Knowledge, attitudes and cardiovascular risk factors in Danish adults

The effect of preventive consultations on young adults with psychosocial problems: a randomized trial

Patients with many problems often face difficulties in modifying their behavior as desired. Uncovered basic needs may be an important barrier. This research tests the effect of patient-centered consultations for 20- to 44-year-old patients with multiple psychosocial and lifestyle problems. We focus on resources and barriers for obtaining self-chosen goals within life circumstances and lifestyle. At 28 general practitioners, 2056 patients aged 20-44 years were screened with a 33-item problem-score on resources, network, lifestyle and social conditions. The 30% who had most problems were invited to complete a more comprehensive questionnaire at home. Intervention was preventive consultation with a 3-month follow-up. A total of 495 patients were randomized. One-year questionnaire follow-up showed significant improvement in Short Form Health-related Quality of Life Mental (MCS-SF12) in the intervention group (7.3) compared with the control group (3.0); the difference was 4.3 (95% confidence interval 1.6-7.0, P = 0.002). The number of problems was reduced significantly more in the intervention than in the control group (1.8 versus 0.8, P = 0.03). Preventive consultation focusing on resources and barriers to self-chosen goals may improve MCS-SF12 and decrease the number of problems in patients with many psychosocial and lifestyle problems. This may be an indicator of improved specific self-efficacy and a key to lifestyle changes.

Evaluation of the knowledge of primary healthcare patients in Poland on the prevention of hypertension: a community study

OBJECTIVES

To investigate the knowledge of Poles on the prevention of arterial hypertension (HT) and identify the main souces of knowledge in order to make health promotion activities more effective, and thus increase the efficiency and efficacy of the Polish healthcare system.

STUDY DESIGN

Community study.

METHODS

This questionnaire study included 180 subjects (120 primary healthcare patients without a history of diagnosed HT and 60 primary care physicians).

RESULTS

The knowledge of most surveyed patients was insufficient (43%, n = 52) or sufficient (40%, n = 48) for the effective prevention of HT; 17% (n = 20) of the respondents had knowledge that was definitely sufficient, and none of the respondents had knowledge that was definitely insufficient. The patients reported that primary care physicians were the most common source of health information (67%, n = 80). Primary care physicians were also the most trusted source of information.

CONCLUSIONS

Patients' knowledge on smoking, diet and exercise is sufficient for the effective prevention of HT. The areas of insufficient knowledge for the development of HT and possible organ complications are drinking alcohol, stress, genetic factors and diabetes.

Patients' knowledge of risk and protective factors for cardiovascular disease

Coronary heart disease is the leading cause of death in the United States. The American Heart Association has proposed improving overall cardiovascular health by promoting 7 components of ideal cardiovascular health, including health behaviors (not smoking, regular exercise, and healthy diet) and health factors (ideal body mass index, cholesterol, blood pressure, and blood glucose). The patients' knowledge of these 7 components is unknown. We performed a cross-sectional survey of patients at 4 primary care and 1 cardiology clinic. The survey measured demographic data, personal behaviors/health factors, cardiovascular disease history, and knowledge about these 7 components. A multivariate model was developed to assess patient characteristics associated with high knowledge scores. Of the 2,200 surveys distributed, 1,702 (77%) were returned with sufficient responses for analysis. Of these, 49% correctly identified heart disease as the leading cause of death, and 37% (95% confidence interval [CI] 35% to 39%) correctly identified all 7 components. The average respondent identified 4.9 components (95% CI 4.7 to 5.0). The lowest recognition rates were for exercise (57%), fruit/vegetable consumption (58%), and diabetes (63%). In a multivariate model, knowledge of all 7 components was positively associated with high school education or greater (odds ratio 2.43, 95% CI 1.68 to 3.52) and white ethnicity (odds ratio 1.78, 95% CI 1.27 to 2.50), and negatively associated with attending an urban neighborhood clinic (odds ratio 0.60, 95% CI 0.44 to 0.82). In conclusion, just >1/3 of patients could identify all 7 components of ideal cardiovascular health. Educational efforts should target patients in low socioeconomic strata and focus on improving knowledge about healthy diet and regular exercise. Although patients with diabetes were more likely than those without diabetes to recognize their risk, 1 in 5 were not aware that diabetes is a risk factor for cardiovascular disease.

Awareness of hypertension and other cardiovascular risk factors in rural and urban areas in Turkey

This study aims to establish the rates of hypertension among individuals living in rural and urban areas in Turkey, and to compare their level of awareness concerning cardiovascular disease risk factors and lifestyle modifications. In total, 1679 people from urban areas and 1321 individuals from rural areas who were over 40 years of age were contacted. Hypertension standardized prevalence rate was 49% in males and 51.3% in females living in urban areas, and 55.3% in males and 59.6% in females living in rural areas. The risk of hypertension was higher in those people living in urban areas with a smoking habit, obesity, a sedentary lifestyle, inappropriate salt intake or a diagnosis of hypercholesterolemia. The risk of hypertension was also higher in people living in rural areas with obesity, a sedentary lifestyle, an inappropriate consumption of fat and red meat or a diagnosis of hypercholesterolemia or diabetes. Awareness of the importance of all of the included cardiovascular risk factors and protection from those risk factors was higher in urban areas. We concluded that cardiovascular risk factor control programs should be conducted together with hypertension control programs in rural and urban areas.

The SF-36 Questionnaire as a measurement of health-related quality of life: assessing short- and medium-term effects of exposure to tobacco versus the known long-term effects

BACKGROUND: In order to determine the magnitude of the short- or medium-term effects of tobacco use on the health-related quality of life (HRQOL) of smokers and ex-smokers, and to compare them with the estimated long-term effects reported in other studies, a cross-sectional epidemiological study was designed. METHODS: A representative study of the general population over 14 years of age was conducted in the western health area of Valladolid, Spain. HRQOL was evaluated using the SF-36 Health Questionnaire. Differences in HRQOL among smokers, non-smokers, and former smokers were determined. Standardized scores from the general population and long-term effects of tobacco exposure were compared. RESULTS: Former smokers had a better HRQOL than smokers and non-smokers on the emotional dimensions, especially "vitality" and "role emotional", while differences between the groups on the physical and emotional dimensions did not reach statistical significance. Smokers displayed deterioration in "bodily pain", "general health", "vitality", "social function", and "role emotional", while deterioration in ex-smokers only occurred in "bodily pain" and "general health." The variable package/year was correlated with "general health." CONCLUSIONS: Short- and medium-range effects of tobacco consumption on HRQOL cannot be demonstrated with the SF-36 Health Questionnaire in the general Spanish population, whereas long-term effects can.

Health-related quality of life of subjects with known and unknown hypertension: results from the population-based Hortega study

OBJECTIVE

Analyze the impact of known and unknown hypertension on health-related quality of life (HRQOL).

DESIGN AND SETTING

A descriptive cross-sectional study in the health coverage area of the Rio Hortega University Hospital, in north-western Spain, on a simple random sample of 33022 individuals.

PARTICIPANTS

Following a multiphase sampling, a final sample of 466 people, representative of the general population, was analyzed. The blood pressure of patients with known hypertension and those with a blood pressure of >or= 140/90 mmHg was subjected to ambulatory monitoring in order to evaluate the degree of blood pressure control and to detect those patients with white-coat hypertension, respectively.

RESULTS

After adjustment for sociodemographic variables, associated cardiovascular risk factors, hypertension complications and comorbidity, the patients with known hypertension presented lower scores on four SF-36 scales: physical function, general health, vitality and mental health. The group of subjects with hypertension, whether diagnosed or not, displayed a poorer HRQOL with respect to the non-hypertensive patients, solely in physical functioning and general health. Those patients with known hypertension reported more bodily pain than those subjects with unknown hypertension, while there were no differences between patients with unknown hypertension and the non-hypertensive ones.

CONCLUSIONS

Patients with known hypertension presented a poorer HRQOL. This deterioration of the subjective state of health was not observed in patients who had not yet been diagnosed, which suggests it is due, above all, to the labeling effect and/or to the treatment more than to the hypertension per se.

Drinking during pregnancy: attitudes and knowledge among pregnant Danish women, 1998

BACKGROUND

During the 1990s, most Western countries officially recommended that pregnant women abstain from alcohol. However, information about the potentially harmful effects of alcohol during pregnancy does not necessarily equate to understanding, and information and knowledge may not be associated with pregnant women's own attitudes toward drinking.

METHODS

From October to December 1998, we interviewed 439 Danish-speaking pregnant women who were referred for routine antenatal care at their first visit at 15 to 16 weeks of gestation. The women were interviewed about their attitudes toward and beliefs and knowledge about drinking during pregnancy. Questions were also asked about information on alcohol provided to the women.

RESULTS

Seventy-six percent of the women considered some alcohol intake during pregnancy to be acceptable, mostly on a weekly level. Binge drinking, however, was considered to be harmful by 85%. These attitudes were not associated with knowledge about the official recommendation or whether the woman had talked to her general practitioner or midwife about alcohol during pregnancy. Most of the women had received information on alcohol from the mass media or relatives, but most women believed that information about alcohol during pregnancy could best be communicated to them by health personnel. Only 21% were aware of the official recommendation from the Danish National Board of Health. One third had discussed alcohol with their general practitioner or midwife, but these women had mostly been advised that some alcohol intake was acceptable.

CONCLUSIONS

Most of the women considered some alcohol intake during pregnancy to be acceptable, mostly on a weekly level, and their attitudes were independent of their knowledge about the subject. Most of the women had not been informed about alcohol during pregnancy.

Community interventions for reducing smoking among adults

BACKGROUND

Since smoking behaviour is determined by social context, the best way to reduce the prevalence of smoking may be to use community-wide programmes which use multiple channels to provide reinforcement, support and norms for not smoking.

OBJECTIVES

To assess the effectiveness of community interventions for reducing the prevalence of smoking.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group specialised register, MEDLINE (1966-August 2001) and EMBASE (1980-August 2001) and reference lists of articles.

SELECTION CRITERIA

Controlled trials of community interventions for reducing smoking prevalence in adult smokers. The primary outcome was smoking behaviour.

DATA COLLECTION AND ANALYSIS

Data were extracted by one person and checked by a second.

MAIN RESULTS

Thirty two studies were included, of which seventeen included only one intervention and one comparison community. Only four studies used random assignment of communities to either the intervention or comparison group. The population size of the communities ranged from a few thousand to over 100,000 people. Change in smoking prevalence was measured using cross-sectional follow-up data in 27 studies. The estimated net decline ranged from -1.0% to 3.0% for men and women combined (10 studies). For women, the decline ranged from -0.2% to + 3.5% per year (n=11), and for men the decline ranged from -0.4% to +1.6% per year (n=12). Cigarette consumption and quit rates were only reported in a small number of studies. The two most rigorous studies showed limited evidence of an effect on prevalence. In the US COMMIT study there was no differential decline in prevalence between intervention and control communities, and there was no significant difference in the quit rates of heavier smokers who were the target intervention group. In the Australian CART study there was a significantly greater quit rate for men but not women.

REVIEWER'S CONCLUSIONS

The failure of the largest and best conducted studies to detect an effect on prevalence of smoking is disappointing. A community approach will remain an important part of health promotion activities, but designers of future programmes will need to take account of this limited effect in determining the scale of projects and the resources devoted to them.

Behavioral diagnosis of 30 to 60 year-old men in the Fabreville Heart Health Program

To develop effective interventions in the Fabreville Heart Health Program, a behavioral diagnosis was conducted on a sample of 1,600 men 30 to 60 years of age residing in the Fabreville district of Laval, Quebec's second most populous city. The response rate of the self-administered postal questionnaire was 73.5%. The results indicate that dietary fat consumption, smoking and a sedentary lifestyle were more prevalent among the younger respondents, particularly those less-educated. The results underline the importance of segmenting the target population so that heart health interventions can respond to the specific needs of each sub-population. Furthermore, the data seem to suggest the need to adapt educational messages to the target lifestyle habits. The results showed that in terms of diet, consumption of meat and dairy products contributed the most to fat intake. Of the 30% who were smokers, a large proportion would be reluctant to stop the habit; 20% smoked 26 cigarettes or more a day, and more than half had already tried once or more to stop. Although 60% of respondents indicated they engaged in physical activity, only 37.0% did it regularly. These results demonstrate the need to clearly target specific behaviours and subgroups in our promotion messages for a healthy heart.

Cardiovascular risks and socioeconomic status: differences between men and women in Finland

STUDY OBJECTIVE

The study aimed to assess the association of different indicators of socioeconomic status with levels of cardiovascular disease risk factors in men and women aged 25-64 years.

DESIGN

This was a cross sectional survey, using a community based random sample.

SETTING

The provinces of North Karelia and Kuopio in eastern Finland and the cities of Turku and Loimaa and surrounding communities in southwestern Finland in 1987.

PARTICIPANTS

Altogether 2164 men and 2182 women aged 25-64 years took part.

MEASUREMENTS AND MAIN RESULTS

Data were collected using self administered questionnaires and the measurement of height, body weight, and blood pressure and blood sampling for lipid determinations were done at the survey site. The risk of cardiovascular disease was determined by calculating a simple risk factor score based on the observed values of HDL and total cholesterol, leisure time, physical activity, blood pressure, medication for hypertension, body mass index, and smoking. Indicators of socioeconomic position used were years of education, family income, marital status, and the person's occupation. Lower levels of education, occupation, and income were all significantly associated with an unfavorable risk factor profile in men and women. Education and occupation showed the strongest associations with the risk factor score in both men and women. The results changed little when adjusting for income and marital status. Family income was more strongly associated with the risk factor score in women than men. When adjusting for occupation and education, income was no longer significantly associated with the risk factor score in men. Marital status was not significantly associated with the risk factor score in either sex.

CONCLUSIONS

Using the strength of the association with the cardiovascular risk factor score as the criterion for a good socioeconomic indicator, the present study suggests that education and occupation may be equally good indicators in both men and women. Family income may have some additional importance, especially in women.