Electrocardiographic findings and incident coronary heart disease among participants in the Atherosclerosis Risk in Communities (ARIC) study.

The associations of many electrocardiographic (ECG) abnormalities at rest with incident coronary heart disease (CHD) are not completely established, and whether individual ECG abnormalities convey similar risk across gender and race is uncertain. We studied the independent association of several ECG findings with incident CHD, testing for effect modification by gender and race, in a large, population-based, prospective cohort study. Findings from the baseline 12-lead electrocardiograms in 1987 to 1989 were classified according to the Minnesota Code in 12,987 black and white men and women, aged 45 to 64 years, who were initially free of CHD and the use of specific cardiac medications. The incidence of CHD was ascertained through 2000. After adjustment for multiple cardiovascular risk factors, the ECG findings that had the highest hazard rate ratios (HRRs) for incident CHD, when considered singly, were left ventricular hypertrophy with ST-T strain pattern in white men (HRR 6.50) and in black women (HRR 2.31) and, in the whole cohort, major (HRR 2.27) and minor (HRR 2.47) ST depression and major T-wave abnormalities (HRR 2.12). Statistically significant associations were also found in the whole cohort for minor Q waves and left ventricular hypertrophy by the Cornell definition, but not for a prolonged QTc interval, major ventricular conduction defects, or ST elevation. In conclusion, several 12-lead ECG findings were independently associated with incident CHD in middle-aged adults. With only a few exceptions, the associations were similar for blacks and whites.

The use of microarrays to study autoimmunity.

As with the development of any novel and potentially powerful technology, the prospect of revealing new information that may dramatically change our understanding of biological processes can generate much excitement. Such is true for the emerging genomic approaches that make possible high-density assays using microarray platforms. Indeed, it is difficult, if not impossible, to imagine any area of biology that could not be affected by the wide range of potential applications of microarray technology. Numerous examples, such as those from the field of oncology, provide striking evidence of the power of microarrays to bring about extraordinary advances in molecularly defining important disease phenotypes that were otherwise unrecognized using conventional approaches such as histology. However, only a few studies in autoimmunity are available to date. Very recent work in alopecia areata, multiple sclerosis, systemic lupus erythematosus, and Sjögren's syndrome illustrates the potential for gaining new insights into the pathophysiology of these complex autoimmune disorders on a global, molecular scale. These new insights are likely to significantly improve our understanding of disease processes, diagnosis, identification of new therapeutic targets, and identification of patients most likely to benefit from specific and tailored therapies.

Uma estratégia simples que aumenta os conhecimentos das mäes em aleitamento materno e melhora as taxas de amamentaçäo / A siple strategy increases mothers' knowledge of breastfeeding and improves the breastfeeding rates

Objetivo: Avaliar o conhecimento das mäes em aleitamento materno antes e após orientaçäo fornecida no período pós-parto e sua relaçäo com a prevalência de amamentaçäo. Métodos: Foi relaizado um ensaio-clínico com 405 mäes de crianças normais nascidas no Hospital de Clínicas de Porto Alegre entre julho e dezembro de 1994, cujo procedimento de intervençäo consistiu de um vídeo abordando tópicos básicos sobre aleitamento materno, de um folheto explicativo e da livre discussäo após o vídeo. As primeiras 208 mäes constituíram o Grupo Controle e as restantes 197, o Grupo Experimental. Todas as mäes responderam a um questionário de identificaçäo e a teste de conhecimento prévios sobre aleitamento materno na maternidade. As mäes dos dois grupos foram acompanhadas por intermédio de visitas domiciliares ao final do primeiro, do segundo, do quarto e do sexto mês ou até a interrupçäo da amamentaçäo, se fosse o caso. Ao final do primeiro mês, as mäes foram submetidas ao mesmo teste de conhecimento da mäe em aleitamento materno e a prevalência da amamentaçäo. Resultados: As mäes que receberam a intervençäo (Grupo Experimental) tiveram um escore significativamente maior no teste de conhecimentos em aleitamento materno ao final do primeiro mês quando comparadas com as mäes do Grupo Controle (17,0 versus 14,7). A intervençäo aumentou a chance das mäes em 1,7 vezes de obter em um escore acima da média. Por sua vez, as mäes cujos escores ficaram acima da média tiveram uma chance 8,2 vezes maior de estar amamentando exclusivamente no final do terceiro mês e duas vezes maior de estarem amamentando no final do sexto mês. Conclusäo: Estratégias simples para aumentar o conhecimento das mäes sobre aleitamento materno podem ter impacto positivo nas taxas de amamentaçäo.