Contribution of changes in risk factors to the decline of coronary heart disease mortality in Australia over three decades

BACKGROUND: Coronary heart disease has been a major cause of mortality in Australian adults, but the rate has declined by 83% from the 1968 peak by the year 2000. The study objective is to determine the contribution of changes in population risk factors - mean serum cholesterol and diastolic blood pressure and tobacco smoking prevalence - to the decline in coronary heart disease mortality in Australia over three decades. METHODS: Coronary heart disease deaths (International Classification of Disease-9, 410-414) and population by year, age group and sex were obtained from the Australian Bureau of Statistics. Risk factor levels were obtained from population surveys and estimated average annual changes by period were used to calculate average annual 'attributable' proportional declines in CHD mortality by period (age 35-64 years). RESULTS: Over the period 1968-2000, 74% of male decline and 81% of the female decline in coronary heart disease mortality rate was accounted for by the combined effect of reductions in the three risk factors. In males 36% of the decline was contributed by reductions in diastolic blood pressure, 22% by cholesterol and 16% by smoking. For females 56% was from diastolic blood pressure reduction, 20% from cholesterol and 5% from smoking. Effects of reductions in serum cholesterol on coronary heart disease mortality occurred mainly in the 1970s. Declines in diastolic blood pressure had effects on coronary heart disease mortality over the three decades, and declines in tobacco smoking had a significant effect in males in the 1980s. CONCLUSION: Most of the spectacular decline in coronary heart disease mortality over the last three decades in Australia can be ascribed to reductions in population risk factors from primary and secondary prevention.

Relative predictive value of intraventricular dysynchrony in determining long-term outcome in patients with known or suspected coronary disease

Improvement of intra-ventricular dysynchrony (IVD) in pts undergoing bi-ventricular pacing is associated with clinical improvementbut little isknownabout the relationship between IVD and prognosis.We sought whether IVD influences long-term outcome in pts with known or suspected coronary disease (CAD). Tissue Doppler imaging was performed in 184 pts (aged 61±10 years, 67% male) prior to dobutamine echo. From velocity curves the interval between QRS onset and max systolic velocity (Ts) was measured in basal septal, lateral, inferior and anterior segments. The maximal difference in Ts between segments (TsMax) was used as a measure of IVD. The standard deviation (TsSD) between all segments and the septal-lateral difference (TsSL) were also calculated. Pts were followed up for a median interval of 5 years and a Cox model used for survival analysis. The medianwall motion index (WMI) was 1.3 (IQR 1.0–1.8) at rest and 1.4 (IQR 1.3–1.9) at stress. The table shows IVD parameters. Forty-one deaths occurred during follow-up. Pts who died during follow-up, compared to survivors, showed greater IVD. WMI at rest (p = 0.03) and peak stress (p = 0.02), TsSD (p = 0.06), TsSL (p = 0.02) and TsMax (p = 0.05) but not QRS width were univariate predictors of mortality. TsSL was the only independent predictor of death (p = 0.01). Therefore, IVD is common in pts with known or suspected CAD. Pts with more IVD have reduced long-term survival, independent of WMI.

Further evidence of linkage at 7p22 with familial hyperaldosteronism type II and exclusion of genetic defects in the RBAK coding regions

Once thought rare, primary aldosteronism (PAL) is now reported to be responsible for 5–10% of hypertension. Unlike familial hyperaldosteronism type I (FH-I), FH-II is not glucocorticoidremediable and not associated with the hybrid CYP11B1/CYP11B2 gene mutation. At least five times more common than FH-I, FH-II is clinically indistinguishable from apparently sporadic PAL, suggesting an even higher incidence. Studies performed in collaboration with C Stratakis (NIH, Bethesda) on our largest Australian family (eight affected members) demonstrated linkage at chromosome 7p22. Linkage at this region was also found in a South American family (DNA provided by MI New, Mount Sinai School of Medicine, New York) and in a second Australian family. The combined multipoint LOD score for these 3 families is 4.61 (q = 0) with markers D7S462 and D7S517, providing strong support for this locus harbouring mutations responsible for FH-II. A newly identified recombination event in our largest Australian family has narrowed the region of linkage by 1.8 Mb, permitting exclusion of approximately half the genes residing in the originally reported 5 Mb linked locus. Candidate genes that are involved in cell cycle control are of interest as adrenal hyperplasia and adrenal adenomas are common in FH-II patients. A novel candidate gene in this linked region produces the retinoblastoma-associated Kruppel-associated box protein (RBaK) which interacts with the retinoblastoma gene product to repress the expression of genes activated by members of the E2F family of transcription factors.

Alfabetização de jovens e adultos no período militar: o MOBRAL segundo alguns críticos e egressos

O presente trabalho focaliza o período da ditadura militar e, de modo especial, discute a proposta criada para a educação de jovens e adultos - (Movimento Brasileiro de Alfabetização) -Mobral. Surgiu de uma indagação sobre a qualidade (ou não) do modelo de educação oferecido aos jovens e adultos durante este período da ditadura militar, ou "a grande noite de 21 anos", no sentido da construção da cidadania de grande parte do povo brasileiro. A partir de uma análise inicial do processo educacional conhecido como Mobral, verifiquei que minhas leituras até então negativas sobre sua metodologia começaram a tomar um outro rumo na medida em que ao realizar as entrevistas, passei a perceber o quão importante, de alguma forma, foi para as suas vidas nesse processo de construção da cidadania. Levando em consideração a dificuldade de implantação, na prática, de toda a teoria do Mobral, ainda assim, é inegável observar o grande investimento econômico para transpô-la; mas, de fato, representou um salto qualitativo na prática pedagógica, quando comparado ao passado histórico sobre a oferta de um processo educacional para jovens e adultos. O presente trabalho não tem a intenção de limitar qualquer análise ou pesquisa posterior sobre a alfabetização de jovens e adultos do referido período de exceção política brasileira.(AU)

A Penhorablidade do Direito de autor na Obra Cinematográfica

O Direito de Autor protege a criação intelectual e, do mesmo modo, protege a obra cinematográfica. A obra cinematográfica caracteriza-se pelo conjunto de obras do realizador, do autor do argumento e dos diálogos, e da banda musical, conforme os artigos 2º, nº 1 alínea f) e 22º, nº 1 do Código de Direito de Autor e Direitos Conexos. O Direito de Autor subdivide-se em direitos patrimoniais e direitos pessoais. Apenas os direitos patrimoniais são passíveis de sofrer alteração de titular. A obra intelectual, enquanto coisa incorpórea, é objeto de transmissão. E como objeto de transmissão ela é possível de ser penhorada apenas no conteúdo patrimonial. E esta questão não é pacífica pela doutrina no Ordenamento Jurídico Português, pois sendo os direitos morais intransmissíveis a utilização que se faça do conteúdo patrimonial pode colidir com estes direitos morais. Embora a penhora incida apenas sobre o conteúdo patrimonial, ela pode ser condicionada pelo exercício dos direitos morais. A questão de máxima importância prende-se no facto de, não havendo mais nada a penhorar, poder-se ou não penhorar o Direito de Exploração do Direito de Autor quando ele esteja na pessoa do criador e/ou quando esteja na pessoa de um terceiro. Outro problema que a obra cinematográfica suscita, prende-se com o facto de, sendo possível penhorar, em que medida é que vamos penhorar, pois verifica-se vários direitos de autor inseridos numa só obra. Ou seja, sobre a “obra cinematográfica” reconhecem-se vários autores e, além disso, integrados na obra cinematográfica reconhece-se a possibilidade de coexistirem várias obras suscetíveis de utilização autónoma, sobre os quais existem direitos de autor, com conteúdos patrimoniais e morais, distintos do que incide sobre a obra cinematográfica como um todo.

Innovation and export performance:evidence from UK and German manufacturing plants

Using comparable plant-level surveys we demonstrate significant differences between the determinants of export performance among the UK and German manufacturing plants. Product innovation, however measured, has a strong effect on the probability and propensity to export in both countries. Being innovative is positively related to export probability in both countries. In the UK the scale of plants’ innovation activity is also related positively to export propensity. In Germany, however, where levels of innovation intensity are higher but the proportion of sales attributable to new products is lower, there is some evidence of a negative relationship between the scale of innovation activity and export performance. Significant differences are identified between innovative and non-innovative plants, especially in their absorption of spill-over effects. Innovative UK plants are more effective in their ability to exploit spill-overs from the innovation activities of companies in the same sector. In Germany, by contrast, non-innovators are more likely to absorb regional and supply-chain spill-over effects. Co-location to other innovative firms is generally found to discourage exporting.

Embedded progressive-three-layered fiber long-period gratings for respiratory monitoring

A long-period grating (LPG) was written into a progressive three-layered single-mode fiber that was embedded into a flexible platform as a curvature sensor. The spectral location and profile of the LPGs were unaltered after implantation in the platform. The curvature sensitivity was 3.747 nm m with a resolution of ±1.1×10–2 m–1. The bend sensor is intended to be part of a respiratory monitoring system and was tested on a resuscitation training manikin.

Dual-wavelength, ultralong Raman laser with Rayleigh-scattering feedback

We present experimental demonstration of a 200-km-long, dual-wavelength Raman laser utilizing two slightly different-wavelength fiber Bragg gratings, one on each side of the fiber span. The obtained results clearly prove the generation of two independent Raman lasers with a distributed “random” Rayleigh scattering mirror forming a cavity together with each of the individual fiber Bragg grating reflectors.