Advances in imaging of new targets for pharmacological intervention in stroke: real-time tracking of T-cells in the ischaemic brain.

BACKGROUND AND PURPOSE: T-cells may play a role in the evolution of ischaemic damage and repair, but the ability to image these cells in the living brain after a stroke has been limited. We aim to extend the technique of real-time in situ brain imaging of T-cells, previously shown in models of immunological diseases, to models of experimental stroke. EXPERIMENTAL APPROACH: Male C57BL6 mice (6-8 weeks) (n= 3) received a total of 2-5 x 10(6) carboxyfluorescein diacetate succinimidyl ester (CFSE)-labelled lymphocytes from donor C57BL6 mice via i.v. injection by adoptive transfer. Twenty-four hours later, recipient mice underwent permanent left distal middle cerebral artery occlusion (MCAO) by electrocoagulation or by sham surgery under isoflurane anaesthesia. Female hCD2-green fluorescent protein (GFP) transgenic mice that exhibit GFP-labelled T-cells underwent MCAO. At 24 or 48 h post-MCAO, a sagittal brain slice (1500 microm thick) containing cortical branches of the occluded middle cerebral artery (MCA) was dissected and used for multiphoton laser scanning microscopy (MPLSM). KEY RESULTS: Our results provide direct observations for the first time of dynamic T-cell behaviour in living brain tissue in real time and herein proved the feasibility of MPLSM for ex vivo live imaging of immune response after experimental stroke. CONCLUSIONS AND IMPLICATIONS: It is hoped that these advances in the imaging of immune cells will provide information that can be harnessed to a therapeutic advantage.

Imaging T-cell movement in the brain during experimental cerebral malaria.

T-cells are known to play a role in the pathology associated with experimental cerebral malaria, although it has not previously been possible to examine their behaviour in brain. Using multiphoton laser scanning microscopy, we have examined the migration and movement of these cells in brain tissue. We believe that this approach will help define host-parasite interactions and examine how intervening in these relationships affects the development of cerebral pathology.

The nitric oxide-donating pravastatin derivative, NCX 6550 [(1S-[1alpha(betaS*, deltaS*), 2alpha, 6alpha, 8beta-(R*), 8a alpha]]-1,2,6,7,8,8a-Hexahydro-beta, delta, 6-trihydroxy-2-methyl-8-(2-methyl-1-oxobutoxy)-1-naphtalene-heptanoic acid 4-(nitrooxy)butyl ester)], reduces splenocyte adhesion and reactive oxygen species generation in normal and atherosclerotic mice.

Statins possess anti-inflammatory effects that may contribute to their ability to slow atherogenesis, whereas nitric oxide (NO) also influences inflammatory cell adhesion. This study aimed to determine whether a novel NO-donating pravastatin derivative, NCX 6550 [(1S-[1alpha(betaS*,deltaS*),2alpha,6alpha,8beta-(R*),8a alpha]]-1,2,6,7,8,8a-hexahydro-beta,delta,6-trihydroxy-2-methyl-8-(2-methyl-1-oxobutoxy)-1-naphthalene-heptanoic acid 4-(nitrooxy)butyl ester)], has greater anti-inflammatory properties compared with pravastatin in normal and atherosclerotic apolipoprotein E receptor knockout (ApoE-/-) mice. C57BL/6 and ApoE-/- mice were administered pravastatin (40 mg/kg), NCX 6550 (48.5 mg/kg), or vehicle orally for 5 days. Ex vivo studies assessed splenocyte adhesion to arterial segments and splenocyte reactive oxygen species (ROS) generation. NCX 6550 significantly reduced splenocyte adhesion to artery segments in both C57BL/6 (8.8 +/- 1.9% versus 16.6 +/- 6.7% adhesion; P < 0.05) and ApoE-/- mice (9.3 +/- 2.9% versus 23.4 +/- 4.6% adhesion; P < 0.05) concomitant with an inhibition of endothelial intercellular adhesion molecule-1 expression. NCX 6550 also significantly reduced phorbol 12-myristate 13-acetate-induced ROS production that was enhanced in isolated ApoE-/- splenocytes. Conversely, pravastatin had no significant effects on adhesion in normal or ApoE-/- mice but reduced the enhanced ROS production from ApoE-/- splenocytes. In separate groups of ApoE-/- mice, NCX 6550 significantly enhanced endothelium-dependent relaxation to carbachol in aortic segments precon-tracted with phenylephrine (-logEC(50), 6.37 +/- 0.37) compared with both vehicle-treated (-logEC50, 5.81 +/- 0.15; P < 0.001) and pravastatin-treated (-logEC50, 5.57 +/- 0.45; P < 0.05) mice. NCX 6550 also significantly reduced plasma monocyte chemoattractant protein-1 levels (648.8 pg/ml) compared with both vehicle (1191.1 pg/ml; P < 0.001) and pravastatin (847 +/- 71.0 pg/ml; P < 0.05) treatment. These data show that NCX 6550 exerts superior anti-inflammatory actions compared with pravastatin, possibly through NO-related mechanisms.

Abdominal adiposity in U.S. adults: prevalence and trends, 1960-2000.

BACKGROUND: There is a large body of epidemiologic evidence linking abdominal obesity to cardiovascular diseases. Abdominal adiposity is an important component of insulin resistance syndrome. OBJECTIVE: To investigate prevalence and trends in abdominal obesity in U.S. adult population. DESIGN, SETTING/PARTICIPANTS: Nationally representative cross-sectional surveys with an in-person interview and measurement of waist circumference; 23,654 adults aged 20-79 years were examined using data from U.S. National Surveys of 1960-1962 [the first National Health Examination Survey (NHES I)], 1988-1994 [the third National Health and Nutrition Examination Survey (NHANES III)] and 1999-2000 [National Health and Nutrition Examination Survey (NHANES 1999-2000)]. Abdominal obesity was defined as waist circumference > or = 102 cm (>40 in.) in men and > or = 88 cm (>35 in.) in women. RESULTS: There was a gradient of increasing waist circumference over the three periods of 1960-1962, 1988-1994 and 1999-2000 in both men and women. In men, the mean waist circumferences were 89, 95 and 99 cm for 1960-1962, 1988-1994 and 1999-2000, respectively. The corresponding values in women were 77, 92 and 94 cm, respectively. A gradient of increasing prevalence of abdominal obesity from 1960 to 2000 was also observed in men and women. In men, the overall age-adjusted prevalences of abdominal obesity were 12.7%, 29% and 38.3% in 1960-1962, 1988-1994 and 1999-2000, respectively. In women, the analogous values were 19.4%, 38.8% and 59.9%, respectively. Similar trends of increasing waist circumference and abdominal obesity were observed in normal weight, underweight and obese subjects defined using body mass index (BMI). Trends of increasing abdominal obesity with increasing BMI over the three time periods were also observed. CONCLUSIONS: The increase in the prevalence of abdominal obesity in the United States between 1960-1962 and 1999-2000 has ominous public health implications across entire population, particularly among normal weight subjects. There is an urgent need to describe a public health strategy for early identification of abdominal obesity. Primary prevention of obesity, including abdominal obesity, should be a major public health priority in the United States.

Estimated risk of death among employees in agriculture and agriculture-related industries in Georgia, 1985-1994.

Farming has an enormous impact on the economy of Georgia, with as many as one in six Georgians working in agriculture. The purpose of this study was to compare the risk of death of white and black farmers to non-farmers in Georgia. Mortality data stratified by age and aggregated by race were retrieved from the Georgia Office of Vital Statistics for the years 1985-1994. The classification system used to code occupation on the death certificate was W473-489, which includes farmers and most all other agricultural occupations. For each cause of death, the Breslow-Day Test was used to determine homogeneity of risk across all age strata (alpha=0.05). A common odds ratio (OR) and 95% confidence intervals were calculated for all homogeneous causes of death using the Mantel-Haenzel procedure. Among white farmers, the risk of death was significantly high for tuberculosis [OR=1.64 (1.01, 2.65)], fires [OR=1.60 (1.15, 2.22)], and accidental drowning [OR=1.52 (1.01, 2.28)]. The leading causes of death among black farmers were accidental drowning [OR=1.53 (1.03, 2.26)], cerebrovascular disease [OR=1.27 (1.18, 1.38)], and ischemic heart disease [OR=1.21 (1.14, 1.29)]. Causes of death reported to be significantly low were also investigated. The findings of this study are varied, but trends related to risk of death appear to be similar to observed national trends.

Trends of abdominal adiposity in white, black, and Mexican-American adults, 1988 to 2000.

OBJECTIVE: To describe changes in the distribution of waist circumference (WC) and abdominal obesity (AO) in white, black, and Mexican-American adults from 1988 through 2000. RESEARCH METHODS AND PROCEDURES: Nationally representative cross-sectional surveys of adults 20 to 79 years of age were examined using data from U.S. National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2000. AO was defined as WC > or =102 cm in men and > or 88 cm in women. RESULTS: There was a gradient of increasing WC and AO with increasing age in both study periods in whites and blacks. In men, the average increase between the study periods in overall WC in whites, blacks, and Mexican Americans were 3, 3.3, and 3.4 cm, respectively. The corresponding values in women were 2.4, 5.3, and 3.7 cm, respectively. In men, the percentage change in prevalence of AO between 1988 and 2000 ranged from 5.5% in Mexican-American men to 8.2% in white men. In women, there was a 1.7% decrease in AO in Mexican Americans, whereas there was an increase of 6.3% for whites and 7% for blacks. DISCUSSION: Despite increased understanding of the need for screening and treatment for obesity, this study indicates increasing prevalence of AO in white and black Americans. Without concerted effort to reduce the prevalence of overall obesity, the increasing prevalence of AO is likely to lead to increased prevalence of metabolic syndromes in the United States. Our results highlight the need to design evidence-based programs that show promise for long-term health behavior changes to facilitate the prevention of AO and related comorbidities.

Diagnosed diabetes and ethnic disparities in adverse health behaviors of American women.

Despite higher rates of some high-risk lifestyle factors in non-Hispanic black women compared to non-Hispanic white women, no data exist examining the role of diagnosed diseases. Having diabetes diagnosed might motivate women and their providers to work together to lower the women's levels of behavioral risk factors. The purpose of this study was to determine the association between diagnosed diabetes and adverse health behaviors, including smoking, alcohol consumption, and sedentary lifestyle in non-Hispanic white (n=270) and non-Hispanic black (n=149) women with type 2 diabetes. Diagnosed diabetes was defined as answering "yes" to the Third US National Health and Nutrition Examination Survey question: "Have you ever been told by a doctor that you have diabetes or sugar diabetes?" Logistic regression analyses were used to determine the association of diagnosed diabetes with the adverse health behaviors. In this study, non-Hispanic black diabetic women had higher prevalences of smoking, sedentary lifestyle, and lower rates of diagnosed diabetes compared with non-Hispanic white women (P<0.01). Relative to non-Hispanic diabetic white, non-Hispanic diabetic black was associated respectively with 25% and 58% increased odds of smoking and sedentary lifestyle, adjusting for diagnosed diabetes and other confounding variables. Approximately 15% of alcohol consumption and 13% excess sedentary lifestyle in non-Hispanic diabetic blacks were associated with their increased rates of diagnosed diabetes relative to non-Hispanic diabetic whites. These excesses in adverse health behaviors, however, were within what can be explained by chance variation. There were non-significant trends toward less smoking and more sedentary lifestyle. Thus, diabetic women with a diagnosis generally had a worse behavioral risk profile than those without a diagnosis even after controlling multiple confounders. This shows the need for physicians to educate their diabetic patients regarding benefits of exercise and smoking avoidance.

Single nucleotide polymorphism and lifestyle-related diseases in the Asia-Pacific region: comparative study in Okinawa, Palau and Thailand.

Genetic differences between Asians and Caucasians may be involved in the rapid increase in lifestyle-related diseases in the Asia-Pacific region that has coincided with Westernisation of diets in the region. In the present study, we assessed correlation between 10 single nucleotide polymorphisms (SNPs) and chronic disease risk factors in age-matched and population-based groups in four Asian-Pacific locations: Okinawa, Palau and Thailand (two areas). The following allelic SNP profiles significantly differed (p<0.01) among the four populations, in both men and women: uncoupling protein 2 (UCP2), uncoupling protein 3 promoter (UCP3p), leptin receptor (LEPR) exon 6, and angiotensinogen (AGTa-20c). Multiple regression analyses showed significant associations between SNPs and clinical data. For men, these associations were between beta3 adrenergic receptor (beta3AR) and diastolic blood pressure (DBP) (p<0.01), UCP3p and total cholesterol (p<0.01), UCP2 and age (p<0.05), and AGTa-20c and age (p<0.01). For women, these associations were between LEPR exon 14 and body mass index (BMI) (p<0.05), UCP2 and systolic blood pressure (p<0.05), UCP3p and DBP (p<0.05), UCP2 and DBP (p<0.01), apolipoprotein E (ApoE)nd total cholesterol (p<0.01), beta3AR and triglyceride (p<0.05), AGTa-20c and triglyceride (p<0.05), and UCP2 and age (p<0.05). These results illustrate the interrelationships among SNPs and risk factors in the Asia-Pacific including China and Japan.

Abdominal obesity and ethnic differences in diabetes awareness, treatment, and glycemic control.

OBJECTIVE: To compare racial/ethnic differences in diabetes awareness, treatment, and glycemic control between non-Hispanic white, non-Hispanic black, and Hispanic Americans. We also determined the impact of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control between these population groups. RESEARCH METHODS AND PROCEDURES: Third National Health and Nutrition Examination Survey (NHANES III) data were utilized for this study. Diabetes awareness was defined as acknowledging diabetic status. Diabetes treatment was defined as current use of anti-diabetic medications, good glycemic control as HbA(1c) < 8%, and abdominal obesity as waist circumference larger than expected. The impacts of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control were assessed using logistic regression analyses. Adjustments were made for age, education, smoking, alcohol intake, and health insurance. RESULTS: Rates of diabetes awareness in whites, blacks, and Hispanics suffering from abdominal obesity were approximately 74%, 30%, and 21% in men and 77%, 32%, and 19% in women, respectively. Rates of diabetes treatment were 70%, 23%, and 14% in men and 57%, 45%, and 23% in women, respectively. In men, rates of glycemic control were 64%, 40%, and 30%, and in women, they were 62%, 51%, and 27%, respectively. Abdominal obesity was associated with decreased diabetes awareness and glycemic control in women. DISCUSSION: Subjects with abdominal obesity were found to have poorer glycemic controls compared to those without abdominal obesity. Because diabetes prevalences were partially explained by racial/ethnic differences in diabetes awareness, treatment, and glycemic control, there is a need to craft diabetes awareness, treatment, and control programs along racial/ethnic origins.

Low birth weight is associated with elevated serum lipoprotein(a) in white and black American children ages 5-11 y.

Nutritional insults experienced by the mother have a life-long imprint on organ size and function of the fetus. Infant low birth weight (LBW) is one of the consequences of such maternal undernutrition. The physiological consequences of nutritional insults can lead to adverse metabolic consequences after birth, including hypertension, diabetes and dyslipidemia. The objective of this study was to determine the association and contribution of LBW to serum concentration of lipoprotein(a) [Lp(a)] in a representative sample of white and black American children aged 5-11 y. Data (n=666) from the Third US National Health and Nutrition Examination Survey were used in this investigation. Racial/ethnic-specific trends in mean values of Lp(a) were compared across tertile distribution of birth weight. Multiple linear regression analysis was employed to determine the association of birth weight with Lp(a), controlling for age, sex and sum of four skinfold thicknesses (SUM). A consistent trend of increasing values of Lp(a) with decreasing birth weight emerged for both white and black children (P<0.001). Black children presented with higher values of serum concentrations of Lp(a) at each level of birth weight distributions than white children (P<0.01). Black race/ethnicity was associated with approximately 0.4 mg/dl greater serum concentration of Lp(a) than white, adjusting for birth weight, age, sex and SUM (P<0.001). LBW sub-population in black children appeared to be relevant to elevated Lp(a) concentration, while a similar scenario did not appear in white children. Since interactions between in utero factors and risk exposures after birth are likely, definitive studies evaluating these interactions are warranted.

Obesity is associated with reduced self-rated general health status: evidence from a representative sample of white, black, and Hispanic Americans.

BACKGROUND: Although the evidence linking obesity with many chronic diseases is well established, the relationship with self-rated health is not clear. Self-rating of health is a broad summary measure of different domains of health that include psychosocial domain. The aims of this study were to examine the relationship between obesity and self-rated health and the degree of agreement between patients' self-rated health status and physicians' impression of patients' health in a representative sample of healthy noninstitutionalized American adults. METHODS: Data (n = 10, 298) used for this analysis were obtained from the Third National Health and Nutrition Examination Survey. Normal weight was defined as BMI 18.5-24.9 kg/m(2) and preobesity was defined as BMI 25-29.9 kg/m(2). Moderate (class I) obesity was defined as BMI 30-34.9 kg/m(2) and severe (class II) obesity as BMI > or =35 kg/m(2). Self-rated health conditions were categorized as excellent, very good, good, fair, or poor. Agreement between physicians' impression and self-rated health and a linear relationship between obesity and individual perceived health were quantified using kappa and gamma statistics, respectively. Using the logistic regression analysis, odds of reporting reduced health in preobese, class I obese, and class II obese individuals were compared with those for normal-weight individuals, adjusting for age, current smoking, and alcohol intake. The contribution of obesity to ethnic differences in reduced self-rated health was determined by comparing blacks with whites and Hispanics with whites fitted in multiple logistic regression models. RESULTS: Among both men and women, there was a statistically significant linear association between obesity and self-rated health (P < 0.05). The proportion of subjects reporting excellent health tended to decrease with increasing level of obesity in the three ethnic groups. In the three ethnic groups, the degrees of concordance between self-rated health and physicians' impressions were poor and decreased with increasing obesity level. In each ethnic group, class II obesity was associated with approximately twofold increased odds of reporting reduced health compared with normal-weight individuals. Compared to whites, black and Hispanic races/ethnicities were respectively associated with 23 and 175% increased odds of reduced self-rated health among men. The corresponding values for women were 45 and 177%, respectively. CONCLUSION: The results of this study provide evidence that obesity has a negative impact on self-rated health among adults, even in the absence of chronic disease conditions. The results of this investigation also underscore the need to craft national preventive strategies to curb obesity in these at-risk population groups.

Hypertension and type 2 diabetes comorbidity in adults in the United States: risk of overall and regional adiposity.

OBJECTIVE: To evaluate the impact of generalized, abdominal, and truncal fat deposits on the risk of hypertension and/or diabetes and to determine whether ethnic differences in these fat patterns are independently associated with increased risk for the hypertension-diabetes comorbidity (HDC). RESEARCH METHODS AND PROCEDURES: Data (n = 7075) from the Third U.S. National Health and Nutrition Examination Survey were used for this investigation. To assess risks of hypertension and/or diabetes that were due to different fat patterns, odds ratios of men and women with various cut-points of adiposities were compared with normal subjects in logistic regression models, adjusting for age, smoking, and alcohol intake. To evaluate the contribution of ethnic differences in obesity to the risks of HDC, we compared blacks and Hispanics with whites. RESULTS: Generalized and abdominal obesities were independently associated with increased risk of hypertension, diabetes and HDC in white, black, and Hispanic men and women. The risk of HDC due to generalized, truncal, and abdominal obesities tended to be higher in whites than blacks and Hispanics. In men, the contribution of black and Hispanic ethnicities to the increased risk of HDC due to the various obesity phenotypes was approximately 73% and approximately 61%, respectively. The corresponding values for black and Hispanic women were approximately 115% and approximately 125%, respectively. CONCLUSIONS: In addition to advocating behavioral lifestyles to curb the epidemic of obesity among at-risk populations in the United States, there is also the need for primary health care practitioners to craft their advice to the degree and type of obesity in these at-risk groups.

Apolipoprotein B, ratio of total cholesterol to HDL-C, and blood pressure in abdominally obese white and black American women.

OBJECTIVE: To compare the association of apolipoprotein B (ApoB) and total cholesterol to high-density lipoprotein cholesterol (TC/HDL) with blood pressure in abdominally obese white and black American women. We also sought to determine if there are ethnic differences in blood pressure values that could be explained by differences in mean values of ApoB and TC/HDL. METHODS: Data (n = 1844) from the Third US National Health and Nutrition Examination Survey were used in this study. Abdominal obesity was defined as waist circumference (WC) of > or =88cm or having WC greater than what was expected as predicted from residuals obtained from linear regression of WC on BMI. Bi-variate Pearson's correlation analysis was used to quantify the degree of association of ApoB and TC/HDL with blood pressure and other lipids. Multiple linear regression analysis was used to assess the independent contribution of ApoB and TC/HDL to blood pressure, adjusting for age, total cholesterol, alcohol intake, and smoking. To determine ethnic differences in blood pressure values associated with ApoB or TC/HDL, dummy variables were used to compare blacks with whites fitted in multiple regression models, while adjusting for age, total cholesterol, alcohol intake and smoking. RESULTS: Elevated ApoB was positively associated with diastolic and systolic blood pressure (DBP/SBP) in blacks and whites, independent of age, total cholesterol, alcohol intake and smoking (P < 0.01). Elevated TC/HDL was also positively associated with increased DBP and SBP in whites (P < 0.05). For the same value of ApoB and TC/HDL whites had higher values of DBP and SBP than blacks, adjusting for confounding variables. CONCLUSIONS: Compared with TC/HDL, ApoB was more strongly associated with DBP and SBP in both abdominally obese white and black women. Since ApoB is associated with hypertension, the combination of elevated ApoB and hypertension may identify a group of patients with more marked risk of vascular disease, thus, warranting further investigation.

Abdominal obesity defined as a larger than expected waist girth is associated with racial/ethnic differences in risk of hypertension.

OBJECTIVE: Waist circumference (WC) cut-points of > or =102 cm and > or =88 cm for men and women, respectively, representing abdominal obesity have been recommended for determining obesity related co-morbidities. However, these cut-points carry the component of generalised obesity estimated by body mass index (BMI). The aim of this investigation was to determine whether abdominal obesity free of the influence of overall heaviness is associated with increased risk of hypertension in a representative sample of white and black Americans. METHODS: Data (n = 11114) from the Third US National Health and Nutrition Examination Survey were used in this investigation. Standardised residual values from the linear regression of WC on BMI were used to define abdominal obesity status. The risk of hypertension associated with abdominal obesity was estimated from the logistic regression model, adjusting for age, smoking and alcohol. We also estimated the public health consequences of abdominal obesity from the population attributable fraction of hypertension. RESULTS: Relative to white, black race/ethnicity was associated with approximately 1.8 and approximately 2.7 greater risk of hypertension in men and women, respectively, adjusting for abdominal obesity, age, smoking and alcohol consumption. Having larger than expected waist girths were associated with 1.58 and 1.39 increased risk of hypertension in black men and black women, respectively, adjusting for confounders. Population attributable risks of hypertension due to abdominal obesity were approximately 24.9% and 15.9%, in black men and black women, respectively. CONCLUSIONS: In Americans, hypertension is a public health problem that is closely linked to abdominal adiposity. An important research challenge therefore is to determine the best way to regulate body weight under conditions of food abundance. There is a need to clarify how lifestyle habits promote large waist sizes leading to abdominal adiposity and associated cardiovascular disease in the US, particularly among black Americans.

Uncoupling protein 3 and peroxisome proliferator-activated receptor gamma2 contribute to obesity and diabetes in palauans.

We examined the genetic contribution of single nucleotide polymorphisms (SNPs) of the energy metabolism-related genes, including beta 3 adrenergic receptor (beta3AR), apolipoprotein E (apo-E), promoter of uncoupling protein 3 (UCP3-p), peroxisome proliferator-activated receptor gamma 2 (PPARgamma2) and leptin receptor (LEPR) to metabolic disorders, in 118 inhabitants of Palau. The data were statistically analyzed and ethnically compared to correlate SNPs and their metabolic parameters. UCP3-p (P < 0.01) and PPARgamma2 (p = 0.05) correlated with plasma HbA1c, and UCP3-p correlated with fasting blood glucose (P < 0.01) in males, but not in females. UCP3-p correlated with body fat (%) (P < 0.01) in females, but not in males. Plasma leptin levels and apo-E were correlated in both groups. The frequency of SNPs for PPARgamma2, LEPR, and UCP3-p are significantly different between Palauans and Caucasians.

Verbal autopsy: a necessary solution for the paucity of mortality data in the less-developed countries.

Although global disease burden can best be described using accurate and reliable mortality data, many investigators rely solely on death certificates, despite the fact that many of the less-developed countries (LDCs) do not have mandated death certifications. In many of these LDCs, particularly in remote areas, verbal autopsy (VA) may be a surrogate for death certificates in ascertaining causes of death. The main benefit of using VA stems from the fact that it is based on laypersons' observations of the diseased, and therefore does not require medical training. Because of human and economic resource constraints in many LDCs, investments in infrastructures for collecting mortality data needed for the planning, monitoring, and evaluation of health are unlikely in the immediate future. Investment in rural health workers who are trained in VA may prove useful in increasing the quality and availability of mortality data from many LDCs. Rural health workers are essentially 'foot doctors' in many of these countries, whose familiarity with nooks and crannies of villages would be beneficial in the collection of needed mortality data. There is a need for international development agencies, such as the World Health Organization, to devote resources for training rural health workers in order to increase the availability of mortality data for describing worldwide disease burdens.

Abdominal adiposity values associated with established body mass indexes in white, black and hispanic Americans. A study from the Third National Health and Nutrition Examination Survey.

PURPOSE: To determine whether white, black and hispanic young (17-39y) and middle-aged (40-59y) adults, and elderly (60-90y) Americans have the same values of abdominal adiposity (estimated from waist circumference (WC) at the established levels of overweight (body mass index, BMI 25-29.9 kg/m2) and obesity (BMI > or = 30 kg/m2). METHODS: Data (n=16,120) from the US Third National Health and Nutrition Survey were utilized. Age-adjusted linear regression analyses were used to estimate gender- and ethnic-specific WC values corresponding to overweight and obesity. Receiver operating characteristic (ROC) curves were also employed to determine the choices of WC values corresponding to the established BMI cut-off points. With ROC, gender- and ethnic-specific cut-off points producing the best combination of sensitivity and specificity were selected as optimal thresholds for WC values corresponding to the established BMI cut-off points. RESULTS: WC values associated with the established BMI were lower in blacks and hispanics compared with whites. In men, the WC values that corresponded to overweight ranged from 89 to 106 cm, from 84 to 95 cm, and from 87 to 97 cm in whites, blacks and hispanics, respectively. The corresponding values for obesity ranged from 99 to 110 cm, from 96 to 107 cm, and from 97 to 108 cm. The WC values that corresponded to overweight in women ranged from 82 to 91 cm, from 81 in to 90 cm, and from 83 to 92 cm in whites, blacks and hispanics, respectively. The analogous values for obesity ranged from 94 to 101 cm, from 93 to 100cm, and from 94 to 101 cm. CONCLUSIONS: The lack of higher WC values in blacks (particularly women) and hispanics at the same levels of BMI for whites challenges previously held assumptions regarding the role of abdominal adiposity in cardiovascular disease experienced by non-whites. Defining the anthropometric variables that satisfactorily describe reasons for ethnic differences in cardiovascular disease is one of the challenges for future research.