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PubMed2004

Baseline data and design for a randomized intervention study of dietary change in religious organizations.

BACKGROUND: Reducing dietary fat has been identified as a potential means of preventing chronic disease. Several studies have identified methods of changing dietary fat consumption in small, intensive intervention settings. Fewer studies have examined how to improve dietary habits of individuals in the general public. METHODS: The Eating for a Healthy Life (EHL) project was a randomized trial [n = 40 religious organizations (ROs) and 2175 individuals, 1099 in intervention]. The study tested an intervention package of self-help books, motivational messages, and social interactions designed to change dietary behaviors (lowering fat, increasing fruit and vegetable consumption) among members of religious organizations aged 18 and over. The primary outcomes are fat- and fruit- or vegetable-related behaviors measured using the Fat and Fiber Behavior (FFB) Questionnaire. RESULTS: Religious organizations and their members participated fully in the initial study activities. CONCLUSIONS: This study will support a rigorous test of the intervention package.

Adolescent↗

PubMedDate not supplied

Mass transfer kinetics in the chromatography of insulin variants under nonlinear conditions.

Experimental data regarding the thermodynamics and kinetics of adsorption of lispro, an insulin variant, onto a YMC ODS-A column, from an aqueous solution of acetonitrile (31%) and TFA are reinterpreted, using a more complex model of the mass transfer kinetics. The adsorption behavior follows the Toth isotherm model, suggesting either a strongly heterogeneous surface or, rather, that when insulin molecules adsorb they contact the surface along different areas of the molecule. The lumped pore diffusion (POR) model of chromatography accounts well for the band profiles. The internal mass transfer resistances are higher than expected, which suggests that intraparticle diffusion is slower. Furthermore, the pore diffusion coefficient increases with decreasing sample size. That surface diffusion accounts for the mass transfer kinetics inside particles explains these results. Assuming that the gradient of the surface concentration is the driving force of surface diffusion, it is possible to account very well for the band profiles of samples of widely different sizes, using a single value of the surface diffusivity.

Acetonitriles↗

PubMed2004

Factors associated with women's and children's body mass indices by income status.

OBJECTIVE: To describe associations between eating behaviors, dietary intake, physical activity, attitudes toward diet and health, sociodemographic variables and body mass index (BMI) among women and children, and differences by household income. DESIGN: Data from the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) and the Diet and Health Knowledge Survey (DHKS) were examined using multivariate regression to estimate the associations between BMI and behavioral and environmental variables among women and children. SUBJECTS: CSFII 1994-1996 is representative of the US population. DHKS surveyed CSFII respondents 20 y of age and over. Our samples consisted of 2419 adult women and 1651 school-age children. MEASUREMENTS: CSFII respondents reported 24 h recalls of all food intakes on 2 nonconsecutive days and their personal and household characteristics, including self-reported height and weight. DHKS collected data on knowledge and attitudes toward dietary guidance and health from CSFII adult respondents. RESULTS: Significant correlations between women's BMI and age, race, dietary patterns, TV watching, and smoking was observed among women from both low- and high-income households. Beverage consumption, eating out, the importance of maintaining healthy weight, and exercise were correlated with BMI only among women from high-income households. Among children, age, race, income, and mother's BMI were significantly correlated with child BMI. CONCLUSIONS: Among women, the associations between some behavioral and environmental factors and BMI differ by household income. Intervention programs need to target specific eating and physical activity behaviors to promote a healthy body weight.

Adult↗

PubMed2002

Older adults' contact with health practitioners: is there an association with smoking practices?

BACKGROUND: Approximately 12% of the North American population aged 65 and older smoke cigarettes daily. Late-life smokers represent an important population for intervention by health practitioners. The objective of this study was to determine the extent to which contact with health practitioners (dentists or physicians) affects smoking status among older adults. METHODS: We used data on a probability-based sample of community-dwelling elderly respondents (N = 13,363) from the Canadian 1996-1997 National Population Health Survey. Descriptive statistics were calculated, and multivariate logistic regression analysis was performed to examine the associations between current tobacco use and contact with health care practitioners controlling for potential confounders, especially sociodemographic characteristics, selected health conditions, self-reported health, body mass index, functional status, perceived social support, and psychological distress. RESULTS: Older adults without a regular physician (adjusted odds ratio [AOR], 1.33; 95% confidence interval [CI], 1.11-1.59), with infrequent physical (AOR, 1.22; 95% CI, 1.07-1.40), and dental (AOR, 2.68; 95% CI, 2.07-3.47) checkups were more likely to be current smokers. Age (younger), church attendance (infrequent), drinking behavior (former or occasional), body mass index (normal weight), and psychological distress were all independently related to current smoking. CONCLUSIONS: Results indicate that patients' contact with health care providers is strongly negatively associated with smoking. More specific data are needed to learn the frequency with which physicians and dental professionals attempt to modify older individuals' smoking behavior and the degree to which such efforts are effective.

Age Distribution↗

PubMed2004

Effects of aversive stimuli on learning and memory in Arctic ground squirrels.

The present study was designed to assess effects of aversive stimuli on learning and memory in wild-caught Arctic ground squirrels (AGS, Spermophilus parryii) using an active avoidance learning paradigm. Results indicate that animals trained with low-value aversive stimuli (air puffs and lights) retained the task better than animals trained with high-value aversive stimuli (air puffs, lights, and foot shock). Poor retention could not be explained by learning impairment, fear-induced freezing behavior or the effects of massed versus spaced training trials. Wild-caught AGS readily hibernate under laboratory conditions and provide a model of pronounced adult synaptic plasticity associated with emergence from hibernation. Characterization of learning and retention using active avoidance as well as other learning paradigms is a first step towards developing behavioral paradigms to assess cognitive function in this wild-trapped species. The present study shows that captive AGS are sensitive to aversive stimuli, argues for a direct effect on retention and suggests that high baseline levels of stress in a captive population may influence behavioral measures. The results further suggest that future studies of the effects of hibernation on learning and retention of active avoidance tasks employ low-level aversive stimuli.

Animals↗

PubMed2003

[Relative validity of self-assessment of silhouette and BMI (body mass index)].

Overweight and obesity in childhood and adolescence is unquestionable risk factor for pathogenic obesity in adulthood, high mortality and morbidity for cardiovascular diseases and other health disorders, and also may cause the worse social and economical adaptation. Nevertheless, little is yet known about subjective perception of own body, the pathway leading to dissatisfaction of the body, development of chronic stress and behavioural disorders (anorexia, binge eating, bulimia) as a consequence. In Health Promotion Department of the National Institute of Hygiene the multidimensional investigations of adolescents' health and life style were undertaken, and analysis of association between subjective image of body and real body mass was a part of these investigations. Data were obtained from 672 randomly selected schoolchildren aged 14-15 years attending seventeen public and private schools in Warsaw. Respondents informed about their weight and high for calculation BMI. Simultaneously, they were asked, whether they assess themselves as leaner than their peers, the same or thicker. The study showed that girls in comparison with boys more accurately assessed their silhouette. The boys were more likely than girls to perceive themselves as the same as their peers, despite they had real underweight or overweight. Our findings suggest that real mass of body itself account for variance of subjective perceived body in moderate degree, and there are other factors influencing body image at least as real mass of body.

Adolescent↗

PubMed2002

Proteomics of light-harvesting proteins in different plant species. Analysis and comparison by liquid chromatography-electrospray ionization mass spectrometry. Photosystem I.

The light-harvesting proteins (Lhca) of photosystem I (PSI) from four monocot and five dicot species were extracted from plant material, separated by reversed-phase high-performance liquid chromatography (HPLC) and subsequently identified on the basis of their intact molecular masses upon on-line hyphenation with electrospray ionization mass spectrometry. Although their migration behavior in gel electrophoresis was very similar, the elution times among the four antenna types in reversed-phase-HPLC differed significantly, even more than those observed for the light-harvesting proteins of photosystem II. Identification of proteins is based on the good agreement between the measured intact molecular masses and the values calculated on the basis of their nucleotide-derived amino acid sequences, which makes the intact molecular masses applicable as intact mass tags. These values match excellently for Arabidopsis, most probably because of the availability of high-quality DNA sequence data. In all species examined, the four antennae eluted in the same order, namely Lhca1 > Lhca3 > Lhca4 > Lhca2. These characteristic patterns enabled an unequivocal assignment of the proteins in preparations from different species. Interestingly, in all species examined, Lhca1 and Lhca2 were present in two or three isoforms. A fifth antenna protein, corresponding to the Lhca6 gene, was found in tomato (Lycopersicon esculentum). However PSI showed a lower heterogeneity than photosystem II. In most plant species, Lhca2 and Lhca4 proteins are the most abundant PSI antenna proteins. The HPLC method used in this study was found to be highly reproducible, and the chromatograms may serve as a highly confident fingerprint for comparison within a single and among different species for future studies of the PSI antenna.

Arabidopsis↗

PubMed1993

Intramyocardial fluid transport effects on coronary flow and left ventricular mechanics.

An integrated left ventricular (LV) model is used to solve, simultaneously and interactively, the LV mechanics, the coronary blood flow and capillary and interstitial fluid and mass transport, and to analyze the LV behavior under normal as well as pathological conditions. Accounting for the interstitial fluid mass balance in a LV flow-mechanical model allows to determine the LV wall volume in terms of the prevailing mechanical and flow conditions; it allows to uniquely define the flow-mechanical relationship and study pathologies, such as myocardial edema, which are directly related to changes in the myocardial fluid transport and content.

Biological Transport↗

PubMed2005

Echocardiographic and hemodynamic characteristics of reconstructed bicuspid aortic valves at rest and exercise.

Repair of diseased bicuspid aortic valves has gained increasing interest as an alternative to conventional valve replacement. Hemodynamic data at exercise have not been reported before. The aim of this study was to investigate the clinical and echocardiographic status of patients after bicuspid aortic valve repair at rest and exercise. Between 03/94 and 09/02 a reconstruction of an incompetent bicuspid aortic valve was performed in 25 patients (mean age 35+/-12.1 years, group A, mean insufficiency 2.8 preoperatively). Patients were investigated clinically and echocardiographically after 2.1+/-2.4 (0.1-8.9) years at rest and exercise and compared to 20 controls (group B). Clinical followup was complete. There were no deaths, reoperations, thromboembolic or bleeding complications. At last examination 21 patients were in NYHA class I, n=4 in NYHA class II and mean aortic valve insufficiency (AI) was 1.0 with one patient having an AI>II degrees. Maximum and mean pressure gradient (dPmax/mean) across the aortic valve at rest were 14+/-5.5/7+/-2.6 mmHg for patients of group A and 7+/-2.5/3.6+/-1.1 mmHg in group B. Mean AVA at rest was 2.6+/-0.8 (group A) vs 2.9+/-0.6 cm(2) (group B, p=0.025), valvular resistance 13.4+/-4.8 (group A) vs 13.6+/-2.9 dyn x s x cm(-5) (group B, p>0.05). All individuals were stressed up to 100 W (dPmax/mean 21+/-6.8/11+/-3.6, group A vs 11+/-2.9/6+/-1.3 mmHg, group B). 56% of group A and 85% of group B could be stressed up to 175 W with dPmax/mean 24.5+/-8.3/12+/-4.2 and 16+/-3.6/8+/-1.4 mmHg, respectively (p<0. 01). Heart rate and blood pressure behavior were comparable. Left ventricular mass regression (preoperatively 369.3+/-76.4 vs 277.3+/-80.7 g at last examination, p<0.01) was significant in group A but did not reach normal values (group B, 227.8+/-71.1; p<0.01). Bicuspid aortic valve reconstruction reduces left ventricular volume load significantly. Although residual mild subclinical obstruction and incompetence were observed, the behavior of hemodynamics at exercise was comparable to controls. The clinical relevance of these findings in long term follow-up has to be evaluated.

Adolescent↗

PubMed1999

The biopsychosocial characteristics of people seeking treatment for obesity.

BACKGROUND: To determine prospectively the characteristics of obese patients allowed to select either a medically supervised weight-reduction treatment program or a surgical treatment program, both offered at the same location. METHODS: This was a cohort study at a university medical center where patients, who self-referred themselves for weight loss treatments, were introduced to two different programs before they were allowed to start either program. Four hundred forty-three patients with a mean body mass index (BMI) of 45.6 +/- 0.5 (85 men, 358 women) self-selected either a combined supplemented fast with behavior modification (DIET, n = 208) or gastric bypass surgery (SURG, n = 235). Three hundred forty of these patients had private insurance (PI,) and 103 were receiving Medicaid/Medicare (publicly funded, PF). Each patient completed a semistructured psychiatric interview, obesity questionnaire, Profile of Mood Status (POMS), Beck Depression Inventory (BDI), Minnesota Multiphasic Personality Inventory (MMPI), and Hollingshead Index. RESULTS: Three distinct groups of patients emerged on the basis of their insurance reimbursement patterns (employed versus disabled or indigent) and biopsychosocial factors. The disabled and/or indigent group receiving PF usually chose SURG (n = 89) because their insurance program covered it, but 14 disabled patients receiving Medicare chose DIET (together labeled the PF:DS group). The PI patients were divided into two groups: SURG (PI:S), n = 146, and DIET (PI: D), n = 194, respectively, based on their program selection. These three groups differed significantly in their biopsychosocial patterns. The PF:DS subjects appeared to have the strongest degree of biologic influence, followed by the PI:S and PI:D subjects. The pattern of social influences was consistent with the pattern of biologic influences and the selection bias created in forming the PF and PI groups. The pattern of psychologic influences, however, did not appear to follow the pattern of biologic and social influences. PF:DS had the strongest psychologic loading, but PI:D had a stronger degree of psychopathologic impairment than PI:S. CONCLUSIONS: The significant differences in the biopsychosocial characteristics of these three groups of obese patients need to be considered by policy-makers when they design and review treatment studies and decide what treatment programs should be offered in medical insurance programs.

Adult↗

PubMed2003

Consumption of coral propagules after mass spawning enhances larval quality of damselfish through maternal effects.

The synchronized spawning of corals in many parts of the Indo-Pacific represents a huge injection of biological material into the waters around reefs. Much of this material is consumed by fishes and filter-feeding invertebrates in the 5 or so days following spawning. The present study is the first to document the effect of the consumption of coral propagules on a population of facultatively planktivorous fish and the transference of physiological condition across generations. The study compares two populations of the damselfish Pomacentrus amboinensis that fed to differing degrees on coral propagules for 5 days after the annual mass spawning of corals at Lizard Island, Great Barrier Reef, Australia. Wind blew coral slicks over the outer lagoon to the inner lagoon some 1.5 km away. While coral propagules were abundant in the water column in the windward location, they were scarce by the time the water mass reached the inner lagoon. Behavioral observations 2-5 days after coral spawning showed that a significantly higher proportion of P. amboinensis was feeding on coral propagules in the windward location than in the inner lagoon location. Windward location females consumed coral propagules almost exclusively and had fuller guts than females from the inner lagoonal location. Five days after the mass coral spawning, windward location females had a higher condition factor and a larger liver mass relative to body mass compared to females within the inner lagoon or females from both locations 2 months later. Fish eggs laid by the windward location females soon after coral spawning yielded larvae that had 25% larger yolk sacs and 100% larger oil globules than did larvae produced from the females from the inner lagoon location, or larvae produced at either location prior to or well after coral spawning in 2 previous years. Larger yolk sacs and oil globules have been shown to have direct survival benefits in the transition from endogenous to exogenous feeding. A feeding experiment conducted on patch reefs showed that diet supplementation of breeding females with a high lipid food for just 5 min per day was sufficient to significantly increase yolk-sac sizes of newly hatched larvae. Evidence suggests that females gain a fitness advantage from feeding on coral spawn and that this is passed on to their offspring.

Animal Nutritional Physiological Phenomena↗

PubMed2004

Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status.

OBJECTIVES: To examine whether providing a midmorning nutrition supplement increases habitual energy intake in seniors with probable Alzheimer's disease (AD) and to investigate the effects of body weight status and cognitive and behavioral function on the response to the intervention. DESIGN: Randomized, crossover, nonblinded clinical trial. SETTING: A fully accredited geriatric teaching facility affiliated with the University of Toronto's Medical School with a home for the aged. PARTICIPANTS: Thirty-four institutionalized seniors with probable AD who ate independently. INTERVENTION: Nutrition supplements were provided between breakfast and lunch for 21 consecutive days and compared with 21 consecutive days of habitual intake. MEASUREMENTS: Investigator-weighed food intake, body weight, cognitive function (Severe Impairment Battery and Global Deterioration Scale), behavioral disturbances (Neuropsychiatric Inventory-Nursing Home Version), and behavioral function (London Psychogeriatric Rating Scale). RESULTS: Relative to habitual intake, group mean analyses showed increased 24-hour energy, protein, and carbohydrate intake during the supplement phase, but five of 31 subjects who finished all study phases completely compensated for the energy provided by the supplement by reducing lunch intake, and 24-hour energy intake was enhanced in only 21 of 31 subjects. Compensation at lunch was more likely in subjects with lower body mass indices, increased aberrant motor behavior, poorer attention, and increased mental disorganization/confusion. CONCLUSION: Nutrition supplements were least likely to enhance habitual energy intake in subjects who would normally be targeted for nutrition intervention-those with low body weight status. Those likely to benefit include those with higher body mass indices, less aberrant motor problems, less mental disorganization, and increased attention.

Aged↗

PubMed2006

Online analysis of europium and gadolinium species complexed or uncomplexed with humic acid by capillary electrophoresis-inductively coupled plasma mass spectrometry.

Detailed information on the geochemical behavior of radioactive and toxic metal ions under environmental conditions (in geological matrices and aquifer systems) is needed in order to assess the long-term safety of waste repositories. This includes knowledge of the mechanisms of relevant geochemical reactions, as well as associated thermodynamic and kinetic data. Several previous studies have shown that humic acid can play an important role in the immobilization or mobilization of metal ions due to complexation and colloid formation. In our project we investigate the complexation behavior of (purified Aldrich) humic acid and its influence on the migration of the lanthanides europium and gadolinium (homologs of the actinides americium and curium) in the ternary system consisting of these heavy metals, humic acid and kaolinite (KGa-1b) under almost natural conditions. Capillary electrophoresis (CE, Beckman Coulter P/ACE MDQ), with its excellent separation performance, was hyphenated with a homemade interface to inductively coupled plasma mass spectrometry (ICP-MS, VG Elemental PlasmaQuad 3) giving a system that is highly sensitive to the rare-earth element species of europium and gadolinium with humic acid. The humic acid used was also halogenated with iodine, which acted as an ICP-MS marker. To couple CE to ICP-MS, a fused silica CE capillary was flexibly fitted into a MicroMist 50 mul nebulizer with a Cinnabar cyclonic spray chamber in the external homemade interface. The chamber was chilled to a temperature of 4 degrees C to optimize the sensitivity. 200 ppb of cesium were added to the CE separation buffer so that the capillary flow could be observed. A make-up fluid including 4 ppb Ho as an internal standard was combined with the flow from the capillary within the interface in order to get a fluid throughput high enough to maintain continuous nebulization. Very low detection limits were achieved: 125 ppt for 153Eu and 250 ppt for 158Gd. Using this optimized CE-ICP-MS coupling system it was possible to quantify metal concentrations from the detection limit up to approximately 1 ppm (the linear range). This set-up was used to separate metal/humic acid-species in a 100 mM acetic acid/10 mM acetate buffer system. Using humic acid as the complexing ligand, uncomplexed metal ion species could be separated from metal-humate complexes on a time-resolved scale.

Journal Article↗

PubMed1991

Advanced gastric cancer of the antrum: anatomic-functional correlation between chief cell mass and serum pepsinogen I.

Chief cell mass and type I serum pepsinogen (PGI) were calculated in 19 advanced antral gastric cancer of intestinal type. Comparisons were also made with parietal cell mass and acid secretion. In gastric cancer of the antrum there is a significant decrease of the chief cell mass and of serum pepsinogen I. The patients were subdivided according to the histological findings of the fundic mucosa. In cases of antral gastric cancer with superficial fundic gastritis there is normozymogenism with hyperpepsinogenemy; with preatrophic fundic gastritis there is hypozymogenism with normopepsinogenemy; with atrophic fundic gastritis there is hypozymogenism with hypopepsinogenemy. Similar behavior of the chief cell mass between antral gastric cancer and fundic atrophic gastritis without cancer has become recognized and while the validity of PGI as a marker of fundic atrophic gastritis has emerged it does not allow discrimination between atrophic fundic gastritis and atrophic fundic gastritis associated with gastric cancer of the antrum.

Aged↗

PubMed2006

Suicide to harass others: clues from mythology to understanding suicide bombing attacks.

Suicide by revenge, the Samsonic suicide, and the suicide by devotio, all described in classical mythology and also reported in the ethnographic literature, belong to the same class of suicidal behaviors as kamikaze suicide and the suicide bombing attack: suicide to harass and burden others or suicide with a hostile intent. The lack of a social dimension to share in a positive manner may lead an individual to integrate him/herself in another social structure, e.g., a military organization, which allows the individual to express his/her desires and personal identity only by destroying others and themselves. The dynamics of these forms of suicide are also likely to work in other displays of life-threatening behavior, such as family annihilation, mass murder, and spree killing. A more thorough investigation of the dynamics operating in suicide bombing attacks could, therefore, contribute to preventative strategies against violence at large.

Attitude↗

PubMedDate not supplied

Construct validity of stages of change for exercise behavior.

PURPOSE: Previous research examining the transtheoretical model of behavior change within the exercise domain has been limited by use of self-report measures exclusively and inconsistent practices with regard to stage of exercise assessment. The present study was designed to partially circumvent these limitations and extend the current literature by determining the degree of association among stage of exercise and body mass index, cardiorespiratory fitness, exercise behavior, relapse, barriers, and self-efficacy, after controlling for several potential confounders. DESIGN: A descriptive, cross-sectional study. SUBJECTS: Two hundred thirty-five adults (M age = 34.7 years) volunteered to participate. MEASURES: Participants were classified by stage of exercise and compared on two behavioral, two biometrical, and three psychological variables while statistically controlling for social desirability and demographic differences. RESULTS: Significant between-stage differences were found for the overall set of dependent variables (p < .0001) and for each dependent variable separately (p < .01). The proportion of variance accounted for by the dependent variables ranged from .06 to .53. CONCLUSIONS: This study offers objective support for the stage-of-change model within the exercise domain. By acknowledging and accurately assessing stage of exercise, researchers and clinicians may be able to improve physical activity promotion efforts.

Adult↗

PubMedDate not supplied

Overweight and obesity in the context of heart failure: implications for practice and future research.

Heart failure (HF) is a major cardiovascular disorder, public health concern, and growing epidemic that affects approximately 5,000,000 people in the United States with 550,000 new cases reported annually. The clinical and economic impact of HF is associated with high hospitalization and early readmission rates. Recognizing factors that contribute to increasing the risk for HF, particularly the persistent rise in prevalence of overweight and obesity, may be imperative to reducing the burdens of this poorly prognostic disease process. Overweight and obesity have been associated with increased morbidity and mortality, and have incited extensive interest in therapeutic interventions. However, within the last decade, studies have illustrated the positive effects of overweight and obesity on survival after the onset of HF, which has prompted a variance of opinion within the healthcare community. This article reviews data supporting both the negative and positive effects of overweight and obesity in relationship to HF with implications for future research, and describes recommendations for practice as it relates to lifestyle modification through diet, exercise, and cognitive-behavioral therapy.

Activities of Daily Living↗

PubMedDate not supplied

Associations between working conditions and angina pectoris symptoms among employed women.

OBJECTIVE: This study aimed to examine whether psychosocial working conditions are associated with angina pectoris (AP) symptoms in women. METHODS: Data were derived from postal questionnaires filled in by 40- to 60-year-old women employed by the City of Helsinki, Finland, in 2000 to 2002 (n = 7093, response rate 67%). AP symptoms were measured by the Rose Questionnaire. Logistic regression analyses were carried out to examine AP symptoms as outcome. Independent variables consisted of Karasek's job demands and job control, work fatigue, working overtime, work-related mental and physical strain, the work-home interface, and social support, adjusted for age. Confounding effects of socioeconomic status, health behaviors (smoking, binge drinking, body mass index), and menopause were also examined. Pregnant women were excluded. RESULTS: AP symptoms were reported by 6% of participants. Work fatigue was strongly associated with AP. In addition, working overtime, low job control, and high physical strain at work were associated with AP. The associations between psychosocial working conditions and AP symptoms were unaffected by health behaviors, socioeconomic status, or menopause. CONCLUSIONS: Working conditions were associated with the AP symptoms identified by the Rose Questionnaire. Longitudinal studies are needed to disentangle the causal relationships, i.e., whether psychosocial stress is a true risk factor/cause of angina symptoms and cardiovascular disease among women.

Adult↗