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For older Americans and for Americans who are living with a chronic illness or a disability, informal caregiving can make an important difference between living independently at home and living [...]

Background/objectives An in-depth understanding of the relationship between food consumption and physical activity is relevant since these behaviours could influence each other, while both have an effect on obesity and chronic diseases. In this context, the aim of this study was to investigate the effect of various combinations of food consumption (fruits, vegetables, sweets and snacks) on the associations with PA domains (leisure and commute) among Brazilian industrial workers. Subjects/methods This is part of a cross-sectional national survey developed in Brazil using data from the 'Lifestyle and Leisure Habits of Industrial Workers' project. A total of 52,774 workers (response rate: 90.6%) responded to a validated questionnaire about the frequency of their consumption of fruit, vegetables, sweets and snacks, their practice of LTPA and active commuting. The answers were analysed by multilevel regression, controlled by sociodemographic behaviour and the presence of hypertension, diabetes and overweight. Results Workers with a simultaneously adequate consumption of fruit, vegetables, sweets and snacks were 2.29 (1.74; 2.99 p-value < 0.001) more likely to perform LTPA. In the full model, there was no association among any of the combinations of food consumption and active commuting. Conclusion A better food consumption behaviour was reported among workers who practiced leisure physical activity when compared to those who did not., Author(s): Jaqueline Aragoni da Silva [sup.1], Kelly Samara da Silva [sup.2], Thiago Sousa Matias [sup.3], Danielle Biazzi Leal [sup.4], Elusa Santina Antunes de Oliveira [sup.5], Markus Vinicius Nahas [sup.6] Author [...]

Objective To determine the fraction of individuals with high total serum cholesterol who get diagnosed and effectively treated in eight high- and middle-income countries. Methods Using data from nationally representative health examination surveys conducted in 1998-2007, we studied a probability sample of 79 039 adults aged 40-79 years from England, Germany, Japan, Jordan, Mexico, Scotland, Thailand and the United States of America. For each country we calculated the prevalence of high total serum cholesterol (total serum cholesterol ≥ 6.-2 mmol/l or ≥ 240 mg/dl) and the mean total serum cholesterol level. We also determined the fractions of individuals being diagnosed, treated with cholesterol-lowering medication and effectively controlled (total serum cholesterol < 6.2 mmol/l or < 240 mg/dl). Findings The proportion of undiagnosed individuals was highest in Thailand (78%; 95% confidence interval, Ch 74-82) and lowest in the United States (16%; 95% CI: 13-19). The fraction diagnosed but untreated ranged from 9% in Thailand (95% CI: 8-11) to 53% in Japan (95% CI: 50-57). The proportion being treated who had attained evidence of control ranged from 4% in Germany (95% CI: 3-5) to 58% in Mexico (95% CI: 54-63). Time series estimates showed improved control of high total serum cholesterol over the past two decades in England and the United States. Conclusion The percentage of people with high total serum cholesterol who are effectively treated remains small in selected high- and middle-income countries. Many of those affected are unaware of their condition. Untreated high blood cholesterol represents a missed opportunity in the face of a global epidemic of chronic diseases. Objectif Determiner la proportion d'individus souffrant d'un taux de cholesterol serique total eleve, qui font l'objet al'un diagnostic et qui recoivent un traitement efficace dans huit pays a revenu moyen ou eleve. Methodes En nous appuyant sur des donnees provenant d'enquetes sur les examens de sante, representatives du niveau national et menees de 1998 a 2007, nous avons etudie un echantillon aleatoire de 79 039 adultes ages de 40 a 79 ans originaires d'Angleterre, d'Allemagne, du Japon, de Jordanie, du Mexique, d'Ecosse, de Thai'lande et des Etats-Unis d'Amerique. Pour chacun de ces pays, nous avons calcule la prevalence de cholesterol serique total eleve (cholesterol serique total ≥ 6,2 mmol/l ou ≥ 240 mg/dl) et le niveau moyen de cholesterol serique total. Nous avons egalement determine la proportion des individus ayant fait l'objet d'un diagnostic et ayant recu un traitement hypocholesterolemiant effectivement controle (cholesterol serique total < 6,2 mmol/l ou < 240 mg/dl). Resultats La proportion des individus non diagnostiques etait la plus forte en Thailande (78%; 95% intervalle de confiance, IC: 74-82) et la plus faible aux Etats-Unis (16%; 95% IC: 13-19). Le pourcentage de personnes ayant fait l'objet d'un diagnostic, mais non d'une therapie, etait compris entre 9% en Thailande (95% IC: 8-11) et 53% au Japon (95% IC: 50-57). La proportion des individus sous traitement ayant obtenu une attestation de controle variait de 4% en Allemagne (95% IC: 3-5) a 58% au Mexique (95% IC: 54-63). Les estimations des series chronologiques ont temoigne d'un meilleur controle de l'hypercholesterolemie en Angleterre et aux Etats-Unis Iors des deux dernieres decennies. Conclusion Le pourcentage de personnes presentant un cholesterol serique total eleve et qui sont effectivement traitees demeure faible dans les pays a revenu moyen ou eleve retenus. Bon nombre des personnes atteintes n'ont pas connaissance de leur etat. Un taux de cholesterol plasmatique eleve non soigne represente une opportunite manquee face a une epidemie mondiale de maladies chroniques. Objetivo Determinar la fraccion de individuos diagnosticados con una concentracion serica elevada de colesterol total y que hayan recibido un tratamiento eficaz en ocho paises de ingresos medios y elevados. Metodos Con los datos de las encuestas de vigilancia sanitaria, representativas a nivel nacional y realizadas entre 1998 y 2007, se estudio una muestra basada en la probabilidad de 79 039 adultos con edades comprendidas entre los 40 y 79 anos en Alemania, Escocia, Estados Unidos de America, Inglaterra, Japon, Jordania, Mexico y Tailandia. Se calculo la prevalencia de la hipercolesterolemia (colesterol serico total ≥ 6,2 mmol/l o ≥ 240 mg/dl) y el nivel medio de colesterol serico total para cada pais.Tambien se determinaron las fracciones de individuos que fueron diagnosticados y tratados con hipocolesterolemiantes y controlados eficazmente (colesterol serico total, Introduction Cardiovascular disease caused over 18 million deaths in the world in 2005. (1) Of these deaths, eight million (44%) occurred in people under 60 years of age and 80% [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2010.04.013 Byline: Erica S. Spatz (a), Joseph S. Ross (b)(c), Mayur M. Desai (d), Maureen E. Canavan (d), Harlan M. Krumholz (e)(f)(g) Abstract: Expanding insurance coverage, while necessary, may not be sufficient to ensure high-quality care for adults with cardiovascular disease. We sought to examine the association between having a usual source of care (USOC) and receiving medication treatment of hypertension and hypercholesterolemia. Author Affiliation: (a) Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT (b) Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY (c) HSR&D Research Enhancement Award Program and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY (d) Division of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT (e) Robert Wood Johnson Clinical Scholars Program and Section of Cardiolovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT (f) Section of Health Policy and Administration, Yale University School of Epidemiology and Public Health, New Haven, CT (g) Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Article History: Received 29 January 2010; Accepted 16 April 2010

Purpose To describe the characteristics of patients who die in emergency departments and the decisions to withhold or withdraw life support. Methods We undertook a 4-month prospective survey in 174 emergency departments in France and Belgium to describe patients who died and the decisions to limit life-support therapies. Results Of 2,512 patients enrolled, 92 (3.7%) were excluded prior to analysis because of missing data; 1,196 were men and 1,224 were women (mean age 77.3 ± 15 years). Of patients, 1,970 (81.4%) had chronic underlying diseases, and 1,114 (46%) had a previous functional limitation. Principal acute presenting disorders were cardiovascular, neurological, and respiratory. Life-support therapy was initiated in 1,781 patients (73.6%). Palliative care was undertaken for 1,373 patients (56.7%). A decision to withhold or withdraw life-sustaining treatments was taken for 1,907 patients (78.8%) and mostly concerned patients over 80 years old, with underlying metastatic cancer or previous functional limitation. Decisions were discussed with family or relatives in 58.4% of cases. The decision was made by a single ED physician in 379 cases (19.9%), and by at least two ED physicians in 1,528 cases (80.1%). Conclusions Death occurring in emergency departments mainly concerned elderly patients with multiple chronic diseases and was frequently preceded by a decision to withdraw and/or withhold life-support therapies. Training of future ED physicians must be aimed at improving the level of care of dying patients, with particular emphasis on collegial decision-taking and institution of palliative care., Author(s): Philippe Le Conte [sup.1], David Riochet [sup.1], Eric Batard [sup.1], Christelle Volteau [sup.2], Bruno Giraudeau [sup.3], Idriss Arnaudet [sup.1], Laetitia Labastire [sup.1], Jacques Levraut [sup.4], Frédéric Thys [sup.5], Dominique [...]