Cardiovascular risk factors in British children from towns with widely differing adult cardiovascular mortality.

OBJECTIVE--To examine whether cardiovascular risk factors differ in children from towns in England and Wales with widely differing adult cardiovascular death rates. DESIGN--School based survey conducted during 1994 in 10 towns, five with exceptionally high adult cardiovascular mortality (standardised mortality ratio 131-143) and five with exceptionally low adult cardiovascular mortality (64-75). Towns were surveyed in high-low pairs. SUBJECTS--3415 white children aged 8-11 years with physical measurements (response rate 75%), including 1287 with blood samples (response rate 64%), of whom 515 had blood samples taken 30 minutes after a glucose load. RESULTS--Children in towns with high cardiovascular mortality were on average shorter than those in towns with low mortality (mean difference 1.2 cm; 95% confidence interval 0.3 to 2.1 cm; P = 0.02) and had a higher ponderal index (0.34 kg/m3; 0.16 to 0.52 kg/m3; P = 0.006). Mean systolic pressure was higher in high mortality towns, particularly after adjustment for height (2.0 mm Hg; 0.8 to 3.2 mm Hg; P = 0.009). Mean waist:hip ratio, total cholesterol concentration, and 30 minute post-load glucose measurements were similar in high and low mortality towns. The differences in height and blood pressure between high and low mortality towns were unaffected by standardisation for birth weight. CONCLUSIONS--The differences in height, ponderal index, and blood pressure between towns with high and low cardiovascular mortality, if persistent, may have important future public health implications. Their independence of birth weight suggests that the childhood environment rather than the intrauterine environment is involved in their development.     

British Regional Heart Study: geographic variations in cardiovascular mortality,and the role of water quality

In a study of regional variations in cardiovascular mortality in Great Britain during 1969-73 based on 253 towns the possible contributions of drinking water quality, climate, air pollution, blood groups, and socioeconomic factors were evaluated. A twofold range in mortality from stroke and ischaemic heart disease was apparent, the highest mortality being in the west of Scotland and the lowest in south-east England. A multifactorial approach identified five principal factors that substantially explained this geographic variation in cardiovascular mortality—namely, water hardness, rainfall, temperature, and two social factors (percentage of manual workers and car ownership). After adjustment for other factors cardiovascular mortality in areas with very soft water, around 0·25 mmol/l (calcium carbonate equivalent 25 mg/l), was estimated to be 10-15% higher than that in areas with medium-hard water, around 1·7 mmol/l (170 mg/l), while any further increase in hardness beyond 1·7 mmol/l did not additionally lower cardiovascular mortality.Thus a negative relation existed between water hardness and cardiovascular mortality, although climate and socioeconomic conditions also appeared to be important influences. Cross-sectional and prospective surveys of 7500 middle-aged men from 24 towns are in progress and will permit further exploration of these geographic differences, especially with regard to personal risk factors such as blood pressure, blood lipid concentrations, and cigarette smoking.     

Urban–rural differences in Roman Dorset,England: A bioarchaeological perspective on Roman settlements

In the Roman period, urban and rural ways of living were differentiated philosophically and legally, and this is the first regional study of these contrasting life‐ways. Focusing on frailty and mortality risk, we investigated how these differed by age, sex, and status, using coffin type as a proxy for social status. We employed skeletal data from 344 individuals: 150 rural and 194 urban (1st–5th centuries A.D.) from Dorset, England. Frailty and mortality risk were examined using indicators of stress (cribra orbitalia, porotic hyperostosis, nonspecific periostitis, and enamel hypoplastic defects), specific metabolic and infectious diseases (rickets, scurvy, and tuberculosis), and dental health (carious lesions and calculus). These variables were studied using Chi‐square, Siler model of mortality, Kaplan–Meier analysis, and the Gompertz model of adult mortality. Our study found that overall, mortality risk and survivorship did not differ between cemetery types but when the data were examined by age, mortality risk was only significantly higher for urban subadults. Demographic differences were found, with urban cemeteries having more 0–10 and >35 year olds, and for health, urban cemeteries had significantly higher frequencies of enamel hypoplastic defects, carious lesions, and rickets. Interestingly, no significant difference in status was observed between rural and urban cemeteries. The most significant finding was the influence of the skeletal and funerary data from the Poundbury sites, which had different demographic profiles, significantly higher frequencies of the indicators of stress and dental health variables. In conclusion, there are significant health, demographic, and mortality differences between rural and urban populations in Roman Britain. Am J Phys Anthropol 157:107–120, 2015. © 2015 Wiley Periodicals, Inc.     

Temporal changes and rural-urban differences in cardiovascular disease risk factors and mortality in China.

We summarize several studies, from the last 10 years, of temporal changes and rural-urban differences in the risk factors of cardiovascular disease (CVD) in China to indicate the influences of economic modernization. Two national blood pressure surveys have shown that the prevalence of hypertension increased from 5.1% to 7.7% between 1958-1959 and 1979-1980. Throughout China hypertension is more prevalent in urban areas than in rural areas. Within the Shanghai region body mass index, blood pressure, and total serum cholesterol were higher in urban districts than in rural areas. Rural-urban differences in lipid levels were also found in the Beijing and Guangzhou regions. A related four-year followup study showed that total serum cholesterol and triglycerides increased markedly in both urban and rural areas of Guangzhou. In Shanghai part-time farmers who worked in factories had a higher age-adjusted prevalence of definite hypertension than farmers who worked full-time in the fields (5.0% versus 2.3%). In a prospective study in Wuhan a new productivity-based salary system was associated with increased serum cholesterol and blood pressure. Age-adjusted CVD mortality increased from 1973 to 1982 in a rapidly industrializing county in the Shanghai metropolitan region. The results from several studies indicate that China is undergoing the expected increase in modernization-related CVD risk factors and mortality, especially in urban metropolitan regions.     

Cognitive impairment and mortality in a cohort of elderly people.

OBJECTIVES--To investigate the relation between cognitive function and cause specific mortality in people aged 65 and over. DESIGN-A 20 year follow up study of a cohort of randomly selected elderly people living in the community who in 1973-4 had taken part in a nutritional survey funded by the Department of Health and Social Security. SETTING--Eight areas in Britain (five in England, two in Scotland, and one in Wales). SUBJECTS--921 men and women whose cognitive function was assessed by a geriatrician in 1973-4 and for whom data on health, socioeconomic circumstances, and diet had been recorded. RESULTS--Cognitive impairment was associated with increased mortality, in particular death from ischaemic stroke. Those who scored 7 or less on the Hodkinson mental test had a relative risk of dying from stroke of 2.8 (95% confidence interval 1.4 to 5.5), compared with those who gained the maximum score (10), after adjustment for age, sex, blood pressure, serum cholesterol concentration, and vitamin C intake. These associations were independent of illness or social class. At the time of the nutritional survey, cognitive function was poorest in those with the lowest vitamin C status, whether measured by dietary intake or plasma ascorbic acid concentration. The relation between vitamin C status and cognitive function was independent of age, illness, social class, or other dietary variables. CONCLUSION--The relation between cognitive function and risk of death from stroke suggests that cerebrovascular disease is an important cause of declining cognitive function. Vitamin C status may be a determinant of cognitive function in elderly people through its effect on atherogenesis. A high vitamin C intake may protect against both cognitive impairment and cerebrovascular disease.     

Migration and geographic variations in blood pressure in Britain.

OBJECTIVE--To evaluate the relative contributions of factors acting at different stages in life to regional differences in adult blood pressure. DESIGN--Prospective cohort study (British regional heart study). SETTING--One general practice in each of 24 towns in Britain. SUBJECTS--7735 Men aged 40-59 years when screened in 1978-80 whose geographic zone of birth and zone of examination were classified as south of England, midlands and Wales, north of England, and Scotland. Non-migrants (n = 3144) were born in the town where they were examined; internal migrants (n = 4147) were born in Great Britain but not in the town where they were examined; and international migrants (n = 422) were born outside Great Britain. MAIN OUTCOME MEASURES--Systolic and diastolic blood pressures and height. RESULTS--Regardless of where they were born, men living in the south of England had lower mean blood pressures than men living in Scotland (142.5/80.1 v 148.1/85.2 mm Hg). The effects of the place of birth and place of examination on adult blood pressure were examined in a multiple regression model. For internal migrants the modelled increase in mean systolic blood pressure across adjacent zones of examination was 2.1 mm Hg (95% confidence interval 1.3 to 2.9); for adjacent zones of birth the corresponding increase was 0.1 mm Hg (-0.7 to 0.7). The place of examination seemed to be a far more important determinant of mean adult blood pressure than the place of birth. Height is an accepted marker of genetic and early life influences. Regional differences in height were therefore analysed to test whether the multiple regression model could correctly distinguish between the influence of place of birth and place of examination. As expected, men born in Scotland were shorter on average than men born in the south of England irrespective of where they lived in Britain (172.6 cm v 175.1 cm for internal migrants). CONCLUSION--Regional variations in blood pressure were strongly influenced by where the men had lived for most of their adult lives rather than by where they were born and brought up. Among middle aged men, factors acting in adult life seemed to be more important determinants of regional differences in blood pressure than those acting early in life such as genetic inheritance, intrauterine environment, and childhood experience.     

ABO blood group and ischaemic heart disease in British men.

OBJECTIVE--To establish whether ABO blood group is related to ischaemic heart disease on an individual and geographic basis in Britain. DESIGN--Prospective study of 7662 men with known ABO blood group selected from age-sex registers in general practices in 24 British towns. MEASUREMENTS--ABO blood group, standard cardiovascular risk factors, social class, and presence or absence of ischaemic heart disease determined at entry to study. END POINTS--Eight year follow up of fatal and nonfatal ischaemic heart disease events achieved for 99% of study population. RESULTS--Towns with a higher prevalence of blood group O had higher incidences of ischaemic heart disease. In individual subjects, however, the incidence of ischaemic heart disease was higher in those with group A than in those with other blood groups (relative risk 1.21, 95% confidence limits 1.01 to 1.46). Total serum cholesterol concentration was slightly higher in subjects of blood group A. No other cardiovascular risk factor (including social class) was related to blood group. CONCLUSIONS--Blood group A is related to the incidence of ischaemic heart disease in individual subjects. Geographic differences in the distribution of ABO blood groups do not explain geographic variation in rates of ischaemic heart disease in Britain. The findings do not support the view that ABO blood group and social class are related.     

Blood flow to long bones indicates activity metabolism in mammals, reptiles and dinosaurs

The cross-sectional area of a nutrient foramen of a long bone is related to blood flow requirements of the internal bone cells that are essential for dynamic bone remodelling. Foramen area increases with body size in parallel among living mammals and non-varanid reptiles, but is significantly larger in mammals. An index of blood flow rate through the foramina is about 10 times higher in mammals than in reptiles, and even higher if differences in blood pressure are considered. The scaling of foramen size correlates well with maximum whole-body metabolic rate during exercise in mammals and reptiles, but less well with resting metabolic rate. This relates to the role of blood flow associated with bone remodelling during and following activity. Mammals and varanid lizards have much higher aerobic metabolic rates and exercise-induced bone remodelling than non-varanid reptiles. Foramen areas of 10 species of dinosaur from five taxonomic groups are generally larger than from mammals, indicating a routinely highly active and aerobic lifestyle. The simple measurement holds possibilities offers the possibility of assessing other groups of extinct and living vertebrates in relation to body size, behaviour and habitat.     

Inequalities in health in Britain: specific explanations in three Lancashire towns.

The reasons why mortality is higher in the poorer areas of Britain are largely unknown. Thus how to reduce inequalities in health is a matter of conjecture. In three neighbouring towns in northern England the rates of death from all causes differ greatly. Socioeconomic conditions in the towns are similar though below average for England and Wales. The pattern of disease specific rates was analysed and related to past differences in infant mortality. It is suggested that past differences in maternal health and physique and in the postnatal environment, particularly infant feeding, housing, and overcrowding, may be determinants of current differences in adult mortality.     

Age‐Related Differences in Daily Attention Patterns in Preschool,Kindergarten, First‐Grade,and Fifth‐Grade Pupils

The purpose of this study was to examine age‐related differences in the daily attention patterns of preschool, kindergarten, first‐grade, and fifth‐grade pupils by means of a cross‐sectional sample of 4–11‐year‐old French students. The importance of this study comes from the need to understand attention and apply the information it provides in educational settings. The first study conducted in a school setting with three age groups (4–5‐, 6–7‐, and 10–11‐year‐olds) demonstrated a rapid rhythmicity (60 minute period) for preschoolers (4–5 years old), with higher performance at the beginning of a teaching session. This pattern evolved until the fifth grade (10–11‐year‐olds), after which the temporal variation in attention was comparable to that of working adults, with fluctuations occurring on a half‐day basis. The children's scores on crossing‐out tests rose during the morning, declined in the early afternoon, and then rose again later during the afternoon. The second study enhanced our understanding of the change of the rhythm in attention of 4–7‐year‐old pupils. The rapid daily rhythmicity, linked to a session effect, seems to gradually disappear as children move from preschool 2 to kindergarten (4–5‐ to 5–6‐year‐olds) and then on to first grade (6–7‐year‐olds), where the daily attention patterns are closer to the standard pattern found by chronopsychology studies. The evolving patterns obtained from group means were confirmed by analysis of individual patterns. Exploratory statistical analysis of the data provided greater detail on the observed interindividual patterns, indicating that within each school grade, the attention patterns of some children are similar to the standard pattern while the attention patterns of others are more atypical. Deviations were mainly found in the 5–6‐year‐old age range (kindergarteners). The greatest ‘mixture’ of patterns was observed in the kindergartners (5–6‐year‐olds). Age plays a role not only in modifying daily changes but also in the distribution of interindividual differences in daily fluctuations, which occur most when children are of kindergarten age (5–6 years of age).     

Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British family heart study. Family Heart Study Group.

OBJECTIVE--To measure the change in cardiovascular risk factors achievable in families over one year by a cardiovascular screening and lifestyle intervention in general practice. DESIGN--Randomised controlled trial in 26 general practices in 13 towns in Britain. SUBJECTS--12,472 men aged 40-59 and their partners (7460 men and 5012 women) identified by household. INTERVENTION--Nurse led programme using a family centred approach with follow up according to degree of risk. MAIN OUTCOME MEASURES--After one year the pairs of practices were compared for differences in (a) total coronary (Dundee) risk score and (b) cigarette smoking, weight, blood pressure, and random blood cholesterol and glucose concentrations. RESULTS--In men the overall reduction in coronary risk score was 16% (95% confidence interval 11% to 21%) in the intervention practices at one year. This was partitioned between systolic pressure (7%), smoking (5%), and cholesterol concentration (4%). The reduction for women was similar. For both sexes reported cigarette smoking at one year was lower by about 4%, systolic pressure by 7 mm Hg, diastolic pressure by 3 mm Hg, weight by 1 kg, and cholesterol concentration by 0.1 mmol/l, but there was no shift in glucose concentration. Weight, blood pressure, and cholesterol concentration showed the greatest difference at the top of the distribution. If maintained long term the differences in risk factors achieved would mean only a 12% reduction in risk of coronary events. CONCLUSIONS--As most general practices are not using such an intensive programme the changes in coronary risk factors achieved by the voluntary health promotion package for primary care are likely to be even smaller. The government''s screening policy cannot be justified by these results.     

贵州石漠化区布依族传统村落人居环境适宜度

为了解传统村落人居环境对石漠化及地形地貌的适应性,采用德尔菲法、综合权重法确定了石漠化区布依族传统村落人居环境适宜度评价指标体系及权重,并收集指标数据和确定人居环境适宜度值与阈值,综合分析了人居环境适宜度.结果表明: 10%的布依族传统村落位于强度与极强度石漠化区,且有择优环境的传统;人居环境适宜度指标体系由经济、历史文化、生态、社会、建筑环境适宜度5个一级指标及26个二级指标组成,该指标体系对喀斯特区村落均适宜;总体上,综合环境适宜度值(2.81～3.77)与经济(0.77～1.17)、历史文化(0.39～0.50)、生态(0.83～1.07)、社会环境(0.38～0.53)适宜度值随石漠化强度递增而递减,而建筑(0.43～0.51)则无显著变化,石漠化对经济、历史文化、生态和社会环境影响深远且有协同关系;人居环境适宜度阈值下限为2.93,低于2.93可考虑搬迁或采取措施提高其值;山地半坡传统村落人居环境适宜度值(3.56)高于洼地(3.42)和谷地(3.16);石漠化区传统村落人居环境适宜度比普通村落高,但低于常态地貌,其主因是经济与生态的差异;石漠化区传统村落人居环境提升应加强石漠化综合治理及政策支撑,发展生态经济与旅游及保护历史文化或生态移民.本研究可为喀斯特区村落人居环境保护规划、建设等提供理论依据.     

Diet and inequalities in health in three English towns

The diets of 2340 middle aged men and women living in three English towns were recorded. Consumption of fat and the other main nutrients was lowest in the northern industrial town, which had the highest death rates from ischaemic heart disease and from all causes combined.The findings suggest that differences in diet in middle age are not a major cause of differences in adult mortality between one part of Britain and another.     

不同海拔地区藏族就诊人群血脂、血液黏度、HCY水平与心血管疾病的相关性研究

目的:探讨不同海拔地区藏族就诊人群血脂、血液黏度、HCY水平与心血管疾病的相关性。方法:采用回顾性分析的方法,将328例来自不同海拔地区的藏族就诊患者为三组,高海拔组(纳入99例),中海拔(纳入120例)和低海拔组(纳入109例),比较不同海拔高度组患者血压、血脂、血液黏度、HCY、疾病类型的差异,采用多元Logistic回归模型分析藏族就诊人群心血管疾病发病的影响因素。结果:不同海拔组收缩压、舒张压、血清HCY、TC、TG、HDL-C、LDL-C水平、全血黏度低切、中切、高切、血浆黏度和红细胞压积比较差异均有统计学意义(P0.05),随着海拔升高,收缩压、舒张压、血清HCY、TC、TG以及LDL-C、全血黏度低切、中切、高切、血浆黏度和红细胞压积水平显著升高(P0.05),而血清HDL-C水平显著下降。41.8%(137/328)的就诊者至少患有一种心血管疾病,和非心血管组比较,心血管疾病组年龄明显偏高,居住主要分布在中度及高度海拔地区,合并高血糖、高血脂、高HCY的比例均明显较高,差异均有统计学意义(P0.05)。年龄、海拔、高血糖、高血脂、高HCY均和心血管疾病相关(r=-0.230~0.334,P0.05)。多元Logistic回归分析显示年龄、居住地海拔、HCY水平、全血低切粘度、TG水平、LDL-C等因素是心血管疾病发生的危险因素,HDL-C是保护因素。结论:来自不同海拔地区的就诊人群在血压、血脂、血液黏度、HCY水平以及心血管疾病患者占比不同。年龄、居住地海拔、HCY水平、血液黏度、血脂水平等增加可能使高原藏族人群心血管疾病发生风险增加。     

The effects of environment and ownership on children's innovation of tools and tool material selection

Research indicates that in experimental settings, young children of 3–7 years old are unlikely to devise a simple tool to solve a problem. This series of exploratory studies done in museums in the US and UK explores how environment and ownership of materials may improve children''s ability and inclination for (i) tool material selection and (ii) innovation. The first study takes place in a children''s museum, an environment where children can use tools and materials freely. We replicated a tool innovation task in this environment and found that while 3–4 year olds showed the predicted low levels of innovation rates, 4–7 year olds showed higher rates of innovation than the younger children and than reported in prior studies. The second study explores the effect of whether the experimental materials are owned by the experimenter or the child on tool selection and innovation. Results showed that 5–6 year olds and 6–7 year olds were more likely to select tool material they owned compared to tool material owned by the experimenter, although ownership had no effect on tool innovation. We argue that learning environments supporting tool exploration and invention and conveying ownership over materials may encourage successful tool innovation at earlier ages.     

Childhood conditions, migration, and mortality: migrants and natives in 19th-century cities

Migrants often have lower mortality than natives in spite of relatively unfavorable social and economic characteristics. Although migrants have a short-run advantage due to the selective migration of healthy workers, persistent health and mortality differences between migrants and natives may be long-run effects of different experiences in childhood. We made use of a natural experiment resulting from rural-to-urban migration in the mid-19th century. Mortality was much higher in urban areas, especially in rapidly growing industrial cities. Migrants usually came from healthier rural origins as young adults. Data used in this study is available from 19th-century Belgian population registers describing two sites: a rapidly growing industrial city and a small town that became an industrial suburb. We found evidence of three processes that lead to differences between the mortality of migrants and natives. First, recent migrants had lower mortality than natives, because they were self-selected for good health when they arrived. This advantage decreased with time spent in the destination. Second, migrants from rural backgrounds had a disadvantage in epidemic years, because they had less experience with these diseases. Third, migrants from rural areas had lower mortality at older (but not younger) ages, even if they had migrated more than 10 years earlier. We interpret this as a long-run consequence of less exposure to disease in childhood.     

Spatio-temporal trends in gastric cancer mortality in Spain: 1975–2008

Aim of the study: There has been a downward trend in gastric cancer mortality worldwide. In Spain, a marked spatial aggregation of areas with excess mortality due to this cause has long been reported. This paper sought to analyse the evolution of gastric cancer mortality risk in Spanish provinces and explore the possible attenuation of the geographical pattern. Methods: We studied a series of gastric cancer mortality data by province, year of death, sex and age group using a conditional autoregressive (CAR) model that incorporated space, time and spatio-temporal interactions. Results: Gastric cancer mortality risk decreased in all Spanish provinces in both males and females. Overall, decreasing trends were more pronounced during the first years of the study period, largely due to a sharper fall in gastric cancer mortality risk among the older population. Recent decades have witnessed a slowing in the rate of decrease, especially among the younger age groups. In most areas, risk declined at a similar rate, thus serving to maintain interprovincial differences and the persistence of the geographical pattern, though with some differences. The north and northwest provinces were the areas with higher mortality risks in both sexes and age groups over the entire study period. Concluding statement: Despite the decline in gastric cancer mortality risk observed for the 50 Spanish provinces studied, geographical differences still persist in Spain, and the cluster of excess mortality in the north-west of the country remains in evidence.     

Seasonal changes in the cardiorespiratory responses to hypercarbia and temperature in the bullfrog, Rana catesbeiana

We assessed the seasonal variations in the effects of hypercarbia (3 or 5% inspired CO2) on cardiorespiratory responses in the bullfrog Rana catesbeiana at different temperatures (10, 20 and 30 degrees C). We measured breathing frequency, blood gases, acid-base status, hematocrit, heart rate, blood pressure and oxygen consumption. At 20 and 30 degrees C, the rate of oxygen consumption had a tendency to be lowest during winter and highest during summer. Hypercarbia-induced changes in breathing frequency were proportional to body temperature during summer and spring, but not during winter (20 and 30 degrees C). Moreover, during winter, the effects of CO2 on breathing frequency at 30 degrees C were smaller than during summer and spring. These facts indicate a decreased ventilatory sensitivity during winter. PaO2 and pHa showed no significant change during the year, but PaCO2 was almost twice as high during winter than in summer and spring, indicating increased plasma bicarbonate levels. The hematocrit values showed no significant changes induced by temperature, hypercarbia or season, indicating that the oxygen carrying capacity of blood is kept constant throughout the year. Decreased body temperature was accompanied by a reduction in heart rate during all four seasons, and a reduction in blood pressure during summer and spring. Blood pressure was higher during winter than during any other seasons whereas no seasonal change was observed in heart rate. This may indicate that peripheral resistance and/or stroke volume may be elevated during this season. Taken together, these results suggest that the decreased ventilatory sensitivity to hypercarbia during winter occurs while cardiovascular parameters are kept constant.     

Cardiometabolic Risk Indicators That Distinguish Adults with Psychosis from the General Population,by Age and Gender

Individuals with psychosis are more likely than the general community to develop obesity and to die prematurely from heart disease. Interventions to improve cardiovascular outcomes are best targeted at the earliest indicators of risk, at the age they first emerge. We investigated which cardiometabolic risk indicators distinguished those with psychosis from the general population, by age by gender, and whether obesity explained the pattern of observed differences. Data was analyzed from an epidemiologically representative sample of 1,642 Australians with psychosis aged 18–64 years and a national comparator sample of 8,866 controls aged 25–64 years from the general population. Cubic b-splines were used to compare cross sectional age trends by gender for mean waist circumference, body mass index [BMI], blood pressure, fasting blood glucose, triglycerides, LDL, HDL, and total cholesterol in our psychosis and control samples. At age 25 individuals with psychosis had a significantly higher mean BMI, waist circumference, triglycerides, glucose [women only], and diastolic blood pressure and significantly lower HDL-cholesterol than controls. With the exception of triglycerides at age 60+ in men, and glucose in women at various ages, these differences were present at every age. Differences in BMI and waist circumference between samples, although dramatic, could not explain all differences in diastolic blood pressure, HDL-cholesterol or triglycerides but did explain differences in glucose. Psychosis has the hallmarks of insulin resistance by at least age 25. The entire syndrome, not just weight, should be a focus of intervention to reduce mortality from cardiovascular disease.     

Changes in incidence and prognosis of ischaemic heart disease in Finland: a record linkage study of data on death certificates and hospital records for 1972 and 1981.

The components of the decline in mortality from ischaemic heart disease in Finland were studied by analysing the changes in incidence and prognosis between 1972 and 1981. Using personal identification numbers, hospital discharge records and death certificates were linked for all men and women aged 40-64. During this period mortality decreased 15.9% in men and 23.5% in women, incidence 14.2% in men and 19.3% in women, being greatest among 40-49 year olds living in urban areas, and case fatality 7.3% in men and 10.3% in women, owing primarily to a decrease in patients dying of ischaemic heart disease without being admitted to hospital; survival was also better among patients admitted to hospital. Factors explaining these changes remain unknown because data on risk factors and factors influencing prognosis are limited and largely ecological.