Anthropometry and blood pressure changes in a caribbean adolescent population of african ancestry: an evaluation of longitudinal data using a multilevel mixed regression approach / Antropometría y cambios de presión sanguínea en una población adolescente caribeña de ascendencia africana: evaluación de datos longitudinales en un enfoque de regresión multinivel mixto

OBJECTIVE: The aim of this study was to determine the effect of growth pattern on blood pressure changes in an adolescent population of African ancestry based on longitudinal data and to compare this with estimates derived from cross-sectional data. METHODS: Participants had measurements of weight, height, blood pressure and percentage body fat taken annually using standardized procedures. Annual blood pressure and anthropometry velocities as well as one- and three-year interval gender specific tracking coefficients were computed. We investigated whether changes in blood pressure could be explained by measures of growth using a multilevel mixed regression approach. RESULTS: The results showed that systolic blood pressure (SBP) increased by 1.27 and 3.09 mmHg per year among females and males, respectively. Similarly, diastolic blood pressure (DBP) increased by 1.16 and 1.92 mmHg per year among females and males, respectively. Multilevel analyses suggested that weight, body mass index, percentage body fat and height were the strongest anthropometric determinants of blood pressure change in this population. The results also suggest that there are gender differences in the relative importance of these anthropometric measures with height playing a minor role in predicting blood pressure changes among adolescent females. With the exception of DBP at 18 years among females, there were no significant differences between mean blood pressure generated from cross-sectional and longitudinal data by age in both males and females. CONCLUSION: Anthropometric measures are important covariates of age-related blood pressure changes and cross-sectional data may provide a more cost-effective and useful proxy for generating age-related blood pressure estimates in this population.

OBJETIVO: El objetivo de este estudio fue determinar el efecto del patrón de crecimiento sobre los cambios de presión sanguínea en una población juvenil de ascendencia africana sobre la base de datos longitudinales, y comparar esto con los estimados derivados de los datos transversales. MÉTODOS: A los participantes se les hicieron mediciones de peso, altura, presión sanguínea, y porcentaje de grasa corporal, las cuales fueron realizadas anualmente mediante procedimientos estandarizados. Se computarizaron la presión sanguínea anual y las velocidades de la antropometría así como los coeficientes de rastreo específicos de género en intervalos de uno y tres años. Se investigó si los cambios de presión sanguínea podrían explicarse por las medidas de crecimiento, usando un enfoque de regresión multinivel mixto. RESULTADOS: Los resultados mostraron que la presión sanguínea sistólica (PSS) aumentaba en 1.27 y 3.09 mmHg por año entre las hembras y los varones respectivamente. De modo similar, la presión sanguínea diastólica (PSD) aumentaba en 1.16 y 1.92 mmHg por año entre las hembras y varones respectivamente. Los análisis multiniveles sugirieron que el peso, el índice de masa corporal, el porcentaje de grasa corporal y la altura, fueron los determinantes antropométricos más fuertes del cambio de presión sanguínea en esta población. Los resultados también sugieren que hay diferencias de género en la importancia relativa de estas mediciones antropométricas, siendo el caso que la altura juega un papel menor a la hora de predecir los cambios de presión sanguínea entre las adolescentes. Con excepción de la PSD a los 18 años entre las hembras, no hubo ninguna diferencia significativa entre la presión sanguínea promedio obtenida a partir de los datos transversales y longitudinales por edad, tanto en los varones como en las hembras. CONCLUSIÓN: Las medidas antropométricas son covariantes importantes de los cambios de presión sanguínea relacionadas con la edad. Los datos transversales pueden ofrecer un recurso útil y costo-efectivo para producir estimados de la presión sanguínea relacionada con la edad en esta población.

Anthropometry and blood pressure changes in a Caribbean adolescent population of African ancestry: an evaluation of longitudinal data using a multilevel mixed regression approach.

OBJECTIVE: The aim of this study was to determine the effect of growth pattern on blood pressure changes in an adolescent population of African ancestry based on longitudinal data and to compare this with estimates derived from cross-sectional data. METHODS: Participants had measurements of weight, height, blood pressure and percentage body fat taken annually using standardized procedures. Annual blood pressure and anthropometry velocities as well as one- and three-year interval gender specific tracking coefficients were computed. We investigated whether changes in blood pressure could be explained by measures of growth using a multilevel mixed regression approach. RESULTS: The results showed that systolic blood pressure (SBP) increased by 1.27 and 3.09 mmHg per year among females and males, respectively. Similarly, diastolic blood pressure (DBP) increased by 1.16 and 1.92 mmHg per year among females and males, respectively. Multilevel analyses suggested that weight, body mass index, percentage body fat and height were the strongest anthropometric determinants of blood pressure change in this population. The results also suggest that there are gender differences in the relative importance of these anthropometric measures with height playing a minor role in predicting blood pressure changes among adolescent females. With the exception of DBP at 18 years among females, there were no significant differences between mean blood pressure generated from cross-sectional and longitudinal data by age in both males and females. CONCLUSION: Anthropometric measures are important covariates of age-related blood pressure changes and cross-sectional data may provide a more cost-effective and useful proxy for generating age-related blood pressure estimates in this population.

Current awareness of delirium in the intensive care unit: a postal survey in the Netherlands.

BACKGROUND: Delirium in the ICU can compromise the recovery process, prolong ICU and hospital stay and increase mortality. Therefore, recognition of delirium is of utmost importance. METHODS: To ascertain current attitude pertaining to delirium in critically ill patients a simple questionnaire was sent to all intensive care units (ICUs) throughout the Netherlands. RESULTS: Seventy-five questionnaires were sent and 44 returned. A delirium protocol was present in the majority of cases (n=35, 80%), although implementation had occurred in only 22 ICUs (50%). The reported general incidence of delirium varied widely (25% of ventilated patients (n=33, 75%) and in patients older than 70 (n=38, 86%). Most participating centres reported that they could certainly (n=9, 20%) or most certainly (n=22, 50%) identify delirium. A geriatrician or a psychiatrist predominantly diagnosed delirium (n=30, 68%), while a diagnostic instrument such as the CAM -ICU was used in a minority of cases (n=11, 25%). A geriatrician or a psychiatrist was consulted when patients were agitated (n=40, 90%), or when routine pharmacological treatment had failed (n=40, 91%). CONCLUSION: In the Netherlands, delirium is considered an important problem in the ICU, although its incidence is estimated to be low by the ICU team. The diagnosis of delirium is most frequently established by a geriatrician or psychiatrist after consultation, while diagnostic instruments are infrequently used. Efforts should be undertaken to implement delirium protocols and a routinely applied diagnostic instrument in the ICU.

BMI-based obesity cutoffs and excess adiposity in a Caribbean adolescent population of African origin.

OBJECTIVE: To evaluate the diagnostic utility of recommended body mass index (BMI)-based classification systems in detecting excess body fat (BF) in an Afro-Caribbean adolescent population. SUBJECTS: All adolescents aged 12-18 years were invited to participate in the study. A total of 3749 persons participated fully in the study. RESULT: Males (12.2%) (95% confidence interval (CI): 10.7, 13.9) and females (43.6%) (95% CI: 41.5, 45.7) had excess adiposity. Specificities were high for all cutoff values (range 90.1-99.7%). Sensitivities ranged from 25.7 to 86.4% and from 15.6 to 54.4% for Centre for Disease Control (CDC) and International Obesity Task Force (IOTF) cutoff values, respectively. The mean areas under the receiver-operating characteristic curves ranged from 62.7 to 88.2% in males and 57.7 to 75.1% in females, while positive likelihood ratios ranged from 8.7 to 90.9 for the recommended BMI cutoff values. CONCLUSIONS: Overall, the CDC cutoffs had a higher sensitivity than the IOTF cutoffs in screening for excess fat. Specificities were high for cutoff values in both systems and would produce fewer false negatives.

Blood pressure and its correlates in Tobagonian adolescents / La presión sanguínea y sus correlatos en los adolescentes de Tobago

OBJECTIVE: To determine age-specific patterns and correlates of blood pressure (BP) in Tobagonian adolescents. METHODS: Blood pressure, weight and heights were measured using standardized procedures. Age-height and gender-specific BP levels were established and compared with those established for adolescents in the United States of America, the United Kingdom and Jamaica. RESULTS: Of the available population, 3749 or 84.9% participated in the study. Among Tobagonian adolescents, the mean one-year age increment in systolic blood pressure (SBP) was 3.6 (95% CI: 3.2, 3.9) mmHg in males and 1.5 (95% CI: 1.2, 1.8) mmHg in females. Likewise, the mean one-year increment in diastolic blood pressure (DBP) was 2.1 (95% CI: 1.7, 2.4) mmHg in males and 1.2 (95% CI: 0.9, 1.4) mmHg in females. There was an inversion of mean BP with age. Females 12-13 years having significantly higher mean SBP while those 15-18 years had lower SBP than their male counterparts. Similarly, females 12-14 years had significantly higher mean DBP while those 16-18 years had lower DBP than their male counterparts. Approximately, 6.1% (95% CI: 5.4, 7.0) and 8.2% (95% CI: 7.4, 9.1) of participants had elevated SBP and DBP based on the US reference standards. Adolescents from the UK had average SBP and DBP that were 10 mmHg higher and lower respectively than their Tobagonian counterparts while Jamaican adolescents had diastolic BP consistently lower than Tobagonian adolescents of similar age. Elevated BP was associated with overweight and family history of hypertension. CONCLUSION: Growth and maturational factors are important determinants of blood pressure levels in this population. Furthermore, the wide variation in these key variables among possible BP referent populations necessitates the development of local blood pressure reference standards for Tobagonian adolescent populations.

Blood pressure and its correlates in Tobagonian adolescents.

OBJECTIVE: To determine age-specific patterns and correlates of blood pressure (BP) in Tobagonian adolescents. METHODS: Blood pressure, weight and heights were measured using standardized procedures. Age-height and gender-specific BP levels were established and compared with those established for adolescents in the United States of America, the United Kingdom and Jamaica. RESULTS: Of the available population, 3749 or 84.9% participated in the study. Among Tobagonian adolescents, the mean one-year age increment in systolic blood pressure (SBP) was 3.6 (95% CI: 3.2, 3.9) mmHg in males and 1.5 (95% CI: 1.2, 1.8) mmHg in females. Likewise, the mean one-year increment in diastolic blood pressure (DBP) was 2.1 (95% CI: 1.7, 2.4) mmHg in males and 1.2 (95% CI: 0.9, 1.4) mmHg in females. There was an inversion of mean BP with age. Females 12-13 years having significantly higher mean SBP while those 15-18 years had lower SBP than their male counterparts. Similarly, females 12-14 years had significantly higher mean DBP while those 16-18 years had lower DBP than their male counterparts. Approximately, 6.1% (95% CI: 5.4, 7.0) and 8.2% (95% CI: 7.4, 9.1) of participants had elevated SBP and DBP based on the US reference standards. Adolescents from the UK had average SBP and DBP that were 10 mmHg higher and lower respectively than their Tobagonian counterparts while Jamaican adolescents had diastolic BP consistently lower than Tobagonian adolescents of similar age. Elevated BP was associated with overweight and family history of hypertension. CONCLUSION: Growth and maturational factors are important determinants of blood pressure levels in this population. Furthermore, the wide variation in these key variables among possible BP referent populations necessitates the development of local blood pressure reference standards for Tobagonian adolescent populations.