1
|
Maia ADS, Soares KJS, Alvarado PEU, da Silva FVA, Mayer DH, Camacho MHB, da Fonseca JHDAP. Thinking Outside the Box: The Interventional Surgeon. Braz J Cardiovasc Surg 2024; 39:e20230207. [PMID: 38569074 PMCID: PMC10989677 DOI: 10.21470/1678-9741-2023-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/08/2023] [Indexed: 04/05/2024] Open
Abstract
Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.
Collapse
Affiliation(s)
- Adnaldo da Silveira Maia
- Department of Cardiovascular Surgery, Instituto Dante Pazzanese de
Cardiologia (IDPC), São Paulo, São Paulo, Brazil
| | | | - Pedro Esteban Ulloa Alvarado
- Department of Cardiovascular Surgery, Instituto Dante Pazzanese de
Cardiologia (IDPC), São Paulo, São Paulo, Brazil
| | | | - Dayara Hoffmann Mayer
- Department of Cardiovascular Surgery, Hospital do
Coração (HCor), São Paulo, São Paulo, Brazil
| | | | - José Honório de Almeida Palma da Fonseca
- Department of Cardiovascular Surgery, Instituto do
Coração (InCor), Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Mohamad AA, Mohamed NA. A Rare Presentation of Probable Training-Related Chronic Myopericarditis in an Endurance Cyclist: A Case Report. Korean J Fam Med 2024; 45:116-120. [PMID: 38351744 DOI: 10.4082/kjfm.23.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/03/2023] [Indexed: 03/27/2024] Open
Abstract
We report a rare case of high-volume training-related myopericarditis. A male, 18 years old, elite road bicycle racing cyclist with high-volume training of 1,000 km per week for >7 years, presented with progressively worsening exertional breathlessness, reduced effort tolerance, and one episode of cardiac syncope. The symptoms were present prior to the coronavirus disease 2019 pandemic but made worse with the sudden increase in the volume of training after lockdown periods in preparation for competition. He exhibited multiple premature ventricular ectopic beats during his resting electrocardiogram, with a normal echocardiogram and non-elevated cardiac enzyme. The exercise stress test revealed similar multiple premature ventricular beats, warranting further investigation using cardiac magnetic resonance imaging (MRI). The findings of the cardiac MRI were suggestive of myopericarditis. He was instructed to refrain from training and initially started with a short course of colchicine. However, his symptoms deteriorated, and cardiac MRI revealed a decrease in the left ventricular ejection fraction from 59% to 50%. His treatment was escalated to a short course of tapered dose steroid, anti-failure medication and gradual, supervised, return to sports program. This case report highlights the discussion of return to play in athletes with myopericarditis.
Collapse
Affiliation(s)
- Azwan Aziz Mohamad
- Sports Medicine Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Nahar Azmi Mohamed
- Sports Medicine Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
3
|
Huang Y, Zhu X, Liu X, Li J. Loneliness Trajectories Predict Risks of Cardiovascular Diseases in Chinese Middle-Aged and Older Adults. J Gerontol B Psychol Sci Soc Sci 2024:gbae018. [PMID: 38381560 DOI: 10.1093/geronb/gbae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Loneliness is considered a risk factor for cardiovascular diseases (CVD), but related evidence is mixed. Examining trajectories of loneliness over time, as compared to the assessment of loneliness at a single time point, can be useful to better understand the risks for CVD. The present study aimed to examine loneliness trajectories and their impacts on CVD in Chinese middle-aged and older adults. METHODS The sample included 9235 adults aged 45 years and above from four waves of the China Health and Retirement Longitudinal Survey from 2011 to 2018. Loneliness was assessed by a single-item question with a four-point scale. CVD events were measured by self-reports of heart diseases and stroke in 2018. RESULTS Group-based trajectory modeling showed that three loneliness trajectories emerged: stable low, moderate increasing, and high increasing loneliness. Binary logistic regression showed that loneliness trajectories were significantly associated with the risk of having CVD after controlling for all covariates. Specifically, compared to the group with stable low loneliness, people with moderate increasing had a higher risk of having stroke, and people with high increasing loneliness had higher risks of having both heart diseases and stroke. In contrast, loneliness at a single time point was not independently associated with the risk of having CVD. DISCUSSION The present study identified groups of people vulnerable to CVD from the perspective of social connections in terms of loneliness trajectories. Middle-aged and older adults showing increasing loneliness may need social and emotional support to protect their cardiovascular health.
Collapse
Affiliation(s)
- Yan Huang
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xinyi Zhu
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiaomei Liu
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Juan Li
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
4
|
Denisenko D, Ekong G, Spotts H. Dementia risk in patients with heart disease and depression. Dement Neuropsychol 2023; 17:e20230024. [PMID: 37885965 PMCID: PMC10599303 DOI: 10.1590/1980-5764-dn-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 10/28/2023] Open
Abstract
The high prevalence of Alzheimer's disease and dementia is a growing concern for healthcare systems and patients. Objective The primary objective of our study was to assess the association of depression and heart disease on the risk of dementias like Alzheimer's disease or vascular dementia in patients. Methods This retrospective study used electronic health records data that was provided by the HealthVerity™ Marketplace. The characteristics of the patient population were recorded and the risk of dementia was examined using adjusted logistic regression models. Results The analysis included 49,735 participants and revealed that patients who have heart disease or depression had a higher risk of dementia. Patients who had both heart disease and depression were over three times more likely to have dementia and Alzheimer's disease, and over five times more likely to have vascular dementia compared to patients who only have a diagnosis of heart disease. Depression was associated with a fourfold increase in the risk of dementia. Participants with a diagnosis of most types of heart disease as well as depression had increased risk for developing dementia. Conclusion This study revealed that patients with both heart disease and depression had increased odds of having dementia as well as vascular dementia and Alzheimer's disease. These findings may serve to support policies and healthcare decision-making to increase preventive measures for dementia and Alzheimer's disease among patients with both depression and heart disease.
Collapse
Affiliation(s)
- Daniel Denisenko
- Western New England University, College of Pharmacy and Health Sciences, Springfield, MA, USA
| | - Gladys Ekong
- Western New England University, College of Pharmacy and Health Sciences, Springfield, MA, USA
| | - Harlan Spotts
- Western New England University, College of Business, Springfield, MA, USA
| |
Collapse
|
5
|
Kamkar MZ, Mahyar M, Maddah SA, Khoddam H, Modanloo M. The effect of melatonin on quality of sleep in patients with sleep disturbance admitted to post coronary care units: A randomized controlled trial. Biomedicine (Taipei) 2021; 11:34-40. [PMID: 35223393 DOI: 10.37796/2211-8039.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background and objectives Patients with cardiovascular disease who required to be admitted in coronary care units (CCU) would have sleep deprivation. During the admission some factors such as continuous ambient light exposure can suppress melatonin release, in consequence sleep deprivation will be occurred and hinder the progress of patients’ treatment. The aim of study was to evaluate the effect of melatonin on the sleep quality of patients admitted to post-CCU. Materials and methods This randomized clinical trial was carried out on 110 patients admitted to post-CCU at SayyadeShirazi Hospital, Gorgan, Iran. Patients with a poor sleep quality (Pittsburgh sleep quality index (PSQI) global score>5) were randomly allocated into two intervention and placebo groups. Patients in the intervention group received melatonin (3 mg; 30 minutes before bedtime), and the placebo group received placebo for 2 weeks, and their sleep quality was re-evaluated after the end of intervention. Data were analyzed using paired t test, Wilcoxon, and Chi-square tests by SPSS version 21. Results The results showed that mean of the patients’ PSQI scores decreased significantly in intervention group (from 14.95 ± 1.48 to 11.65 ± 1.50, P < 0.001), while in placebo group the difference was not significant (from 15.48 ± 1.47 to 15.24 ± 1.71, P = 0.129). Post-intervention score of patients in intervention group was also lower than the placebo group (P < 0.001). Conclusion The melatonin can improve the sleep quality of the patients admitted to post-CCU who suffer from sleep disturbance.
Collapse
|
6
|
Khoddam H, Alemi Z, Modanloo M. Comparison of Prevalence and Risk Factors of Acute Coronary Syndrome in Patients with Different Ethnicity: A Cross-sectional Study. Ethiop J Health Sci 2021; 31:1011-1018. [PMID: 35221618 PMCID: PMC8843153 DOI: 10.4314/ejhs.v31i5.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although the main risk factors of acute coronary syndrome (ACS) have been previously identified, there is not yet strong and consistent evidence about the ethnical differences of these risk factors. The aim of this study was to identify and compare the distribution of risk factors of ACS among two ethnic groups in northern Iran. METHODS This cross-sectional study was done on a total of 250 patients (100 Fars and 150 Turkmen ethnics) with ACS admitted in coronary care units (CCU) of medical centers in Gonbad-e Kavus, a city in the Northeast of Iran. The demographic characteristics, clinical parameters and anthropometric indices of patients in two ethnic groups were recorded. In addition, Beacke's questionnaire and Cohen's scale were used to evaluate and compare the patients' level of physical activity and perceived stress, respectively. RESULTS The mean age of the patients was 60.9±11.9 years and they were mostly males (54.8%) and married (84.8%). Findings showed that the prevalence of myocardial infarction in Fars patients was significantly higher than Turkmens (24% versus 15.3%; P=0.04). In addition, there was a significant difference in terms of the history of using opium (P=0.07) and opium sap (P=0.03), socioeconomic status (P=0.009), the place of residence (P=0.001) and type of health insurance services (P=0.001) between two groups. However, the clinical parameters and anthropometric indices and the level of physical activity and perceived stress were not significantly different between two groups (P>0.05). CONCLUSION This study showed a significant difference in the prevalence and risk factor of ACS in patients with different ethnicity in northern Iran. This finding points to the importance of paying attention to the ethnicity-based difference in ACS prevalence and risk factors, especially in patients who are at high to intermediate risk for ACS, such as Turkmens.
Collapse
Affiliation(s)
- Homeira Khoddam
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zobeide Alemi
- Student Research Committee, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahnaz Modanloo
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| |
Collapse
|
7
|
Delgado-Serrano JF, Torres-Cordón M, Peña-Rangel MA, Torres-Langhammer MP, Useche-Traslaviña CA, Duarte H, Serrano-Gómez S, Torres-Dueñas D. [Myocardial dysfunction and its prognostic utility in sepsis and septic shock]. Rev Med Inst Mex Seguro Soc 2021; 59:300-305. [PMID: 35020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/03/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sepsis is a potentially mortal infection which is related to multiple organ dysfunction; it has a high morbidity and mortality. Myocardial dysfunction is frequent in sepsis and it is related to unfavorable outcomes. Objective: To describe by transthoracic echocardiography the clinical distribution of myocardial dysfunction in sepsis and septic shock and estimate its prognostic utility. MATERIAL AND METHODS Cross-sectional study based on a multi-centric prospective cohort study in 4 reference centers in Bucaramanga, Colombia, and its metropolitan area. 271 patients with sepsis and septic shock were included; they underwent standard transthoracic echocardiography and a 30-day follow-up. RESULTS There was no difference in the left ventricular ejection fraction (p = 0.061) between survivors and non-survivors. 51 patients (48.71%) had grade I diastolic dysfunction, 48 patients (14.52%) had grade II dysfunction and 21 patients (36.75%) had grade III diastolic dysfunction. Mortality was higher in patients with grade I diastolic dysfunction when compared to those with grade II dysfunction (p = 0.023). CONCLUSIONS The higher mortality in grade I diastolic dysfunction suggests that patients with low filling pressures have worst outcomes. On the other hand, left ventricular ejection fraction per se is not associated with a higher mortality in sepsis.
Collapse
Affiliation(s)
- Josué Fernando Delgado-Serrano
- Universidad Autónoma de Bucaramanga, Facultad de Ciencias de la Salud, Unidad de Medicina. Bucaramanga, Santander, Colombia
| | | | - María Angélica Peña-Rangel
- Universidad Autónoma de Bucaramanga, Facultad de Ciencias de la Salud, Unidad de Medicina. Bucaramanga, Santander, Colombia
| | - María Paula Torres-Langhammer
- Universidad Autónoma de Bucaramanga, Facultad de Ciencias de la Salud, Unidad de Medicina. Bucaramanga, Santander, Colombia
| | | | - Hedilberto Duarte
- Instituto del Corazón, Departamento de Cardiología Clínica. Bucaramanga, Santander, Colombia
| | - Sergio Serrano-Gómez
- Universidad Autónoma de Bucaramanga, Facultad de Ciencias de la Salud, Unidad de Investigaciones. Bucaramanga, Santander, Colombia
| | - Diego Torres-Dueñas
- Universidad Autónoma de Bucaramanga, Facultad de Ciencias de la Salud, Departamento de Ciencias Médicas Básicas. Bucaramanga, Santander, Colombia
| |
Collapse
|
8
|
Moon JB, Cho SG, Yoo SW, Bom HSH. Increasing Use of Cardiac PET/CT for Inflammatory and Infiltrative Heart Diseases in Korea. Chonnam Med J 2021; 57:139-143. [PMID: 34123742 PMCID: PMC8167443 DOI: 10.4068/cmj.2021.57.2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
Recently the incidence of inflammatory and infiltrative heart diseases is increasing in Korea. Cardiac PET/CT is a useful technology evaluating inflammatory and infiltrative heart diseases. This study analyzed trends in the use of cardiac PET/CT for evaluating inflammatory and infiltrative heart diseases in the Chonnam National University Hospital and Chonnam National University Hwasun Hospital. The general trend in Korea was also assessed based on the domestic nuclear medicine database. There was a common increasing trend in the number of F-18 FDG PET/CT for the evaluation of inflammatory and infiltrative heart diseases. A representative case with cardiac sarcoidosis is illustrated.
Collapse
Affiliation(s)
- Jang Bae Moon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hee-Seung Henry Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| |
Collapse
|
9
|
Selçuk ÜN, Sargın M, Baştopçu M, Mete EMT, Erdoğan SB, Öcalmaz Ş, Orhan G, Aka SA. Microbiological Spectrum of Nosocomial ECMO Infections in a Tertiary Care Center. Braz J Cardiovasc Surg 2021; 36:338-345. [PMID: 33355788 PMCID: PMC8357375 DOI: 10.21470/1678-9741-2020-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment in cardiogenic and respiratory shock. It is prone to various complications, infection being among the most frequent. This study aims to define the prevalence and characteristics of infections in ECMO patients in a tertiary care center for cardiac diseases. METHODS All ECMO patients between 2012 and 2016 in a single cardiac center were retrospectively included. Demographic data, ECMO indications, type, site, duration, and infection-related data were recorded. Data were analyzed among all patients and separately between pediatric and adult patient groups. RESULTS One hundred and twenty-six patients, 66 (53.4%) pediatric and 60 (47.6%) adult, received ECMO within the study period. Mean age was 3.54±4.27 years in the pediatric group and 54.92±15.57 years in the adult group. The main indication for ECMO was postcardiotomy shock (77.8%). Forty-six (36.5%) of all cases developed a culture-proven nosocomial infection with a rate of 49/1000 ECMO days. Infection was associated with > 5 days of ECMO duration and hemodialysis requirement in all patients and lower age in the pediatric group. The most frequent infection site was the lower respiratory tract (14.3%), while the most common isolated organisms were Klebsiella (8.7%) and Streptococcus (4.8%) species. CONCLUSION The respiratory tract is the most common site of infection, however, all sites impose a threat to recovery, with longer treatment durations required for patients with culture-proven infections. A better understanding of the infectious spectrum and its effect on the mortality and morbidity is required for more successful treatment of ECMO patients.
Collapse
Affiliation(s)
- Ümmühan Nehir Selçuk
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Sargın
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Baştopçu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Evren Müge Taşdemir Mete
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sevinç Bayer Erdoğan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Şeyda Öcalmaz
- Department of Infectious Diseases and Clinical Microbiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gökçen Orhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Serap Aykut Aka
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
Nemati R, Ganjoo M, Jadidi F, Tanha A, Baghbani R. Electrocardiography in Early Diagnosis of Cardiovascular Complications of COVID-19; a Systematic Literature Review. Arch Acad Emerg Med 2020; 9:e10. [PMID: 33490967 PMCID: PMC7812158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2023]
Abstract
INTRODUCTION Many reports have stated that patients admitted for COVID-19 may also suffer from cardiovascular diseases, suggesting cardiovascular involvement in COVID-19. Since there is direct association between electrocardiography (ECG) data and the prognosis of cardiovascular disease, a systematic literature review was performed in the present study to address this association and make a conclusive agreement on the early diagnostic and prognostic values of ECG in patients with COVID-19. METHODS Electronic databases including PubMed, Scopus, Web of Science, Science Direct, Ovid, Embase, and Google Scholar were searched for "COVID-19" and "ECG" using all their equivalents and similar terms as search words. Afterwards, the records were limited to English articles and irrelevant documents, as well as articles that reported drug-induced cardiac dysfunction or patients with previous history of cardiovascular complications were excluded. RESULTS Overall, 31 articles with 2379 patients were found and used for qualitative data extraction. Findings showed that there is a significant association between COVID-19 infection and ECG findings. Also, ST-segment changes, T wave inversions, QT prolongation, and atrial fibrillation were found to be early indicators of cardiac involvement of COVID-19, which were associated with worse outcomes. CONCLUSION It is recommended to use ECG as a valuable diagnostic and prognostic tool for cardiac evaluation of patients with COVID-19.
Collapse
Affiliation(s)
- Reza Nemati
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mahasty Ganjoo
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Faezeh Jadidi
- Student Research Committee, Zarand School of Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Tanha
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Baghbani
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| |
Collapse
|
11
|
Nemati R, Ganjoo M, Jadidi F, Tanha A, Baghbani R. Electrocardiography in Early Diagnosis of Cardiovascular Complications of COVID-19; a Systematic Literature Review. Arch Acad Emerg Med 2020. [PMID: 33490967 PMCID: PMC7812158 DOI: 10.22037/aaem.v9i1.957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many reports have stated that patients admitted for COVID-19 may also suffer from cardiovascular diseases, suggesting cardiovascular involvement in COVID-19. Since there is direct association between electrocardiography (ECG) data and the prognosis of cardiovascular disease, a systematic literature review was performed in the present study to address this association and make a conclusive agreement on the early diagnostic and prognostic values of ECG in patients with COVID-19. METHODS Electronic databases including PubMed, Scopus, Web of Science, Science Direct, Ovid, Embase, and Google Scholar were searched for "COVID-19" and "ECG" using all their equivalents and similar terms as search words. Afterwards, the records were limited to English articles and irrelevant documents, as well as articles that reported drug-induced cardiac dysfunction or patients with previous history of cardiovascular complications were excluded. RESULTS Overall, 31 articles with 2379 patients were found and used for qualitative data extraction. Findings showed that there is a significant association between COVID-19 infection and ECG findings. Also, ST-segment changes, T wave inversions, QT prolongation, and atrial fibrillation were found to be early indicators of cardiac involvement of COVID-19, which were associated with worse outcomes. CONCLUSION It is recommended to use ECG as a valuable diagnostic and prognostic tool for cardiac evaluation of patients with COVID-19.
Collapse
Affiliation(s)
- Reza Nemati
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mahasty Ganjoo
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Faezeh Jadidi
- Student Research Committee, Zarand School of Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Tanha
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Reza Baghbani
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| |
Collapse
|
12
|
Fitzpatrick V, Rivelli A, Bria K, Chicoine B. Heart Disease in Adults With Down Syndrome Between 1996 and 2016. J Am Board Fam Med 2020; 33:923-31. [PMID: 33219071 DOI: 10.3122/jabfm.2020.06.190425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe demographic factors and calculate prevalence of heart disease-related conditions among the adult Down syndrome (DS) sample population and to compare demographic and heart disease-related conditions between the DS sample population (n = 2342) and the general population. METHODS Using a retrospective, descriptive cohort study design, analyses were based on 20 years of data collected on the Adult Down Syndrome Center patient population. Prevalence of heart disease, stroke, and associated risk conditions are reported as counts (%) with corresponding odds ratio (OR) indicating odds of diagnosis among the DS sample compared with the general population. Corresponding Pearson c2P-values were calculated to represent statistically significant differences between prevalence of diagnoses in the DS sample compared with the general population. In cases where prevalence was low, Fisher's Exact Test P-value were calculated. RESULTS Adults with DS had lower odds of diagnosis of heart disease and most associated risk conditions, specifically coronary heart disease (OR = 0.0537, P < .0001), heart failure (OR = 0.6353, P = .0091), hypertension (OR = 0.0325, P < .0001), diabetes (OR = 0.4840, P < .0001), and high total cholesterol (OR = 0.2086, P < .0001), while experiencing higher odds of overweight status (OR = 1.2185, P = .0002) and obese status (OR = 1.3238, P < .0001). CONCLUSION Adults with DS generally experience less heart disease and associated risk conditions commonly seen in the general population. Prevention and treatment guidelines for heart disease for the DS population should be adjusted after more research is conducted.
Collapse
|
13
|
Brown KA, Melby JA, Roberts DS, Ge Y. Top-down proteomics: challenges, innovations, and applications in basic and clinical research. Expert Rev Proteomics 2020; 17:719-733. [PMID: 33232185 PMCID: PMC7864889 DOI: 10.1080/14789450.2020.1855982] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
Introduction- A better understanding of the underlying molecular mechanism of diseases is critical for developing more effective diagnostic tools and therapeutics toward precision medicine. However, many challenges remain to unravel the complex nature of diseases. Areas covered- Changes in protein isoform expression and post-translation modifications (PTMs) have gained recognition for their role in underlying disease mechanisms. Top-down mass spectrometry (MS)-based proteomics is increasingly recognized as an important method for the comprehensive characterization of proteoforms that arise from alternative splicing events and/or PTMs for basic and clinical research. Here, we review the challenges, technological innovations, and recent studies that utilize top-down proteomics to elucidate changes in the proteome with an emphasis on its use to study heart diseases. Expert opinion- Proteoform-resolved information can substantially contribute to the understanding of the molecular mechanisms underlying various diseases and for the identification of novel proteoform targets for better therapeutic development . Despite the challenges of sequencing intact proteins, top-down proteomics has enabled a wealth of information regarding protein isoform switching and changes in PTMs. Continuous developments in sample preparation, intact protein separation, and instrumentation for top-down MS have broadened its capabilities to characterize proteoforms from a range of samples on an increasingly global scale.
Collapse
Affiliation(s)
- Kyle A. Brown
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Jake A. Melby
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - David S. Roberts
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ying Ge
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Human Proteomics Program, University of Wisconsin-Madison, Madison, Wisconsin, United States
| |
Collapse
|
14
|
Franco B, Morais MA, Holanda ASDS, Manconi M, de Mello MT, Esteves AM. Impact of Covid-19 on the restless legs syndrome. Sleep Sci 2020; 13:186-190. [PMID: 33381285 PMCID: PMC7755267 DOI: 10.5935/1984-0063.20200031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 01/09/2023] Open
Abstract
The COVID-19 pandemic is strongly impacting global health and mental health, and has caused routine changes in much of the world. All of these changes can have physical and mental consequences for the population. Metabolic changes, mood disorders and their pharmacotherapy, such as the use of antidepressants can increase the chances of developing sleep disorders, such as Restless Legs Syndrome (RLS). As a way to avoid immunosuppression and the greater risk of contamination of COVID-19, it is recommended to perform exercise in light or moderate intensity. This is the first paper to reflect a possible impact of social distancing on RLS, and how it can affect the incidence of mood disorders and metabolic changes in this syndrome, as well as the quality of life of the population. We suggest that regular exercise at light or moderate intensity during home confinement may be effective strategies to minimize the changes caused by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Beatriz Franco
- Universidade Estadual de Campinas, Faculdade de Educação Física - Campinas - Sao Paulo - Brazil
| | - Milca Abda Morais
- Universidade Estadual de Campinas, Faculdade de Ciências Aplicadas - Limeira - Sao Paulo - Brazil
| | | | - Mauro Manconi
- Civic Hospital of Lugano (EOC), Sleep and Epilepsy Center, Neurocenter of Southern Switzerland - Lugano - Ticino - Switzerland
| | - Marco Túlio de Mello
- Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional - Belo Horizonte - Minas Gerais - Brazil
| | - Andrea Maculano Esteves
- Universidade Estadual de Campinas, Faculdade de Ciências Aplicadas - Limeira - Sao Paulo - Brazil
| |
Collapse
|
15
|
Abstract
BACKGROUND Despite improvements in palliative care for critically ill children, the characteristics of end-of-life care for pediatric patients with advanced heart disease are not well-known. We investigated these characteristics among hospitalized children with advanced heart disease in a tertiary referral center in Korea. METHODS We retrospectively reviewed the records of 136 patients with advanced heart disease who died in our pediatric department from January 2006 through December 2013. RESULTS The median age of patients at death was 10.0 months (range 1 day-28.3 years). The median duration of the final hospitalization was 16.5 days (range 1-690 days). Most patients (94.1%) died in the intensive care unit and had received mechanical ventilation (89.7%) and inotropic agents (91.2%) within 24 hours of death. The parents of 74 patients (54.4%) had an end-of-life care discussion with their physician, and the length of stay of these patients in the intensive care unit and in hospital was longer. Of the 90 patients who had been hospitalized for 7 days or more, the parents of 54 patients (60%) had a documented end-of-life care discussion. The time interval from the end-of-life care discussion to death was 3 days or less for 25 patients. CONCLUSION Children dying of advanced heart disease receive intensive treatment at the end of life. Discussions regarding end-of-life issues are often postponed until immediately prior to death. A pediatric palliative care program must be implemented to improve the quality of death in pediatric patients with heart disease.
Collapse
Affiliation(s)
- Joowon Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea.
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Abstract
Dialysis technologies have continued to advance over recent decades; however, these advancements have not always been met with improved patient outcomes. In part, the high morbidity and mortality associated with dialysis have been attributed to a group of uremic toxins, which are described as "difficult to remove." With a new generation of hemodialysis membranes now making meaningful clearance of these molecules possible, it is an apt time to review the clinical relevance of these middle molecules. Our review describes the developments in membrane technology that enable the removal of large middle molecules (molecular mass >15 kD) that is limited with high-flux dialysis membranes. Of the known 58 middle molecules, a literature search identified 27 that have molecular mass >15 kD. This group contains cytokines, adipokines, hormones, and other proteins. These molecules are implicated in chronic inflammation, atherosclerosis, structural heart disease, and secondary immunodeficiency in the literature. Single-center safety and efficacy studies have identified that use of these membranes in maintenance dialysis populations is associated with limited loss of albumin and increased clearance of large middle molecules. Larger, robustly conducted, multicenter studies are now evaluating these findings. After completion of these safety and efficacy studies, the perceived clinical benefits of providing clearance of large middle molecules must be assessed in rigorously conducted, randomized clinical studies.
Collapse
Affiliation(s)
- Martin Wolley
- Department of Renal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Meg Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital and University of Sydney, Sydney, New South Wales, Australia; and
| | - Colin A. Hutchison
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Medicine, Hawke’s Bay District Health Board, Hastings, New Zealand
| |
Collapse
|
17
|
Maharlou H, Niakan Kalhori SR, Shahbazi S, Ravangard R. Predicting Length of Stay in Intensive Care Units after Cardiac Surgery: Comparison of Artificial Neural Networks and Adaptive Neuro-fuzzy System. Healthc Inform Res 2018; 24:109-117. [PMID: 29770244 PMCID: PMC5944185 DOI: 10.4258/hir.2018.24.2.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives Accurate prediction of patients' length of stay is highly important. This study compared the performance of artificial neural network and adaptive neuro-fuzzy system algorithms to predict patients' length of stay in intensive care units (ICU) after cardiac surgery. Methods A cross-sectional, analytical, and applied study was conducted. The required data were collected from 311 cardiac patients admitted to intensive care units after surgery at three hospitals of Shiraz, Iran, through a non-random convenience sampling method during the second quarter of 2016. Following the initial processing of influential factors, models were created and evaluated. Results The results showed that the adaptive neuro-fuzzy algorithm (with mean squared error [MSE] = 7 and R = 0.88) resulted in the creation of a more precise model than the artificial neural network (with MSE = 21 and R = 0.60). Conclusions The adaptive neuro-fuzzy algorithm produces a more accurate model as it applies both the capabilities of a neural network architecture and experts' knowledge as a hybrid algorithm. It identifies nonlinear components, yielding remarkable results for prediction the length of stay, which is a useful calculation output to support ICU management, enabling higher quality of administration and cost reduction.
Collapse
Affiliation(s)
- Hamidreza Maharlou
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrbanoo Shahbazi
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Ravangard
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Health Human Resources Research Centre, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
18
|
Enaba MM, Hasan DI, Alsowey AM, Elsayed H. Multidetector Computed Tomography (CT) in Evaluation of Congenital Cyanotic Heart Diseases. Pol J Radiol 2017; 82:645-659. [PMID: 29657630 PMCID: PMC5894010 DOI: 10.12659/pjr.903222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/03/2017] [Indexed: 11/09/2022] Open
Abstract
Background The aim of the study is to emphasize the role of 128 MSCT angiography in the diagnosis of congenital cyanotic heart diseases. Material/Methods This study included sixty patients and was conducted from December 2014 to July 2016 in the Multidetector CT unit of Zagazig University hospitals. All images included axial, MPR, MIP, and VRT and were interpreted in one session. Pulmonary veins were assessed for PAPVR or TAPVR, PDA, cardiac apex and heart chambers, interatrial or interventricular septal defects, pericardium, and site and size of the great veins (IVC and SVC). Results This study included 60 patients. Thirty-four were boys (56.7%), and 26 were girls (43.3%). The age ranged from nine months to five years, and the mean age was 34.5 months. We found the following anomalies: tetralogy of Fallot (15 patients, 25%), tricuspid atresia (12 patients, 20%), Ebstein's anomaly (4 patients, 6.5%), pulmonic atresia or stenosis (7 patients, 11.5%), truncus arteriosus (6 patients, 10%), TGA (10 patients, 17%), and TAPVR (6 patients, 10%). Conclusions MDCT proved to be an important modality for decision-making in patients with congenital cyanotic heart diseases.
Collapse
Affiliation(s)
- Moanes M Enaba
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Doaa I Hasan
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Ahmed M Alsowey
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Hany Elsayed
- Department of Pediatrics, Zagazig University, Zagazig, Egypt
| |
Collapse
|
19
|
Jannot AS, Burgun A, Thervet E, Pallet N. The Diagnosis-Wide Landscape of Hospital-Acquired AKI. Clin J Am Soc Nephrol 2017; 12:874-884. [PMID: 28495862 PMCID: PMC5460713 DOI: 10.2215/cjn.10981016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The exploration of electronic hospital records offers a unique opportunity to describe in-depth the prevalence of conditions associated with diagnoses at an unprecedented level of comprehensiveness. We used a diagnosis-wide approach, adapted from phenome-wide association studies (PheWAS), to perform an exhaustive analysis of all diagnoses associated with hospital-acquired AKI (HA-AKI) in a French urban tertiary academic hospital over a period of 10 years. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We retrospectively extracted all diagnoses from an i2b2 (Informatics for Integrating Biology and the Bedside) clinical data warehouse for patients who stayed in this hospital between 2006 and 2015 and had at least two plasma creatinine measurements performed during the first week of their stay. We then analyzed the association between HA-AKI and each International Classification of Diseases (ICD)-10 diagnostic category to draw a comprehensive picture of diagnoses associated with AKI. Hospital stays for 126,736 unique individuals were extracted. RESULTS Hemodynamic impairment and surgical procedures are the main factors associated with HA-AKI and five clusters of diagnoses were identified: sepsis, heart diseases, polytrauma, liver disease, and cardiovascular surgery. The ICD-10 code corresponding to AKI (N17) was recorded in 30% of the cases with HA-AKI identified, and in this situation, 20% of the diagnoses associated with HA-AKI corresponded to kidney diseases such as tubulointerstitial nephritis, necrotizing vasculitis, or myeloma cast nephropathy. Codes associated with HA-AKI that demonstrated the greatest increase in prevalence with time were related to influenza, polytrauma, and surgery of neoplasms of the genitourinary system. CONCLUSIONS Our approach, derived from PheWAS, is a valuable way to comprehensively identify and classify all of the diagnoses and clusters of diagnoses associated with HA-AKI. Our analysis delivers insights into how diagnoses associated with HA-AKI evolved over time. On the basis of ICD-10 codes, HA-AKI appears largely underestimated in this academic hospital.
Collapse
Affiliation(s)
- Anne-Sophie Jannot
- Departments of Medical Informatics, Biostatistics and Public Health
- Assistance Publique Hôpitaux de Paris, Paris, France
- Paris Descartes University, Paris, France; and
- National Institute for Health and Research (INSERM) U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Anita Burgun
- Departments of Medical Informatics, Biostatistics and Public Health
- Assistance Publique Hôpitaux de Paris, Paris, France
- Paris Descartes University, Paris, France; and
- National Institute for Health and Research (INSERM) U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Eric Thervet
- Nephrology, and
- Assistance Publique Hôpitaux de Paris, Paris, France
- Paris Descartes University, Paris, France; and
| | - Nicolas Pallet
- Nephrology, and
- Clinical Chemistry, Hôpital Européen Georges Pompidou, Paris, France
- Assistance Publique Hôpitaux de Paris, Paris, France
- Paris Descartes University, Paris, France; and
| |
Collapse
|
20
|
Castela E. [Coimbra Telemedicine Service Improves Access to Pediatric Cardiology in Cape Verde]. ACTA MEDICA PORT 2017; 30:253-254. [PMID: 28555549 DOI: 10.20344/amp.9034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Eduardo Castela
- Serviço de Cardiologia Pediátrica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.; Presidente. Associação Portuguesa de Telemedicina. Ordem dos Médicos. Coimbra. Portugal.; Promotor Interno de Telesaúde. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| |
Collapse
|
21
|
Abstract
Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care.
Collapse
Affiliation(s)
- Fliss E.M. Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, United Kingdom
| | - Aine Burns
- Department of Nephrology, Royal Free Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Olivier Moranne
- Institut Universitaire de Recherche Clinique, EA2415, Epidémiologie, Biostatistiques et santé publique, Faculté de Médecine, Université de Montpellier, Montpellier, France
- Nephrology and Dialysis Department, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Rachael L. Morton
- National Health and Medical Research Centre Clinical Trials Centre, University of Sydney, Sydney, Australia; and
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
22
|
Wiharto W, Kusnanto H, Herianto H. Interpretation of Clinical Data Based on C4.5 Algorithm for the Diagnosis of Coronary Heart Disease. Healthc Inform Res 2016; 22:186-95. [PMID: 27525160 PMCID: PMC4981579 DOI: 10.4258/hir.2016.22.3.186] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/20/2016] [Accepted: 07/13/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives The interpretation of clinical data for the diagnosis of coronary heart disease can be done using algorithms in data mining. Most clinical data interpretation systems for diagnosis developed using data mining algorithms with a black-box approach cannot recognize examination attribute relationships with the incidence of coronary heart disease. Methods This study proposes a system to interpretation clinical examination results for the diagnosis of coronary heart disease based the decision tree algorithm. This system comprises several stages. First, oversampling is carried out by a combination of the synthetic minority oversampling technique (SMOTE), feature selection, and the C4.5 classification algorithm. System testing is done using k-fold cross-validation. The performance parameters are sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV) and the area under the curve (AUC). Results The results showed that the performance of the system has a sensitivity of 74.7%, a specificity of 93.7%, a PPV of 74.2%, an NPV of 93.7%, and an AUC of 84.2%. Conclusions This study demonstrated that, by using C4.5 algorithms, data can be interpreted in the form of a decision tree, to aid the understanding of the clinician. In addition, the proposed system can provide better performance by category.
Collapse
Affiliation(s)
- Wiharto Wiharto
- Department of Informatic, Sebelas Maret University, Surakarta, Indonesia.; Department of Biomedical Engineering, Gadjah Mada University, Yogyakarta, Indonesia
| | - Hari Kusnanto
- Department of Biomedical Engineering, Gadjah Mada University, Yogyakarta, Indonesia.; Department of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Herianto Herianto
- Department of Biomedical Engineering, Gadjah Mada University, Yogyakarta, Indonesia.; Department of Mechanical εt Industrial Engineering, Gadjah Mada University, Yogyakarta, Indonesia
| |
Collapse
|
23
|
Tavassoli E, Reisi M, Javadzade SH, Gharlipour Z, Gilasi HR, Ashrafi Hafez A. The effect of education on improvement of intake of fruits and vegetables aiming at preventing cardiovascular diseases. Med J Islam Repub Iran 2015; 29:183. [PMID: 26034736 PMCID: PMC4431428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 07/22/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cardiovascular diseases refer to a group of diseases that affect the cardiovascular system; principally cardiac diseases, vascular diseases of the brain and kidney and peripheral arterial diseases which are caused by various factors. Considering the importance of nutrition education, especially the intake of fruits and vegetables, this study was performed to determine the effect of health education, Based on the Health Belief Model, on the improvement of intake of fruits and vegetables aiming at preventing cardiovascular diseases among high school girls in the city of Shahre- Kord, Iran. METHODS This was a quasi-experimental intervention study, in which 120 female students of high schools in Isfahan were selected through convenient sampling and were divided into two groups of experimental (60) and control (60). The instruments for data collection were the Health Belief Model and FFQ questionnaires. The HBM questionnaire was completed three times (before, immediately and two months after the intervention) and the FFQ questionnaire was completed two times (before and two months after the intervention) by the students. After the pre-test, six educational sessions were provided for the experimental group. Finally, data were collected and analyzed by SPSS 16 (ttest, paired t-test and repeated measure ANOVA). RESULTS There were no differences between the two groups in terms of demographic variables. Before the intervention, there were not any significant differences between the scores of different structures of this model between the two groups (p>0.05); however, after the intervention, significant differences were found between the experimental and control groups in the levels of knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived efficacy and performance (p<0.001). CONCLUSION According to the results, the intervention had a positive impact on the improvement of intake of fruits and vegetables among the students.
Collapse
Affiliation(s)
- Elahe Tavassoli
- 1 PhD in Health Education & Promotion, Department of Public Health, School of Health, Shahrekord University of Medical Science, Shahrekord, Iran.
| | - Mahnoush Reisi
- 2 PhD Candidate in Health Education & Promotion, Department of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Seyed Homamodin Javadzade
- 3 PhD Candidate in Health Education & Promotion, Department of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Zabihollah Gharlipour
- 4 Faculty member, Department of Public Health, school of Health, Qom University of Medical Sciences, Qom, Iran.
| | - Hamid Reza Gilasi
- 5 Department of Public Health, School of Health, Kashan University of Medical Science, Kashan, Iran.
| | - Asghar Ashrafi Hafez
- 6 MD, Researcher, Candidate for PhD by Research, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
24
|
Eckard N, Janzon M, Levin LÅ. Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden. Int J Health Policy Manag 2014; 3:323-32. [PMID: 25396208 DOI: 10.15171/ijhpm.2014.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/22/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. METHODS A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. RESULTS This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. CONCLUSION Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit.
Collapse
Affiliation(s)
- Nathalie Eckard
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
25
|
Malhotra P, Mychaskiw G, Rai A. Desflurane versus opioid anesthesia for cardiac shunt procedures in infants with cyantoic congential heart disease. Anesth Pain Med 2013; 3:191-7. [PMID: 24223361 PMCID: PMC3821147 DOI: 10.5812/aapm.9511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 12/27/2012] [Accepted: 01/12/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Placement of a Blalock-Taussig (BT) shunt is frequently performed for palliation of cyanotic congenital heart disease (CCHD). OBJECTIVES Inhalational anesthetics, when used in adult heart surgery, offer advantages of myocardial protection and decrease in use of inotropes, duration of ventilation, ICU and hospital length of stay (LOS).There is little literature, however, in the comparative use of inhalational and narcotic anesthesia in CCHD. PATIENTS AND METHODS Following Institutional Ethical Review Board approval and parental consent, 35 patients presenting for BT shunt were prospectively randomized to receive either a desflurane anesthetic or a narcotic anesthetic. Institutional practice for all patients undergoing BT shunt is to undergo cardiopulmonary bypass (CPB) following median sternotomy. Induction was accomplished with 5-7% sevoflurane in 100% oxygen, 2ug/kg fentanyl, 0.05mg/kg midazolam and 0.1mg/kg vecuronium. After intubation, patients in the narcotic group (n=16) received an additional 5-10ug/kg fentanyl, 0.1mg/kg midazolam, 100% oxygen and vecuronium. Patients in the inhalational group (n=19) received desflurane, 0.6-1 MAC, 100% oxygen, 0.05mg/kg midazolam, IV paracetamol 15mg/kg and vecuronium. At the end of surgery, patients were transferred to the ICU and received IV paracetamol and midazolam. Ventilation was weaned when the patient was hemodynamically stable. Demographics, baseline, intra and post-op heart rates, duration of inotrope use, ICU and hospital LOS, pre and post-op creatinine and serious adverse events (SAE) were recorded. Data were analyzed using Student, paired t, Mann-Whitney U and Chi square/Fisher exact tests, P < 0.05 significant. RESULTS Demographic data were similar, except for a modestly higher pre-op heart rate in the group receiving opioid anesthesia. Patients receiving desflurane had a significantly shorter duration of mechanical ventilation and length of ICU and hospital stay. Inotrope use was similar in both groups. The group receiving opioid anesthesia had an increase in creatinine post operatively which was not observed in the desflurane group. There was no difference in incidence of significant adverse events in either group. CONCLUSIONS Use of inhalational anesthesia has increased in adult cardiac surgery and has proved to reduce duration of elective ventilation, decrease ICU and hospital LOS, and mortality. Inhalational anesthetics are less well-studied in CCHD. In the current study, desflurane was chosen because of its low solubility, decreased recovery time and lack of metabolism or organ system toxicities. Although it is a popular belief that desflurane is associated with tachycardia and airway irritation, findings of the current study are consistent with those of the previous works demonstrating a lack of these side effects below 1 MAC3. No hemodynamic instability was encountered and there was no evidence that desflurane exerted a negative inotropic effect. Markers of cardio protection were not examined, although desflurane may have had a renal protective effect compared to narcotic technique. In the current study, a desflurane anesthetic for BT shunt decreased the duration of mechanical ventilation and ICU and hospital LOS by nearly three days, with no difference in perioperative morbidity or mortality. Larger studies are required to determine whether these changes result in overall decreased complication rate and morbidity/mortality and whether desflurane has a cardio or renal protective effect in the patient population.
Collapse
Affiliation(s)
| | - George Mychaskiw
- Nemours Children’s Hospital, Orlando, USA
- Corresponding author: George Mychaskiw, Nemours
Children’s Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA. Tel:
+1-4076507816, Fax: +1-4076507089, E-mail:
| | - Amit Rai
- India Institute for Medical Sciences, New Delhi,
India
| |
Collapse
|
26
|
Park DK, Jung EY, Park RW, Lee YH, Hwang HJ, Son IA, Hu MH. Telecare system for cardiac surgery patients: implementation and effectiveness. Healthc Inform Res 2011; 17:93-100. [PMID: 21886870 PMCID: PMC3155172 DOI: 10.4258/hir.2011.17.2.93] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 06/06/2011] [Indexed: 11/23/2022] Open
Abstract
Objectives To manage a patient's blood pressure and recovery, and to reduce unnecessary hospital visits after heart surgery, we developed and established a telecare service. Methods We established and test-operated the system that enabled biometric data to be measured and monitored at home, and directed connections to the video consultation with monitoring personnel and medical staff when abnormal symptoms were detected. Results As a result of using the telecare service with patients discharged from the hospital after undergoing heart surgery, the patients were mostly satisfied with the service and use of the equipment, and some patients wanted to actually receive the service continuously along with a device which could be more easily used. Conclusions Telecare services are greatly needed for patients discharged after heart surgery for a certain period of time. A model should be developed which provides devices necessary for each disease in package form and customizes the content and services in one package.
Collapse
Affiliation(s)
- Dong Kyun Park
- U-Healthcare Center, Gachon University Gil Hospital, Incheon, Korea
| | | | | | | | | | | | | |
Collapse
|
27
|
Salonen JT. Oral contraceptives, smoking and risk of myocardial infarction in young women. A longitudinal population study in eastern Finland. Acta Med Scand 2009; 212:141-4. [PMID: 7148505 DOI: 10.1111/j.0954-6820.1982.tb03186.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The use of oral contraceptives (OC) and smoking habits were studied by using a questionnaire in a random population sample of women from two counties of Eastern Finland in 1972. The participation rate was 95%. Data on use of OC and smoking were collected for 2,653 women aged 35-49 years. During the next seven years, 27 of them had developed an acute myocardial infarction (AMI). Smokers had a 2.6-fold (95% confidence interval (CI)=1.2-6.0) crude risk of developing AMI compared with non-smokers. Women taking OC had a 1.3-fold (95% CI = 0.4-6.9) risk of developing AMI compared with those who did not. Women who both smoked and used OC had a 7.2-fold (95% CI = 2.1-24.7) risk of AMI compared with non-smokers and non-users of OC. The results indicate that use of OC is associated with an excessive risk of AMI among female smokers.
Collapse
|
28
|
Tomasson RF. The components of the sex differential in mortality in industrialized populations, 1979-1981: Swedes, US whites, and US blacks. Comp Soc Res 2002; 7:287-311. [PMID: 12340262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
29
|
Cholakova T, Vylchev A, Petrunova K. [Mortality rate due to ischemic heart disease and cerebrovascular disease in Bulgaria for a five-year period]. Hig Zdraveopaz 2002; 24:117-21. [PMID: 12338771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
30
|
Liu SC, Tang GH, Hu XQ. [Sperm autoimmunity in vasectomized men and its relation to atherosclerotic coronary heart disease--report of the detection of circulating antisperm antibodies in 707 cases]. Shengzhi Yu Biyun 2002; 7:20-4. [PMID: 12341306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
31
|
No link between OC use and heart attack. Contracept Technol Update 1999; 20:115-6. [PMID: 12322318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
32
|
Gunawardene N. Sri Lanka's double burden kills rich and poor alike. Health Millions 1999; 25:27. [PMID: 12295397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
|
33
|
Dunn N, Thorogood M, Faragher B, de Caestecker L, MacDonald TM, McCollum C, Thomas S, Mann R. Oral contraceptives and myocardial infarction: results of the MICA case-control study. BMJ 1999; 318:1579-83. [PMID: 10364115 PMCID: PMC28136 DOI: 10.1136/bmj.318.7198.1579] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the association between myocardial infarction and use of different types of oral contraception in young women. DESIGN Community based case-control study. Data from interviews and general practice records. SETTING England, Scotland, and Wales. PARTICIPANTS Cases (n=448) were recruited from women aged between 16 and 44 who had suffered an incident myocardial infarction between 1 October 1993 and 16 October 1995. Controls (n=1728) were women without a diagnosis of myocardial infarction matched for age and general practice. MAIN OUTCOME MEASURES Odds ratios for myocardial infarction in current users of all combined oral contraceptives stratified by their progestagen content compared with non-users; current users of third generation versus second generation oral contraceptives. RESULTS The adjusted odds ratio for myocardial infarction was 1.40 (95% confidence interval 0.78 to 2. 52) for all combined oral contraceptive users, 1.10 (0.52 to 2.30) for second generation users, and 1.96 (0.87 to 4.39) for third generation users. Subgroup analysis by progestagen content did not show any significant difference from 1, and there was no effect of duration of use. The adjusted odds ratio for third generation users versus second generation users was 1.78 (0.66 to 4.83). 87% of cases were not exposed to an oral contraceptive, and 88% had clinical cardiovascular risk factors or were smokers, or both. Smoking was strongly associated with myocardial infarction: adjusted odds ratio 12.5 (7.29 to 21.5) for smoking 20 or more cigarettes a day. CONCLUSIONS There was no significant association between the use of oral contraceptives and myocardial infarction. The modest and non-significant point estimates for this association have wide confidence intervals. There was no significant difference between second and third generation products.
Collapse
Affiliation(s)
- N Dunn
- Drug Safety Research Unit, Bursledon Hall, Southampton SO31 1AA
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Bobak M, Hense HW, Kark J, Kuch B, Vojtisek P, Sinnreich R, Gostomzyk J, Bui M, von Eckardstein A, Junker R, Fobker M, Schulte H, Assmann G, Marmot M. An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men. Int J Epidemiol 1999; 28:437-44. [PMID: 10405845 DOI: 10.1093/ije/28.3.437] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The large differences in cardiovascular disease rates between Eastern and Western Europe have largely developed over the last few decades, and are only partly explained by classical risk factors. This study was set up to identify other potential determinants of these differences. METHODS This was an ecological study comparing random samples of men aged 45-64 years selected from three cities representing populations with different rates of cardiovascular mortality: Pardubice (Czech Republic), Augsburg (Bavaria, Germany), and Jerusalem (Israel). In total, 191 (response rate 70%), 153 (70%) and 162 (62%) men, respectively, participated. All centres followed the same study protocol. Lifestyle, anthropometry and biochemical risk factors were assessed by identical questionnaires, standardized medical examination, and central analyses of fasting blood samples. RESULTS The mortality rates in the study populations, as well as the prevalence of coronary heart disease in study samples, were highest in Czech, intermediate in Bavarian and low in Israeli men. This pattern was replicated across the three samples by mean blood pressure (P < 0.001), cigarette smoking (not significant), triglycerides (P < 0.05), fibrinogen or D-dimer levels (P < 0.05). On the other hand, the prevalence of diabetes and obesity were similar; total and high density lipoprotein (HDL)-cholesterol, apolipoprotein B, lipoprotein (Lp(a)) and glucose did not differ between Czech and Bavarian men; and Czechs had particularly low levels of serum insulin and factor VIIc. Israelis had low fasting glucose and total cholesterol, as well as HDL-cholesterol levels and a high Lp(a) (each P < 0.001) compared with the two other samples. Striking differences were found for plasma homocysteine (10.5 in Czechs versus 8.9 mumol/l in Bavarians, P < 0.001) and for alpha-carotene (geometric mean in Czechs 16, Bavarians 21 and Israelis 30 micrograms/l), beta-carotene (60, 110 and 102 micrograms/l), and lycopene (84, 177 and 223 micrograms/l), respectively; all P-values < 0.001). Adjustment for obesity or smoking did not change these estimates. There were no differences in the levels of tocopherol and retinol. CONCLUSIONS Czech men had high levels of blood pressure, triglycerides, fibrinogen and D-dimer but many other traditional risk factors, as well as indicators of metabolic disorders and vitamins A and E, did not differ between the study samples. The low levels of carotenoids and high concentrations of homocysteine in Czech men seem to reflect their low dietary intakes of fruit and vegetables. The results provide indirect support for the importance of dietary factors in the East-West morbidity and mortality divide.
Collapse
Affiliation(s)
- M Bobak
- Department of Epidemiology and Public Health, University College London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVES The study was intended to evaluate the effects of oral contraceptives and smoking on the risks of arterial and venous thromboembolic diseases among young women. STUDY DESIGN The study included a survey of data from published epidemiologic studies and evaluation of registry records of all Danish women discharged from the hospital from 1980 through 1993 after a first thromboembolic event. Questionnaires returned by survivors of such events and by control women during the period from 1994 through 1995 were analyzed. RESULTS In the 1980-1993 data the absolute risk of thrombotic diseases was seen to increase rapidly with age-exponentially for acute myocardial infarction or cerebral thromboembolic attack, linearly for venous thromboembolism-with risks of arterial diseases exceeding those of venous diseases. In the 1994-1995 data the relative risk of thrombotic diseases was seen to increase among users of oral contraceptives irrespective of age. Risk of venous thromboembolism (but not of acute myocardial infarction or cerebral thromboembolic attack) declined as duration of current oral contraceptive use lengthened, risk of acute myocardial infarction or cerebral thromboembolic attack was significantly decreased as ethinyl estradiol doses were reduced, and the relative risk (compared with nonusers of oral contraceptives) for arterial thromboembolic disease among users of desogestrel or gestodene (in conjunction with midrange or low doses of ethinyl estradiol) was lower than the relative risk among users of second-generation progestogens (in conjunction with midrange doses of ethinyl estradiol). The combination of smoking with oral contraceptive use may have a synergistic effect on risks of acute myocardial infarction and cerebral thromboembolic attack (but not of venous thromboembolism), particularly among users of high-dose (50 micrograms) ethinyl estradiol preparations. CONCLUSION Among the formulations currently marketed in Denmark, where only the progestins desogestrel and gestodene are available with low-dose (20 micrograms) ethinyl estradiol (and only desogestrel was available in that form at the time of our studies), we prefer these third-generation oral contraceptives for smokers. We might also consider such oral contraceptives for women >35 years old as long as they had no other risk factors for thrombotic arterial diseases.
Collapse
Affiliation(s)
- O Lidegaard
- Department of Obstetrics and Gynecology, Herlev Hospital, Copenhagen, Denmark
| |
Collapse
|
36
|
Abstract
Due to previous animal research suggesting accelerated atherosclerosis following vasectomy, we examined whether vasectomy increases the risk of subsequent cardiovascular disease (CVD), including myocardial infarction (MI), angina pectoris, coronary revascularization, and stroke, in the US Physicians' Health Study. Of 22,071 US male physicians participating in the study, aged 40 to 84 years at entry and free from cardiovascular disease and cancer, 21,028 reported on the 60-month questionnaire whether they had undergone vasectomy prior to randomization. Of the 4546 physicians with vasectomy, 1159 had undergone the procedure at least 15 years before entry. During 258,892 person-years of follow-up, we documented 773 cases of MI (719 nonfatal and 54 fatal), 1907 cases of angina pectoris or coronary revascularization, and 604 confirmed cases of ischemic or hemorrhagic stroke (566 nonfatal and 38 fatal). When compared to men without prior vasectomy, the multivariate relative risk (RR) of total MI adjusted for age and other coronary risk factors was 0.94 (95% confidence interval [CI], 0.77-1.14) among men with vasectomy. Risk estimates for fatal and nonfatal events did not appreciably differ from each other. For angina or coronary revascularization or both, the multivariate relative risk was 0.99 (0.88-1.12) and for total stroke the RR was 0.95 (0.75-1.21). For men who had undergone vasectomy 15 or more years previously, the multivariate relative risks were 0.98 (0.73-1.32) for total MI, 1.17 (0.87-1.57) for total stroke, and 1.12 (0.94-1.35) for angina/revascularization. These results provide reassuring evidence that vasectomy does not materially increase the risk of subsequent cardiovascular disease, even 15 or more years following the procedure.
Collapse
Affiliation(s)
- J E Manson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Lidegaard O, Bygdeman M, Milsom I, Nesheim BI, Skjeldestad FE, Toivonen J. Oral contraceptives and thrombosis. From risk estimates to health impact. Acta Obstet Gynecol Scand 1999; 78:142-9. [PMID: 10023878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The scientific debate on oral contraceptives (OCs) and thrombotic diseases continues unabated. The aim of this survey was to evaluate available scientific data on OCs and thrombotic diseases and to make tentative prescription recommendations of OCs to women with and without various thrombotic risk factors. CONSENSUS In women 15-29 years old, venous thromboembolism is about twice as common as arterial complications. In women between 30 and 44 years, the number of arterial complications exceeds venous diseases by about 50%. The mortality from arterial diseases is 3.5 times higher than the number of deaths from venous diseases in women below 30 years, and 8.5 times higher in women 30-44 years old. A significant disability is more frequent in women suffering and surviving an arterial complication than in women with venous thromboembolism. Although many important scientific issues still have to be addressed, the available scientific data suggests a differential influence of OCs with second and third generation progestagens on the risk of venous and arterial diseases. OCs with second generation progestagens seem to confer a smaller increase in the risk of venous diseases and a higher increase in risk of arterial complications, compared with OCs containing third generation progestagens. The possible difference on the venous side seems to be smaller than primarily anticipated. RESULTS Young women without any known risk factor for thrombotic diseases may use any low-dose OC. If OCs are prescribed to women with known risk factors for arterial thrombotic disease; e.g. smoking, diabetes, controlled hypertension, migraine without aura, family disposition of acute myocardial infarction (AMI) or thrombotic stroke, a low-dose pill with a third generation progestagen may have an advantage. If OCs are considered for women with risk factors for venous disease such as severe obesity, varicose veins, family history of VTE or with factor V Leiden mutation, a low-dose combined pill with a second generation progestagen may be preferable. In women above 30 years, OCs with third generation progestagens generally seem to confer less overall thrombotic morbidity, mortality and disability than OCs with second generation progestagens. These women should reconsider, however, the indication of combined OCs in the presence of significant risk factors of thrombotic diseases.
Collapse
Affiliation(s)
- O Lidegaard
- Department of Obstetrics & Gynecology, Herlev University Hospital, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
38
|
Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol 1999; 149:151-61. [PMID: 9921960 DOI: 10.1093/oxfordjournals.aje.a009781] [Citation(s) in RCA: 208] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To investigate whether greater intakes of calcium, vitamin D, or milk products may protect against ischemic heart disease mortality, the authors analyzed data from a prospective cohort study of 34,486 postmenopausal Iowa women 55-69 years old and without a history of ischemic heart disease who completed a dietary questionnaire in 1986. Through 1994, 387 deaths due to ischemic heart disease were documented (International Classification of Diseases, Ninth Revision, codes 410-414, 429.2). The multivariate-adjusted relative risks for the highest versus the lowest quartiles of total calcium, vitamin D, and milk product intakes were as follows: 0.67 (95% confidence interval (CI) 0.47-0.94; p for trend = 0.09) for calcium, 1.41 (95% CI 0.93-2.15; p for trend = 0.12) for vitamin D, and 0.94 (95% CI 0.66-1.35; p for trend = 0.68) for milk products. The relative risk was 0.63 (95% CI 0.40-0.98) for high dietary calcium but no supplemental calcium intake and 0.66 (95% CI 0.36-1.23) for high supplemental calcium but low dietary calcium intake. These results suggest that a higher intake of calcium, but not of vitamin D or milk products, is associated with reduced ischemic heart disease mortality in postmenopausal women, and reduced risk may be achievable whether the higher intake of calcium is attained by diet, supplements, or both.
Collapse
Affiliation(s)
- R M Bostick
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, USA
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Laboratory studies suggest that electric and magnetic field exposure may affect heart rate and heart rate variability. Epidemiologic evidence indicates that depressed heart rate variability is associated with reduced survival from coronary heart disease as well as increased risk of developing coronary heart disease. The authors examined mortality from cardiovascular disease in relation to occupational magnetic field exposure among a cohort of 138,903 male electric utility workers from five US companies over the period 1950-1988. Cardiovascular disease deaths were categorized as arrhythmia related (n = 212), acute myocardial infarction (n = 4,238), atherosclerosis (n = 142), or chronic coronary heart disease (n = 2,210). Exposure was classified by duration of work in jobs with elevated magnetic field exposure and indices of cumulative magnetic field exposure. Adjusting for age, year, race, social class, and active work status, longer duration in jobs with elevated magnetic field exposure was associated with increased risk of death from arrhythmia-related conditions and acute myocardial infarction. Indices of magnetic field exposure were consistently related to mortality from arrhythmia and acute myocardial infarction, with mortality rate ratios of 1.5-3.3 in the uppermost categories. No gradients in risk were found for atherosclerosis or for chronic coronary heart disease. These data suggest a possible association between occupational magnetic fields and arrhythmia-related heart disease.
Collapse
Affiliation(s)
- D A Savitz
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA
| | | | | | | | | |
Collapse
|
40
|
Abstract
OBJECTIVE Our purpose was to estimate the annual risk of death in the United States from cardiovascular disease attributable to low-dose combination oral contraceptives. STUDY DESIGN Estimates of the risk of death from cardiovascular disease attributable to low-dose oral contraceptives were modeled on data from studies published through 1997 and from age-specific mortality rates in the United States for 1993 and 1994. RESULTS Attributable risk of death from cardiovascular disease resulting from oral contraceptive use is 0.06 and 3.0 per 100,000 nonsmokers 15 to 34 years of age and 35 to 44 years of age, respectively. In smokers this risk increases, respectively, to 1.73 and 19.4 per 100,000 users in these 2 age groups; however, 97% and 85% of this risk is due to the combined effects of smoking and using oral contraceptives. The attributable risk of death from cardiovascular disease in nonsmoking oral contraceptive users is lower than the risk of death from pregnancy in nonusers of oral contraceptives at all ages; however, among smoking oral contraceptive users more than 35 years of age, the excess risk of death from oral contraceptives is higher than the risk of death from pregnancy. CONCLUSION There is virtually no excess attributable risk of death from cardiovascular disease related to oral contraceptive use in young women. However, smokers more than 35 years of age should use a nonestrogen contraceptive.
Collapse
Affiliation(s)
- P J Schwingl
- Family Health International, Biomedical Affairs Department, Research Triangle Park, Durham, North Carolina 27709, USA
| | | | | |
Collapse
|
41
|
Kunst AE, Groenhof F, Andersen O, Borgan JK, Costa G, Desplanques G, Filakti H, Giraldes MDR, Faggiano F, Harding S, Junker C, Martikainen P, Minder C, Nolan B, Pagnanelli F, Regidor E, Vågerö D, Valkonen T, Mackenbach JP. Occupational class and ischemic heart disease mortality in the United States and 11 European countries. Am J Public Health 1999; 89:47-53. [PMID: 9987464 PMCID: PMC1508498 DOI: 10.2105/ajph.89.1.47] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.
Collapse
Affiliation(s)
- A E Kunst
- Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Recent observational studies show a slightly increased risk of venous thromboembolism among users of newer combined oral contraceptives with odds ratios between 0.8 and 2.3 when compared with users of older oral contraceptives. The controversy regarding the newer oral contraceptives is reviewed by analyzing the recent studies with epidemiologic methods. Key studies on venous thromboembolism may be subject to bias related to prescribing criteria, diagnostics, hospital referral, cohort effects, and residual confounding, resulting in an overestimate of the risk of venous thromboembolism associated with the newer oral contraceptives. The studies on stroke showed no difference between newer and older oral contraceptives, and studies on myocardial infarction show that newer oral contraceptives carry no risk of this event. Newer-generation oral contraceptives are unlikely to constitute a significant hazard to the user population with regard to venous thromboembolism. The results for other disease entities also need to be taken into account when the results on venous thromboembolism are assessed on a population basis.
Collapse
Affiliation(s)
- M A Lewis
- EPES Epidemiology, Pharmacoepidemiology and Systems Research, Berlin, Germany
| |
Collapse
|
43
|
Rosamond WD, Chambless LE, Folsom AR, Cooper LS, Conwill DE, Clegg L, Wang CH, Heiss G. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N Engl J Med 1998; 339:861-7. [PMID: 9744969 DOI: 10.1056/nejm199809243391301] [Citation(s) in RCA: 567] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND METHODS To clarify the determinants of contemporary trends in mortality from coronary heart disease (CHD), we conducted surveillance of hospital admissions for myocardial infarction and of in-hospital and out-of-hospital deaths due to CHD among 35-to-74-year-old residents of four communities of varying size in the United States (a total of 352,481 persons in 1994). Between 1987 and 1994, we estimate that there were 11,869 hospitalizations for myocardial infarction (on the basis of 8572 hospitalizations sampled) and 3407 fatal coronary events (3023 sampled). RESULTS The largest average annual decrease in mortality due to CHD occurred among white men (change in mortality, -4.7 percent; 95 percent confidence interval, -2.2 to -7.1 percent), followed by white women (-4.5 percent; 95 percent confidence interval, -0.7 to -8.2 percent), black women (-4.1 percent; 95 percent confidence interval, -10.3 to +2.5 percent), and black men (-2.5 percent; 95 percent confidence interval, -6.9 to +2.2 percent). Overall, in-hospital mortality from CHD fell by 5.1 percent per year, whereas out-of-hospital mortality declined by 3.6 percent per year. There was no evidence of a decline in the incidence of hospitalization for a first myocardial infarction among either men or women; in fact, such hospital admissions increased by 7.4 percent per year (95 percent confidence interval for the change, +0.5 to +14.8 percent) among black women and 2.9 percent per year (95 percent confidence interval, -3.6 to +9.9 percent) among black men. Rates of recurrent myocardial infarction decreased, and survival after myocardial infarction improved. CONCLUSIONS From 1987 to 1994, we observed a stable or slightly increasing incidence of hospitalization for myocardial infarction. Nevertheless, there were significant annual decreases in mortality from CHD. The decline in mortality in the four communities we studied may be due largely to improvements in the treatment and secondary prevention of myocardial infarction.
Collapse
Affiliation(s)
- W D Rosamond
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Recent studies have suggested that weight loss in middle-aged persons antecedes increased mortality. Therefore, the authors sought to examine the association between changes in body weight and subsequent mortality, according to self-reported dieting status. The authors followed 9,228 men aged 40-65 years in 1963, for whom weight changes between 1963 and 1968 were recorded and extensive clinical, anthropometric, biochemical, and dietary assessments were made. Of these men, 2,471 reported being on a diet when first examined in 1963, and 636 were dieting primarily to lose weight. Mortality follow-up covered an 18-year period (1968-1986). Men who lost 5 kg or more between 1963 and 1968 ("extreme weight losers") exhibited the following age-pooled risks of mortality relative to the stable weight group: for total mortality, 1.36 (95% confidence interval (CI) 1.20-1.55); for all cardiovascular disease mortality, 1.40 (95% CI 1.16-1.69); for all non-cardiovascular disease mortality, 1.33 (95% CI 1.11-1.59); for coronary heart disease mortality, 1.55 (95% CI 1.25-1.93); and for cancer mortality, 0.90 (95% CI 0.65-1.24). After adjustment for differences in coronary heart disease risk factor levels and morbidity between these groups at the end of the weight change period (1968), the excess risks associated with extreme weight loss declined by approximately one third. They declined further if adjustment was made for 1963 (pre-weight-change period) morbidity and risk factor levels. Being on a slimming diet, as reported in 1963, was associated with an approximate doubling of excess mortality in men with extreme weight loss. Weight loss in 1963-1968 coincided with an increased incidence of coronary heart disease and diabetes mellitus and a declining level of serum total cholesterol. This and other studies indicate that both voluntary and involuntary weight loss might be associated with a small increase in the risk of all-cause mortality.
Collapse
Affiliation(s)
- S Yaari
- Computing Center, Bar-Ilan University, Ramat-Gan, Israel
| | | |
Collapse
|
45
|
Ashmore JP, Krewski D, Zielinski JM, Jiang H, Semenciw R, Band PR. First analysis of mortality and occupational radiation exposure based on the National Dose Registry of Canada. Am J Epidemiol 1998; 148:564-74. [PMID: 9753011 DOI: 10.1093/oxfordjournals.aje.a009682] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A cohort mortality study of occupational radiation exposure was conducted using the records of the National Dose Registry of Canada. The cohort consisted of 206,620 individuals monitored for radiation exposure between 1951 and 1983 with mortality follow-up through December 31, 1987. A total of 5,426 deaths were identified by computerized record linkage with the Canadian Mortality Data Base. The standardized mortality ratio for all causes of death was 0.61 for both sexes combined. However, trends of increasing mortality with cumulative exposure to whole body radiation were noted for all causes of death in both males and females. In males, cancer mortality appeared to increase with cumulative exposure to radiation, without any clear relation to specific cancers. Unexplained trends of increasing mortality due to cardiovascular diseases (males and females) and accidents (males only) were also noted. The excess relative risk for both sexes, estimated to be 3.0% per 10 mSv (90% confidence interval 1.1-4.8) for all cancers combined, is within the range of risk estimates previously reported in the literature.
Collapse
Affiliation(s)
- J P Ashmore
- Radiation Protection Bureau, Health Canada, Ottawa, Ontario
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Recent discussions have centered on the small apparent risk increase for venous thromboembolism found with newer oral contraceptives (third-generation oral contraceptives containing the progestins desogestrel and gestodene) compared with older oral contraceptives (second-generation). This article reviews the studies addressing the association between oral contraceptive use and thromboembolic conditions affecting the arterial system, ischemic stroke, and myocardial infarction. Differences are found between a US database study, which showed no risk of ischemic stroke or myocardial infarction associated with low-dose oral contraceptive use, and the European studies, which showed oral contraceptive use in general to be associated with increased risks of ischemic stroke and myocardial infarction. The European studies showed no difference between oral contraceptive generations with respect to the occurrence of ischemic stroke; however, the risk of myocardial infarction associated with oral contraceptive use was consistently lower for third- than for second-generation oral contraceptives. Although there seems to be no differential risk of ischemic stroke associated with oral contraceptive generations, third-generation oral contraceptives appear to be consistently associated with no excess risk of myocardial infarction. In all instances, however, cardiovascular risk factors other than oral contraceptive use play the predominant role in the occurrence of ischemic stroke and myocardial infarction.
Collapse
Affiliation(s)
- M A Lewis
- EPES Epidemiology, Pharmacoepidemiology, and Systems Research, Berlin, Germany
| |
Collapse
|
47
|
Abstract
Late in 1995 and early 1996, 4 epidemiologic studies were published that resulted in a crude mean weighted relative risk of approximately 2 when third-generation oral contraceptives were compared with second-generation oral contraceptives as risk factors for venous thromboembolism. This article reviews empirical evidence on bias or systematic error that may have influenced the estimates of association. The Bradford-Hill criteria to distinguish causality from an observed association were used to consider whether third-generation oral contraceptives cause an apparent excess in the occurrence of venous thromboembolism. Bias is more likely than a causal relationship to explain the associations observed for venous thromboembolism. For myocardial infarction, bias may mask the full benefit of third-generation oral contraceptives. For stroke, the question of causality is moot because statistically significant differences between third- and second-generation products have not been detected. The clinical importance and the public health significance of any differences among the various products with respect to adverse cardiovascular outcomes are trivial and undetectable because of the extremely low incidence of those disorders among users of oral contraceptives. The oral contraceptive pill is 99.9% effective when used correctly. All oral contraceptives on the market are safe and getting safer.
Collapse
|
48
|
|
49
|
Abstract
OBJECTIVE In the evaluation of the clinical impact of thrombotic diseases in young women, age-specific incidence rates must be calculated for both arterial and venous thrombotic diseases, but also the case-fatality rate and figures for the clinical consequences among those who survive thrombosis must be included. The aim of this analysis was to quantify the clinical impacts of both arterial and venous thrombotic diseases among young, nonpregnant women and thereafter to assess the influences of oral contraceptives on these measures. STUDY DESIGN Nationwide register data on the morbidity and mortality of venous thromboembolism, myocardial infarction, and thrombotic stroke in Denmark, 1980-1993, and 3 ongoing case-control studies to assess the influence of oral contraceptives on the risk for development of these thrombotic diseases. RESULTS In women 15-29 years old venous thromboembolism is about twice as common as arterial complications, whereas in women 30-44 years old the number of arterial complications exceeds that of venous diseases by about 50%. The mortality rate from arterial diseases is 3.5 times higher than that from venous diseases among women <30 years old and 8.5 times higher than that from venous diseases in women 30-44 years old. The proportion of women with a significant disability among women who had an arterial complication was about 30%; the proportion was about 5% among women with venous thromboembolism. CONCLUSION Anticipating a differential influence on venous and arterial diseases from oral contraceptives with second- and third-generation progestogens, it was calculated that users of oral contraceptives with second-generation progestogens had 30% greater increased risk of thrombotic diseases, 260% greater increased risk of thrombotic deaths, and 220% greater increased risk of thrombotic disability than users of oral contraceptives with third-generation progestogens.
Collapse
Affiliation(s)
- O Lidegaard
- Department of Obstetrics and Gynaecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| |
Collapse
|
50
|
Hallqvist J, Lundberg M, Diderichsen F, Ahlbom A. Socioeconomic differences in risk of myocardial infarction 1971-1994 in Sweden: time trends, relative risks and population attributable risks. Int J Epidemiol 1998; 27:410-5. [PMID: 9698128 DOI: 10.1093/ije/27.3.410] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The general trend in incidence of myocardial infarction (MI) in the Stockholm area changed from increasing to decreasing around 1980. The objective of this study is to examine time trends in incidence in major socioeconomic strata, relative risk between socioeconomic groups and population risk attributable to socioeconomic differences during this period. METHODS All cases of MI from 1971 to 1986 were identified from hospital discharge and cause-of-death registers. Person-years for each year of follow-up were calculated from the population register in the Stockholm region 1971-1986. Census registers were used for information on socioeconomic status. Register information was individually linked through the Swedish personal identification number. Supplementary information for 1992-1994 was taken from the case-control study SHEEP (Stockholm Heart Epidemiology Program). RESULTS The decline in MI risk among male high- and middle-level employees started in 1976 and in male manual workers in 1981. For women incidence increased from 1971 to 1986 among manual workers and decreased among high- and middle-level employees. The increase over time of the relative risk from low socioeconomic position continued into the 1990s. Despite the reduction of the category of manual workers, the population attributable risk from socioeconomic differences also increased over time. The process of social change influencing the size of the socioeconomic groups contributes to the change in time trends of MI morbidity. CONCLUSIONS The increase over time of relative and population attributable risks of MI from low socioeconomic status add to the public health importance of social inequity.
Collapse
Affiliation(s)
- J Hallqvist
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | | | | |
Collapse
|