Metabolic syndrome according to different definitions in a rapidly developing country of the African region

AIMS: We examined, in a country of the African region, i) the prevalence of the metabolic syndrome (MetS) according to three definitions (ATP, WHO and IDF); ii) the distribution of the MetS criteria; iii) the level of agreement between these three definitions and iv) we also examined these issues upon exclusion of people with diabetes. METHODS: We conducted an examination survey on a sample representative of the general population aged 25-64 years in the Seychelles (Indian Ocean, African region), attended by 1255 participants (participation rate of 80.3%). RESULTS: The prevalence of MetS increased markedly with age. According to the ATP, WHO and IDF definitions, the prevalence of MetS was, respectively, 24.0%, 25.0%, 25.1% in men and 32.2%, 24.6%, 35.4% in women. Approximately 80% of participants with diabetes also had MetS and the prevalence of MetS was approximately 7% lower upon exclusion of diabetic individuals. High blood pressure and adiposity were the criteria found most frequently among MetS holders irrespective of the MetS definitions. Among people with MetS based on any of the three definitions, 78% met both ATP and IDF criteria, 67% both WHO and IDF criteria, 54% both WHO and ATP criteria and only 37% met all three definitions. CONCLUSION: We identified a high prevalence of MetS in this population in epidemiological transition. The prevalence of MetS decreased by approximately 32% upon exclusion of persons with diabetes. Because of limited agreement between the MetS definitions, the fairly similar proportions of MetS based on any of the three MetS definitions classified, to a substantial extent, different subjects as having MetS.

Lack of seasonal variation in cardiovascular mortality in a country near the equator

Introduction: Mortality from cardiovascular disease (CVD) varies according to seasons in countries that are located far away from the equator, likely linked to concomitant seasonal variation in underlying CVD risk factors. We assessed temporal variation in CVD mortality in the Seychelles, a small island state situated near the equator and where the climate is virtually constant throughout the year. Seychelles is one of the few countries located near the equator where all deaths are registered. Methods: We recoded all deaths along broad causes, including CVD (n=5643), stroke (2112) and myocardial infarction (MI, 804). Stroke and MI were considered as the cause of death if the diagnosis appeared in any of the four fields for underlying causes of death in the death certificates. In view of the small size of the population, we pooled all deaths (n=13'163) between 1989 and 2010. Results: Mortality for all CVD, stroke and MI did not systematically vary according to month or season (chi square >0.05). A lack of variation was also observed within sex and age categories. Conclusion: The lack of seasonal variation in CVD mortality in a country located near the equator is consistent with the hypothesis that seasonal variation in CVD decreases along decreasing a country's latitude.

Fertilizer Use by Crop at the Country Level (1990–2010)

We compute the fertilizer use in corn, cotton, soybeans, and rapeseed in the period from 1990 to 2010 for a set of selected countries. In each case, we present the consumption of nitrogen, phosphate, and potash by crop and by year, reporting both the fertilizer application rates (in kilograms per hectare) and the fertilizer consumption (in thousand metric tonnes). We allocate a country’s total nutrient consumption in a given year among competing crops based on publicly available statistics. The resulting allocation of fertilizer among crops is a function of the country’s nutrients total use, the country’s cropped areas, crop world prices, and crop- and country-specific fertilizer application rates for some years. In this report we show results on fertilizer consumption by crop for the top fertilizer consuming countries, and a downloadable MS Excel file “FertilizerDemandByCropData.xls” shows the complete set of results.

Performance anxiety : cardiorespiratory activity in high- and low-anxious professional music students in a performance situation

Questionnaire studies indicate that high-anxious musicians may suffer from hyperventilation symptoms before and/or during performance. Reported symptoms include amongst others shortness of breath, fast or deep breathing, dizziness and thumping heart. A self-report study by Widmer, Conway, Cohen and Davies (1997) shows that up to seventy percent of the tested highly anxious musicians are hyperventilators during performance. However, no study has yet tested if these self-reported symptoms reflect actual cardiorespiratory changes just before and during performance. Disturbances in breathing patterns and hyperventilation may negatively affect the performance quality in stressful performance situations. The main goal of this study is to determine if music performance anxiety is manifest physiologically in specific correlates of cardiorespiratory activity. We studied 74 professional music students of Swiss Music Universities divided into two groups (high- and lowanxious) based on their self-reported performance anxiety (State-Trait Anxiety Inventory by Spielberger). The students were tested in three distinct situations: baseline, performance without audience, performance with audience. We measured a) breathing patterns, end-tidal carbon dioxide, which is a good non-invasive estimator for hyperventilation, and cardiac activation and b) self-perceived emotions and self-perceived physiological activation. Analyses of heart rate, respiratory rate, self-perceived palpitations, self-perceived shortness of breath and self-perceived anxiety for the 15 most and the 15 least anxious musicians show that high-anxious and low-anxious music students have a comparable physiological activation during the different measurement periods. However, highanxious music students feel significantly more anxious and perceive significantly stronger palpitations and significantly stronger shortness of breath just before and during a public performance. The results indicate that low- and high-anxious music students a) do not differ in the considered physiological responses and b) differ in the considered self-perceived physiological symptoms and the selfreported anxiety before and/or during a public performance.

Macbride nature recreation area : hiking and cross-country ski trails, 1987.

This brochure contains information on the hiking and cross-country ski trails in the Macbride Nature Recreation Area located 15 minutes north of Iowa City in Johnson County.

National Identity and the Preference for State Opting-Out in the Basque Country

We argue that preferences for secession are the expression of a common unobserved mechanisms determining national identity. This paper examines the hypothesis of independence of both preferences for secession (independent Euskadi) and Basque national identity in the light of Akerloff and Kranton (2000). We deal with psychological determinants of individuals' national identity formation as well as those that influence the propensity of individuals to support the secession of their perceived ¿imagined community¿ or nation.. We undertake econometric survey analysis for the Basque Country using a bivariate probit model and publicly available data from the Spanish Centre for Sociological Research. Our results provide robust evidence of a common determination of national identity and political preferences for the secession of the Basque Country consistently with Akerloff and Kranton model.

Decomposing Cross-Country Gaps in Obesity and Overweight: Does the Social Environment Matter?

[cat] Una qüestió clau sobre la producció de salut relativament poc explorada es refereix a la influència dels factors socioeconòmics i mediambientals sobre el pes i l’obesitat. Aquesta problemàtica adquireix particular rellevància quan es comparen dos països Mediterranis com Itàlia i Espanya. És interessant adonar-se que l’obesitat a Espanya és 5 punts percentual més elevada al 2003 mentre que a l’any 1990 era aproximadament la mateixa en ambdós països. Aquesta article presenta una descomposició no lineal dels gaps o diferencials en taxes de sobrepès (índex de massa corporal – IMC- entre 25 i 29.9 9 kg/m2), obesitat classe 1 (IMC≥30 kg/m2) i classe 2 (IMC≥35 kg/m2) entre Espanya i Itàlia per gènere i grups d’edat. En explicar aquests gaps entre països aïllem les influències dels estils de vida, els efectes socioeconòmics i els mediambientals. Els nostres resultats indiquen que quan no es controla pels efectes mediambientals (efectes de grup o ‘peer effects’) els hàbits alimentaris i el nivell educatiu són els principals predictors del gaps totals entre països (36-52%), si bé aquests dos factors exerceixen un impacte diferenciat segons gènere i edat. Un tant paradoxalment, quan controlem pels efectes de grup aquests predictors perden la seva capacitat explicativa i els efectes de grup passen a explicar entre el 46-76% dels gaps en sobrepès i obesitat i mostren un patró creixent amb l’edat.

Metabolic syndrome according to different definitions in a rapidly developing country of the African region

Rapport de synthèseLe syndrome métabolique représente un ensemble de facteurs de risque métaboliques souvent présents simultanément et il est associé à un risque accru de développer des maladies cardiovasculaires. La prevalence du syndrome métabolique est à la hausse au niveau mondial comme cela a souvent été documenté, en particulier dans les pays développés. Pourtant, les données concernant le syndrome métabolique dans les pays de la région sub-saharienne restent rares.Au cours des dernières années, plusieurs définitions du syndrome métabolique ont été formulées, dont celle du 'National Cholesterol Education Program Adult Treatment Panel III', celle de 1 Organisation Mondiale de la Santé et celle du 'International Diabetes Federation'. Parmi les controverses au sujet du syndrome métabolique persiste la question de l'utilité de rechercher la présence du syndrome métabolique chez les patients diabétiques, étant donné que la présence d'un diabète en soit suffit pour identifier un individu à haut risque de faire un événement cardiovasculaire.L'objectif de ce travail de thèse a été de déterminer la prévalence du syndrome métabolique selon les trois définitions majeures mentionnées ci-dessus, grâce à une étude de population transversale, réalisée aux Seychelles en 2004 dans un échantillon représentatif de la population âgée de 24-65 ans (n=1255, taux de participation de 80.3%). L'intérêt d'examiner cette question dans ce pays était d'obtenir des informations dans un pays en transition épidémiologique.Les résultats de ce travail montrent que la prévalence du syndrome métabolique aux Seychelles est élevée, quelque soit la définition utilisée. Selon la définition utilisée, cette prévalence était d'environ 25% chez les hommes et variant entre 25 et 35% chez les femmes.Cependant, malgré des prévalences semblables selon ces trois définitions, la concordance entre ces définitions n'était pas bonne, impliquant que ces différentes définitions classifient, à un certain degré, des individus différents comme étant porteurs du syndrome métabolique.En outre, la plupart (environ 80%) des individus diabétiques avaient un syndrome métabolique. Après exclusion des individus diabétiques, la prévalence du syndrome métabolique dans la population est réduite d'environ un tiers, à environ 20-25%.Ces résultats montrent que, d'une part, le fardeau de maladie dû au syndrome métabolique aux Seychelles, un pays en voie de développement, est considérable. Cette observation peut potentiellement s'appliquer à d'autres pays à un stade de développement semblable. Cela renforce le besoin de mettre en oeuvre des stratégies de santé publique afin de cibler les causes de ces désordres métaboliques, tels que le surpoids et la sédentarité. D'un point de vue du diagnostic, les trois définitions du syndrome métabolique semblent classifier un nombre semblable de personnes atteints du syndrome métabolique dans cette population. Par contre, la relativement mauvaise concordance entre ces définitions - certaines personnes identifiés comme porteurs du syndrome métabolique selon une définition ne le sont pas selon une autre - confirme la nécessité de clarifier la signification de ces différentes définitions et/ou éventuellement de développer une définition unifiée et fiable du syndrome métabolique.

Discordant secular trends in elevated blood pressure and obesity in children and adolescents in a rapidly developing country

BACKGROUND: The effect of the increasing prevalence of obesity on blood pressure (BP) secular trends is unclear. We analyzed BP and body mass index secular trends between 1998 and 2006 in children and adolescents of the Seychelles, a rapidly developing island state in the African region. METHODS AND RESULTS: School-based surveys were conducted annually between 1998 and 2006 among all students in 4 school grades (kindergarten and 4th, 7th, and 10th years of compulsory school). We used the Centers for Disease Control and Prevention criteria to define obesity and elevated BP. The same methods and instruments were used in all surveys. Some 25 586 children and adolescents 4 to 18 years of age contributed 43 867 observations. Although the prevalence of obesity in boys and girls increased from 5.1% and 6.0%, respectively, in 1998 to 2000 to 8.0% and 8.7% in 2004 to 2006, the prevalence of elevated BP decreased from 8.4% and 9.8% to 6.9% and 7.8%. During the interval, mean age-adjusted body mass index increased by 0.57 kg/m(2) in boys and 0.58 kg/m(2) in girls. Mean age- and height-adjusted systolic BP decreased by -3.0 mm Hg in boys and -2.8 mm Hg in girls, whereas mean diastolic BP did not change substantially in boys (-0.2 mm Hg) and increased slightly in girls (0.4 mm Hg). CONCLUSIONS: At a population level, the marked increase in the prevalence of obesity in children and adolescents in the Seychelles was not associated with a commensurate secular rise in mean BP.

Geophagia secondary to anaemia in a rich country?

Case Report: A 19 year old female, originally from Cameroon, residentin Switzerland for 10 years, consults for chronic fatigue, constipationand menorrhagia. Clinical examination reveals pain in the iliac fossa,laboratory tests show an iron deficiency anaemia with a hemoglobinof 74 g/l (N: 117-157) and a ferritin less than 3 μg/l (N: 30-300).Gynecological aetiology is strongly suspected.Findings: The dietary history reveals a high intake of African chalkcalled "Mabel" in Lingala, for which she has a craving with criteria forsubstance dependence according to the Diagnostic and StatisticalManual IV. Eating non-food products is called "PICA" and the eatingof earth "geophagia". It is often assumed by the patient that geophagiaoffers nutritional virtues of the earth, and that the land would act asantitoxic, anti-emetic, immune-stimulant, strengthen the intestinalbarrier and be rich in calcium, iron and many nutrients. But insteadgeophagia causes anemia, iron chelation, heavy metal poisoningand significant constipation or obstruction.Management: The patient, following our advice, stopped ingestingchalk. Parenteral iron substitution of ferric carboxymaltose 1000 mgstopped the craving, and resolved her subjective state of fatigue andher haemoglobin normalized to 140 g/l. The menorrhagia resolved withhormone replacement and the constipation subsequently disappeared.Discussion: Our patient was suffering from iron deficiency resulting ina craving for non-food products in this case the earth. We advisepractitioners to systematically ask the question in patients of Africanand South American origin by using synonyms for the word "Mabel"(African chalk, kaolin, Kalaba, calabash chalk, calabash Stone, Kaolin,hurdle, or clay Nzu). A simple question can sometimes avoid costlyinvestigations. The ferrous replacement intravenously can probably stopthe practice of geophagy faster. Finally, we must remember that thispractice is underestimated and rarely expressed by patients as it isoften felt to be a shameful practice.

Aufftrittsangst : kardiorespiratorische Aktivität bei ängstlichen und nichtängstlichen Musikstudenten in einer Auftrittssituation = Performance anxiety : cardiorespiratory activity in high- and low-anxious professional music students in a performance situation

Fragebogenstudien haben gezeigt, dass ängstliche Musiker vor und/oder während eines Auftritts möglicherweise unter Hyperventilationssymptomen leiden. Berichtete Symptome beinhalten Kurzatmigkeit, schnelles oder tiefes Einatmen, Schwindelgefühl und Herzklopfen. Bisher hat jedoch noch keine Studie getestet, ob diese selbstberichteten Symptome tatsächlich kardiorespiratorische Veränderungen widerspiegeln. Das Hauptziel dieser Studie ist es, zu bestimmen, ob sich Auftrittsangst bei Musikern physiologisch über kardiorespiratorische Muster äußert. Wir haben insgesamt 74 Musikstudenten von Schweizer Musikhochschulen getestet. Diese Studenten wurden aufgrund ihrer selbstberichteten Auftrittsangst (STAI-S) in zwei Gruppen unterteilt: ängstliche Musiker und nichtängstliche Musiker. Die Studenten wurden in drei unterschiedlichen Situationen getestet: Ausgangszustand, Auftritt ohne Publikum, Auftritt mit Publikum. Wir haben folgende Parameter gemessen: a) kardiorespiratorische Muster und endexpiratorisches CO2, welches eine gute nichtinvasive Schätzung des Hyperventilationsgrades liefert und b) subjektiv wahrgenommene Emotionen und subjektiv wahrgenommene physiologische Aktivität. Das Poster zeigt die ersten Resultate der 15 ängstlichsten und der 15 am wenigsten ängstlichen Musiker. Das Hauptinteresse gilt den folgenden Punkten: Herz- und Atemfrequenz, subjektiv wahrgenommenes Herzklopfen, subjektiv wahrgenommene Kurzatmigkeit und subjektiv wahrgenommenes Angstgefühl. Die Resultate dieser Studie zeigen erstens, dass ängstliche und nichtängstliche Musikstudenten zu den verschiedenen Messzeitpunkten eine vergleichbare physiologische Aktivität aufweisen und zweitens, dass ängstliche Musikstudenten ein signifikant höheres Angstgefühl haben und signifikant mehr Herzklopfen und Kurzatmigkeit wahrnehmen vor und/oder während eines Auftritts mit Publikum. Dies deutet darauf hin, dass sich ängstliche und nichtängstliche Musikstudenten a) bezüglich der subjektiv wahrgenommenen physiologischen Symptome und des selbst berichteten Angstgefühls vor und/oder während eines öffentlichen Auftritts unterscheiden und sich b) bezüglich der untersuchten physiologischen Reaktionen nicht unterscheiden.