Comparison of relative coronary Doppler flow velocity reserve to stress myocardial perfusion imaging in patients with coronary artery disease

To compare relative coronary artery vasodilator reserve (rCVR = CVRtarget/CVRreference) to myocardial perfusion stress imaging, 48 patients with coronary artery stenoses (61% +/- 16%; mean, +/- SD; range, 30%-91%) had measurements of target and reference vessel CVR (Doppler-tipped guidewire). rCVR was computed and compared to stress 201thallium or (99m)technetium-sestamibi myocardial tomography. Compared to 24 patients with negative stress imaging studies, 24 patients with positive stress studies had angiographically more severe stenoses (74% +/- 13% vs. 44% +/- 24%; P = 0.0005) with lower CVR(target) (1.68 +/- 0.55 vs. 2.46 +/- 0.74; P = 0.002) and lower rCVR (0.72 +/- 0.22 vs. 1.0 +/- 0.26; P < 0.003). Based on receiver-operator characteristic (ROC) cut points (CVR > 1.9; rCVR > 0.75), compared to CVR, rCVR had similar agreement (Kappa 0.54 vs. 0.50), sensitivity (63% vs. 71%), specificity (88% vs. 83%), and positive predictive value (83% vs. 81%) with myocardial perfusion tomography. A concordant CVRtarget/rCVR only slightly increased sensitivity, specificity, and positive predictive values (77%, 90%, and 87%, respectively). Although rCVR, like CVR, correlates with stress myocardial perfusion imaging results, rCVR did not have significant incremental prognostic value over CVR alone for myocardial perfusion imaging. However, rCVR does provide additional information regarding the status of the microcirculation in patients with coronary artery disease and complements the CVR for lesion assessment.

Latin American population prospects in the next fifteen years

Abstract This paper discusses some of the results of population projections by age and sex for the period 1965-85 which were prepared some years ago for Latin American countries. Despite the limitation of the data there are several short-range implications which deserve attention. The area which had the highest rate of growth among all the major areas of the world during the last 50 years, is expected to maintain a stable rate during the next 15 years. Though some fertility decline is anticipated, it is bound to be slower, in general, than expected in East and South Asia where cultural factors are not as strong. The gain in mortality is also expected to be relatively slow, but this is only because mortality has already reached fairly low levels compared to Asia and Africa. However, because of the young age distribution, the area is expected to have in the near future crude death rates which are so low that they have probably not been experienced before in normal human populations. A simple grouping of the population into pertinent age-sex groups gives information which undoubtedly raises serious questions concerning the adequacy of the measures which are now being taken or planned to meet the various needs of different population categories. For instance, in addition to existing problems, the economies will have to face the problem of absorbing within the next 15 years the anticipated increases of about 84 million in the labour force, the educational systems will have to provide for the schooling of about 28 million additional children of school age, and the planners for social and economic development will have to consider the measures necessary to face an increase of about 56% in the number of females of reproductive ages. The figures show clearly that the problems have different dimensions in different regions, with those of Central America being perhaps particularly serious.

A study of differential fertility in bombay

This study is based on special tabulations of the "order of pregnancy," as reported on the birth certificate, according to mother's age, locality, and religion and father's state of birth and duration of stay in Bombay, India. The sample consists of 50 percent of the births registered in 1960 in Bombay (where birth registration has a fairly high degree of completeness).Despite the limitations of statistical information on the complex of factors influencing fertility, it wasfound that three indicators derived from the 1961 census could numerically account for 51 percent of the total variance of the parity averages in the sections of Bombay. Overcrowding (which is an indicator of the level of living) had the strongest influence and accounted alone for 44 percent of the variance. Knowledge of thereligious patternraised thepercentage to49, whileinclusionof theilliteracy measure added only another two to this percentage.An assessment of fertility differences by religious groups, as well as by place of origin of the father, is then carried out. The data show significant differences among religious groups, with Moslems and Buddhists having the highest parity averages, followed by Hindus and Jains. A considerably lower level is shown by Christians, but the lowest parity level is that of the small Parsi community. Mothers whose husbands were born in the south and east were found to show the lowest parity level, while those who have north-born husbands showed the highest level.Finally, the data show consistent increase in age-standardized parity averages with increase of the duration of stay in Bombay. This pattern is observed for each of the three main geographic regions of origin. While this increase is difficult to explain on the basis of the available data, the fact that the pattern of parity differences among regions persists from one duration group to the next lends support to the conclusion that little assimilation seems to have been taking place.