Abstract-A workshop was held September 27 through 29, 1999, to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made. Key Words: cardiovascular diseases Ⅲ epidemiology Ⅲ prevention T he 20th century witnessed dynamic, worldwide changes in cardiovascular disease (CVD) mortality, including death from coronary heart disease (CHD), stroke, and other CVDs. Many Western countries documented a rise in mortality from CVD until the 1960s and 1970s, with substantial declines since those peaks. Other parts of the world have shown different patterns, including high rates of CVD mortality in Eastern Europe that continue to rise and an ominous epidemic of CHD and stroke emerging in developing countries. 1 In the United States, recent evidence has suggested that the decline in CHD mortality since the late 1960s has slowed. This may be especially true in specific subgroups (defined by socioeconomic status, race or ethnicity, and region), whose declines have lagged. This has led to relatively higher CVD rates, which constitute a major challenge to reaching the Healthy People 2010 Objectives set for the American people. 2 The causes of these disparities in CVD burden are primarily environmental and likely include differences in CVD risk factors, lifestyle, and the availability and use of primary and secondary preventive services.The National Conference on CVD Prevention was a transagency conference convened at the encouragement of the US Congress 3 from September 27 through 29, 1999, in Bethesda, Maryland to as...
A method is presented that determines optimum bids in a competitive-bidding situation where each competitor submits one closed bid. The number of bidders may be large or may be unknown. This method makes use of the previous “bidding patterns” of all possible opposition bidders and in the case where the bidding is on contracts, the estimated probability distribution of the cost of fulfilling the contract. The case where a number of bids are to be submitted simultaneously is also discussed.
Ultrasound is emerging as a viable imaging modality in the diagnosis and assessment of the musculoskeletal system. Advantages of ultrasound include its easy availability and multiplanar capability, as well as economic advantages. Unlike magnetic resonance imaging, ultrasound demonstrates the fibrillar microanatomy of tendons, ligaments and muscles, enhancing its diagnostic capability. The ability to compress. dynamically assess structures and compare easily with the contralateral side is advantageous. The patient's exact point of clinical tenderness can be correlated with underlying anatomical structures and associated pathology. The main strength of knee ultrasound is the assessment of para-articular disease. The specific structures best suited for ultrasound assessment include tendons, muscles and ligaments, as well as periarticular soft tissue masses. Joint effusions, synovial thickening, bursal fluid collections, intra-articular loose bodies, ganglion cysts, ligament and tendons tears, tendonitis and occult fractures can be diagnosed. With experience, ultrasound is a time-efficient, economical imaging tool for assessment of the knee.
CHANGES IN THE GINGIVAL TISSUES during pregnancy have been termed "pregnancy gingivitis." During this period, the gingiva may appear hyperemic and enlarged and bleeding may be frequent during brushing or on external manipulation. Histopathologic evidence suggests that the microscopic changes observed in the gingiva during pregnancy do not differ from the microscopic changes observed in gingivitis in nonpregnant females. It is suggested that an accentuated inflammatory response to local irritants during pregnancy is the basic cause for the altered appearance of the gingival structures. Löe et al, in a cross-sectional study, examined 121 pregnant and 61 postpartum women. He reported that 100 percent of the women examined during pregnancy and postpartum demonstrated gingival changes which at the clinical level can be adequately described as inflammation of the gingiva (gingivitis), and that the severity of these changes were significantly higher in pregnant than in postpartum patients. The purpose of this investigation was to apply longitudinal epidemiologic techniques to:1. Measure the prevalence of periodontal disease during pregnancy and postpartum. Document the gingival and periodontal changesduring pregnancy and postpartum. 3. Determine what influence, if any, the gingival changes have on the underlying periodontium during pregnancy. 4. Document the presence of hard and soft irritants in the mouth during pregnancy and postpartum. 5. Determine what role local irritants play in the etiology of periodontal disease during pregnancy and postpartum.
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