An evaluation of door to needle time (DNT) of thrombolytic therapy following acute myocardial infarction in three large tertiary referral hospitals in Dhaka City.

This study was conducted in three tertiary hospitals in Dhaka city at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH) and National Institute of Cardiovascular Disease (NICVD) as a part of Inter-Heart Study. Secondary data was obtained from the standard questionnaires to determine door to needle time (DNT) following thrombolytic therapy in patients with Acute Myocardial Infarction (AMI) in coronary care units at three large tertiary referral hospitals in Dhaka city. Of total 192 patients studied in three centres, 156 (81.2%) received thrombolytic therapy. In BSMMU, 33 out of 45 (73.33%) patients received thrombolysis. Mean DNT was 147 minutes. Eighteen (55%) patients received thrombolysis within 90 minutes and 9 patients (27%) received with in 91-180 minutes, 6 patients (18%) received thrombolysis after 180 minutes. In DMCH, 44 out of 57 patients (77.1%) received thrombolysis. Mean DNT was 210 minutes. Five patients (11%) received within 90 minutes, 19 (43%) received thrombolysis between 91 to 180 minutes and 20 patients (46%) received thrombolysis outside the range of 180 minutes. In the NICVD, 79 out of total 90 (87.7%) patients received thrombolysis. Mean DTN was 64 minutes. Sixty seven (82%) patients received therapy within 90 minutes, 6 patients (9%) received between thrombolysis 91-180 minutes and 6 (9%) patients received after 180 minutes of reaching hospital. Inspite of overall improvement in the management of patients with AMI in coronary care units of major teaching hospitals, there seem to remain certain difficulty in our system which causes delay in thrombolysing patients with AMI. In this study, the mean DNT for thrombolysis was quickest (64 minutes) at NICVD and slowest (210 minutes) at DMCH. Although the study was conducted almost four years ago, it gives some insight regarding strength and weaknesses in the infrastructure of public sector hospitals in our country.

Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies.

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiological transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization.

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Dietary calcium, phytate, and zinc intakes and the calcium, phytate, and zinc molar ratios of the diets of a selected group of East African children.

Dietary zinc, calcium, and phytate intakes of 66 rural Malawian children aged 4-6 y were determined during three seasons on the basis of weighed food records and analyzed food composition data. Height and weight measurements were also recorded and hair samples were collected for zinc analysis. Seasonal daily zinc, calcium, and phytate intakes of females ranged from 6.2 +/- 1.7 to 6.8 +/- 2.1 mg (mean +/- SD), from 335 +/- 170 to 401 +/- 257 mg, and from 1621 +/- 660 to 1729 +/- 592 mg, respectively and, for males, 7.0 +/- 1.7 to 8.0 +/- 2.3 mg, 342 +/- 164 to 473 +/- 310 mg, and 1857 +/- 530 to 2161 +/- 684 mg, respectively. Cereals provided greater than 42% of dietary zinc. Seasonal mean molar ratios of phytate to Zn and Ca x phytate to Zn [per 1000 kcal (4.2 MJ)] and the median Ca to phytate molar ratio ranged from 24 to 27, 151 to 188 mmol/1000 kcal (4.2 MJ), and 3.1 to 3.4, respectively. Over 78% of the children consumed diets with phytate-to-Zn and Ca x phytate.Zn-1 . 1000 kcal-1 molar ratios above values suggested to jeopardize zinc status. Correlations between hair zinc, phytate-to-Zn, and Ca x phytate.Zn-1 . 1000 kcal-1 molar ratios suggest that high phytic acid intakes may compromise zinc status in these children.

Step length reductions in advanced age: the role of ankle and hip kinetics.

BACKGROUND: Aging is associated with a reduction in gait velocity, which is due to a shortened step length. This study investigated the relationship between joint kinetics and step length. METHODS: Three-dimensional gait kinematics and kinetics were measured during usual pace gait in 26 older subjects (average age 79) and in 32 young subjects (average age 26). Gait measures were obtained at maximal velocity in five older subjects. Lower extremity strength was measured in the older subjects on an isokinetic dynamometer. RESULTS: Older persons had a 10% shorter step length during usual gait, when corrected for leg length (.65 +/- .07, .74 +/- .04/leg length, respectively, p < .001). Older persons had reduced ankle plantarflexion during late stance (13 +/- 5 degrees, 17 +/- 5 degrees, p = .02) and lower ankle plantarflexor power (2.9 +/- 0.9 W kg-1, 3.5 +/- 0.9 W kg-1, respectively, p = .007). Ankle strength was associated with plantarflexor power developed during late stance (r = .49, p < .001). When gait kinetics were corrected for step length, the older subjects developed 16% greater hip flexor power during late stance than younger subjects (estimate of effect: .15 W kg-1, p = .002). Older subjects were unable to increase ankle plantarflexor power at maximal pace, but increased hip flexor power 72% (1.1 +/- 0.3 W kg-1 to 1.9 +/- 1.0 W kg-1, p = .02). CONCLUSIONS: Older subjects had lower ankle plantarflexor power during the late stance phase of gait and appeared to compensate for reductions in plantarflexor power by increasing hip flexor power. Appropriate training of ankle plantarflexor muscles may be important in maintaining step length in advanced age.

Defining stage of change for lower-fat eating.

OBJECTIVE: To test the validity of staging methodology for dietary fat reduction by examining cognitive profiles of persons classified in these groups: precontemplation, lowerfat maintenance (< or = 30% of energy as fat), and higher-fat maintenance (> 30% of energy as fat). DESIGN: Cross-sectional survey of a random sample of 491 women residing in Guelph, Ontario, Canada, recruited by telephone. SETTING/SUBJECTS: Mean age of subjects was 43.7 +/- 12.2 years. The majority (58%) lived with a spouse or partner and had completed high school (68%). STATISTICAL ANALYSES: Multivariate analysis of variance was used to compare the pros and cons of lower-fat eating, level of self-efficacy in avoiding high-fat foods, and use of 9 processes of change to support lower-fat eating habits in women assigned to the precontemplation, higher-fat, and lower-fat maintenance stages. RESULTS: When compared with subjects classified in the precontemplation stage, the 2 groups of subjects in the maintenance stage had higher ratings of the pros (49.7 +/- 9.5 vs 43.7 +/- 7.2, P < .05), lower ratings of the cons (47.2 +/- 8.2 vs 51.9 +/- 11.8, P < .05), higher self-efficacy scores, and more frequent use of processes of change than subjects classified in the precontemplation stage. No differences between women in the 2 maintenance groups were observed in self-efficacy; however, those in the lower-fat maintenance group reported lower cons than those in the higher-fat maintenance group (46.2 +/- 7.2 vs 48.2 +/- 9.1, P < .05) and more frequent use of all processes of change. CONCLUSIONS/APPLICATIONS: Stage of change for dietary fat reduction is a cognitive variable that provides insights into attitudes about and motivations to consume lower-fat foods.

Strategies for the assessment of pediatric gait in the clinical setting.

Clinical gait analysis is a term that can be applied to numerous methods of evaluating a subject's walking pattern. These methods may include observation, videotaping, electromyography, kinematics, kinetics, and energetics. Modern gait analysis is based on the integration of these component methods of measurement to derive a complete analysis of gait. The data may then be used to help determine the treatment course of a patient with ambulatory problems or to document the effects of treatment. The purpose of this article is to provide an overview of the individual components of gait analysis. Emphasis will be placed on the type of information that can be derived from each component and how the information may be used clinically. Normal pediatric kinematics and kinetics are provided with literature references for phasic electromyography and temporal and stride variables. Two case examples illustrate the clinical utility of gait analysis information applied to cerebral palsy in surgical decision making and orthotic assessment. Guidelines are also provided for the referral of patients to a gait analysis laboratory.

Effects of age on the biomechanics and physiology of gait.

There are significant changes in gait across the life span, but particularly after the age of 70 years. This article reviews the physiology of gait and the motor control challenges during gait. The kinematics (motion) and the kinetics (moment and power) of normal gait of a database of healthy young and older adults are compared. Older subjects generate significantly lower peak ankle plantar flexor power during gait. The clinical significance of the reduction in ankle plantar flexion power is discussed.

Using the U.S. Behavior Risk Factor Surveillance System's health related quality of life survey tool in a Canadian city.

As responsibility for health funding shifts from central to local governments, providers find themselves in decision-making roles or asked to give guidance in allocation of resources. To develop a picture of a population's health, data are needed about the effects that illness and disability have on a person's ability to function and thus on quality of life. This study assessed the validity in a Canadian city, of a Health-related Quality of Life (HRQoL) instrument developed by the US Centers for Disease Control and used in the US Behavioral Risk Factor Surveillance System. The HRQoL was administered to a random sample of 1,042 adults. The patterns of association among the HRQoL questions, and the direction of the relationships among independent variables and HRQoL were consistent with those hypothesized. The accumulating evidence for validity of the HRQoL support its use in monitoring the performance of local health initiatives in Canada.

The biomechanics of running: a kinematic and kinetic analysis.

This paper discusses the biomechanics of running and emphasizes three-dimensional joint kinematics and kinetics. To summarize the major points: (1) the major power generator--the ankle--generates three and two times the power of the knee and hip, respectively; (2) the large eccentric action of the ankle plantar flexors illustrates the ankle's secondary role as an absorber of the vertical velocity during absorption; (3) the hip is a secondary power generator, with generation occurring during absorption, initial swing, and terminal swing; and (4) the knee--the primary power absorber--has three periods of absorption that occur during absorption, initial swing, and terminal swing in phasing opposite that of the hip. The knee muscles absorb almost three times the power of the hip and ankle. Comparisons between running and walking data emphasize the higher peak forces found in running, and these may play a significant role in injury. In this day of high-performance athletics, it is important for physicians who treat sports injuries to increase their knowledge of the mechanisms behind injuries. This requires an understanding of the mechanics of locomotion, which will allow more accurate diagnosis and ultimately better treatment of injuries.

The biomechanics of walking and running.

An increased knowledge of the biomechanics of normal walking and running will improve our understanding of the possible mechanisms of pathology and ultimately improve the treatment of pathology and injury. Running, a natural extension of walking, involves increased velocities, joint range of motion, forces, muscle activity, joint moments, and joint powers as compared with walking. These differences not only stress the mechanics of the body to a greater extent but also contribute to the development of injury due to overuse. With the use of modern computerized gait analysis techniques that provide objective information, comprehension of normal and also pathologic walking and running patterns can be improved.

Bilateral electromyographical analysis of the lower limbs during walking in normal adults.

Electromyographic (EMG) data were collected simultaneously from multiple muscles of both legs. EMG signals were normalized using the mean signal obtained by applying the same hanging weight (isometric torque) to each muscle in a muscle pair. Comparative analyses between sides were carried out for individual subjects as well as for 10 subjects grouped by dominance (all dominant side data averaged and compared with averaged non-dominant side data). We concluded the following: (1) the assumption of symmetry is not valid for individual subjects, (2) there is some evidence to suggest that the plantar-flexor EMG is related to dominance, and (3) pooled subject data conceal bilateral differences in individual subjects.

INTER-HEART: A global study of risk factors for acute myocardial infarction.

BACKGROUND: Although declines in mortality rates have occurred in most developed countries, increases are being seen in developing countries. Our knowledge of risk factors for acute myocardial infarction (AMI) is largely derived from studies in the former. Applicability of these results to other populations is unknown. The objectives of INTER-HEART are to determine the association between risk factors and AMI within populations defined by ethnicity and/or geographic region and to assess the relative importance of risk factors across these populations. METHODS: INTER-HEART is a study of 14,000 cases of AMI and 16,000 matched control patients from 46 countries, which was conducted with a standardized protocol. Questionnaires were translated into 11 languages; physical measurements were obtained, and 20 mL of blood was drawn and shipped frozen to a central laboratory in Canada. The study will evaluate the importance of conventional and emerging risk factors within each geographic region and whether their impact varies by region. RESULTS: INTER-HEART is sponsored by the World Health Organization and the World Heart Federation and has received funding from several peer-reviewed agencies and many different pharmaceutical companies. A vanguard phase (February 1999 to 2000) enrolled 4000 subjects from 41 countries. Full data collection started in April 2000 and is expected to be completed by October 2002. CONCLUSIONS: Several years of targeted work have allowed the development of the concepts that were tested in the pilot studies. This has ensured the feasibility of INTER-HEART. This study has the potential to have a major impact in developing a worldwide strategy for cardiovascular disease prevention, especially in developing countries and nonwhite populations.

Three-dimensional lower extremity joint kinetics in normal pediatric gait.

Gait analysis is becoming a more integral part of the decision-making process in treatment of children with neuromuscular problems. A normal reference, however, must be available for comparison when one makes decisions. We wished to develop a normal pediatric database for joint kinematics and kinetics which could then be used as a reference for clinical gait analysis. Thirty-one normal children underwent a complete gait analysis including calculations of three-dimensional joint kinematics and kinetics. The pediatric data were similar to that of normal adults.

Validity of the US Behavioral Risk Factor Surveillance System's health related quality of life survey tool in a group of older Canadians.

Investigators at the Centers for Disease Control and Prevention in the US have developed a brief survey tool to measure health-related quality of life (HRQOL-4). In order to support use of such tools in surveillance, it is important to assess their validity in different groups. Subjects were 926 non-institutionalized men and women (age > or = 65 years) who completed a health exam and questionnaire. Results indicated that physical and mental health and physical activity limitation were each related to self-perceived health. Compared with subjects who reported excellent health, those with poor self-rated health reported a more than 17-fold increase in the number of unhealthy days in the previous 30. While responses to questions addressing psychosocial factors were most consistently associated with the HRQOL item relating to mental health, responses to health and health behaviour questions were more consistently associated with items related to physical health. This study demonstrated that the HRQOL-4 is not only accepted by older adults in a self-administered format, but also stands up to tests of its validity.

Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocnemius fascia in children with cerebral palsy.

The effect of surgical lengthening of the gastrocnemius fascia on ankle joint kinematics and kinetics during gait in patients with cerebral palsy (CP) was evaluated. Twenty independent ambulators (24 sides) were included in this retrospective study. The evaluation included clinical examination, calculation of joint kinematics and kinetics, and collection of surface electromyography (EMG) during gait. Postoperative improvements were noted in static heelcord range of motion (ROM), with an associated increase in dorsiflexion in stance and swing. Kinetic analysis showed a decrease in the abnormal energy generated around the ankle in midstance and a statistically significant increase in the energy generated in late stance for push-off.

Selenium intakes of children from Malawi and Papua New Guinea consuming plant-based diets.

Dietary selenium intakes were determined over three seasons for 66 children aged 4-6 y in rural Malawi, and at one season for 67 children aged 6-10 y in rural Papua New Guinea. The selenium content of the foods consumed was assessed using instrumental neutron activation analysis. Median intakes of selenium for the Malawian children were 20 micrograms per day, 21 micrograms per day, and 15 micrograms per day at harvest, postharvest, and preharvest seasons, respectively. More than 43% of the Malawian intakes were below the U.S. Recommended Dietary Allowances for 4-6 y olds (20 micrograms per day). Median intake of Se for the Papua New Guinean children was 20 micrograms per day, with 87% of the intakes below the recommended level for 7-10 y olds (30 micrograms per day). Statistical comparisons of selenium intakes over three seasons for the 51 children present in all survey periods revealed that mean intakes were not significantly different in survey periods one and two, but decreased significantly in survey period three, when expressed per day (p less than 0.002), per MJ (p less than 0.003), or per kg (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

An examination of the knee function during gait in children with myelomeningocele.

In this retrospective study, 37 patients with myelomeningocele who had undergone gait analysis were examined. Patients were divided into groups based on the level of involvement (29 sides: L4; 26 sides: L5; 19 sides: S1-2). Results showed increased knee flexion and associated knee extensor moments with increasing level of neurologic involvement. The mean coronal plane knee position in stance was normal in all groups and not related to coronal plane knee moment. However, there was an increased incidence of a net knee adductor moment in stance with increasing involvement (mean, 0.02 +/-0.18 N.m/kg for the L4 group). The presence of a visual valgus thrust based on video records was not reliable in predicting an abnormal knee coronal plane moment. An abnormal knee adductor moment in stance was most highly related to coronal plane trunk motion (r = -0.62) and not tibial torsion (r = -0.340). Increased transverse plane range of motion of the knee was most highly related to transverse plane trunk motion (r = 0.67).

An evaluation of the posterior leaf spring orthosis using joint kinematics and kinetics.

The primary function of the posterior leaf spring orthosis (PLS) is to prevent excessive equinus or drop foot in swing. The name of the orthosis, posterior leaf "spring," suggests that it also mechanically augments push-off in stance. The purpose of this study was to determine the effect of the PLS on ankle function by using computerized gait-analysis techniques. Multiple barefoot versus brace walks were compared in 31 children with cerebral palsy. Results indicate that the PLS reduces excessive equinus in swing and is sufficiently flexible to allow ankle dorsiflexion in midstance. In terminal stance, the peak power-generating capabilities of the ankle were reduced when the child was wearing the PLS. Energy results indicate that more mechanical energy was absorbed during midstance and less produced during terminal stance with the PLS. Therefore, the PLS improved ankle function but did not augment ankle function through storage and return of mechanical, or spring, energy.