Pre-awakening diastolic hypotension in treated hypertensive patients: prevalence and predictors.

In the pre-awakening hours, diastolic blood pressure (DBP) is normally at its lowest, and diastolic hypotension is a risk factor for cardiac ischemia. We investigated pre-awakening DBP values and its predictors in treated hypertensive patients who underwent ambulatory blood pressure monitoring. The pre-awakening period was defined as the 3-h period ending 1 h before awakening (most frequently 03:00-06:00). In 269 included subjects, office DBP was 86.4±12.0 mm Hg, 24-h DBP was 78.6±9.6 mm Hg, mean pre-awakening DBP was 70.3±10.9 mm Hg, and trough pre-awakening DBP was 62.5±11.2 mm Hg. Half of the patients (51%) had a mean pre-awakening DBP <70 mm Hg, and 14% had <60 mm Hg. Trough pre-awakening DBP <60 mm Hg was seen in 36% and <50 mm Hg in 12% of patients. Office DBP was the most important predictor of mean and trough pre-awakening DBP (both beta=0.4; P<0.001), and of pre-awakening DBP <70 mm Hg and <60 mm Hg (both P⩽0.001). Diabetes mellitus was associated with a lower trough pre-awakening DBP (beta=-3.2; P=0.02). Among variables that failed to independently predict low pre-awakening DBP were age, a history of vascular disease, and classes and number of antihypertensive drugs. We found that many hypertensive patients have low DBP in the pre-awakening period. Office DBP is the main predictor of low pre-awakening DBP. Further studies are needed to define the prognostic relevance and potential risks of low pre-awakening DBP.

Improvement of neonatal care in Zhejiang Province, China through a self-instructional continuing education programme.

Major upheavals have taken place in medical education in the last three decades in China. This has meant that at every level there are personnel with a wide range of training backgrounds. Continuing education programmes to ameliorate the situation have been seen as a priority of the Ministry of Public Health (MOPH). However, many of the training courses offered are too academic in approach and do little to raise standards of clinical care. The shortcomings in neonatal education are particularly acute and this is reflected in the relatively high neonatal mortality rate. At the request of Zhejiang Provincial Bureau of Public Health (BOPH), Project HOPE, an American non-governmental organization (NGO), collaborated with Zhejiang Medical University (ZMU) on the development of a neonatal outreach programme. The programme was self-instructional in approach with individual hospitals having autonomy in the mode of implementation of the programme. There were 225 participants in four county level hospitals. Cognitive knowledge test scores improved by an average of 56%. Observation of clinical practices showed that 54% improved following the programme, with 34% meeting the criteria set by the modules. An inventory of facilities showed that of a list of essential items an average of 38% were present before the programme compared with 76% after completion of the programme. As a result of the success of the programme it is being expanded into a comprehensive teaching and evaluation package for use throughout Zhejiang Province and Eastern China.

Pilot survey of oral mucosa in areca (betel) nut chewers on Hainan Island of the People's Republic of China.

100 people on Hainan Island were studied for their smoking and chewing habits and the condition of their oral mucosa. Ninety-five percent of the study population chewed areca (betel) nut. In men this habit was supplemented with either smoking cigarettes or water pipe. In two men a small commissural leukoplakia was found. In three women clinical and histologic changes pointed towards oral submucous fibrosis.