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Bolen SD, Koroukian S, Wright JT, Persaud H, Einstadter D, Fiegl J, Perzynski AT, Gunzler D, Sullivan C, Lever J, Konstan M, Crane D, Lorenz A, Menegay M, Spence D, RajanBabu A, Groznik W, Oberly T, Qian X, Jordan CR, Virgil P, Yarberry S, Saunders E, Teall AM, Zurmehly J, Nance M, Albanese S, Wharton D, Applegate MS. A Medicaid Statewide Hypertension Quality Improvement Project: Initial Results. Cureus 2023; 15:e36132. [PMID: 37065351 PMCID: PMC10100600 DOI: 10.7759/cureus.36132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
Background Hypertension control is critical to reducing cardiovascular disease, challenging to achieve, and exacerbated by socioeconomic inequities. Few states have established statewide quality improvement (QI) infrastructures to improve blood pressure (BP) control across economically disadvantaged populations. In this study, we aimed to improve BP control by 15% for all Medicaid recipients and by 20% for non-Hispanic Black participants. Methodology This QI study used repeated cross-sections of electronic health record data and, for Medicaid enrollees, linked Medicaid claims data for 17,672 adults with hypertension seen at one of eight high-volume Medicaid primary care practices in Ohio from 2017 to 2019. Evidence-based strategies included (1) accurate BP measurement; (2) timely follow-up; (3) outreach; (4) a standardized treatment algorithm; and (5) effective communication. Payers focused on a 90-day supply (vs. 30-day) of BP medications, home BP monitor access, and outreach. Implementation efforts included an in-person kick-off followed by monthly QI coaching and monthly webinars. Weighted generalized estimating equations were used to estimate the baseline, one-year, and two-year implementation change in the proportion of visits with BP control (<140/90 mm Hg) stratified by race/ethnicity. Results For all practices, the percentage of participants with controlled BP increased from 52% in 2017 to 60% in 2019. Among non-Hispanic Whites, the odds of achieving BP control in year one and year two were 1.24 times (95% confidence interval: 1.14, 1.34) and 1.50 times (1.38, 1.63) higher relative to baseline, respectively. Among non-Hispanic Blacks, the odds for years one and two were 1.18 times (1.10, 1.27) and 1.34 times (1.24, 1.45) higher relative to baseline, respectively. Conclusions A hypertension QI project as part of establishing a statewide QI infrastructure improved BP control in practices with a high volume of disadvantaged patients. Future efforts should investigate ways to reduce inequities in BP control and further explore factors associated with greater BP improvements and sustainability.
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Qin W, Xu L. Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients. BMC Geriatr 2023; 23:57. [PMID: 36721087 PMCID: PMC9890848 DOI: 10.1186/s12877-023-03769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension. METHODS Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The "KHB-method" was used to perform mediation analysis. RESULTS Among 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78-7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control. CONCLUSIONS Individual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.
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Affiliation(s)
- Wenzhe Qin
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012 China
| | - Lingzhong Xu
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012 China
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Bolen SD, Beverly EA, Khoury S, Regan S, Wright JT, Koroukian S, Wexler R, Rao G, Hargraves D, Bricker D, Solomon GD, Holliday M, Gardner-Buckshaw S, Dworkin L, Perzynski AT, Littman E, Nevar A, Swiatkowski SM, Applegate M, Konstan MW. Forming Cardi-OH: A Statewide Collaborative to Improve Cardiovascular Health in Ohio. Cureus 2022; 14:e28381. [PMID: 36171829 PMCID: PMC9508792 DOI: 10.7759/cureus.28381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
Background Cardiovascular risk factor control is challenging, especially in disadvantaged populations. However, few statewide efforts exist to tackle this challenge. Therefore, our objective is to describe the formation of a unique statewide cardiovascular health collaborative so others may learn from this approach. Methodology With funding from the Ohio Department of Medicaid’s Ohio Medicaid Technical Assistance and Policy Program, we used a collective impact model to link the seven medical schools in Ohio, primary care clinics across the state, the Ohio Department of Medicaid, and Ohio’s Medicaid Managed Care Plans in a statewide health improvement collaborative for expanding primary care capacity to improve cardiovascular health in Ohio. Results Initial dissemination activities for primary care teams included a virtual case-based learning series focused on hypertension and social determinants of health, website resources, a monthly newsletter with clinical tips, webinars, and in-person conferences. The collaborative is aligned with a separately funded hypertension quality improvement project for paired implementation. Conclusions The collective impact model is a useful framework for developing a statewide collaborative focused on the dissemination and implementation of evidence-based best practices for cardiovascular health improvement and disparity reduction. Statewide collaboratives bringing payers, clinicians, and academic partners together have the potential to substantially impact cardiovascular health.
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Fentaw Z, Adamu K, Wedajo S. Blood pressure control status of patients with hypertension on treatment in Dessie City Northeast Ethiopia. BMC Public Health 2022; 22:917. [PMID: 35534831 PMCID: PMC9081953 DOI: 10.1186/s12889-022-13368-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Uncontrolled blood pressure contributes a huge contribution to many hypertension-related complications and it is one of the unbeaten problems for patients taking antihypertensive drugs. The association of social support and other factors with uncontrolled blood pressure during the covid-19 pandemic is not well investigated. Therefore, this study explored the determinants of blood pressure control status during the COVID-19 pandemic among patients with hypertension who were on an antihypertensive treatment. METHOD A cross-sectional study was done from March to May 2021 among adults aged 18 or more patients with hypertension for three months or more on treatment in Dessie City. An interview-administered questionnaire was done using simple random sampling from hypertension follow-up register for 380 patients with hypertension. Blood pressure measurement was taken from their arm using a stethoscope and mercury sphygmomanometer at a sitting position with 90-degree back support. Uncontrolled blood pressure was also computed either the systolic or diastolic blood pressure greater than or less than the limit of uncontrolled blood pressure with regarding the age and diabetic status of patients. The perceived social support-related questionnaire was adopted from the Multidimensional Scale of Perceived Social Support (MSPSS) -12 item checklist. It was sum-up and transformed into three categories using tertile of their computed raw scores. The adjusted prevalence ratio with a 95 percent confidence interval (CI) was used to calculate the strength of the association between uncontrolled blood pressure and independent predictors using log-binomial regression analysis. A P-value less than 0.05 was declared as statistically significant in multivariable log-binomial regression analysis. RESULT A total of 360 study participants were included in this study. The prevalence of uncontrolled blood measures in patients with hypertension with a 95% CI was 55.8(50.7, 61.0). In a multivariable analysis adjusted prevalence ratio with 95% CI for poor medication adherence 1.86(1.59,2.19), being male 1.35(1.11,1.64), secondary education 0.52(0.35,0.77), and low social support 1.24(1.01, 1.54) were the predictors of uncontrolled blood pressure. CONCLUSION Uncontrolled blood pressure for patients with hypertension on treatment is higher during the COVID-19 pandemic. Being male, poor medication adherence, educational status and low social support are factors that contribute to uncontrolled blood pressure.
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Affiliation(s)
- Zinabu Fentaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Kidist Adamu
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Shambel Wedajo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Chauhan S, Gupte SS, Kumar S, Patel R. Urban-rural differential in diabetes and hypertension among elderly in India: A study of prevalence, factors, and treatment-seeking. Diabetes Metab Syndr 2021; 15:102201. [PMID: 34265493 DOI: 10.1016/j.dsx.2021.102201] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
AIMS This study estimates the prevalence of hypertension and diabetes among older adults and brings forth the urban-rural differentials in the said morbidities. The treatment-seeking approach of older adults is also looked at with regard to hypertension and diabetes. METHODS Study utilized Longitudinal Ageing Study in India (LASI) data. Logistic regression was used to check the likelihood of hypertension and diabetes with socioeconomic and demographic variables. Fairlie's decomposition technique was applied to check the difference in the probability of hypertension and diabetes between rural and urban areas by estimating contributions of a group (rural-urban) differences. RESULTS Study noted a higher prevalence of hypertension and diabetes among elderly residing in urban areas than their rural counterparts. Prevalence of hypertension and diabetes was higher among those aged 70+, elderly females, less educated, and non-poor. Education status alone accounts for more than four-fifths (88.62%) and more than half (52.02%) of the inequality in the prevalence of urban-rural hypertension and diabetes, respectively. CONCLUSIONS Since treatment-seeking is relatively low among elderly in poor households, practices must be identified for a poverty-stricken elderly population to overcome the financial barriers that may prevent the elderly from seeking and complying with treatment.
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Affiliation(s)
- Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
| | - Samriddhi S Gupte
- Max Institute of Healthcare Management, Indian School of Business, Mohali, India.
| | - Shubham Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
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Bolen SD, Love TE, Einstadter D, Lever J, Lewis S, Persaud H, Fiegl J, Liu R, Ali-Matlock W, Bar-Shain D, Caron A, Misak J, Wagner T, Kauffman E, Cook L, Hebert C, White S, Kobaivanova N, Cebul R. Improving Regional Blood Pressure Control: a Positive Deviance Tiered Intensity Approach. J Gen Intern Med 2021; 36:1591-1597. [PMID: 33501526 PMCID: PMC8175516 DOI: 10.1007/s11606-020-06480-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities. OBJECTIVE To determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems. DESIGN Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017). PARTICIPANTS Adults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (N = 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative. INTERVENTIONS Identification of a "positive deviant" and dissemination of this system's best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (low: Learning Collaborative events describing the best practices; moderate: Learning Collaborative events plus consultation when requested; and high: Learning Collaborative events plus practice coaching). MAIN MEASURES We used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics. KEY RESULTS BP control post-intervention improved by 7.6% [95% confidence interval (CI) 6.0-9.1], from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5-13.5), Hispanic (10.5%, 95% CI 8.4-12.5), and African American (9.0%, 95% CI 7.7-10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2-19.5; moderate: 5.2%, 95% CI 0.8-9.5; low: 0.2%, 95% CI-3.9 to 4.3). CONCLUSIONS Employing a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.
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Affiliation(s)
- Shari D Bolen
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA.
- Better Health Partnership, Cleveland, OH, USA.
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA.
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | - Thomas E Love
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas Einstadter
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Steven Lewis
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | - Harry Persaud
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jordan Fiegl
- Department of Data Science and Analytics, University Hospitals, Cleveland, OH, USA
| | | | | | - David Bar-Shain
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | - Aleece Caron
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | - James Misak
- Department of Family Medicine, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
| | | | | | | | | | - Suzanne White
- Northeast Ohio Neighborhood Health Services, Inc., Cleveland, OH, USA
| | | | - Randall Cebul
- Center for Health Care Research and Policy, Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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Fu SN, Dao MC, Wong CKH, Cheung BMY. Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter? Postgrad Med J 2021; 98:610-616. [PMID: 34039693 PMCID: PMC9340004 DOI: 10.1136/postgradmedj-2020-139329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 11/04/2022]
Abstract
Background Little is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme. Methods A cluster randomised controlled trial in five primary care clinics recruited participants with uncontrolled hypertension. Clinics were randomised either to a HBPM group education (Risk Assessment and Management Programme (RAMP-group), or individual counselling of self-management (RAMP-individual). Health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care. Practice and knowledge of HBPM were surveyed by a 10-item HBPM knowledge checklist and patient record review 6 months after interventions. Predictors for regular HBPM and good HBPM knowledge were assessed by multivariate logistic regression models. Results 287 participants (RAMP-group: 151; RAMP-individual: 136) were follow-up for 6 months. 272 participants completed the knowledge questionnaires (response rate 94.8%). 67.8% of the participants performed HBPM regularly, and there was no statistical difference between both interventions. Age more than 65 (adjusted odds ratios (aOR) 2.58, 95% CI 1.37 to 4.86, p=0.003), not working (aOR 2.34, 95% CI 1.10 to 4.97, p=0.027)and adequate health literacy (aOR 2.25, 95% CI 1.28 to 3.95, p=0.005) predicted regular HBPM. Participants in RAMP-group demonstrated a significant lower body weight than those in RAMP-individual (−0.3±2.0 kg vs +0.7 ±1.7 kg, p<0.001).The RAMP-group participants were eight times more likely to have full HBPM knowledge score than the RAMP-individual participants (aOR 8.46, 95% CI 4.68 to 15.28, p<0.001). Conclusion Patients could retain HBPM knowledge better after RAMP-group than RAMP-individual. Older, retired and patients with adequate health literacy were more likely to continue weekly HBPM 6 months after education. Trial registration number NCT02551393.
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Affiliation(s)
- Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Hospital Authority Kowloon West Cluster, New Territories, Hong Kong
| | - Man Chi Dao
- Department of Family Medicine and Primary Health Care, Hospital Authority Kowloon West Cluster, New Territories, Hong Kong
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Bernard M Y Cheung
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
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Schlosser AV, Joshi K, Smith S, Thornton A, Bolen SD, Trapl ES. "The coupons and stuff just made it possible": economic constraints and patient experiences of a produce prescription program. Transl Behav Med 2020; 9:875-883. [PMID: 31570919 DOI: 10.1093/tbm/ibz086] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although produce prescription (PRx) programs have been shown to improve fruit and vegetable (FV) consumption, few studies have examined how economic constraints influence participant experience. We conducted a qualitative study of patient experience of a 3-month PRx program for hypertension (PRxHTN) including 3 safety-net clinics and 20 farmers' markets (FMs). We interviewed 23 PRxHTN participants using semistructured guides to understand their program experiences. Interviews were audio-taped, transcribed, and analyzed to identify a priori and emergent themes. PRxHTN participants completing qualitative interviews were mostly middle-aged (mean: 62 years) African American (100%) women (78%). Economic hardship as a barrier to maximum program participation and sustainability was a main theme identified, with three subthemes: (i) transportation issues shaped shopping and eating patterns and limited participant ability to access FMs to utilize PRxHTN vouchers; (ii) limited and unstable income shaped participant shopping and eating behavior before, during, and after PRxHTN; and (iii) participants emphasized individual-level influences like personal or perceived motivations for program participation, despite significant structural constraints, such as economic hardship, shaping their program engagement. Future PRx programs should bolster economic and institutional supports beyond FM vouchers such as transportation assistance, partnering with local food banks and expansion to local grocery stores offering year-round FV access to support sustained behavior change. Additionally, structural competency tools for providers may be warranted to reorient focus on structural influences on program engagement and away from potentially stigmatizing individual-level explanations for program success. These efforts have potential to enhance the translation of PRx programs to the needs of economically vulnerable patients who struggle to manage chronic illness and access basic nutrition.
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Affiliation(s)
- Allison V Schlosser
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Kakul Joshi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Anna Thornton
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Shari D Bolen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Better Health Partnership, Cleveland, OH, USA.,Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.,Center for Health Care Research and Policy, Case Western Reserve University at the MetroHealth System, Cleveland, OH, USA
| | - Erika S Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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Hansen LS, Lykkegaard J, Thomsen JL, Hansen MP. Acute lower respiratory tract infections: Symptoms, findings and management in Danish general practice. Eur J Gen Pract 2019; 26:14-20. [PMID: 31650886 PMCID: PMC7034054 DOI: 10.1080/13814788.2019.1674279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Acute lower respiratory tract infections (LRTIs) are among the most common infections managed in general practice. Objectives: To describe differences in reported symptoms, findings and management of patients diagnosed with acute LRTIs, and to explore possible associations between these findings and being diagnosed with pneumonia. Methods: During one winter season (2017 or 2018), a prospective registration of patients diagnosed with either acute bronchitis (ICPC-2: R78) or pneumonia (ICPC-2: R81) was conducted in Danish general practice for 20 days. A 42 item registration chart was filled in for each patient. Descriptive statistics, Pearson's chi-square test and multiple logistic regressions were used for data analysis. Results: In total, 70 general practices participated with 1384 patients registered. Patients diagnosed with pneumonia were more often reported as having a fever, dyspnoea, increased purulent sputum, abnormal pulmonary auscultation/chest retractions, and were more often assessed as unwell by the healthcare professional, than those diagnosed with acute bronchitis. Very few patients had a chest X-ray. Contrary, most patients had a C-reactive protein (CRP) test performed (pneumonia: 83%; acute bronchitis: 71%). Respectively, 93% and 20% of patients were treated with antibiotics. Having a fever, an abnormal pulmonary auscultation/chest retractions or being assessed as unwell increased the likelihood of the diagnosis pneumonia at least fivefold. Even a slightly elevated CRP (≥11 mg/L) was positively associated with being diagnosed with pneumonia. Conclusion: Danish healthcare professionals are highly influenced by symptoms, signs and CRP tests when diagnosing patients with acute LRTIs in general practice.
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Affiliation(s)
| | - Jesper Lykkegaard
- Audit Project Odense, Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Knight JM, Rizzo JD, Wang T, He N, Logan BR, Spellman SR, Lee SJ, Verneris MR, Arevalo JMG, Cole SW. Molecular Correlates of Socioeconomic Status and Clinical Outcomes Following Hematopoietic Cell Transplantation for Leukemia. JNCI Cancer Spectr 2019; 3:pkz073. [PMID: 31763620 PMCID: PMC6859844 DOI: 10.1093/jncics/pkz073] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background Clinical outcomes among allogeneic hematopoietic cell transplant (HCT) recipients are negatively affected by low socioeconomic status (SES), yet the biological mechanisms accounting for this health disparity remain to be elucidated. Among unrelated donor HCT recipients with acute myelogenous leukemia, one recent pilot study linked low SES to increased expression of a stress-related gene expression profile known as the conserved transcriptional response to adversity (CTRA) in peripheral blood mononuclear cells, which involves up-regulation of pro-inflammatory genes and down-regulation of genes involved in type I interferon response and antibody synthesis. Methods This study examined these relationships using additional measures in a larger archival sample of 261 adults who received an unrelated donor HCT for acute myelogenous leukemia to 1) identify cellular and molecular mechanisms involved in SES-related differences in pre-transplant leukocyte transcriptome profiles, and 2) evaluate pre-transplant CTRA biology associations with clinical outcomes through multivariable analysis controlling for demographic-, disease-, and transplant-related covariates. Results Low SES individuals showed increases in classic monocyte activation and pro-inflammatory transcription control pathways as well as decreases in activation of nonclassic monocytes, all consistent with the CTRA biological pattern. Transplant recipients in the highest or lowest quartiles of the CTRA pro-inflammatory gene component had a more than 2-fold elevated hazard of relapse (hazard ratio [HR] = 2.47, 95% confidence interval [CI] = 1.44 to 4.24), P = .001; HR = 2.52, 95% CI = 1.46 to 4.34, P = .001) and more than 20% reduction in leukemia-free survival (HR = 1.57, 95% CI = 1.08 to 2.28, P = .012; HR = 1.49, 95% CI = 1.04 to 2.15, P = .03) compared with the middle quartiles. Conclusions These findings identify SES- and CTRA-associated myeloid- and inflammation-related transcriptome signatures in recipient pre-transplant blood samples as a potential novel predictive biomarker of HCT-related clinical outcomes.
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Affiliation(s)
| | - J Douglas Rizzo
- See the Notes section for the full list of authors' affiliations
| | - Tao Wang
- See the Notes section for the full list of authors' affiliations
| | - Naya He
- See the Notes section for the full list of authors' affiliations
| | - Brent R Logan
- See the Notes section for the full list of authors' affiliations
| | | | - Stephanie J Lee
- See the Notes section for the full list of authors' affiliations
| | | | | | - Steve W Cole
- See the Notes section for the full list of authors' affiliations
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Factors Associated with Practice-Level Performance Indicators in Primary Health Care in Hungary: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173153. [PMID: 31470573 PMCID: PMC6747708 DOI: 10.3390/ijerph16173153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022]
Abstract
The performance of general practitioners (GPs) is frequently assessed without considering the factors causing variability among general medical practices (GMPs). Our cross-sectional national-based study was performed in Hungary to evaluate the influence of GMP characteristics on performance indicators. The relationship between patient’s characteristics (age, gender, education) and GMP-specific parameters (practice size, vacancy of GP’s position, settlement type, and county of GMP) and the quality of care was assessed by multilevel logistic regression models. The variations attributable to physicians were small (from 0.77% to 17.95%). The education of patients was associated with 10 performance indicators. Practicing in an urban settlement mostly increased the quality of care for hypertension and diabetes care related performance indicators, while the county was identified as one of the major determinants of variability among GPs’ performance. Only a few indicators were affected by the vacancy and practice size. Thus, the observed variability in performance between GPs partially arose from demographic characteristics and education of patients, settlement type, and regional location of GMPs. Considering the real effect of these factors in evaluation would reflect better the personal performance of GPs.
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Qu Z, Parry M, Liu F, Wen X, Li J, Zhang Y, Wang D, Li X. Self-management and blood pressure control in China: a community-based multicentre cross-sectional study. BMJ Open 2019; 9:e025819. [PMID: 30898823 PMCID: PMC6528047 DOI: 10.1136/bmjopen-2018-025819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study explored the relationship between self-management and blood pressure (BP) control in China. DESIGN A cross-sectional study. SETTING Eight community health centres from four cities in the Northeast (Shenyang), Northwest (Xi'an), Southwest (Chengdu) and South (Changsha) of China. PARTICIPANTS A total of 873 adults with hypertension, including 360 men and 513 women. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg. OUTCOME MEASUREMENTS BP control was the primary outcome variable. This was categorised as good control if individuals with hypertension reduced their BP to <140/90 mm Hg, otherwise, it was categorised as poor control. Secondary outcomes included self-management, defined as: (1) context or condition-specific factors or physical/social environments (eg, age, sex, marital status, education, personal income and health insurance) and (2) process or knowledge/beliefs, self-regulation skills/abilities and social facilitation (eg, treatment, diet, exercise and risk factor management). Data were analysed using logistic regression models using SPSS V.20. RESULTS A total of 67.1% (n=586) participants had poor BP control. Limited outpatient care benefits in mainly rural residents (OR 2.26, 95% CI 1.06 to 4.81) and longer disease duration (OR 1.03, 95% CI 1.01 to 1.04) were associated with poor BP control. Self-management practices reduced the odds of having poor BP control (OR 0.98, 95% CI 0.97 to 0.99). CONCLUSIONS The individual and family self-management theory can serve as an effective theory for understanding the key contexts, processes and outcomes essential for BP control in China. Future research should evaluate the effect of a self-management intervention (eg, self-monitoring, medication adherence, regular and routine doctor visits, and social supports) for BP control in China using a multisite cluster randomised controlled trial. Sex and gender difference, cost and patient-reported outcomes should also be examined.
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Affiliation(s)
- Zhan Qu
- School of Nursing, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Fang Liu
- School of Nursing, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| | - Xiulin Wen
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jieqiong Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yanan Zhang
- School of Public Health, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
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Vart P, Grams ME, Ballew SH, Woodward M, Coresh J, Matsushita K. Socioeconomic status and risk of kidney dysfunction: the Atherosclerosis Risk in Communities study. Nephrol Dial Transplant 2018; 34:1361-1368. [DOI: 10.1093/ndt/gfy142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/22/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is strong evidence of an association between socioeconomic status (SES) and end-stage renal disease (ESRD). However, the association of SES with the risk of chronic kidney disease (CKD) and the rate of change in kidney function is unclear.
Methods
A cohort of 14 086 participants with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 at baseline in the Atherosclerosis Risk in Communities study (1987–89) were studied. The association of annual household income, educational attainment and neighborhood deprivation with incident ESRD, incident CKD and change in eGFR using four measurements over ∼23 years was assessed.
Results
A total of 432 participants developed ESRD and 3510 developed CKD over a median follow-up time of ∼23 years. After adjustment for demographics and baseline eGFR, the hazard ratio (HR) for incident ESRD compared with the high-income group was 1.56 [95% confidence interval (CI) 1.22–1.99 in the medium-income group and 2.30 (95% CI 1.75–3.02) in the low-income group (P-trend < 0.001), and for CKD was 1.10 (95% CI 1.01–1.20) in the medium-income group and 1.30 (95% CI 1.17–1.44) in the low-income group (P-trend < 0.001). After full adjustments, the HR for ESRD was 1.33 (95% CI 1.03–1.70) in the medium-income group and 1.50 (95% CI 1.14–1.98) in the low-income group (P-trend = 0.003) and for CKD was 1.01 (95% CI 0.92–1.10) in the medium-income group and 1.04 (95% CI 0.93–1.16) in the low-income group (P-trend = 0.50). The eGFR decline was 5% and 15% steeper in the medium- and low-income groups, respectively, after full adjustment (P-trend < 0.001). Results were similar, with lower educational attainment and higher neighborhood deprivation being associated with adverse outcomes.
Conclusions
SES (annual household income, educational attainment or neighborhood deprivation) was associated not only with ESRD risk but also with eGFR decline, although the association with CKD appeared weaker.
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Affiliation(s)
- Priya Vart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Mark Woodward
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Repo T, Tykkyläinen M, Mustonen J, Rissanen TT, Ketonen M, Toivakka M, Laatikainen T. Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040724. [PMID: 29641497 PMCID: PMC5923766 DOI: 10.3390/ijerph15040724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
Abstract
Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has a very high cardiovascular burden, in order to form a general view of the state of secondary prevention in a high-risk region. Appropriate disease codes of CHD-diagnoses and coding for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were used to identify from the electronic patient records the patient group eligible for secondary prevention. The cumulative incidence rate of new patients (n = 2556) during 2011–2014 varied from 1.9% to 3.5% between municipalities. The success in secondary prevention of CHD was assessed using achievement of treatment targets as defined in national guidelines. Health centres are administrated by municipalities whereupon the main reporting units were municipalities, together with composed classification of patients by age, gender and dwelling location. Health disparities between municipalities, settlement types and patient groups were found and are interpreted. Moreover, spatial high-risk and low-risk clusters of acute CHD were detected. The proportion of patients achieving the treatment targets of low-density lipoprotein cholesterol (LDL-C) varied from 21% to 38% between municipalities. Variation was also observed in the follow-up of patients; e.g., the rate of follow-up measurements of LDL-C in municipalities varied from 72% to 86%. Spatial variation in patients’ sociodemographic and neighbourhood characteristics and morbidity burden partly explain the differences in outcomes, but there are also very likely differences in the care process between municipalities which requires a study in its own right.
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Affiliation(s)
- Teppo Repo
- Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland.
| | - Markku Tykkyläinen
- Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland.
| | - Juha Mustonen
- North Karelia Hospital District, 80210 Joensuu, Finland.
| | | | - Matti Ketonen
- North Karelia Hospital District, 80210 Joensuu, Finland.
| | - Maija Toivakka
- Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland.
| | - Tiina Laatikainen
- North Karelia Hospital District, 80210 Joensuu, Finland.
- National Institute for Health and Welfare (THL), 00271 Helsinki, Finland.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland.
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Trends in prevalence, awareness, treatment and control of high blood pressure in the Seychelles between 1989 and 2013. J Hypertens 2017; 35:1465-1473. [DOI: 10.1097/hjh.0000000000001358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Knight JM, Syrjala KL, Majhail NS, Martens M, Le-Rademacher J, Logan BR, Lee SJ, Jacobsen PB, Wood WA, Jim HSL, Wingard JR, Horowitz MM, Abidi MH, Fei M, Rawls L, Rizzo JD. Patient-Reported Outcomes and Socioeconomic Status as Predictors of Clinical Outcomes after Hematopoietic Stem Cell Transplantation: A Study from the Blood and Marrow Transplant Clinical Trials Network 0902 Trial. Biol Blood Marrow Transplant 2016; 22:2256-2263. [PMID: 27565521 PMCID: PMC5116244 DOI: 10.1016/j.bbmt.2016.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/15/2016] [Indexed: 01/15/2023]
Abstract
This secondary analysis of a large, multicenter Blood and Marrow Transplant Clinical Trials Network randomized trial assessed whether patient-reported outcomes (PROs) and socioeconomic status (SES) before hematopoietic stem cell transplantation (HCT) are associated with each other and predictive of clinical outcomes, including time to hematopoietic recovery, acute graft-versus-host disease, hospitalization days, and overall survival (OS) among 646 allogeneic and autologous HCT recipients. Pretransplantation Cancer and Treatment Distress (CTXD), Pittsburgh Sleep Quality Index (PSQI), and mental and physical component scores of the Short-Form 36 were correlated with each other and with SES variables. PROs and SES variables were further evaluated as predictors of clinical outcomes, with the PSQI and CTXD evaluated as OS predictors (P < .01 considered significant given multiple testing). Lower attained education was associated with increased distress (P = .002), lower income was related to worse physical functioning (P = .005) and increased distress (P = .008), lack of employment before transplantation was associated with worse physical functioning (P < .01), and unmarried status was associated with worse sleep (P = .003). In this large heterogeneous cohort of HCT recipients, although PROs and SES variables were correlated at baseline, they were not associated with any clinical outcomes. Future research should focus on HCT recipients at greater psychosocial disadvantage.
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Affiliation(s)
- Jennifer M Knight
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | | | - Michael Martens
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephanie J Lee
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Paul B Jacobsen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Heather S L Jim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muneer H Abidi
- Spectrum Health and Michigan State University, Grand Rapids, Michigan
| | - Mingwei Fei
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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Zhang K, Eastwood D, Ertl K, Whittle J. Educational attainment does not modify the effect of educational interventions on blood pressure control: a secondary analysis of data from a randomised trial. JRSM Open 2016; 7:2054270416654359. [PMID: 27540491 PMCID: PMC4973411 DOI: 10.1177/2054270416654359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess whether the effects of community-based educational interventions to improve blood pressure, weight and health behaviours benefit participants with lower educational levels more than those with higher educational levels. DESIGN Secondary data analysis. SETTING Two 12-month community-based educational interventions, one led by trained peers and one delivered by health professionals. PARTICIPANTS A total of 403 hypertensive individuals, grouped by education (high school or less; 1-3 years college; 4 + years college). MAIN OUTCOME MEASURES Blood pressure, weight, physical activity and fruit and vegetable intake. RESULTS We found that changes in blood pressure, weight and physical activity were similar across education levels; college graduates consumed more daily servings of fruits and vegetables at baseline (3.7 versus 3.6 for those with 12-15 years and 3.1 for those with < 12 years, p = 0.0112), and increased intake more after the intervention (+0.4 versus -0.1 and -0.1, p = 0.0142). The two methods of delivery - peer-led versus professional - had similar effects on all measures. CONCLUSIONS We conclude that educational interventions, whether delivered by peers or professionals, may improve chronic disease self-management among participants but do not confer greater benefits on participants with lower educational levels.
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Affiliation(s)
- Kun Zhang
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dan Eastwood
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kristyn Ertl
- Center for Patient Care Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Primary Care Research Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI 53295, USA
| | - Jeff Whittle
- Center for Patient Care Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Primary Care Research Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI 53295, USA
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Barfoed BL, Paulsen MS, Christensen PM, Halvorsen PA, Kjær T, Larsen ML, Larsen PV, Nielsen JB, Søndergaard J, Jarbøl DE. Associations between patients' risk attitude and their adherence to statin treatment - a population based questionnaire and register study. BMC FAMILY PRACTICE 2016; 17:28. [PMID: 26956487 PMCID: PMC4784361 DOI: 10.1186/s12875-016-0423-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 02/29/2016] [Indexed: 11/25/2022]
Abstract
Background Poor adherence to medical treatment may have considerable consequences for the patients’ health and for healthcare costs to society. The need to understand the determinants for poor adherence has motivated several studies on socio-demographics and comorbidity. Few studies focus on the association between risk attitude and adherence. The aim of the present study was to estimate associations between patients’ adherence to statin treatment and different dimensions of risk attitude, and to identify subgroups of patients with poor adherence. Methods Population-based questionnaire and register-based study on a sample of 6393 persons of the general. Danish population aged 20–79. Data on risk attitude were based on 4 items uncovering health-related as well as financial dimensions of risk attitude. They were collected through a web-based questionnaire and combined with register data on redeemed statin prescriptions, sociodemographics and comorbidity. Adherence was estimated by proportion of days covered using a cut-off point at 80 %. Results For the dimension of health-related risk attitude, “Preference for GP visit when having symptoms”, risk-neutral and risk-seeking patients had poorer adherence than the risk-averse patients, OR 0.80 (95 %-CI 0.68–0.95) and OR 0.83 (95 %-CI 0.71–0.98), respectively. No significant association was found between adherence and financial risk attitude. Further, patients in the youngest age group and patients with no CVD were less adherent to statin treatment. Conclusion We find some indication that risk attitude is associated with adherence to statin treatment, and that risk-neutral and risk-seeking patients may have poorer adherence than risk-averse patients. This is important for clinicians to consider when discussing optimal treatment decisions with their patients. The identified subgroups with the poorest adherence may deserve special attention from their GP regarding statin treatment.
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Affiliation(s)
- Benedicte Lind Barfoed
- Research Unit of General practice, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Maja Skov Paulsen
- Danish Quality Unit of General Practice, JB Winsløws Vej 9A, 5000, Odense C, Denmark.
| | | | - Peder Andreas Halvorsen
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, 9037, Tromsø, Norway.
| | - Trine Kjær
- Centre of Health Economics Research, COHERE, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | - Pia Veldt Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark. .,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Jesper Bo Nielsen
- Research Unit of General practice, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Jens Søndergaard
- Research Unit of General practice, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Dorte Ejg Jarbøl
- Research Unit of General practice, Department of Public Health, University of Southern Denmark, JB Winsløws Vej 9A, 5000, Odense C, Denmark.
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Perceived stress, sex and occupational status interact to increase the risk of future high blood pressure: the IPC cohort study. J Hypertens 2016; 32:1979-86; discussion 1986. [PMID: 24999800 DOI: 10.1097/hjh.0000000000000288] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contrary to lay beliefs, current perceived stress is not consistently associated with the incidence of high blood pressure (BP) in prospective studies, possibly because of moderating factors. The present prospective study examined this association and explored the potential moderating effects of sex or occupational status. METHOD The 4-item Perceived Stress Scale was filled at baseline by 19 766 normotensive adults (13 652 men, mean age ± SD: 46.8 ± 9.3 years), without history of cardiovascular and renal disease, and not on either psychotropic or antihypertensive drugs. RESULTS After a mean follow-up of 5.8 ± 2.1 years, 3774 participants (19.1%) had high BP, defined as having a SBP at least 140 mmHg or a DBP at least 90 mmHg, or using antihypertensive drugs. There was a significant interaction between baseline-perceived stress and sex (P = 0.02) in relation to high BP at follow-up. After adjustment for potential confounders, baseline perceived stress was associated with high BP at follow-up in women [odds ratio 1.20, 95% confidence interval 1.03-1.38, P = 0.016). In addition, the interaction between perceived stress and occupational status was significant among women (P = 0.02). Baseline-perceived stress was positively associated with high BP at follow-up among women of medium or low occupational status, with odds ratio suggesting a linear increase of the risk (P = 0.005). CONCLUSION Perceived stress may be considered as a risk factor for hypertension in women of lower occupational status. Research addressing the relationships between stress and high BP should systematically look for possible interactions with sex and occupational status.
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Törmä E, Carlberg B, Eriksson M, Jansson JH, Eliasson M. Long term trends in control of hypertension in the Northern Sweden MONICA study 1986-2009. BMC Public Health 2015; 15:957. [PMID: 26404853 PMCID: PMC4581080 DOI: 10.1186/s12889-015-2280-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/14/2015] [Indexed: 11/13/2022] Open
Abstract
Background A large proportion of treated hypertensive subjects do not achieve target blood pressure (BP) levels. We investigated trends in treatment and BP levels in the population, and among treated hypertensive subjects in northern Sweden. Methods The six Northern Sweden MONICA population surveys 1986 to 2009, included 6342 subjects aged 45 to 74 years of age, participation rate 79.3 %. Factors associated with lack of BP control are presented for 1106 participants in 2009. BP control was defined as a systolic BP <140 and a diastolic BP <90 mm Hg among treated hypertensive patients. Results Between 1986 and 2009, the proportion of the population that received antihypertensive treatment increased. The proportion of the whole population having BP <140/90 mm Hg increased for all (p < 0.001 for each subgroup), except for men 45–55 years old. In 2009, 62.4 % of the population had BP <140/90 mm Hg, 67.2 % in women and 58.1 % in men (p = 0.002). In the group of treated hypertensive patients, the proportion having BP control increased (p < 0.001) with no difference between sex or age groups. In 2009 52.1 % of treated hypertensives had BP control. In 2009, adequate BP control among treated hypertensive patients was 63.9 % for those with BMI <25, but only 48.8 % for those with BMI > 25 (p = 0.015). Abdominal obesity was associated with less BP control (48.1 %) than without abdominal obesity (66.2 %, p = 0.007). Women who were physically inactive had better BP control than those who were active (p = 0.03). Men treated with two or more antihypertensive drugs were 50 % more likely to reach target BP than men with monotherapy (60.4 % vs. 40.0 %, p = 0.035). Rural or urban living, level of education, diabetes mellitus or having a high cardiovascular risk were not associated with better BP control. Conclusion Antihypertensive treatment and BP control have increased in northern Sweden since 1986, although in 2009 still barely half of the treated patients achieved adequate BP levels. Intensified treatment and weight reduction may help to further improve BP control.
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Affiliation(s)
- Ellinor Törmä
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden.
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden.
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden.
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden.
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Mathewson KJ, Van Lieshout RJ, Saigal S, Morrison KM, Boyle MH, Schmidt LA. Autonomic Functioning in Young Adults Born at Extremely Low Birth Weight. Glob Pediatr Health 2015; 2:2333794X15589560. [PMID: 27335960 PMCID: PMC4784639 DOI: 10.1177/2333794x15589560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autonomic functioning is altered in infants born at extremely low birth weight (ELBW; <1000 g), but we know little about how such alterations manifest in adulthood. We examined associations between birth weight and resting heart rate (R-R interval), high-frequency (HF) and low-frequency (LF) heart rate variability, and systolic (SBP) and diastolic (DBP) blood pressure, in 60 participants (ages 22-26) born at ELBW and free of major neurosensory impairment, and 79 controls born at normal birth weight (NBW; >2500 g). HF in the smallest-born ELBW participants was significantly lower than in NBW controls. In both groups, greater birth weight was associated with higher HF. Among ELBW survivors, lower birth weight predicted faster heart rate and higher DBP, but neither heart rate nor DBP appeared to be well-coordinated with baroreflex activity (LF), the principal mechanism for short-term blood pressure regulation. Adult autonomic regulation may be significantly altered in those born extremely preterm.
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Ryborg CT, Søndergaard J, Lous J, Munck A, Larsen PV, Thomsen JL. Quality of life in children with otitis media--a cohort study. Fam Pract 2014; 31:30-7. [PMID: 24243868 DOI: 10.1093/fampra/cmt066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies about health-related quality of life (HRQOL) in children with otitis media have primarily focused on short-term effects of the disease, and how treatment with insertion of ventilation tubes (VTs) affects the HRQOL. More knowledge is needed about how long-term HRQOL is associated with different factors like insertion of VT and use of antibiotics. OBJECTIVE We aimed to analyse HRQOL in children with otitis media 1 year after inclusion and to what extent insertion of VT, use of antibiotics, diagnoses, symptoms in the children, day-care attention, parental absence from work and parental smoking were associated with the long-term HRQOL in children with otitis media. METHODS A cohort study including 397 children was carried out. The children were followed for 13 months, and symptoms, HRQOL and so on were identified by means of questionnaires. RESULTS HRQOL in children with otitis media was significantly improved after 13 months. The improvement of HRQOL was significantly lower for children with sleep problems compared with children without sleep problems. The improvement in HRQOL was significantly lower in children whose parents had been absent from work during the preceding 3 months due to the child' s otitis media compared with children with parents not being absent from their work. There were no statistically significant differences in the improvement of HRQOL in children who had received a VT during the follow-up period compared with children without a VT. CONCLUSION HRQOL in children with otitis media was significantly improved after 13 months. The improvement in HRQOL was significantly lower for children with sleep problems. The improvement in HRQOL was significantly lower in children whose parents had been absent from work due to the child's otitis media. There were no statistically significant differences in the improvement of HRQOL in children who had received a VT during the follow-up period.
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Koefoed MM, Søndergaard J, Christensen RD, Jarbøl DE. Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease: a population-based cohort study. BMC Public Health 2013; 13:580. [PMID: 23768408 PMCID: PMC3729528 DOI: 10.1186/1471-2458-13-580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 06/03/2013] [Indexed: 11/22/2022] Open
Abstract
Background Socioeconomic status is known to influence the prevalence, severity and mortality of obstructive lung diseases, but it is uncertain whether it affects the use of diagnostic spirometry in patients initiating treatment for these conditions. The objective of this paper was to examine a possible association between education, income, labour market affiliation, cohabitation status and having spirometry performed when initiating medication targeting obstructive pulmonary disease. Methods We conducted a population-based cohort study. Danish national registers were linked, retrieving data on prescriptions, spirometry testing, socioeconomic and demographic variables in all first time users of medication targeting obstructive lung disease in 2008. Results A total of 37,734 persons were included and approximately half of the cohort had spirometry performed. Among medication users under 65 years of age, being unemployed was significantly associated with reduced odds of having spirometry performed, the strongest association was seen in men (OR = 0.82, CI = 0.73-0.91). Medium income was associated with increased odds of having spirometry performed in men (OR = 1.18, CI = 1.06-1.30) and high educational level (>12 years) was associated with reduced odds of having spirometry performed in women (OR = 0.86, CI = 0.78-0.94). Cohabitation status was not associated with having spirometry performed. Among medication users over 65 years of age, living alone was associated with reduced odds of having spirometry performed among men (OR = 0.78, CI = 0.69-0.88). Conclusion Social inequity in spirometry testing among patients initiating medication targeting obstructive lung disease was confirmed in this study. Increased focus on spirometry testing among elderly men living alone, among the unemployed and among women with higher education is required when initiating medication.
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Affiliation(s)
- Mette M Koefoed
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J,B, Winsløws Vej 9A, 1, DK-5000, Odense C, Denmark.
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Ryborg CT, Søndergaard J, Lous J, Munck A, Larsen PV, Hansen MP, Thomsen JL. Factors associated with antibiotic prescribing in children with otitis media. ISRN FAMILY MEDICINE 2013; 2013:587452. [PMID: 24967325 PMCID: PMC4041257 DOI: 10.5402/2013/587452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/30/2013] [Indexed: 11/23/2022]
Abstract
Background. Acute otitis media (AOM) is often treated with antibiotics. However, initial observation is recommended. Denmark has a low use of antibiotics compared with other countries, but the total use of antibiotics has increased by 32% during the last decade, and it is important to know whether general practitioners (GPs) prescribe antibiotics according to guidelines. Objective. The aim of the study was to analyse associations between GPs' antibiotic prescribing for AOM and symptoms, diagnoses, and characteristics of children. Methods. A cohort study where GPs consecutively included 954 children between 0 and 7 years old with a new ear symptom was carried out. The GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. Results. Fever with and without earache was statistically associated with prescribing antibiotics, and it applies to both children up to two years of age (OR: 5.89 (confidence interval (CI): 2.62-13.21) and OR: 8.13 (CI: 4.61-14.32)) and children older than two years of age (OR: 4.59 (CI: 2.55-8.25) and OR: 19.45 (CI: 6.38-59.24)). A red tympanic membrane was statistically associated with the prescribing antibiotics in both age groups (0-2 years: OR: 4.73 (CI: 2.52-8.86) and >2-7 years: OR: 3.76 (CI: 2.13-6.64)). A flat tympanometry curve was only statistically associated with prescribing antibiotics in the oldest children (OR: 2.42 (CI: 1.17-5.00)). Conclusion. This study indicates that GPs to a large degree prescribe antibiotics appropriately according to guidelines.
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Affiliation(s)
- Christina T. Ryborg
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Jørgen Lous
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Anders Munck
- Audit Project Odense, Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Denmark
| | - Pia V. Larsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | | | - Janus Laust Thomsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
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Ryborg CT, Søndergaard J, Lous J, Munck A, Larsen PV, Thomsen JL. Associations between symptoms, clinical findings and the short-term prognosis among children with otitis media: a cohort study. Int J Pediatr Otorhinolaryngol 2013. [PMID: 23200872 DOI: 10.1016/j.ijporl.2012.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Otitis media (OM) is a common childhood disease and a frequent reason for seeking medical care in general practice. Only few studies have focused on what happens after diagnosis and initial treatment of OM. In particular, there is a lack of research on how different patient- and disease-related factors influence the course of OM. The aim of this study was to analyze to what extent symptoms at the time of initial diagnosis are associated with the short-term course of otitis media. METHODS Cohort study in general practice comprising 747 children between 0 and 7 years with a new ear symptom. At the first consultation the GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. The children were followed up four weeks later. RESULTS Sleep problems at inclusion are statistically significant associated with having one or more symptom after four weeks in children between 0 and 2 years (OR: 2.02 (95% confidence interval (CI): 1.24-3.31)). If the result of tympanometry is a flat curve, the OR for being referred is 3.24 (CI: 1.61-6.55) in children between 0 and 2 years compared to children without a flat curve. The OR for being referred in children between 2 and 7 years with a flat curve is 8.94 (CI: 4.18-19.11) when compared to children without a flat curve. CONCLUSION Sleep problems at inclusion were the only symptom statistically significant associated with having one or more symptoms after four weeks in children between 0 and 2 years.
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Affiliation(s)
- Christina T Ryborg
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Denmark.
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Holm LV, Hansen DG, Larsen PV, Johansen C, Vedsted P, Bergholdt SH, Kragstrup J, Søndergaard J. Social inequality in cancer rehabilitation: a population-based cohort study. Acta Oncol 2013; 52:410-22. [PMID: 23320776 DOI: 10.3109/0284186x.2012.745014] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In a healthcare system with equal access we analysed possible associations between cancer survivors' socioeconomic status (SES) and their: 1) need for rehabilitation; 2) participation in rehabilitation activities; and 3) unmet needs for rehabilitation in a 14-month period following date of diagnosis. METHODS A population-based cohort study including incident cancer patients diagnosed from 1 October 2007 to 30 September 2008 in Denmark. Fourteen months after diagnosis participants completed a mailed out questionnaire developed to measure different aspects and dimensions of rehabilitation. Individual information on cohabitation status, education, income and labour market status was retrieved from national registers. Logistic regression analyses were used to explore associations between socioeconomic status and rehabilitation outcomes. RESULTS A total of 3439 patients responded (70%). Significant interactions between SES and sex were demonstrated and further analyses were therefore stratified for gender. In general, women and to a lesser extent men with short education and low income participated less often in activities and had in some areas more unmet needs. Women living alone more often expressed a rehabilitation need in the physical, emotional and financial area and had to a higher extent unmet needs in a number of areas. Men living alone and men outside the workforce had increased odds of unmet needs in the physical area. CONCLUSIONS Despite equal access to care, SES had a significant impact on cancer survivors' rehabilitation. In general, the associations were most pronounced for female cancer patients. We suggest that special attention should be paid to socioeconomically disadvantaged groups by taking into account differences in SES in a clinical setting and when developing targeted rehabilitation programmes.
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Affiliation(s)
- Lise Vilstrup Holm
- Research Centre for Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Odense C, Denmark.
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Rastrelli G, Corona G, Fisher AD, Silverii A, Mannucci E, Maggi M. Two Unconventional Risk Factors for Major Adverse Cardiovascular Events in Subjects with Sexual Dysfunction: Low Education and Reported Partner's Hypoactive Sexual Desire in Comparison with Conventional Risk Factors. J Sex Med 2012; 9:3227-38. [DOI: 10.1111/j.1743-6109.2012.02947.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Svendsen RP, Paulsen MS, Larsen PV, Hansen BL, Støvring H, Jarbøl DE, Søndergaard J. Associations between reporting of cancer alarm symptoms and socioeconomic and demographic determinants: a population-based, cross-sectional study. BMC Public Health 2012; 12:686. [PMID: 22914003 PMCID: PMC3560107 DOI: 10.1186/1471-2458-12-686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/13/2012] [Indexed: 11/30/2022] Open
Abstract
Background Reporting of symptoms which may signal cancer is the first step in the diagnostic pathway of cancer diseases. Cancer alarm symptoms are common in the general population. Public awareness and knowledge of cancer symptoms are sparse, however, and many people do not seek medical help when having possible cancer symptoms. As social inequality is associated with cancer knowledge, cancer awareness, and information-seeking, our hypothesis is that social inequality may also exist in the general population with respect to reporting of cancer alarm symptoms. The aim of this study was to investigate possible associations between socioeconomic and demographic determinants and reporting of common cancer alarm symptoms. Methods A cross-sectional questionnaire survey was performed based on a stratified sample of the Danish general population. A total of 13 777 randomly selected persons aged 20 years and older participated. Our main outcome measures were weighted prevalence estimates of self-reporting one of the following cancer alarm symptoms during the preceding 12 months: a lump in the breast, coughing for more than 6 weeks, seen blood in urine, or seen blood in stool. Logistic regression models were used to calculate unadjusted and adjusted odds ratios with 95% confidence intervals for the associations between each covariate and reporting of cancer alarm symptoms. Results A total of 2 098 (15.7%) of the participants reported one or more cancer alarm symptoms within the preceding 12 months. Women, subjects out of the workforce, and subjects with a cancer diagnosis had statistically significantly higher odds of reporting one or more cancer alarm symptoms. Subjects with older age and subjects living with a partner had lower odds of reporting one or more cancer alarm symptoms. When analysing the four alarm symptoms of cancer separately most tendencies persisted. Conclusions Socioeconomic and demographic determinants are associated with self-reporting of common cancer alarm symptoms.
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Affiliation(s)
- Rikke Pilsgaard Svendsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, JB, Winsløwsvej 9A, DK-5000 Odense C, Denmark.
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