aromasin) is an irreversible aromatase inactivator used for the treatment of postmenopausal women with advanced breast cancer. The objective of this study was to evaluate the effect of formulation comparing a sugar-coated tablet (SCT) with a suspension and food on the pharmacokinetics (PK) and pharmacodynamics (PD) with respect to plasma estrone sulphate (E1S) concentrations of exemestane, using a PK/PD approach.

METHODS

This was an open, three-period, randomized, crossover study. Twelve healthy postmenopausal women received single oral doses of 25 mg exemestane as a SCT after fasting or food and as a suspension after fasting. Exemestane and E1S concentrations were determined before and up to 14 days after drug administration. Population analysis was performed in two steps: (i) a compartmental PK model was selected incorporating the effect of food and formulation; (ii) conditional on the PK model, a PD model was developed employing indirect response models. Model selection was performed using standard statistical tests. Validation and assessment of the predictive capability of the selected model was performed using real test data sets obtained from the literature.

RESULTS

A three-compartment model with first-order elimination rate best described exemestane disposition (k12 0.454, k21 0.158, k13 0.174, k31 0.016 and k 0.738 h(-1)). Absorption was described by a mono-exponential function [ka 2.3 (SCT after fasting), 1.1 (SCT after food) and 7.6 h(-1) (suspension); lag time 0.2 h]. The PD model assumed that E1S plasma concentrations are determined by a zero-order synthesis rate (6.5 pg ml(-1) h(-1)) and a first-order elimination constant (0.032 h(-1)). Exemestane inhibited E1S synthesis with a C50 value of 22.1 pg ml(-1). The mean population estimates were used to simulate the administration of different doses of the drug (0.5, 1, 2.5, 5 and 25 mg day(-1)). The model predictions were in agreement with historical data.

CONCLUSIONS

Exemestane absorption is influenced by the formulation of the drug and by food, but its disposition is independent of both. PK differences do no translate into clinically important differences in the PD. The PK/PD model developed was able to predict successfully the response to different doses and administration schedules with respect to oestrogen suppression.

Does waist indicate dyslipidemia better than BMI in Korean adult population?

Obesity is an independent and modifiable risk factor for cardiovascular disease, and known as a core of the metabolic syndrome. Obesity has been largely diagnosed based upon anthrompometric measurements like waist circumference (WC) and body mass index (BMI). We sought to determine associations between anthropometric measurements and dyslipidemia in a community adult sample composed of 1,032 community residents (356 men, 676 women) aged 50 yr and over in Namwon, Korea. Blood tests for lipid profiles, including total cholesterol (TC) and HDL cholesterol (HDL) were performed, and dyslipidemia was defined as TC/HDL greater than 4. Anthropometric measurements included WC, waist-to-height ratio (WHtR), waist-to-hip ratio, and BMI. All anthropometric measures were categorized into quartiles and evaluated for associations with dyslipidemia. TC/HDL showed the significant associations with the anthropometric measures, independently of potential confounders. In women, increases of obesity indexes by quartile analyses showed linear increases of odds ratios for dyslipidemia (p values <0.01 by trend test). In men, except BMI, same patterns of association were noted. WC and WHtR were significantly associated with dyslipidemia in Korean adult population. As a simple and non-invasive method for a detection of obesity and dyslipidemia, anthropometric measurements could be efficiently used in clinical and epidemiologic fields.

Population Dynamics and Tropical Deforestation: State of the Debate and Conceptual Challenges

What is the role of population in driving deforestation? This question was put forth as a discussion topic in the cyberseminar hosted by Population Environment Research Network (PERN) in Spring, 2003. Contributors from diverse backgrounds weighed in on the discussion, citing key factors in the population-deforestation nexus and suggesting further courses of action and research. Participants explored themes of their own choosing, with many coming to the forefront. Scale, time, and place-based effects were cited as areas in need of particular attention. Consumption patterns as the mechanism for spurring deforestation were discussed, drawing attention to the differential patterns associated with urban vs. rural demands on forest resources and land. The applicability of the IPAT formula and the influence of its component parts, affluence and technology, when operating in tandem with population, was debated. The relation of demographic factors to these pathways was critically examined. Institutional and governmental influence, such as infrastructure and policies affecting access and incentives, the valuation of resources, and institutional failures such as mismanagement and corruption emerged as a crucial set of factors. This article synthesizes the critical debates in the population-deforestation literature, makes suggestions for future paths of research, and discussed possible policy and direct action initiatives.

Does chiropractic 'add years to life'?

The chiropractic cliché "Chiropractic Adds Life to Years and Years to Life" was examined for validity. It was assumed that chiropractors themselves would be the best informed about the health benefits of chiropractic care. Chiropractors would therefore be most likely to receive some level of chiropractic care, and do so on a long-term basis. If chiropractic care significantly improves general health then chiropractors themselves should demonstrate longer life spans than the general population. Two separate data sources were used to examine chiropractic mortality rates. One source used obituary notices from past issues of Dynamic Chiropractic from 1990 to mid-2003. The second source used biographies from Who Was Who in Chiropractic - A Necrology covering a ten year period from 1969-1979. The two sources yielded a mean age at death for chiropractors of 73.4 and 74.2 years respectively. The mean ages at death of chiropractors is below the national average of 76.9 years and is below their medical doctor counterparts of 81.5.This review of mortality date found no evidence to support the claim that chiropractic care "Adds Years to Life."

Blood pressure differences between northern and southern Chinese: role of dietary factors: the International Study on Macronutrients and Blood Pressure

Blood pressure and prevalence of high blood pressure are greater for northern than southern Chinese. Reasons for these differences are unclear. Relationships of north-south blood pressure differences with multiple dietary factors were investigated in 839 Chinese participants, International Study on Macronutrients and Blood Pressure (INTERMAP), 561 northern, 278 southern, aged 40 to 59 years. Daily nutrient intakes were determined from four 24-hour dietary recalls and 2 timed 24-hour urine collections. Average systolic/diastolic pressure levels were 7.4/6.9 mm Hg higher for northern than southern participants. Southern participants had lower body mass index, sodium intake, sodium/potassium ratio, and higher intake of calcium, magnesium, phosphorus, and vitamins A and C. Considered singly, with control for age and gender, several dietary variables (eg, body mass index, urinary sodium/potassium ratio, urinary sodium, dietary phosphorus, and magnesium) reduced north-south blood pressure differences by > or =10%. Controlled for age and gender, nondietary variables had little effect on north-south blood pressure differences. With inclusion in regression models of multiple dietary variables (sodium, potassium, magnesium or phosphorus, body mass index), north-south blood pressure differences became much smaller (systolic -1.1, diastolic 1.6 mm Hg) and statistically nonsignificant. In conclusion, multiple dietary factors accounted importantly for north-south blood pressure differences. Efforts are needed to improve nutrition in China, especially in the north, as well as in other populations including those in the United States, for prevention and control of adverse blood pressure levels and major adult cardiovascular disease.

Proximate Population Factors and Deforestation in Tropical Agricultural Frontiers

Forest conversion for agriculture expansion is the most salient signature of human occupation of the earth's land surface. Although population growth and deforestation are significantly associated at the global and regional scales, evidence for population links to deforestation at micro-scales-where people are actually clearing0020forests-is scant. Much of the planet's forest elimination is proceeding along tropical agricultural frontiers. This article examines the evolution of thought on population-environment theories relevant to deforestation in tropical agricultural frontiers. Four primary ways by which population dynamics interact with frontier forest conversion are examined: population density, fertility, and household demographic composition, and in-migration.

Chronic venous disease in an ethnically diverse population: the San Diego Population Study

In a 1994-1998 cross-sectional study of a multiethnic sample of 2,211 men and women in San Diego, California, the authors estimated prevalence of the major manifestations of chronic venous disease: spider veins, varicose veins, trophic changes, and edema by visual inspection; superficial and deep functional disease (reflux or obstruction) by duplex ultrasonography; and venous thrombotic events based on history. Venous disease increased with age, and, compared with Hispanics, African Americans, and Asians, non-Hispanic Whites had more disease. Spider veins, varicose veins, superficial functional disease, and superficial thrombotic events were more common in women than men (odds ratio (OR) = 5.4, OR = 2.2, OR = 1.9, and OR = 1.9, respectively; p < 0.05), but trophic changes and deep functional disease were less common in women (OR = 0.7 for both; p < 0.05). Visible (varicose veins or trophic changes) and functional (superficial or deep) disease were closely linked; 92.0% of legs were concordant and 8.0% discordant. For legs evidencing both trophic changes and deep functional disease, the age-adjusted prevalences of edema, superficial events, and deep events were 48.2%, 11.3%, and 24.6%, respectively, compared with 1.7%, 0.6%, and 1.3% for legs visibly and functionally normal. However, visible disease did not invariably predict functional disease, or vice versa, and venous thrombotic events occurred in the absence of either.

Mortality and recurrent cardiac events after coronary artery bypass graft: long term outcomes in a population study

OBJECTIVE

To determine 30 day mortality, long term survival, and recurrent cardiac events after coronary artery bypass graft (CABG) in a population.

DESIGN

Follow up study of patients prospectively entered on to a cardiothoracic surgical database. Record linkages were used to obtain data on readmissions and deaths.

PATIENTS

8910 patients undergoing isolated first CABG between 1980 and 1993 in Western Australia.

MAIN OUTCOME MEASURES

30 day and long term survival, readmission for cardiac event (acute myocardial infarction, unstable angina, percutaneous transluminal coronary angioplasty or reoperative CABG).

RESULTS

There were 3072 deaths to mid 1999. 30 day and long term survival were significantly better in patients treated in the first five years than during the following decade. The age of the patients, proportion of female patients, and number of grafts increased over time. An urgent procedure (odds ratio 3.3), older age (9% per year) and female sex (odds ratio 1.5) were associated with increased risk for 30 day mortality, while age (7% per year) and a recent myocardial infarction (odds ratio 1.16) influenced long term survival. Internal mammary artery grafts were followed by better short and long term survival, though there was an obvious selection bias in favour of younger male patients.

CONCLUSIONS

This study shows worsening crude mortality at 30 days after CABG from the mid 1980s, associated with the inclusion of higher risk patients. Older age, an acute myocardial infarction in the year before surgery, and the use of sephenous vein grafts only were associated with poorer long term survival and greater risk of a recurrent cardiac event. Female sex predicted recurrent events but not long term survival.