Motivational, volitional and multiple goal predictors of walking in people with type 2 diabetes

Acknowledgment MN's PhD scholarship was provided by Ministry of Health and Medical Education (Islamic Republic of Iran). This study was funded by the University of Aberdeen. FFS is funded by Fuse, the UK Clinical Research Collaboration Centre of Excellence for Translational Research in Public Health. The researchers gratefully acknowledge all the Type 2 diabetic patients and their household members who participated in the study for their contribution to this study; without them there would be no data. The researchers gratefully acknowledge the SDRN for providing the list of Type 2 diabetes and helping for sampling.

Post-cesarean Section Peritonitis at a Referral Hospital in Rwanda: Factors Associated with Maternal Morbidity and Mortality

Background: Post-cesarean section peritonitis is the leading cause of maternal morbidity and mortality at the main referral hospital in Rwanda. Published data on the management of post-cesarean section peritonitis is limited. This study examined predictors of maternal morbidity and mortality for post-cesarean peritonitis.

Methods: We performed a prospective observational cohort study at the University Teaching Hospital Kigali (CHUK) from January 1 until December 31 2015, followed by a retrospective chart review of all subjects with post-cesarean section peritonitis admitted to CHUK from January 1 until December 31, 2014. All patients admitted with the diagnosis of post-cesarean section peritonitis undergoing exploratory laparotomy at CHUK were enrolled. Patients were followed to either discharge or death. Study variables included baseline demographic/clinical characteristics, admission physical exam, intraoperative findings, and management. Data were analyzed using STATA version 14.

Results: Of the 167 patients enrolled, 81 survived without requiring hysterectomy (49%), 49 survived requiring hysterectomy (29%), and 36 died (22%). In the multivariate analysis, severe sepsis was the most significant predictor of mortality (RR=4.0 [2.2-7.7]) and uterine necrosis was the most significant predictor of hysterectomy (RR=6.3 [1.6-25.2]). There were high rates of antimicrobial resistance (AMR) among the bacterial isolates cultured from intra-abdominal pus, with 52% of bacteria resistant to third-generation cephalosporins.

Conclusions: Post-cesarean section peritonitis carries a high mortality rate in Rwanda. It is also associated with a high rate of hysterectomy. Understanding the disease process and identifying factors associated with outcomes can help guide management during admission.

Impacto das características e condições de trabalho no absentismo em assistentes operacionais de escolas e jardins de infância

O trabalho é capaz de proporcionar sentimentos de identificação, permitindo a partilha de experiências, a aquisição de status social e identidade profissional, mas também pode colocar o trabalhador em situações desagradáveis. As condições a que os trabalhadores estão expostos no seu trabalho e os constrangimentos organizacionais podem despoletar riscos para a sua saúde mental, social e física. A exposição a riscos psicossociais no trabalho tem consequências para a saúde dos trabalhadores. Riscos estes que estão relacionados com a organização do trabalho, com o conteúdo das tarefas e com o ambiente vivenciado no local de trabalho. Para além de consequências para a saúde, a exposição a fatores de risco pode ter consequências que prejudicam o trabalhador, a organização e a sociedade em geral, exemplo dessa consequência é o absentismo. O absentismo é caracterizado pela ausência do trabalhador ao seu local de trabalho, podendo ter na sua essência múltiplas causas, sendo, por sua vez, causador de diversos problemas. A insatisfação com as condições e características do trabalho e os problemas de saúde causados e agravados pela exposição aos riscos leva ao elevado absentismo. Esta dissertação tem como intuito compreender a perceção dos assistentes operacionais acerca da exposição a fatores de riscos psicossociais, compreender a que se deve o elevado índice de absentismo laboral e perceber se existe relação entre este e as condições de trabalho e a perceção de exposição a riscos psicossociais. Participaram do estudo 85 assistentes operacionais, entre os 32 e os 65 anos, de escolas e jardins de infância do conselho. A recolha de dados foi realizada através do questionário INSAT2013 e pela técnica de observação não sistematizada, onde se procurou observar, com o intuito de compreender, as atividades, comportamentos, dificuldades, interações/relações e satisfação do trabalhador assistente operacional. Os principais resultados apresentam uma percepção moderada, por parte dos trabalhadores a riscos psicossociais de modo geral e a sua relação com o elevado absentismo. Umas das conclusões que se destaca na dissertação é que a elevada carga de trabalho reforçada com a redução de colaboradores levam ao aumento do absentismo.

A ambiência como ferramenta de humanização da unidade de pediatria: contribuições da enfermagem

A assistência em pediatria suscita a promoção de um ambiente que atenda as necessidades da criança, por meio de um olhar diferenciado que pondere a especificidade desta fase da vida em que se tem maior dificuldade em lidar com o adoecimento e enfrentar o desconhecido e o medo causado por ele. Considerando que qualquer desestruturação poderá interferir no pleno desenvolvimento da criança, o cuidar em Enfermagem Pediátrica deve contribuir para a diminuição dos efeitos estressores do ambiente hospitalar de forma a tornar a assistência humanizada. Assim, faz-se necessário investir em questões fundamentais de adequação do ambiente de pediatria, com equipamentos e tecnologias que considerem e respeitem a singularidade das necessidades tanto dos usuários quanto dos profissionais. Trabalhar a ambiência em pediatria mostra-se relevante no contexto atual, tendo em vista que devemos preconizar a assistência calcada nos princípios da humanização, que demandam a revisão das práticas cotidianas, com ênfase na criação de espaços de trabalho menos alienantes que valorizem a dignidade do profissional de saúde, da criança e da família. Por esta razão, este estudo teve como objetivo analisar a ambiência de unidades pediátricas como ferramenta para a humanização da assistência a partir da percepção dos diferentes atores implicados no processo de produção de saúde. Para atingi-lo, adotou-se o delineamento da pesquisa qualitativa com caráter exploratório. Os ambientes de investigação foram as Unidades de Pediatria do Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU/FURG) e do Hospital Escola da Universidade Federal de Pelotas (HE/UFPel), tendo como sujeitos 20 usuários, 20 trabalhadores das referidas unidades, bem como 04 gestores de enfermagem e saúde. A coleta de dados ocorreu no período compreendido de agosto a outubro de 2014, por meio da triangulação metodológica, utilizando-se imagens e dados verbais obtidos por meio de fotos e entrevistas semiestruturadas com emprego de foto-elicitação, respectivamente. Para análise dos dados empregou-se o software Nvivo 10, emergindo as seguintes categorias: Confortabilidade das crianças e de suas famílias; Produção de subjetividades nas crianças e familiares; Produção de subjetividade e autonomia dos trabalhadores de enfermagem; Ambiência como ferramenta facilitadora do processo de trabalho e da produção de saúde. Cada categoria exibe subcategorias que expõem a perspectiva dos sujeitos envolvidos no processo de produção de saúde: usuários, profissionais de enfermagem e gestores. A partir dos resultados do estudo são apontadas as potencialidades e os desafios para a consolidação da ambiência como ferramenta de humanização da unidade de pediatria. Pode-se inferir que para que a unidade de pediatria seja percebida como humanizada deve ser projetada de forma que a sua ambiência comporte aspectos que visem a confortabilidade das crianças e suas famílias; possibilite a produção de subjetividades nas crianças, familiares e a autonomia dos trabalhadores de enfermagem por meio da reflexão acerca dos processos de trabalho e possibilite a utilização do próprio espaço como ferramenta facilitadora da produção de saúde.

Predictive Models for Tomato Spotted Wilt Virus Spread Dynamics, Considering Frankliniella occidentalis Specific Life Processes as Influenced by the Virus

Several models have been studied on predictive epidemics of arthropod vectored plant viruses in an attempt to bring understanding to the complex but specific relationship between the three cornered pathosystem (virus, vector and host plant), as well as their interactions with the environment. A large body of studies mainly focuses on weather based models as management tool for monitoring pests and diseases, with very few incorporating the contribution of vector's life processes in the disease dynamics, which is an essential aspect when mitigating virus incidences in a crop stand. In this study, we hypothesized that the multiplication and spread of tomato spotted wilt virus (TSWV) in a crop stand is strongly related to its influences on Frankliniella occidentalis preferential behavior and life expectancy. Model dynamics of important aspects in disease development within TSWV-F. occidentalis-host plant interactions were developed, focusing on F. occidentalis' life processes as influenced by TSWV. The results show that the influence of TSWV on F. occidentalis preferential behaviour leads to an estimated increase in relative acquisition rate of the virus, and up to 33% increase in transmission rate to healthy plants. Also, increased life expectancy; which relates to improved fitness, is dependent on the virus induced preferential behaviour, consequently promoting multiplication and spread of the virus in a crop stand. The development of vector-based models could further help in elucidating the role of tri-trophic interactions in agricultural disease systems. Use of the model to examine the components of the disease process could also boost our understanding on how specific epidemiological characteristics interact to cause diseases in crops. With this level of understanding we can efficiently develop more precise control strategies for the virus and the vector.

Deficiencies in education and experience in the management of acute kidney injury among Malawian healthcare workers

Background Acute kidney injury (AKI) is a common but under-recognised disease process, which carries a high risk of mortality or chronic complications, such as chronic kidney disease and other organ dysfunction. Management of AKI, however, is suboptimal, both in developed settings and in Malawi. This is partly because of deficiencies in AKI education and training. Aim To establish current levels of AKI education in a range of healthcare workers in Malawi. Methods An AKI symposium was held in Blantyre in March 2015. Delegates were asked to complete a survey at the start of the symposium to assess their clinical experience and education in the management of AKI. Results From 100 delegates, 89 nurses, clinical officers, and physicians, originating from 11 different districts, responded to the survey. Twenty-two percent of healthcare workers (including 28% of district workers of the various cadres and 31% of nurses) had never received teaching on any aspect of renal disease, and 50% (including 63% of district workers and 61% of nurses) had never received teaching specifically on AKI. Forty-four percent did not feel confident managing AKI, and 98% wanted more support managing patients with renal disease. Thirty-four percent (including 55% of district workers) were unaware that haemodialysis was available at Queen Elizabeth Central Hospital (QECH) for the treatment of AKI and 53% (74% of district workers) were unaware that peritoneal dialysis was available for the treatment of AKI in children. Only 33% had ever referred a patient with AKI to QECH. Conclusions There are deficiencies in education about, and clinical experience in, the management of AKI among Malawian healthcare workers, in addition to limited awareness of the renal service available at QECH. Urgent action is required to address these issues in order to prevent morbidity and mortality from AKI in Malawi.

Objeção da consciência e aborto previsto em lei : vivências em um serviço público de saúde

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem, 2015.

Mesmo com o sacrifício da própria vida : vivências de prazer e sofrimento no trabalho entre policiais militares do DF

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Economia, Administração e Contabilidade, Programa de Pós-Graduação em Administração, 2016.

Development of an antigen-driven colitis model to study presentation of antigens by antigen presenting cells to T cells

Inflammatory bowel disease (IBD) is a chronic inflammation which affects the gastrointestinal tract (GIT). One of the best ways to study the immunological mechanisms involved during the disease is the T cell transfer model of colitis. In this model, immunodeficient mice (RAG-/-recipients) are reconstituted with naive CD4+ T cells from healthy wild type hosts. This model allows examination of the earliest immunological events leading to disease and chronic inflammation, when the gut inflammation perpetuates but does not depend on a defined antigen. To study the potential role of antigen presenting cells (APCs) in the disease process, it is helpful to have an antigen-driven disease model, in which a defined commensal-derived antigen leads to colitis. An antigen driven-colitis model has hence been developed. In this model OT-II CD4+ T cells, that can recognize only specific epitopes in the OVA protein, are transferred into RAG-/- hosts challenged with CFP-OVA-expressing E. coli. This model allows the examination of interactions between APCs and T cells in the lamina propria.

Chronic inflammation inhibits GH secretion and alters the serum insulin-like growth factor system in rats

Adjuvant-induced arthritis in rats is associated with growth failure, hypermetabolism and accelerated protein breakdown. The aim of this work was to study the effects of adjuvant-induced arthritis on GH and insulin-like growth factor-I (IGF-I). Arthritis was induced by an intradermal injection of complete Freund's adjuvant and rats were killed 18 and 22 days later. IGF-I and GH levels were measured by radioimmunoassay. Pituitary GH mRNA was analyzed by northern blot and IGF binding proteins (IGFBPs) by western blot. Arthritic rats showed a decrease in both serum and hepatic concentrations of IGF-I. On the contrary, arthritis increased the circulating IGFBPs. The serum concentration of IGF-I in the arthritic rats was negatively correlated with the body weight loss observed in these animals. Arthritis decreased the serum concentration of GH and this decrease seems to be due to an inhibition of GH synthesis, since pituitary GH mRNA content was decreased in arthritic rats (p<0.01). These data suggest that the decrease in body weight gain in arthritic rats may be, at least in part, secondary to the decrease in GH and IGF-I secretion. Furthermore, the increased serum IGFBPs may also be involved in the disease process.

The role of chondrocyte senescence in the pathogenesis of canine osteoarthritis

The aims of this study were to (1) evaluate cellular senescence in chondrocytes from osteoarthritic articular cartilage, (2) investigate the hypothesis that oxidative stress is a feature of canine OA chondrocytes and that oxidative stress contributes to cellular senescence in canine chondrocytes, (3) investigate the hypothesis that osteoarthritic chondrocytes alter the gene expression of adjacent normal chondrocytes in OA joints leading to modulation of genes known to play a role in the pathogenesis of OA and (4) evaluate the presentation of dogs undergoing femoral head excision in veterinary referral practice in the UK as a treatment for osteoarthritis of the coxofemoral joint, and to categorise the distribution and severity of associated pathological lesions. Chondrocytes from osteoarthritic and normal cartilage were examined for levels of senescence. Initially chondrocytes were cultured using an alginate bead culture system, thought to mimic the extracellular matrix of articular cartilage. However, these chondrocytes showed almost no growth as compared to monolayer culture where they grew rapidly. OA chondrocytes entered the senescent state after 1.5 to 4.9 population doublings in monolayer culture, while normal chondrocytes underwent 4.8 to 14.6 population doublings before entering the senescent state. Osteoarthritic chondrocytes had increased levels of markers of cellular senescence (senescence associated beta-galactosidase accumulation and p16 protein accumulation) as compared to normal chondrocytes, suggesting that chondrocyte senescence is a feature of canine osteoarthritis. An experimental model for the induction of oxidative stress in chondrocyte cell culture was developed using tert-Butyl hydroperoxide and total cellular glutathione was measured as an indicator of cellular oxidative stress levels. Experimental induction of oxidative stress in both normal and osteoarthritic chondrocytes in cell culture resulted in increased amounts of cellular senescence, shown by an increase in levels of senescence associated beta-galactosidase accumulation and decreased replicative capacity. Experimental induction of oxidative stress also resulted in altered gene expression of three genes important to the degradation of the extracellular matrix; MMP-13, MMP-3 and Col-3A1, measured by RT-PCR, in normal canine chondrocytes in monolayer cell culture. MMP-3 showed the greatest relative expression change, with a fold-change of between 1.43 and 4.78. MMP-13 had a fold change of 1.16 to 1.38. Col-3A1 was down regulated, with a fold-change of between 0.21 and 0.31. These data demonstrate that experimentally induced oxidative stress in chondrocytes in monolayer culture increases levels of cellular senescence and alters the expression of genes relevant to the pathogenesis of canine OA. Coculture of osteoarthritic chondrocytes with normal canine chondrocytes resulted in gene modulation in the normal chondrocytes. Altered gene expression of ten genes known to play a role in the pathogenesis of osteoarthritis was detected in the normal chondrocytes (fold change shown in brackets); TNF-alpha (11.95), MMP-13 (5.93), MMP-3 (5.48), IL-4 (7.03), IL-6 (5.3), IL-8 (4.92), IL-F3 (4.22), COL-3A1 (4.12), ADAMTS-4 (3.78) and ADAMTS-5 (4.27). In total, 594 genes were significantly modulated suggesting that osteoarthritic chondrocytes contribute to the disease propagation by altering the gene expression of adjacent normal chondrocytes, thus recruiting them into the disease process. Gene expression changes were measured by microarray analysis and validated by RT-PCR and Western blot analysis. An epidemiological study of femoral heads collected from dogs undergoing total hip replacement surgery as a treatment for osteoarthritis of the coxofemoral joint secondary to canine hip dysplasia revealed that there was no characteristic pattern of cartilage lesion for canine hip dysplasia. Severe pathology of the femoral head with cartilage erosion occurred in 63.9% of cases and exposure of subchondral bone in 31.3% of cases. The work presented in this thesis has demonstrated that cellular senescence is a feature of chondrocytes from canine osteoarthritic cartilage and suggests that cellular senescence and oxidative stress play an important role in the pathogenesis of osteoarthritis in dogs.

Patterns in the space use of the Bearded Reedling, Panurus biarmicus, on the Tay Reedbeds, Scotland

This thesis presents research into the space use of a specialist reedbed Passerine, the Bearded Reedling, or Bearded Tit, Panurus biarmicus, with a view to inform the conservation of this species and reedbeds as a whole. How a species uses space, and how space use changes between individuals or over time, can influence: the ability to forage and hunt effectively, breeding success, susceptibility to predation, genetic health, disease spread, robustness against environmental change and ultimately, colonisation or extinction. Thus, understanding the space use of animals can provide critical insight into ecological systems. Birds offer interesting models when studying animal space use, as, by being intrinsically mobile, many bird species can occupy multiple spatial scales. As a consequence of being completely dependent on patchy and ephemeral reedbed habitats, the Bearded Reedling, has a clustered, inhomogeneous distribution throughout its range. This drives the existence of distinct spatial scales upon which space use studies should be characterised. Distribution and movement within a single reedbed can be considered local-scale, while spatial processes between reedbeds can be considered wide-scale. Temporal processes may act upon both of these scales. For example, changing interactions with predators may influence nest positioning at a local-scale, while seasonal changes in resource requirements might drive processes such as migration at a wide-scale. The Bearded Reedling has a wide temperate breeding range, extending over much of Eurasia. On the IUCN’s red list, it is listed as ‘of least concern’, with an estimated European population between 240,000-480,000 breeding pairs. Despite its relatively favourable conservation status, its dependence on reedbed habitats drives a fragmented distribution, with populations being concentrated in small, isolated, stands. Over the last century reedbed wetlands have suffered rapid declines caused by drainage schemes undertaken to improve land for development or agriculture. Additionally, many remaining reed stands are subject to extensive commercial management to produce thatch or biofuel. Conversely, in other areas, management is driven by conservation motives which recognise the present threats to reedbeds, and aim to encourage the diversity of species associated with these habitats. As the Bearded Reedling is fundamentally linked to the quality and structure of a reed stand, understanding the space use of this species will offer information for the direct conservation of this specialist species, and for the effects of reedbed management as a whole. This thesis first presents studies of space use at a local-scale. All local-scale research is conducted at the Tay Reedbeds in eastern Scotland. Mist netting and bird ringing data are used within capture recapture models, which include an explicit spatial component, to gain insight into the abundance of the Bearded Reedling on the Tay. This abundance estimation approach suggests the Tay reedbeds are a stronghold for this species on the British Isles, and that, as a high latitude site, the Tay may have importance for range expansion. A combination of transect surveys and radio-tracking data are then used to establish the local-scale space use of this species during the breeding and autumnal seasons. These data are related to changes in the structure of reed caused by local management in the form of mosaic winter reed cutting. Results suggest that birds exploit young and cut patches of reed as foraging resources when they are available, and that old, unmanaged reed is critical for nesting and winter foraging. Further local-scale studies concern the spatial patterns in the nesting habits of this species. Mosaic reed cutting creates clear edges in a reedbed. Artificial nests placed in the Tay Reedbeds demonstrate increased nest predation rates closer to the edges of cut patches. Additionally, high predation rates become reduced as the cut reed re-grows, suggesting that reed cutting may increase accessibility of the stand to predators. As Bearded Reedling nests are uncommon and difficult to locate, the timing, site selection and structure of a sample of real nests from the Tay is then detailed. These demonstrate an early, and relatively rigid breeding onset in this species, the importance of dense, compacted reeds as nesting sites and a degree of flexibility in nest structure. Conservation efforts will also benefit from studies into wide-scale spatial processes. These may be important when establishing how colonisation events occur and when predicting the effects of climatic change. The Bearded Reedling has been traditionally considered a resident species which only occasionally undertakes wide-scale, between-reedbed, movements. Indeed, the ecology of this species suggests strict year round local residency to reedbeds, with distinct seasonal changes in diet allowing occupation of these habitats year round. The European ringing recoveries of this species, since the 1970s are investigated to better characterise the wider movements of specialist resident. These suggest residency in southern populations, but higher instances of movement than expected in more northerly regions. In these regions wide-scale movement patterns resemble those of partial regular migratory species. An understanding of local and wide-scale spatial processes can offer a strong foundation on which to build conservation strategies. This thesis aims to use studies of space use to provide this foundation for the Bearded Reedling and offer further insight into the ecology of reedbed habitats as a whole. The thesis concludes by proposing an effective strategy for the conservation management of reedbeds that will especially benefit the Bearded Reedling.

Accidentes de trabajo e índice de masa corporal en vigilantes atendidos en una I.P.S. de salud ocupacional, Bogotá - Colombia, 2015

INTRODUCCIÓN: Todos los individuos dentro de una sociedad tienen derecho a disfrutar de una integridad física, mental y de sus bienes materiales, que en principio debe ser garantizada por el Estado, sin embargo, debido a la ineficacia y falta de alcance en la disponibilidad de hombres y mujeres para cuidar a cada persona y empresa, la Seguridad Privada ha surgido como actividad económica para garantizar éste servicio de manera individualizada. No obstante a ello, poco se sabe acerca de las características de las personas que desempeñan ésta labor, así como las demandas inherentes a ésta actividad económica; sin embargo, en poblaciones económicamente similares, se documenta a través de la literatura la aparente relación entre la condición física del individuo y la presentación de accidentes de trabajo. OBJETIVO: Establecer la relación entre los accidentes de trabajo y el índice de masa corporal (IMC) en vigilantes atendidos en una I.P.S. de Salud Ocupacional en la ciudad de Bogotá-Colombia, durante el año 2015. MATERIALES Y MÉTODOS: Se llevó a cabo un estudio de corte transversal, con datos secundarios de una base de datos de 76 registros, procedentes de las historias clínicas médico ocupacionales realizadas a una población de trabajadores del sector de la Vigilancia o Seguridad Privada, durante su atención en una Institución Prestadora de Salud (I.P.S.) de Salud Ocupacional. Se incluyeron variables sociodemográficas, ocupacionales, las relacionadas con los accidentes de trabajo y el índice de masa corporal. Se obtuvieron las frecuencias univariadas y para las variables de tipo cuantitativo, medidas de tendencia central y dispersión, además de buscar potenciales asociaciones estadísticas, para conocer las variables que se relacionan con el evento estudiado. RESULTADOS: En éste proyecto se destaca que de los trabajadores que desempeñan la actividad económica de Vigilancia y Seguridad Privada, se encuentran en el grupo de 20 a 39 años (56.5%) y pertenecen al género masculino (84.2%); dichos factores contribuyen a la ocurrencia de los accidentes de trabajo (OR de 1.7 y 2.0 respectivamente). Además el I.M.C. de sobrepeso (OR 1.8), la obesidad (OR 1.4); y en sí el cargo de Vigilante concurren a la accidentalidad laboral (OR de 1.1) y con ello al incremento de incapacidad laboral en un 85.5% de 0 a 60 días. CONCLUSIONES: Se deben establecer medidas encaminadas al emprendimiento de sistemas de vigilancia epidemiológica que mitiguen y minimicen el riesgo, con ello la presencia de eventos no deseados en el ámbito laboral para ésta población y la disminución del ausentismo laboral.

Healthcare Computer Reasoning Addressing Chronically Ill Societies Using IoT: Deep Learning AI to the Rescue of Home-Based Healthcare

The authors present a proposal to develop intelligent assisted living environments for home based healthcare. These environments unite the chronical patient clinical history sematic representation with the ability of monitoring the living conditions and events recurring to a fully managed Semantic Web of Things (SWoT). Several levels of acquired knowledge and the case based reasoning that is possible by knowledge representation of the health-disease history and acquisition of the scientific evidence will deliver, through various voice based natural interfaces, the adequate support systems for disease auto management but prominently by activating the less differentiated caregiver for any specific need. With these capabilities at hand, home based healthcare providing becomes a viable possibility reducing the institutionalization needs. The resulting integrated healthcare framework will provide significant savings while improving the generality of health and satisfaction indicators.

The Aging Process of the Heart: Obesity Is the Main Risk Factor for Left Atrial Enlargement During Aging The MONICA/KORA (Monitoring of Trends and Determinations in Cardiovascular Disease/Cooperative Research in the Region of Augsburg) Study

Objectives This prospective study evaluated the association of obesity and hypertension with left atrial (LA) volume over 10 years. Background Although left atrial enlargement (LAE) is an independent risk factor for atrial fibrillation, stroke, and death, little information is available about determinants of LA size in the general population. Methods Participants (1,212 men and women, age 25 to 74 years) originated from a sex-and age-stratified random sample of German residents of the Augsburg area (MONICA S3). Left atrial volume was determined by standardized echocardiography at baseline and again after 10 years. Left atrial volume was indexed to body height (iLA). Left atrial enlargement was defined as iLA >= 35.7 and >= 33.7 ml/m in men and women, respectively. Results At baseline, the prevalence of LAE was 9.8%. Both obesity and hypertension were independent predictors of LAE, obesity (odds ratio [OR]: 2.4; p < 0.001) being numerically stronger than hypertension (OR: 2.2; p < 0.001). Adjusted mean values for iLA were significantly lower in normal-weight hypertensive patients (25.4 ml/m) than in obese normotensive individuals (27.3 ml/m; p = 0.016). The highest iLA was found in the obese hypertensive subgroup (30.0 ml/m; p < 0.001 vs. all other groups). This group also presented with the highest increase in iLA (+6.0 ml/m) and the highest incidence (31.6%) of LAE upon follow-up. Conclusions In the general population, obesity appears to be the most important risk factor for LAE. Given the increasing prevalence of obesity, early interventions, especially in young obese individuals, are essential to prevent premature onset of cardiac remodeling at the atrial level. (J Am Coll Cardiol 2009; 54: 1982-9) (C) 2009 by the American College of Cardiology Foundation