Study Of Urban Population Research Articles

Periodontitis and premature death: a 16‐year longitudinal study in a Swedish urban population

Growing experimental evidence implicates chronic inflammation/infection due to periodontal diseases as a risk factor for death. The objective was to evaluate the role of periodontitis in premature death in a prospective study. The causes of death in 3273 randomly-selected subjects, aged 30-40 years, from 1985 to 2001 were registered. At baseline, 1676 individuals underwent a clinical oral examination (Group A) and 1597 did not (Group B). Mortality and causes of death from 1985 to 2001 were recorded according to ICD-9-10. In Groups A (clinically examined group) and B, a total of 110 subjects had died: 40 subjects in Group A, and 70 in Group B. In Group A significant differences were present at baseline between survivors and persons who later died, with respect to dental plaque, calculus, gingival inflammation and number of missing molars in subjects with periodontitis (p < 0.001). The multiple logistic regression analysis results of the relationship between being dead (dependent variable) and several independent variables identified periodontitis with any missing molars as a principal independent predictor of death. Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems.

Impact of a genetic variant in CYP3A4 on risk and clinical presentation of prostate cancer among white and African-American men ☆

Genes involved in androgen metabolism are strong candidates for having an important role in the pathogenesis of prostate cancer. CYP3A4, a protein in the cytochrome P-450 supergene family, facilitates the oxidative deactivation of testosterone. In previous studies, patients with the G variant of a genetic polymorphism in CYP3A4 had prostate cancers with clinically aggressive characteristics at diagnosis. The association was strongest among elderly men. We investigated whether the CYP3A4 variant was linked with the diagnosis or clinical presentation of prostate cancer in a case control study of a multiethnic urban population. Biologic specimens were genotyped for CYP3A4, and analyzed for the impact of this genotype on risk and tumor characteristics at presentation, controlling for the effect of several cofactors. The CYP3A4 variant was more common among African-Americans than among white men. Race-stratified analyses revealed little association between the CYP3A4 variant and prostate cancer risk among white men but were limited by the small number of white men with the CYP3A4 variant. Of African-American men, while the variant G allele was not associated with prostate cancer that had less aggressive characteristics, it was associated with risk of aggressive prostate cancer when men with the AG genotype (odds ratio = 9.3, 95% confidence interval 1.3−411) or GG genotype (odds ratio = 11.9 95% confidence interval 1.6−533) were compared with those with the AA genotype. The association between the CYP3A4 genotype and aggressive prostate cancer in African-American men is consistent with findings of other studies.

What health domains and items are important to patients with knee osteoarthritis? A focus group study in a multiethnic urban Asian population

To determine important health-related quality of life (HRQoL) domains and items within each domain affected by knee osteoarthritis (OA), identify ethnic variations in the importance of these domains and items among three ethnic groups, and determine how identified domains and items mapped onto selected OA-specific HRQoL instruments. Focus groups were conducted among subjects with knee OA stratified by gender, ethnicity, and language spoken. All focus groups were audio-taped and transcribed verbatim, with subsequent translation into English for groups conducted in other languages. Data analysis was performed by combining the key elements of grounded theory and content analysis with the assistance of the qualitative software ATLAS/ti 5.0. Five domains (pain, physical disability, other symptoms of OA, mental health, and social health) were identified from the 74 items reported as important by at least one subject. These domains were important for subjects from all ethnic groups with the exception of social health, which was more often important for Malay subjects. Items more commonly reported as important in the pain, physical disability, and other symptoms of OA domains were generally similar across ethnic groups. In contrast, important items in the mental and social health domains differed among ethnic groups. The impact of knee OA on HRQoL is broadly similar in both Asian and Western socio-cultural contexts. Both similarities and differences in important domains and items were identified among subjects with knee OA from three major Asian ethnic groups.

Association of physical inactivity with components of metabolic syndrome and coronary artery disease—the Chennai Urban Population Study (CUPS no. 15)

The aim of the study was to assess the influence of physical activity on the components of metabolic syndrome (MS) in an urban south Indian population in Chennai. The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in South India. Of the total of 1399 eligible subjects (age > or = 20 years), 1262 individuals participated in the study. MS was diagnosed based on modified Adult Treatment Panel (ATP) III guidelines. Details about the physical activity were collected using questionnaire, which included job-related and leisure-time activities, and specific questions on exercise. Study individuals were then graded as light, moderate and heavy using a scoring system. We assessed the relationship between the grades of physical activity and the components of MS and coronary artery disease (CAD). Insulin resistance was calculated using the homeostasis assessment model (HOMA-IR). Prevalence of most of the components of MS (diabetes P < 0.001, obesity P = 0.003, abdominal obesity P < 0.001 and hypertension P < 0.001) and MS per se (P < 0.001) increased significantly with decrease in physical activity. Among non-diabetic subjects, HOMA-IR was significantly higher in subjects who did light-grade activity compared with heavy-grade activity (P = 0.041). Logistic regression analysis revealed physical activity to be significantly associated with MS [heavy activity: reference, moderate activity, odds ratio (OR) 1.639, (P = 0.017); light activity: OR 2.289, (P < 0.001)]. Subjects in the light-grade activity group also had higher odds of CAD (OR 2.42, 95% confidence interval 1.40, 4.24, P = 0.011), compared with the heavy-grade activity group. Physical inactivity is associated with the components of MS and CAD in this urban south-Indian population. Lifestyle changes focusing on increasing physical activity could help to prevent the exploding epidemic of MS and CAD in India.

Perfluorinated organic compounds in human blood serum and seminal plasma: a study of urban and rural tea worker populations in Sri Lanka

Concentrations and accumulation of 13 fluorinated organic compounds (FOCs) in human sera and seminal plasma were measured in an Asian developing country, Sri Lanka. Six of the FOCs, PFOS (perfluorooctanesulfonate), PFHS (perfluorohexanesulfonate), PFUnA (perfluoroundecanoic acid), PFDA (perfluorodecanoic acid), PFNA (perfluorononanoic acid) and PFOA (perfluorooctanoic acid), were detected in all of the sera samples. Measurable quantities of two main perfluorosulfonates, PFOS and PFHS, were found in all seminal plasma samples. The detection frequency of the predominant perfluoroalkylcarboxylate, PFOA, in seminal plasma was >70%. Accumulation of PFOS in sera was significantly positively correlated with PFOA, PFHS and PFNA. Positive linear regressions were also found between PFNA and PFUnA and PFNA and PFDA suggesting that these compounds may have a similar origin of exposure and accumulation. Significantly positive associations were observed for partitioning of both PFOS and PFNA between sera and seminal plasma. The accumulation of FOCs was not significantly different in sera from Colombo (urban population) and Talawakele (rural conventional tea workers). However, the Haldummulla population (rural organic tea workers) had relatively lower exposure to FOCs compared to the other two groups, urban and rural conventional tea workers. Concentrations of FOCs in Sri Lanka were similar to those reported for industrialized countries suggesting that human exposure to such chemicals is widespread even in developing countries. The novel finding of FOCs in human seminal plasma implies that further studies are needed to determine whether long-term exposure in humans can result in reproductive impairments.

Polymorphisms in the Fatty Acid-Binding Protein 2 and Apolipoprotein C-III Genes Are Associated with the Metabolic Syndrome and Dyslipidemia in a South Indian Population

The Chennai Urban Population Study investigates a South Indian population with a high prevalence of cardiovascular disease associated with the metabolic syndrome (MS). The Ala54Thr polymorphism in the fatty acid-binding protein 2 (FABP2) gene as well as the T-455C and C-482T polymorphisms in the apolipoprotein C-III (APOC3) gene promoter have been associated with features of the MS in specific populations. This study evaluates in Asian-Indians the association between these polymorphisms with MS and dyslipidemia, defined according to National Cholesterol Education Program Adult Treatment Panel III. Allelic frequencies in 70 controls and 110 patients with diabetes from the Chennai Urban Population Study were 52.9% for FABP2 Thr54, 73.0% for APOC3 -482T, and 80.2% for APOC3 -455C. The polymorphisms were in agreement with Hardy-Weinberg equilibrium. Controls carrying FABP2 Thr54 were more likely to have MS than noncarriers (Fisher's exact test P = 0.031; odds ratio = 6.9 with a 95% confidence interval of 1.1, 43.9). Those carrying at least one polymorphic allele in both genes had a higher likelihood of having MS than wild type (Fisher's exact test P = 0.003; odds ratio = 12.1 with a 95% confidence interval of 1.88, 77.6). Dyslipidemia was associated with the polymorphism as well. The polymorphisms were not associated with MS in patients with diabetes. The association of the polymorphisms with MS and dyslipidemia could contribute to the high cardiovascular disease prevalence in this population.

Association of hypertension with cluster of insulin resistance syndrome factors: the Chennai Urban Population Study (CUPS-12).

The objective of this study was to investigate the association of insulin resistance and the cluster of insulin resistance syndrome (IRS) factors with hypertension in a native urban population from southern India. The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in southern India. Of the total of 1399 eligible subjects (age >or=20 years), 1262 (90.2%) participated in the study. Subjects were classified as hypertensives if they had systolic blood pressure (SBP) >or=140 mmHg or diastolic blood pressure (DBP) >or=0 mmHg, if they were known hypertensives, or if they were receiving treatment with antihypertensive drugs. Insulin resistance was computed using the homeostasis model assessment (HOMA IR). The overall prevalence of hypertension in the population was 22.1%. Prevalence of hypertension increased with an increase in quartiles of fasting insulin levels ( p=0.035) and HOMA IR ( p=0.03). Logistic regression analysis revealed that HOMA IR was significantly associated with hypertension, which was not altered even after addition of risk factors like age, smoking habit and alcohol consumption into the model. However, inclusion of variables associated with IRS abolished the association of insulin resistance with hypertension. Factor analysis identified four factors: factor 1 had positive loading of body mass index, age, systolic and diastolic blood pressures; factor 2 had positive loading of HOMA IR, fasting plasma glucose, triglycerides and body mass index; factor 3 had positive loading of waist-hip ratio, triglycerides and smoking habit and negative loading of alcohol consumption; factor 4 was loaded with age and serum cholesterol. Factor 1, the hypertension factor loaded with systolic and diastolic blood pressures, shared a correlation with the insulin resistance cluster through body mass index. Our results suggest that the "insulin resistance cluster" is associated with hypertension in this urban population of southern India.

Trends in hypertension epidemiology in India.

Cardiovascular diseases caused 2.3 million deaths in India in the year 1990; this is projected to double by the year 2020. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. Indian urban population studies in the mid-1950s used older WHO guidelines for diagnosis (BP > or =160 and/or 95 mmHg) and reported hypertension prevalence of 1.2-4.0%. Subsequent studies report steadily increasing prevalence from 5% in 1960s to 12-15% in 1990s. Hypertension prevalence is lower in the rural Indian population, although there has been a steady increase over time here as well. Recent studies using revised criteria (BP > or =140 and/or 90 mmHg) have shown a high prevalence of hypertension among urban adults: men 30%, women 33% in Jaipur (1995), men 44%, women 45% in Mumbai (1999), men 31%, women 36% in Thiruvananthapuram (2000), 14% in Chennai (2001), and men 36%, women 37% in Jaipur (2002). Among the rural populations, hypertension prevalence is men 24%, women 17% in Rajasthan (1994). Hypertension diagnosed by multiple examinations has been reported in 27% male and 28% female executives in Mumbai (2000) and 4.5% rural subjects in Haryana (1999). There is a strong correlation between changing lifestyle factors and increase in hypertension in India. The nature of genetic contribution and gene-environment interaction in accelerating the hypertension epidemic in India needs more studies. Pooling of epidemiological studies shows that hypertension is present in 25% urban and 10% rural subjects in India. At an underestimate, there are 31.5 million hypertensives in rural and 34 million in urban populations. A total of 70% of these would be Stage I hypertension (systolic BP 140-159 and/or diastolic BP 90-99 mmHg). Recent reports show that borderline hypertension (systolic BP 130-139 and/or diastolic BP 85-89 mmHg) and Stage I hypertension carry a significant cardiovascular risk and there is a need to reduce this blood pressure. Population-based cost-effective hypertension control strategies should be developed.

A qualitative approach to examining information transfer via social networks among homeless populations

Traditionally, social network analysis has utilized mathematical models and graphical constructs to examine information exchange and diffusion. This paper will suggest the use of a qualitative approach as a complimentary method that allows for the collection of rich data, leading to a better understanding of the context in which information exchange and diffusion occur. The qualitative approach is then discussed as it is used in a recent study, which examined information as social capital and as embedded in social support networks of homeless populations in Seattle and North Carolina. In-depth interviews conducted in homeless shelters are combined with the use of an egocentric social network-mapping device to gather rich data that provide insights into the everyday establishment and network of informational support networks. A clearer picture of the information sources, the strength of information sources, the nature of the information exchange and measures of social capital emerged from the qualitative data. The paper concludes with a discussion of the planned future use of the approach to study the diffusion of information on acquired immune deficiency syndrome among the homeless in an international, multi-phased study of rural and urban Western populations in addition to Africa and the Caribbean.

‘Lost solidarity’ or ‘changed solidarity’: a comparative European view of normative family solidarity

This paper discusses filial norms, personal preferences for care, and policy opinions about the proper role of the family and the welfare state in elder care, by drawing from a comparative study of urban populations in Norway, England, Germany, Spain and Israel. Support for filial norms has a north-south dimension in Europe, and is highest in Spain and Israel and lowest – but still substantial – in Norway, England and Germany. National differences in preferences and policy opinions are more substantial, and more or less congruent with national family and social policy traditions. Filial solidarity is, however, not incompatible with generous welfare state arrangements, nor do filial obligations necessarily imply that the family is seen as the ‘natural’ care provider. In fact, many in the countries with the highest scores for filial responsibility still find the welfare state to be the main source of care provision. Normative familism is correlated with expressed familism in individuals' preferences and in policy opinions, but the correlations are weak, implying that while filial solidarity may be resilient, as circumstances alter its expressions change.

Diabetes and vascular disease: common links in the emerging epidemic of coronary artery disease

Although diabetes mellitus (DM) is primarily a metabolic disorder, it is also a vascular disease. Most patients with diabetes die from cardiovascular disease (CVD). Several lines of available evidence suggest that cardiovascular complications account for most of the morbidity and mortality associated with diabetes. 1–5 Recent data suggest that diabetes at a younger age (45 years) is associated with increased risk of CVD, and the presence of DM takes away the natural protection from coronary heart disease (CHD) in premenopausal women. 2–3 Perhaps the best evidence regarding the impact of DM on CVD is illustrated by data from a recent prospective study that demonstrated that the risk of developing a myocardial infarction in diabetic patients with no prior history of CHD was equivalent to the risk observed in nondiabetic survivors with a prior myocardial infarction who participated in the same study and were followed for a similar duration of 7 years. 5 These data suggest that diabetic patients may already have developed vascular disease by the time a clinical diagnosis of DM is made. Ravikumar et al’s Chennai Urban Population Study (CUPS) provides strong evidence in support of this concept. 6 THE CHENNAI URBAN POPULATION STUDY (CUPS) The results of CUPS 6 evaluated atherosclerotic markers by noninvasive means and showed evidence of vascular disease by revealing endothelial dysfunction and increased carotid intima-media thickness in diabetic patients with no history of coronary artery disease. 6 The investigators utilized standard methods for the evaluation of endothelial function and carotid intima-media thickness. They carefully selected their patients with diabetes, who were not only free of CHD but who also did not have a history of hypertension or smoking. The clinical characteristics of the nondiabetic control subjects enrolled in the study were well matched with those of the diabetic patients. 6

Comparison of carotid intima-media thickness, arterial stiffness, and brachial artery flow mediated dilatation in diabetic and nondiabetic subjects (The Chennai Urban Population Study [CUPS-9

This study compares flow-mediated dilation (FMD) and the augmentation index (AI) in diabetic and nondiabetic subjects and correlates these measurements with carotid intima-media thickness (IMT). Fifty diabetic subjects and 50 age- and sex-matched nondiabetic control subjects were recruited from the Chennai Urban Population Study. IMT of the common carotid artery and FMD of the brachial artery were determined using high-resolution B-mode ultrasonography. AI was measured using the Sphygmocor apparatus. The mean AI of diabetic subjects was significantly higher than the nondiabetic subjects (27.48 ± 7.41% vs 19.10 ± 8.19%, p <0.0001). The FMD values were significantly lower among diabetic subjects compared with the nondiabetic subjects (2.1 ± 2.95% vs 6.64 ± 4.38%, p <0.0001). At any given age point, diabetic subjects had significantly higher AI and lower FMD values compared with nondiabetic subjects (p <0.05). In the total population, AI and FMD showed a correlation with age (p <0.001), fasting plasma glucose (p <0.01), glycosylated hemoglobin (p = 0.001), and IMT (p = 0.001). Among the nondiabetic subjects, FMD and AI showed a strong correlation with IMT. FMD also showed a strong correlation with age and systolic blood pressure, whereas AI showed a correlation with fasting plasma glucose in diabetic subjects. AI and FMD values showed a strong correlation with age. AI values increased and FMD values decreased with an increase in quartiles of IMT both in diabetic and nondiabetic subjects. Multivariate linear regression analyses in the total study population showed that age and glycosylated hemoglobin were the risk factors associated with AI and FMD, in addition to diastolic blood pressure with AI. Diabetic patients have decreased FMD and increased arterial stiffness compared with age- and sex-matched nondiabetic subjects. These functional changes correlate well with the structural changes of the arteries measured by IMT.

Socio-economic status and serum lipids:: A cross-sectional study in a Chinese urban population

Socio-economic status and serum lipids are important factors in the progression of cardiovascular disease. We studied the association between socio-economic status and serum lipids in a Chinese urban population. In all, 4,541 respondents (2,231 men and 2,310 women) between 25–64 years of age participated in a cross-sectional population survey carried out in Tianjin, China, and provided blood samples. Three socio-economic indicators (education, occupation, and income), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were determined. People in higher socio-economic groups had a more unfavorable serum lipid profile compared with those in lower socio-economic groups. This significant association was especially apparent in men. Education seemed to be the most important predictor of serum lipids in the three socio-economic indicators. The direction of the association between high socio-economic status and poor serum lipid profiles appears to be opposite to those observed in the developed countries.

Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5)

OBJECTIVESThe aim of this study was to assess the prevalence and risk factors for coronary artery disease (CAD) in a native urban South Indian population.BACKGROUNDHigh prevalence rates of premature CAD have been reported in migrant Asian Indians. There are very few studies on CAD in native Indians living in the Indian subcontinent.METHODSThe Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in South India. Of the total of 1,399 eligible subjects (age ≥20 years), 1,262 (90.2%) participated in the study. All the study subjects underwent a glucose tolerance test and were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or diabetes. Twelve-lead electrocardiogram (ECG) was performed in 1,175 individuals (84%). Coronary artery disease was diagnosed based on previous medical history or Minnesota coding of ECGs.RESULTSThe overall prevalence rate of CAD is 11.0% (age standardized, 9.0%). The prevalence rates of CAD were 9.1%, 14.9% and 21.4% in those with NGT, IGT and diabetes, respectively. Prevalence of CAD increased with an increase in total cholesterol (trend chi-square: 26.2, p < 0.001), low-density lipoprotein (LDL) cholesterol (trend chi-square: 24.5, p < 0.001), triglycerides (trend chi-square: 9.96, p = 0.002) and total cholesterol/high-density lipoprotein ratio (trend chi-square: 6.14, p = 0.0132). Multiple logistic regression analysis identified age (odds ratio [OR]: 1.05, p < 0.001) and LDL cholesterol (OR: 1.009, p = 0.051) as the risk factors for CAD.CONCLUSIONSThe prevalence of CAD is rising rapidly in urban India. Lifestyle changes and aggressive control of risk factors are urgently needed to reverse this trend.

Women's Work: Volunteer AIDS Care Giving in Northern Thailand

SUMMARY Because persons with AIDS in Thailand usually are cared for by their families, and because government AIDS policy relies upon this assistance for the care of the country's sick, the research reported here addressed the questions: Who are the home and community care givers for PWA? What kind of care do they give? And, What is the impact of care giving on the care giver(s)? Informants were drawn in 1998–99 from a long-term birth cohort study of a non-clinical urban population in the country's province of highest AIDS mortality, Chiang Mai. The study was part of a larger, exploratory ethnographic study of the interplay among health, reproduction and development among persons born in 1964 and their mothers that I began in 1973. Findings include that among care-givers, parents, overwhelmingly mothers, and wives considered it their place, duty and moral benefit to care for adult children or husbands sick with AIDS.

Cervical length at 16–22 weeks’ gestation and risk for preterm delivery

Objective: To determine whether cervical length, as measured by transvaginal sonogram in asymptomatic gravidas at 16–22 weeks, is associated with risk of spontaneous preterm delivery. Methods: In a prospective observational study in an unselected urban tertiary care population, cervical length was measured by transvaginal ultrasound during routine anatomic surveys in 760 gravidas at 16 0/7 to 22 6/7 weeks. The predictor variable was cervical length and the outcome variable was gestational age at delivery. Care providers were not masked to the results. Spontaneous preterm delivery was analyzed as before 37, 35, and 32 weeks. Shortened cervical length was defined by the tenth, fifth, and two and a half percentiles for our population. Yates-corrected χ 2 was used to evaluate the significance on univariate analysis of the relative risk (RR) and 95% confidence intervals (CI). Multiple logistic regression analysis was used to control for background variables in evaluating the probability of preterm delivery at less than 35 weeks. Sensitivity, specificity, positive and negative predictive values also were calculated. Results: Cervical lengths were normally distributed (mean 38.5 ± 8.0 mm at 19.9 ± 1.5 weeks) independent of gestational age at measurement, and the tenth, fifth, and two and a half percentiles were 30, 27, and 22 mm, respectively. Eighty-five women delivered before 37 weeks, 51 before 35 weeks, and 27 before 32 weeks. Relative risks (95% CI) for spontaneous preterm delivery before 37 weeks were 3.8 (2.6, 5.6), 5.4 (3.3, 9.0), and 6.3 (3.0, 13.0) for the tenth, fifth, and two and a half percentiles, respectively; RRs for before 35 weeks were 4.5 (2.9, 6.9), 7.5 (4.5, 12.5), and 7.8 (3.6, 16.7); and for before 32 weeks were 5.2 (3.3, 8.3), 9.7 (5.8, 16.1), and 8.4 (3.6, 19.9), respectively. Multiple logistic regression analysis confirmed that cervical length was a significant predictor of preterm birth before 35 weeks, and that paras had a 43% greater risk compared with nulliparas. Sensitivity ranged from 13–44%, specificity 90–99%, positive predictive value 15–47%, and negative predictive value 80–98%. Conclusion: Transvaginal measurement of cervical length during routine ultrasound at 16–22 weeks’ gestation in asymptomatic gravidas might help identify women at risk for spontaneous preterm delivery.

Prevalence of neuropathy using biothesiometry in a selected South Indian population - the Chennai Urban Population Study (CUPS)

Prevalence of neuropathy using biothesiometry in a selected South Indian population - the Chennai Urban Population Study (CUPS)

Hyperinsulinemia and coronary artery disease among South Indian Population - the Chennai urban population study (CUPS)

Hyperinsulinemia and coronary artery disease among South Indian Population - the Chennai urban population study (CUPS)

Prevalence of coronary artery disease in a selected south Indian population - the Chennai Urban population study (CUPS)

Prevalence of coronary artery disease in a selected south Indian population - the Chennai Urban population study (CUPS)

Intra urban differences in the prevalence of metabolic syndrome - the chennai urban population study (CUPS)

Intra urban differences in the prevalence of metabolic syndrome - the chennai urban population study (CUPS)