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Omidi F, Rahmannia M, Khalili F, Shahidi Bonjar AH, Nasiri MJ. Comparing higher-dose and single standard-dose influenza vaccines in preventing cardiovascular events: a meta-analysis with 68,713 patients. Public Health 2024; 235:71-75. [PMID: 39068775 DOI: 10.1016/j.puhe.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/14/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION This manuscript offers an in-depth comparative examination of the effectiveness of higher-dose (double standard-dose and high-dose) influenza vaccines in contrast to a single standard-dose vaccine when it comes to alleviating major cardiovascular events. STUDY DESIGN Meta-Analysis. METHODS To conduct this study, an exhaustive search was carried out in the medical English literature using databases such as PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL until 10 April 2024. The evaluation of associations was achieved through the calculation of pooled relative risks (RRs) accompanied by their corresponding 95% confidence intervals (CIs). RESULTS A meticulous analysis encompassed a comprehensive cohort of 68,713 patients. Among these participants, 34,430 individuals were randomly assigned to receive a higher-dose influenza vaccination, whereas 34,283 received the standard influenza vaccination. Contrary to initial expectations, a higher-dose influenza vaccine did not manifest elevated efficacy compared to the standard-dose vaccine in terms of mitigating major cardiovascular events. The computed pooled RR stood at 1.0, accompanied by a 95% CI ranging from 0.93 to 1.10. CONCLUSION While this systematic review and meta-analysis did not find a statistically significant advantage of higher-dose influenza vaccines over a single standard-dose vaccine in preventing major cardiovascular events, the observed trend towards risk reduction warrants continued investigation. These findings contribute to the ongoing dialogue surrounding vaccination strategies and their implications for cardiovascular outcomes.
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Affiliation(s)
- F Omidi
- Department of Cardiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Rahmannia
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Khalili
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A H Shahidi Bonjar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M J Nasiri
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Grice-Jackson T, Rogers I, Ford E, Dickinson R, Frere-Smith K, Goddard K, Silver L, Topham C, Nahar P, Musinguzi G, Bastiaens H, Van Marwijk H. A community health worker led approach to cardiovascular disease prevention in the UK-SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project. FRONTIERS IN HEALTH SERVICES 2024; 4:1152410. [PMID: 38784704 PMCID: PMC11113076 DOI: 10.3389/frhs.2024.1152410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/20/2024] [Indexed: 05/25/2024]
Abstract
Background This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions. Methods A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework. Results Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme. Conclusion Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.
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Affiliation(s)
- Thomas Grice-Jackson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Robert Dickinson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Kat Frere-Smith
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Katie Goddard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Linda Silver
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Catherine Topham
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Papreen Nahar
- Department of Global Health Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Central Region, Uganda
| | - Hilde Bastiaens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
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Ogungbe O, Grant JK, Ayoola AS, Bansah E, Miller HN, Plante TB, Sheikhattari P, Commodore-Mensah Y, Turkson-Ocran RAN, Juraschek SP, Martin SS, Lin M, Himmelfarb CR, Michos ED. Strategies for Improving Enrollment of Diverse Populations with a Focus on Lipid-Lowering Clinical Trials. Curr Cardiol Rep 2023; 25:1189-1210. [PMID: 37787858 DOI: 10.1007/s11886-023-01942-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW We review under-representation of key demographic groups in cardiovascular clinical trials, focusing on lipid-lowering trials. We outline multilevel strategies to recruit and retain diverse populations in cardiovascular trials. RECENT FINDINGS Barriers to participation in trials occur at the study, participant, health system, sponsor, and policy level, requiring a multilevel approach to effectively increase participation of under-represented groups in research. Increasing the representation of marginalized and under-represented groups in leadership positions in clinical trials can ensure that their perspectives and experiences are considered. Trial design should prioritize patient- and community-indicated needs. Women and individuals from racially/ethnically diverse populations remain under-represented in lipid-lowering and other cardiovascular clinical trials relative to their disease burden in the population. This limits the generalizability of trial results to the broader population in clinical practice. Collaboration between community stakeholders, researchers, and community members can facilitate shared learning about trials and build trust.
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Affiliation(s)
- Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jelani K Grant
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Eyram Bansah
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hailey N Miller
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Payam Sheikhattari
- School of Community Health & Policy, Morgan State University, Baltimore, MD, 21251, USA
- Prevention Sciences Research Center, Morgan State University, Baltimore, MD, 21251, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Seth S Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA.
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Ivanova MY, Hall A, Weinberger S, Buckingham SL, Copeland WE, Crockett P, Dainer-Best J, D'Alberto C, Dewey L, Foret D, Galano M, Goodrich L, Holly L, Lane N, Leahey M, Lerner M, Marsh J, McGinnis E, Paiva-Salisbury M, Shaw JS, Swift P, Tinker R, Hudziak JJ. The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life. Child Psychiatry Hum Dev 2023; 54:1297-1308. [PMID: 35246775 PMCID: PMC9793330 DOI: 10.1007/s10578-022-01329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 01/30/2023]
Abstract
This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.
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Affiliation(s)
- Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - Allison Hall
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Sara L Buckingham
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Phoenix Crockett
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | | | - Lauren Dewey
- Department of Psychological Sciences, University of Vermont, Burlington, VT, USA
| | - DeShan Foret
- University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Maria Galano
- Department of Psychological and Brain Sciences, University of Massachusetts at Amherst, Amherst, MA, USA
| | - Lisa Goodrich
- University of Vermont Medical Center, Burlington, VT, USA
| | - Lindsay Holly
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Nalini Lane
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Maureen Leahey
- University of Vermont Medical Center, Burlington, VT, USA
| | - Mathew Lerner
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jasmine Marsh
- University of Vermont Medical Center, Burlington, VT, USA
| | - Ellen McGinnis
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Judith S Shaw
- Department of Pediatrics, University of Vermont, Burlington, VT, USA
| | - Pamela Swift
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Rebekah Tinker
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - James J Hudziak
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
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Bauer KL, Haapanen KA, Demeke N, Fort MP, Henderson KH. Increasing use of systems science in cardiovascular disease prevention to understand how to address geographic health disparities in communities with a disproportionate burden of risk. Front Cardiovasc Med 2023; 10:1216436. [PMID: 37522076 PMCID: PMC10374219 DOI: 10.3389/fcvm.2023.1216436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Marginalized communities shoulder a disproportionate burden of cardiovascular disease (CVD) driven by concentrated neighborhood social risk factors. We provide a case study of systems science application to address geographic CVD health disparities at the community level - informing the science of CVD health disparities research. Methods We conducted a two-phased, multi-methods needs assessment in the Denver, Colorado area. Phase I consisted of a social network analysis to map a two-mode network of existing CVD prevention interventions and their implementing organizations. In Phase II, group model building (GMB) sessions with key community, public health, and healthcare provider stakeholders, were utilized to identify and visualize community factors contributing to disparities in CVD risk, producing a consensus-based causal loop diagram. Results Between May 2021 and June 2022, we conducted 24 virtual, semi-structured interviews in Phase I to describe CVD prevention interventions, and 7 virtual GMB sessions in Phase II to describe experiences of disparities in CVD risk. For the purposes of this paper, we focus on a subset of results for both phases. In Phase I we identified 89 active CVD prevention interventions, 29 of which addressed tobacco use. In Phase II, causal loop diagrams revealed root causes of disparities in CVD risk. We provide an example of a causal loop diagram that focuses on the community prevalence of tobacco use, identifying stress as a key underlying factor driving disparities. The integration of findings from both phases highlighted the alignment and misalignment between quit tobacco intervention goals and how they are being experienced in marginalized communities. Conclusion Systems science methods were useful to organize a large number of CVD prevention efforts, and evaluate the root causes of CVD health disparities in a high risk community. By integrating these two aspects, interventions may be reoriented to more effectively address the root causes of CVD health disparities.
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Affiliation(s)
- Kyla L. Bauer
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Krista A. Haapanen
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, United States
| | - Nathaniel Demeke
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Meredith P. Fort
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kamal H. Henderson
- Department of Cardiology, University of Colorado Denver School of Medicine, Aurora, CO, United States
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Zhao M, Duan X. Assessing financial performance through green bond markets and energy reliance in Asian economies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:70421-70436. [PMID: 37148516 DOI: 10.1007/s11356-023-27173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
This article's overarching goal is to learn more about the effects of financial performance on the reliance upon or migration to energy efficiency sources in Asian countries using data envelopment analysis (DEA) and system GMM from 2017 to 2022. The results demonstrated the importance of relying on renewable energy sources when expanding the electricity sector effectively in an Asian environment. This same influence of green bond financing on energy investment during an eco-friendly improving economy is in addition to the proportion of renewable energy demands, power usage to gross domestic product, power manufacturing stretchability, electricity usage stretchability, or the overall impact of renewable energy transformation. The analysis revealed that the organizational climate has implicit implications that advance wage activity and that Asian financial systems drove a 30% point transition in the period studied from traditional power generation manufacturing and use methods toward sustainable energy. With this, we see a dramatic increase in the use of green power. This is largely attributable to the widespread use of green financing in constructing hydroelectric facilities throughout Asia. The theoretical underpinnings and empirical setting of the research are both original. Moreover, the association between green bond issuance and green, sustainable growth in industry and agriculture supports the response theory. Major governmental aspects include modernizing and expanding the finance system, updating national efficiency metrics, and creating a technological long-term infrastructure market. While previous studies have looked into the connections between green finance and economic growth, technological advancements in the energy sector, environmental responsibility, and renewable energy sources, this study is the first to focus on how green finance facilitates the shift to renewable energy in Asia's economies. The study's findings suggest how to manage renewable energy in Asia in a way that could work.
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Affiliation(s)
- Meng Zhao
- School of Economics, Henan Institute of Technology, Xinxiang, 453003, Henan, China.
| | - Xiao Duan
- School of Journalism and Communication, Xinxiang University, Xinxiang, 453003, Henan, China
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A Brief Report: Effectiveness of a One Time Health Promotion Intervention in Sustaining Knowledge About Cardiovascular Diseases Among Latino/Hispanic Women. J Immigr Minor Health 2023; 25:489-495. [PMID: 36460937 DOI: 10.1007/s10903-022-01431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/04/2022]
Abstract
Health promotion programs are effective at reducing cardiovascular diseases (CVDs). One-time health promotion programs are effective at increasing immediate knowledge gain about CVDs. It is unknown if such interventions translate into sustained knowledge gain or actual behavior modifications. We surveyed a group of mostly Latino/Hispanic women who previously participated in a Por Tu Corazon even to determine if knowledge gain were sustained after two years and risk reduction behaviors were implemented. Of 125, participants, 56% returned two years later. There was no difference between the knowledge score of the initial post-event survey and the subsequent pre-event survey (78.85 ± 22.55 vs. 75.2 ± 24.01, p = 0.34). Of the 70 participants who returned two years later, 63% reported implementing at least one risk modification. Sustained knowledge gain about CVDs and implementation of risk modifications can be achieved after a single health promotion intervention in a highly motivated group of Latino/Hispanic women.
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Lontano A, Marziali E, Galletti C, Mazza E, Gambioli S, Galasso V, Mingarelli A, D'Ambrosio F, Tamburrano A, Paolini M, Bande A, Damiani G, de Waure C, Laurenti P. A real opportunity to modify cardiovascular risk through primary care and prevention: A pilot study. Front Public Health 2023; 10:1009246. [PMID: 36703856 PMCID: PMC9871452 DOI: 10.3389/fpubh.2022.1009246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiovascular diseases (CVDs) represent a major threat to health and primary prevention outstands as the most effective instrument to face this issue, addressing multiple risk factors at a time and influencing behavioral patterns. Community nurses have been involved in many interdisciplinary prevention activities, resulting in effective control of CV risk factors. We conducted a pilot study aiming at describing the impact on the CV risk profile of an 18-month interdisciplinary intervention on lifestyle habits. From September 2018 to May 2020, four general practitioners (GPs) working in the Roman neighborhood of Torresina recruited patients having a cardiovascular risk score (CRS) equal to or higher than 3% and lower than 20%; those patients were included in a nutritional, physical, and psychological counseling program. Assessments of patients' health status were led at baseline, 6, 12, and 18 months by a nutritionist, a physiotherapist, a psychologist, their GPs, and a community nurse. The CRS was estimated at every examination, based on the Italian Progetto Cuore algorithm. A total of 76 patients were included (mean age of 54.6 years; 33 men and 43 women). Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8); both total cholesterol and systolic blood pressure (SBP) significantly decreased at 6 months of follow-up (respectively, from 211.1 to 192 and from 133.1 to 123.1). Nonetheless, the reduction was later maintained only for SBP. However, during the last 6 months of the intervention, the COVID-19 pandemic broke out, thus, it is not possible to know how much the results achieved at 18 months were influenced by the restrictive measures introduced by the Italian government. When stratifying according to the presence of hypertension/diabetes and physical activity, no differences in the CRS could be highlighted between the two groups. Our pilot study proved that an interdisciplinary counseling intervention program can improve CV risk profile and could be further spread to people that, according to their CRS, would benefit more from changes in lifestyles.
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Affiliation(s)
| | - Eleonora Marziali
- Università Cattolica del Sacro Cuore, Rome, Italy,*Correspondence: Eleonora Marziali ✉
| | | | - Eduardo Mazza
- Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | | | - Alessandro Mingarelli
- DiagnostiCare ONLUS, Rome, Italy,Scuola di Specializzazione in Psicologia della Salute–Università degli Studi di Roma “La Sapienza”, Rome, Italy
| | | | | | | | | | - Gianfranco Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Patrizia Laurenti
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Umishio W, Ikaga T, Kario K, Fujino Y, Suzuki M, Hoshi T, Ando S, Yoshimura T, Yoshino H, Murakami S. Association between Indoor Temperature in Winter and Serum Cholesterol: A Cross-Sectional Analysis of the Smart Wellness Housing Survey in Japan. J Atheroscler Thromb 2022; 29:1791-1807. [PMID: 35570002 PMCID: PMC9881535 DOI: 10.5551/jat.63494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM Issuance of the WHO Housing and health guidelines has paralleled growing interest in the housing environment. Despite accumulating evidence of an association between outdoor temperature and serum cholesterol, indoor temperature has not been well investigated. This study examined the association between indoor temperature and serum cholesterol. METHODS We collected valid health checkup data of 2004 participants (1333 households), measured the indoor temperature for 2 weeks in winter, and divided participants according to whether they lived in a warm (average bedroom temperature ≥ 18℃), slightly cold (12-18℃) or cold house (<12˚C). The relationship between bedroom temperature and serum cholesterol was analyzed using multivariate logistic regression models, adjusting for demographics, lifestyle habits and the season in which the health checkup was conducted, with a random effect of climate areas in Japan. RESULTS The sample sizes for warm, slightly cold, and cold houses were 206, 940, and 858, respectively. Compared to those in warm houses, the odds ratio of total cholesterol exceeding 220 mg/dL was 1.83 (95%CI: 1.23-2.71, p=0.003) for participants in slightly cold houses and 1.87 (95%CI: 1.25-2.80, p=0.002) in cold houses. Similarly, the odds ratio of LDL/non-HDL cholesterol exceeding the standard range was 1.49 (p=0.056)/1.67 (p=0.035) for those in slightly cold houses and 1.64 (p=0.020)/1.77 (p=0.021) in cold houses. HDL cholesterol and triglycerides were not significantly associated with bedroom temperature. CONCLUSION Besides lifestyle modification, improving indoor thermal environment through strategies such as installing high thermal insulation and appropriate use of heating devices may contribute to better serum cholesterol condition.
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Affiliation(s)
- Wataru Umishio
- Department of Architecture and Building Engineering, School of Environment and Society, Tokyo Institute of Technology, Tokyo, Japan,Department of System Design Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Toshiharu Ikaga
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masaru Suzuki
- Department of Emergency Medicine, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | | | - Shintaro Ando
- Department of Architecture, Faculty of Environmental Engineering, The University of Kitakyushu, Fukuoka, Japan
| | | | | | - Shuzo Murakami
- Institute for Built Environment and Carbon Neutral for SDGs, Tokyo, Japan
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10
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Slater K, Colyvas K, Taylor R, Collins CE, Hutchesson M. Primary and secondary cardiovascular disease prevention interventions targeting lifestyle risk factors in women: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1010528. [PMID: 36439996 PMCID: PMC9681924 DOI: 10.3389/fcvm.2022.1010528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/25/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND AND AIMS Over seven million women die from cardiovascular disease (CVD) annually. While lifestyle modification is recommended for CVD prevention, there are no systematic reviews evaluating the effectiveness of interventions targeted to women. The primary aim of this systematic review is to determine the efficacy of primary and secondary CVD prevention interventions targeting lifestyle risk factors in women. METHODS Six electronic databases were searched up to January 2022. Eligible studies included randomized controlled trials of primary or secondary CVD prevention interventions targeting CVD lifestyle risk factors (diet, physical activity, sedentary behavior, smoking, alcohol, sleep, and weight management) in women (≥18 years) that reported CVD risk markers or lifestyle risk factors. Meta-analyses were conducted on CVD risk markers and body mass index (BMI), and the level of evidence was applied to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and reported. RESULTS Thirty-five RCTs were included (24 primary and 11 secondary prevention). Meta-analyses demonstrated that lifestyle CVD prevention interventions achieved statistically significant reductions in BMI at ≤ 6 months (0.95 kg/m2, 95% CI = 0.54 to 1.35, p < 0.0001), 12 months (0.61 kg/m2, 95% CI = 0.07 to 1.16, p = 0.03) and >12 months (0.58 kg/m2, 95% CI = 0.01 to 1.16, p = 0.05), and systolic blood pressure (mmHg) at ≤ 6 months (3.51, p < 0.001). CONCLUSIONS Lifestyle interventions are important for the prevention of CVD in women, specifically to reduce systolic blood pressure in the short term (≤ 6 months) and BMI long term (>12 months). SYSTEMATIC REVIEW REGISTRATION https://osf.io/bkwqm, identifier: osf-registrations-bkwqm-v1.
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Affiliation(s)
- Kaylee Slater
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kim Colyvas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Rachael Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Melinda Hutchesson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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11
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Werba JP, Giroli MG, Simonelli N, Vigo L, Gorini A, Bonomi A, Veglia F, Tremoli E. Uptake and effectiveness of a primary cardiovascular prevention program in an underserved multiethnic urban community. Nutr Metab Cardiovasc Dis 2022; 32:1110-1120. [PMID: 35260313 DOI: 10.1016/j.numecd.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Cardiometabolic risk is increased among disadvantaged people and ethnic minorities. Paradoxically, their uptake of primary cardiovascular prevention is relatively low. New strategies are needed to tackle this public health problem. Aims of this study were to assess the uptake (as well as its determinants) and effectiveness of a primary cardiovascular prevention program for communities devised to facilitate access of disadvantaged and inclusion of ethnic minorities in addition to providing a state-of-the-art interdisciplinary personalized care. METHODS AND RESULTS Single center, hospital-based, open study. All the residents in an underserved multiethnic urban community aged 40-65 years (n = 1646, 43.6% immigrants) were proactively invited by post mail to participate in a cardiovascular prevention program and different approaches were adopted to promote accessibility and inclusiveness. Program uptake was 23% and individual features independently associated with program uptake were status of immigrant (OR [CI 95%]: 3.6 [2.6-5.1]), higher educational level (3.6 [2.8-4.7]), and female gender (1.6 [1.2-2.1]). Retention was 82% at 6 months and 69% at 12 months. A predefined outcome of global cardiovascular risk improvement at 12 months in subjects with glycaemia >126 mg/dl, LDL-C >115 mg/dl, systolic blood pressure ≥140 mmHg or BMI >28 at baseline was reached in 35%, 33%, 37% and 7% of the patients, respectively. 20% of smokers quitted and significant favorable changes were reported in diet quality, anxiety, depression and physical activity. CONCLUSION Access inequalities to effective prevention may be counteracted, but increasing global uptake requires further upstream sensitization and awareness actions. REGISTERED IN CLINICALTRIALS.GOV: NCT03129165.
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Affiliation(s)
- José P Werba
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.
| | - Monica G Giroli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Niccolò Simonelli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Struttura Complessa Cardiologia, Azienda Ospedaliera Ss. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Lorenzo Vigo
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Alessandra Gorini
- Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/a, 20122 Milan, Italy; Istituti Clinici Scientifici Maugeri di Milano, IRCCS, 20138 Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola Ravenna, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola Ravenna, Italy
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12
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Khodayari‐Zarnaq R, Alizadeh G. Cardiovascular diseases preventive policy‐making process in Iran: A framework‐based policy analysis. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rahim Khodayari‐Zarnaq
- Department of Health Policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute Tabriz University of Medical Sciences Tabriz Iran
| | - Gisoo Alizadeh
- Department of Health Policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
- Social Determinants of Health Research Center Zanjan University of Medical Sciences Iran
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13
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The Feasibility of a Primary Care Based Navigation Service to Support Access to Health and Social Resources: The Access to Resources in the Community (ARC) Model. Int J Integr Care 2022; 22:13. [PMID: 36474646 PMCID: PMC9695153 DOI: 10.5334/ijic.6500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. METHODS We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. RESULTS Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). CONCLUSION The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients' access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).
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Fritz M, Fromell H. How to Dampen the Surge of Non-Communicable Diseases in Southeast Asia: Insights from a Systematic Review and Meta-Analysis. Health Policy Plan 2021; 37:152-167. [PMID: 34791261 PMCID: PMC8757494 DOI: 10.1093/heapol/czab138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 01/04/2023] Open
Abstract
Non-communicable diseases (NCDs), such as diabetes, cancer, cardiovascular diseases and chronic respiratory diseases, have overtaken infectious diseases as the number one cause of death worldwide. The rise of these diseases is especially grave in Southeast Asia, where existing research however falls short on offering guidance on how policy can best prevent and control NCDs in the region. Additionally, low- and middle-income countries in Southeast Asia cannot directly incorporate lessons drawn from interventions in richer countries, since health system capacities and human and financial resources are thoroughly different. Preventive interventions, thus, need to correspond to local capacities and require contextual solutions. In this article, we provide a systematic review of a wide scope of NCD interventions conducted in Southeast Asia to inform about existing intervention designs and to derive sound evidence of their effectiveness. Our literature search results in 51 studies from five Southeast Asian countries from which we can extract 204 estimates. We sort the studies into six intervention categories and analyse them with respect to 23 different health and behavioural outcomes. While we find positive and significant average effects across all six types of interventions, we also document evidence of substantial publication bias. Using a meta-regression approach in which we correct for the publication bias, we instead fail to confirm positive average effects for some interventions. Especially dietary and physical activity interventions fail to achieve improvements in analysed health outcomes, while programs focusing on smoking cessation, on the take-up of preventive screening activities or educating patients on how to cope with NCDs achieve sizeable effects. We also present evidence that the size of the effect differs with the participants’ characteristics as well as with design features of the intervention. For local policymakers, the results provide important knowledge on how to address the increasing NCD burden in the coming years.
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Affiliation(s)
- Manuela Fritz
- University of Passau, Faculty of Economics, Business and Information Systems, Chair of Development Economics, Innstraße 29, 94032 Passau, Germany.,University of Groningen, Department of Economics, Econometrics and Finance, Nettelbosje 2, 9747 AE Groningen, The Netherlands
| | - Hanna Fromell
- University of Groningen, Department of Economics, Econometrics and Finance, Nettelbosje 2, 9747 AE Groningen, The Netherlands.,Aarhus University, Department of Economics and Business Economics, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
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15
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Soltani S, Saraf-Bank S, Basirat R, Salehi-Abargouei A, Mohammadifard N, Sadeghi M, Khosravi A, Fadhil I, Puska P, Sarrafzadegan N. Community-based cardiovascular disease prevention programmes and cardiovascular risk factors: a systematic review and meta-analysis. Public Health 2021; 200:59-70. [PMID: 34700187 DOI: 10.1016/j.puhe.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to summarise the effect of community-based intervention programmes on the prevention of cardiovascular disease (CVD) by reducing cardiometabolic risk factors. STUDY DESIGN This was a systematic review and meta-analysis. METHODS A systematic search in the PubMed database and screening of reference lists aimed to identify community-based CVD prevention programmes from inception up to April 2020. The mean differences and standard deviations for CVD risk factors, including blood pressure, lipid profile, blood glucose and body weight indices, were extracted and pooled using a random effects model. RESULTS Screening of 11,889 titles/abstracts and full texts resulted in 48 studies being included in this review. The meta-analysis showed that community-based programmes have led to considerable decreases in systolic blood pressure (weighted mean difference [WMD] = -2.90 mm Hg, 95% confidence interval [95% CI]: -3.63, -2.16), diastolic blood pressure (WMD = -2.21 mm Hg, 95% CI: -3.12, -1.29), serum levels of low-density lipoprotein cholesterol (LDL-C; WMD = -8.88 mg/dl, 95% CI: -12.84, -4.92), triglycerides (WMD = -8.40 mg/dl, 95% CI: -12.10, -4.70), total cholesterol (WMD = -2.96 mg/dl, 95% CI: -3.10, -2.81) and fasting blood glucose (WMD = -2.06 mg/dl, 95% CI: -3.02, -1.10). A moderate decrease in body weight was also found with community-based CVD prevention programmes. However, community-based CVD prevention programmes were not associated with any significant changes in serum levels of high-density lipoprotein. CONCLUSIONS The present study indicates that community-based strategies have successfully led to an improvement in CVD risk factors, particularly by reducing blood pressure, serum levels of LDL-C and triglycerides, obesity indices and blood glucose. The impact of these programmes on CVD is modified by the type of intervention and by different cultural and physical environments.
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Affiliation(s)
- S Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - S Saraf-Bank
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R Basirat
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Salehi-Abargouei
- Nutrition and Food Security Research Center, Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - N Mohammadifard
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - I Fadhil
- Eastern Mediterranean NCD Alliance, Kuwait City, Kuwait
| | - P Puska
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - N Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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16
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Ndejjo R, Hassen HY, Wanyenze RK, Musoke D, Nuwaha F, Abrams S, Bastiaens H, Musinguzi G. Community-Based Interventions for Cardiovascular Disease Prevention in Low-and Middle-Income Countries: A Systematic Review. Public Health Rev 2021; 42:1604018. [PMID: 34692177 PMCID: PMC8386815 DOI: 10.3389/phrs.2021.1604018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/07/2021] [Indexed: 01/05/2023] Open
Abstract
Objectives: To synthesize evidence on the effectiveness of community-based interventions for cardiovascular disease (CVD) prevention in low- and middle-income countries (LMICs) to inform design of effective strategies for CVD prevention. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane register of controlled studies and PSYCINFO databases for studies published between January 2000 and June 2019. Other studies were identified from gray literature sources and review of reference lists of included studies. The primary outcomes for the review were those aimed at primary prevention of CVD targeting physical activity, diet, smoking and alcohol consumption. Results: Database searches yielded 15,885 articles and 94 articles were identified through snowball searching. After screening, the articles from LMICs were 32 emanating from 27 studies: 9 cluster randomized trials, eight randomized controlled trials and 10 controlled before and after studies. Community-based interventions successfully improved population knowledge on CVD and risk factors and influenced physical activity and dietary practices. Evidence of interventions on smoking cessation and reduced alcohol consumption was inconsistent. Conclusion: This evidence should inform policy makers in decision-making and prioritizing evidence-based interventions.
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Affiliation(s)
- Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hamid Yimam Hassen
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steven Abrams
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), UHasselt, Belgium
| | - Hilde Bastiaens
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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17
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Umishio W, Ikaga T, Kario K, Fujino Y, Suzuki M, Ando S, Hoshi T, Yoshimura T, Yoshino H, Murakami S. Electrocardiogram abnormalities in residents in cold homes: a cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan. Environ Health Prev Med 2021; 26:104. [PMID: 34641787 PMCID: PMC8513347 DOI: 10.1186/s12199-021-01024-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Background Excess winter mortality caused by cardiovascular disease is particularly profound in cold houses. Consistent with this, accumulating evidence indicates that low indoor temperatures at home increase blood pressure. However, it remains unclear whether low indoor temperatures affect other cardiovascular biomarkers. In its latest list of priority medical devices for management of cardiovascular diseases, the World Health Organization (WHO) included electrocardiography systems as capital medical devices. We therefore examined the association between indoor temperature and electrocardiogram findings. Methods We collected electrocardiogram data from 1480 participants during health checkups. We also measured the indoor temperature in the living room and bedroom for 2 weeks in winter, and divided participants into those living in warm houses (average exposure temperature ≥ 18 °C), slightly cold houses (12–18 °C), and cold houses (< 12 °C) in accordance with guidelines issued by the WHO and United Kingdom. The association between indoor temperature (warm vs. slightly cold vs. cold houses) and electrocardiogram findings was analyzed using multivariate logistic regression models, with adjustment for confounders such as demographics (e.g., age, sex, body mass index, household income), lifestyle (e.g., eating habit, exercise, smoking, alcohol drinking), and region. Results The average temperature at home was 14.7 °C, and 238, 924, and 318 participants lived in warm, slightly cold, and cold houses, respectively. Electrocardiogram abnormalities were observed in 17.6%, 25.4%, and 30.2% of participants living in warm, slightly cold, and cold houses, respectively (p = 0.003, chi-squared test). Compared to participants living in warm houses, the odds ratio of having electrocardiogram abnormalities was 1.79 (95% confidence interval: 1.14–2.81, p = 0.011) for those living in slightly cold houses and 2.18 (95% confidence interval: 1.27–3.75, p = 0.005) for those living in cold houses. Conclusions In addition to blood pressure, living in cold houses may have adverse effects on electrocardiogram. Conversely, keeping the indoor thermal environment within an appropriate range through a combination of living in highly thermal insulated houses and appropriate use of heating devices may contribute to good cardiovascular health. Trial registration The trial was retrospectively registered on 27 Dec 2017 to the University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, https://www.umin.ac.jp/ctr/, registration identifier number UMIN000030601). Supplementary Information The online version contains supplementary material available at 10.1186/s12199-021-01024-1.
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Affiliation(s)
- Wataru Umishio
- Department of Architecture and Building Engineering, School of Environment and Society, Tokyo Institute of Technology, W8-11, 2-12-1, Ookayama, Meguro-ku, Tokyo, 152-8552, Japan. .,Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, Japan.
| | - Toshiharu Ikaga
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, Japan
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Masaru Suzuki
- Department of Emergency Medicine, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Chiba, Japan
| | - Shintaro Ando
- Department of Architecture, Faculty of Environmental Engineering, University of Kitakyushu, Kitakyushu, Fukuoka, Japan
| | - Tanji Hoshi
- Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Takesumi Yoshimura
- University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | | | - Shuzo Murakami
- Institute for Building Environment and Energy Conservation, Kojimachi, Chiyoda-ku, Tokyo, Japan
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Sidebottom AC, Miedema MD, Benson G, Vacquier M, VanWormer JJ, Sillah A, Lindberg R, Boucher JL, Bradley SM. The impact of a population-based prevention program on cardiovascular events: Findings from the heart of new Ulm project. Am Heart J 2021; 239:38-51. [PMID: 33957104 DOI: 10.1016/j.ahj.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and its associated risk factors are the principal drivers of mortality and healthcare costs in the United States with rural residents experiencing higher CVD death rates than their urban counterparts. METHODS The purpose of this study was to examine incidence of major CVD events over 9 years of implementation of the Heart of New Ulm (HONU) Project, a rural population-based CVD prevention initiative. HONU interventions were delivered at individual, organizational, and community levels addressing clinical risk factors, lifestyle behaviors and environmental changes. The sample included 4,056 residents of New Ulm matched with 4,056 residents from a different community served by the same health system. The primary outcome was a composite of major CVD events (myocardial infarction, ischemic stroke, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and CVD-related death). Secondary outcomes were the individual CVD events and procedures. RESULTS The proportion of residents in New Ulm with a major CVD event (7.79%) was not significantly different than the comparison community (8.43%, P = .290). However, the total number of events did differ by community with fewer events in New Ulm than the comparison community (447 vs 530, P = .005), with 48 fewer strokes (84 vs 132, P = .001) and 42 fewer PCI procedures (147 vs 189, P = 0.019) in New Ulm. Incidence of ischemic stroke was lower in the New Ulm community (1.85 vs 2.61, P = .020) than in the comparison community. Other specific CVD events did not have significantly different incidence or frequencies between the 2 communities. CONCLUSION In HONU, the proportion of residents experiencing a CVD event was not significantly lower than a match comparison community. However, there was a significant reduction in the total number of CVD events in New Ulm, driven primarily by lower stroke, PCI, and CABG events in the intervention community.
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19
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Kuneinen SM, Eriksson JG, Kautiainen H, Ekblad MO, Korhonen PE. The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century. Scand J Prim Health Care 2021; 39:157-165. [PMID: 34092186 PMCID: PMC8293959 DOI: 10.1080/02813432.2021.1913893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. DESIGN A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner's (GP) appointment for high-risk persons. Screening and interventions were performed during 2005-2006. SETTING A public health care centre in the town of Harjavalta, Finland. SUBJECTS All home-dwelling 45-70-year old inhabitants without manifested CVD or diabetes. MAIN OUTCOME MEASURES All-cause and CVD mortality. RESULTS Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants'. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. CONCLUSIONS Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis.Key PointsPreviously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality.With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community.Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons.Subjects not willing to participate in health surveys have the worst prognosis.
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Affiliation(s)
- Susanna M. Kuneinen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Mikael O. Ekblad
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
| | - Päivi E. Korhonen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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Evolution of Cardiovascular Risk Factors in a Worker Cohort: A Cluster Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115610. [PMID: 34074004 PMCID: PMC8197309 DOI: 10.3390/ijerph18115610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 12/03/2022]
Abstract
The identification of the cardiovascular risk factor (CVRF) profile of individual patients is key to the prevention of cardiovascular disease (CVD), and the development of personalized preventive approaches. Using data from annual medical examinations in a cohort of workers, the aim of the study was to characterize the evolution of CVRFs and the CVD risk score (SCORE) over three time points between 2009 and 2017. For descriptive analyses, mean, standard deviation, and quartile values were used for quantitative variables, and percentages for categorical ones. Cluster analysis was performed using the Kml3D package in R software. This algorithm, which creates distinct groups based on similarities in the evolution of variables of interest measured at different time points, divided the cohort into 2 clusters. Cluster 1 comprised younger workers with lower mean body mass index, waist circumference, blood glucose values, and SCORE, and higher mean HDL cholesterol values. Cluster 2 had the opposite characteristics. In conclusion, it was found that, over time, subjects in cluster 1 showed a higher improvement in CVRF control and a lower increase in their SCORE, compared with cluster 2. The identification of subjects included in these profiles could facilitate the development of better personalized medical approaches to CVD preventive measures.
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21
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Lotfaliany M, Mansournia MA, Azizi F, Hadaegh F, Zafari N, Ghanbarian A, Mirmiran P, Oldenburg B, Khalili D. Long-term effectiveness of a lifestyle intervention on the prevention of type 2 diabetes in a middle-income country. Sci Rep 2020; 10:14173. [PMID: 32843718 PMCID: PMC7447773 DOI: 10.1038/s41598-020-71119-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/31/2020] [Indexed: 01/01/2023] Open
Abstract
This study aims to assess the effects of a community-based lifestyle intervention program on the incidence of type 2 diabetes (T2D). For this purpose, three communities in Tehran were chosen; one community received a face-to-face educational session embedded in a long-term community-wide lifestyle intervention aimed at supporting lifestyle changes. We followed up 9,204 participants (control: 5,739, intervention: 3,465) triennially from 1999 to 2015 (Waves 1-5). After a median follow-up of 3.5 years (wave 2), the risk of T2D was 30% lower in the intervention community as compared with two control communities by (Hazard-ratio: 0.70 [95% CI 0.53; 0.91]); however, the difference was not statistically significant in the following waves. After a median follow-up of 11.9 years (wave 5), there was a non-significant 6% reduction in the incidence of T2D in the intervention group as compared to the control group (Hazard-ratio: 0.94 [0.81, 1.08]). Moreover, after 11.9 years of follow-up, the intervention significantly improved the diet quality measured by the Dietary Approaches to Stop Hypertension concordance (DASH) score. Mean difference in DASH score in the intervention group versus control group was 0.2 [95% CI 0.1; 0.3]. In conclusion, the intervention prevented T2D by 30% in the short-term (3.5 years) but not long-term; however, effects on improvement of the diet maintained in the long-term.Registration: This study is registered at IRCT, a WHO primary registry ( https://irct.ir ). The registration date 39 is 2008-10-29 and the IRCT registration number is IRCT138705301058N1.
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Affiliation(s)
- Mojtaba Lotfaliany
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Mohamad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Arash Ghanbarian
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Brian Oldenburg
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P O Box: 19395-4763, Tehran, Iran.
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Journath G, Hammar N, Vikström M, Linnersjö A, Walldius G, Krakau I, Lindgren P, de Faire U, Hellenius ML. A Swedish primary healthcare prevention programme focusing on promotion of physical activity and a healthy lifestyle reduced cardiovascular events and mortality: 22-year follow-up of 5761 study participants and a reference group. Br J Sports Med 2020; 54:1294-1299. [PMID: 32680841 PMCID: PMC7588408 DOI: 10.1136/bjsports-2019-101749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2020] [Indexed: 11/04/2022]
Abstract
Objective To evaluate long-term risk of first cardiovascular (CV) events, CV deaths and all-cause deaths in community-dwelling participants of a cardiovascular disease (CVD) prevention programme delivered in a primary care setting. Methods Individuals who visited a primary healthcare service in Sollentuna (Sweden) and agreed to participate in the programme between 1988 and 1993 were followed. They had at least one CV risk factor but no prior myocardial infarction and received support to increase physical activity using the programme Physical Activity on Prescription and to adopt health-promoting behaviours including cooking classes, weight reduction, smoking cessation and stress management. Participants (n=5761) were compared with a randomly selected, propensity score-matched reference group from the general population in Stockholm County (n=34 556). All individuals were followed in Swedish registers until December 2011. Results In the intervention group and the reference group there were 698 (12.1%) and 4647 (13.4%) first CV events, 308 (5.3%) and 2261 (6.5%) CV deaths, and 919 (16.5%) and 6405 (18.5%) all-cause deaths, respectively, during a mean follow-up of 22 years. The HR (95% CI) in the intervention group compared with the reference group was 0.88 (0.81 to 0.95) for first CV events, 0.79 (0.70 to 0.89) for CV deaths and 0.83 (0.78 to 0.89) for all-cause deaths. Conclusions Participation in a CVD prevention programme in primary healthcare focusing on promotion of physical activity and healthy lifestyle was associated with lower risk of CV events (12%), CV deaths (21%) and all-cause deaths (17%) after two decades. Promoting physical activity and healthy living in the primary healthcare setting may prevent CVD.
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Affiliation(s)
- Gunilla Journath
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Max Vikström
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anette Linnersjö
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Krakau
- Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Lindgren
- Medical Management Center, Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,The Swedish Institute for Health Economics, Stockholm, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mai-Lis Hellenius
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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23
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A Comparison of Strategies to Improve Population Diets: Government Policy versus Education and Advice. J Nutr Metab 2020; 2020:5932516. [PMID: 32566280 PMCID: PMC7292975 DOI: 10.1155/2020/5932516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022] Open
Abstract
Different strategies have been utilized in order to improve the healthiness of the population diet. Many interventions employ education, advice, and encouragement (EAE). Those interventions have been carried out in diverse settings and may achieve modest success; the estimated risk of cardiovascular disease is lowered by about 5–15%. An alternative strategy is action policies carried out by the governments. The removal of trans-fatty acids from food is a model for a successful action policy. Other action policies include requiring a substantial reduction in the amount of salt added to processed foods and ordering schools to cease supplying unhealthy food to students. Taxes and subsidies can be used to increase the price of unhealthy foods, such as sugar-rich foods, and reduce the price of healthy foods, such as fruit and vegetables. It is very probable that action policies are more effective than those based on EAE. They are also much more cost-effective.
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Kino S, Bernabé E, Sabbah W. Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234642. [PMID: 31766584 PMCID: PMC6926506 DOI: 10.3390/ijerph16234642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 01/03/2023]
Abstract
This study examined inequalities in dental check-ups and medical screenings using subjective and objective socioeconomic indicators. Data from 23,464 adults, aged 20 years old and over, who participated in a multi-national survey across Europe (Eurobarometer 72.3) were analysed. Participants’ socioeconomic position (SEP) was measured by education, difficulty in paying bills and subjective social status. Use of preventive services was measured by attendance for dental check-ups, cancer and cardiovascular screenings in the past 12 months. Socioeconomic inequalities were assessed in two-level logistic regression (adults nested within countries), adjusting for demographic factors and type of healthcare system. There were apparent social inequalities in using all three preventive services. However, only dental check-ups showed consistent and significant inequalities across all socioeconomic indicators with those in the bottom groups in education (odds ratio: 0.51; 95% confidence interval: 0.46–0.55), difficulty in paying bills (OR: 0.64; 95% CI: 0.59–0.72) and subjective social status (OR: 0.63; 95% CI: 0.57–0.69) having lower odds of reporting dental check-ups in the past 12 months than those in the top groups. Cancer screening was not associated with difficulty in paying bills whereas cardiovascular disease screening was not associated with education and subjective social status. Despite the availability of universal health coverage, there were clear social gradients in using preventive services particularly across education and subjective social status groups. The stronger and more consistent gradients observed in dental check-ups compared to cancer and cardiovascular screening could be attributed to difference in the level of coverage of dental and medical services in Europe.
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Affiliation(s)
- Shiho Kino
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University of Boston, Boston, MA 02115, USA;
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE5 9RS, UK;
- Correspondence:
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE5 9RS, UK;
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25
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Dahrouge S, James K, Gauthier A, Chiocchio F. Engaging patients to improve equitable access to community resources. CMAJ 2019; 190:S46-S47. [PMID: 30404854 DOI: 10.1503/cmaj.180408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Simone Dahrouge
- Department of Family Medicine (Dahrouge), University of Ottawa, Ottawa, Ont.; patient partner (James), Ottawa, Ont.; Centre for Rural and Northern Health Research, (Gauthier), Laurentian University, Sudbury, Ont.; Telfer School of Management (Chiocchio), University of Ottawa, Ottawa, Ont.
| | - Karen James
- Department of Family Medicine (Dahrouge), University of Ottawa, Ottawa, Ont.; patient partner (James), Ottawa, Ont.; Centre for Rural and Northern Health Research, (Gauthier), Laurentian University, Sudbury, Ont.; Telfer School of Management (Chiocchio), University of Ottawa, Ottawa, Ont
| | - Alain Gauthier
- Department of Family Medicine (Dahrouge), University of Ottawa, Ottawa, Ont.; patient partner (James), Ottawa, Ont.; Centre for Rural and Northern Health Research, (Gauthier), Laurentian University, Sudbury, Ont.; Telfer School of Management (Chiocchio), University of Ottawa, Ottawa, Ont
| | - Francois Chiocchio
- Department of Family Medicine (Dahrouge), University of Ottawa, Ottawa, Ont.; patient partner (James), Ottawa, Ont.; Centre for Rural and Northern Health Research, (Gauthier), Laurentian University, Sudbury, Ont.; Telfer School of Management (Chiocchio), University of Ottawa, Ottawa, Ont
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26
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Chen S, Sudharsanan N, Huang F, Liu Y, Geldsetzer P, Bärnighausen T. Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China. BMJ 2019; 366:l4064. [PMID: 31296584 PMCID: PMC6619453 DOI: 10.1136/bmj.l4064] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To estimate the causal impact of community based blood pressure screening on subsequent blood pressure levels among older adults in China. DESIGN Regression discontinuity analysis using data from a national cohort study. SETTING 2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults in China. PARTICIPANTS 3899 older adults who had previously undiagnosed hypertension. INTERVENTION Community based hypertension screening among older adults in 2011-12. MAIN OUTCOME MEASURE Blood pressure two years after initial screening. RESULTS The intervention reduced systolic blood pressure: -6.3 mm Hg in the model without covariates (95% confidence interval -11.2 to -1.3) and -8.3 mm Hg (-13.6 to -3.1) in the model that adjusts additionally for demographic, social, and behavioural covariates. The impact on diastolic blood pressure was smaller and non-significant in all models. The results were similar when alternative functional forms were used to estimate the impact and the bandwidths around the intervention threshold were changed. The results did not vary by demographic and social subgroups. CONCLUSIONS Community based hypertension screening and encouraging people with raised blood pressure to seek care and adopt blood pressure lowering behaviour changes could have important long term impact on systolic blood pressure at the population level. This approach could address the high burden of cardiovascular diseases in China and other countries with large unmet need for hypertension diagnosis and care.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Feng Huang
- School of Economics and Key Laboratory of Mathematical Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Yuanli Liu
- School of Public Health, Peking Union Medical College, Beijing, China
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
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27
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Redondo-Bravo L, Fernández-Alvira JM, Górriz J, Mendiguren JM, Sanz J, Fernández-Friera L, García-Ruiz JM, Fernández-Ortiz A, Ibáñez B, Bueno H, Fuster V. Does Socioeconomic Status Influence the Risk of Subclinical Atherosclerosis? J Am Coll Cardiol 2019; 74:526-535. [DOI: 10.1016/j.jacc.2019.05.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/24/2019] [Accepted: 05/03/2019] [Indexed: 12/11/2022]
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28
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Eggink E, Moll van Charante EP, van Gool WA, Richard E. A Population Perspective on Prevention of Dementia. J Clin Med 2019; 8:E834. [PMID: 31212802 PMCID: PMC6617301 DOI: 10.3390/jcm8060834] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 01/21/2023] Open
Abstract
The global number of people living with dementia is expected to increase to 130 million in 2050. Based on extensive evidence from observational studies, it is estimated that about 30% of dementia cases may be attributable to potentially modifiable risk factors. This suggests that interventions targeting these factors could perhaps delay or prevent the onset of dementia. Since the vast majority of people with dementia live in low- and middle-income countries, such interventions should preferably be easy and affordable to implement across a wide range of health care systems. However, to date, results from dementia prevention trials do not provide convincing evidence that treatment of these risk factors reduces the risk of dementia. The current paper aims to give an overview of available evidence for the potential for dementia prevention. In particular, we discuss methodological issues that might complicate the development of effective prevention interventions and explore the opportunities and challenges for future dementia prevention research. Currently, several ongoing and planned trials are testing the effect of multi-domain interventions on dementia risk in high-risk populations. It is desirable that future dementia strategies also target the wider population, through interventions on the individual, community, and population level, in order to constrain the growing prevalence of dementia worldwide.
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Affiliation(s)
- Esmé Eggink
- Department of General Practice, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Willem A van Gool
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Edo Richard
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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29
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Ozoemena EL, Iweama CN, Agbaje OS, Umoke PCI, Ene OC, Ofili PC, Agu BN, Orisa CU, Agu M, Anthony E. Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: a quasi-experimental study. Arch Public Health 2019; 77:23. [PMID: 31143446 PMCID: PMC6532220 DOI: 10.1186/s13690-019-0349-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Education is vital to increasing knowledge, improving prevention and self-care practices for hypertension in older adults. This study aimed to determine the effectiveness of a health education intervention in improving hypertension (HT) knowledge, prevention and self-care practices among retirees in Enugu State, South-east, Nigeria. METHODS In this quasi-experimental study, we enrolled 400 participants in Enugu and Nsukka cities in Enugu State, south-east Nigeria. Participants were assigned to the treatment and control groups. Participants in the intervention/treatment group (T-group) received the intervention provided by public health experts and nurses and participants in the control group (C-group) received health talk without the intervention. Data collected at baseline (before intervention), 16 weeks (4th month) and follow-up (5th month) included demographic variables, knowledge about hypertension, prevention and self-care practices. We used paired samples t-test, Chi-square test and one-way ANOVA repeated measures for data analyses. RESULTS The mean age of the participants was 65.9 (± 8.9) years, the mean SBP and DBP were 136.5 (± 13.3) and 87.9 (± 9.1) respectively. More than half of the participants were (50.3%) were males, and the mean BMI was 23.9 (± 5.1) kg/m2. The paired comparison analysis showed that the mean HT knowledge score significantly increased in the T-group between baseline and 1 month (4th month) post-intervention compared to those in the C-group (P < 0.0001). Also, PA (P = 0.007), sleep pattern and quality (P = 0.003), substance use abstinence (P = 0.000), healthy diet (P = 0.000), and medication adherence (P = 0.000) improved significantly in the T-group compared to the control between baseline and 1 month after intervention. The repeated measures analyses showed statistically significant effects (between-groups analysis) for all outcomes with small to large effect sizes. Similarly, the repeated measures ANOVA analyses showed significant time-by-group interaction effects (within-groups) for all the outcomes with small to large effect sizes. CONCLUSION Community-based health education intervention targeted at older adults can increase HT knowledge, improve prevention and self-care practices of hypertension at the population level.
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Affiliation(s)
- Eyuche L. Ozoemena
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Cylia N. Iweama
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Olaoluwa S. Agbaje
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Prince C. I. Umoke
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Osmond C. Ene
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Perpetua C. Ofili
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Benedicta N. Agu
- Department of Public Health, Faculty of Health Sciences, Madonna University Elele, Port Harcourt, Rivers State Nigeria
| | - Charity U. Orisa
- Department of Human Kinetics, Health and Safety Education, Ignatius Ajuru University of Education, Port Harcourt, Rivers State Nigeria
| | - Michael Agu
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Enejoh Anthony
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
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30
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Khalili D, Asgari S, Lotfaliany M, Zafari N, Hadaegh F, Momenan AA, Nowroozpoor A, Hosseini-Esfahani F, Mirmiran P, Amiri P, Azizi F. Long-Term Effectiveness of a Lifestyle Intervention: A Pragmatic Community Trial to Prevent Metabolic Syndrome. Am J Prev Med 2019; 56:437-446. [PMID: 30777162 DOI: 10.1016/j.amepre.2018.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate the long-term effectiveness of a community-based lifestyle education on primary prevention of metabolic syndrome in a middle-income country. STUDY DESIGN This study followed 3,180 individuals free of metabolic syndrome who were under the coverage of three health centers in Tehran from 1999 until 2015. They were undergoing triennial examinations resulting in four re-exams. People in one of three areas received interventions consisting of family-, school-, and community-based educational programs, including a face-to-face educational session at baseline. Data were analyzed considering the incidence of metabolic syndrome at each re-exam and also repeated-measure analysis including all re-exams together. Weighting was considered to correct selection bias because of loss to follow-up. Data were analyzed in 2017. RESULTS After 3 years, 149 of 852 participants in the intervention and 471 of 2,328 people in control area developed metabolic syndrome at first re-exam resulting in a RR of 0.78 (95% CI=0.67, 0.92). The difference between groups remained unchanged up to the 6-year follow-up (RR=0.79, 95% CI=0.66, 0.93, at second re-exam), but disappeared during the third and fourth re-exams (RR=1.04, 95% CI=0.91, 1.18 and RR=1.03, 95% CI=0.91, 1.16, respectively). Marginal models for longitudinal data showed a significant interaction between intervention and time of re-exams. Further analyses showed that the effect of the intervention might have been rooted in improvement of lipid profile and glucose level. CONCLUSIONS In a middle-income country, face-to-face educational sessions followed by a long-term maintenance community-level educational program could reduce the risk of metabolic syndrome for up to 6 years. A booster face-to-face session is recommended to retain this preventive effect. TRIAL REGISTRATION This study is registered at Iran Registry for Clinical Trials (http://irct.ir) IRCT138705301058N1.
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Affiliation(s)
- Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir-Abbas Momenan
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Nowroozpoor
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Firoozeh Hosseini-Esfahani
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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A Community-Based Intervention for Improving Medication Adherence for Elderly Patients with Hypertension in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050721. [PMID: 30823383 PMCID: PMC6427311 DOI: 10.3390/ijerph16050721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based hypertension intervention intended to enhance patient adherence to prescribed medications. This study applied a non-equivalent control group design using the Korean National Health Insurance Big Data. Hongcheon County has been continuously implementing the intervention program since 2012. This study involved a cohort of patients with hypertension aged >65 and <85 years, among residents who lived in the study area for five years (between 2010 and 2014). The final number of subjects was 2685 in both the intervention and control region. The indirect indicators were analyzed as patients’ adherence and level of continuous treatment using the difference-in-difference regression. The proportion of hypertensive patients who continuously received insurance benefits for >240 days in 2014 was 81.0% in the intervention region and 79.7% in the control region. The number of dispensations per prescription and the dispensation days per hypertensive patient in the intervention region increased by approximately 10.88% and 2.2 days on average by month, respectively, compared to those in the control region. The intervention program encouraged elderly patients with hypertension to receive continuous care. Another research is needed to determine whether further improvement in the continuity of comprehensive care will prevent the progression of cardiovascular diseases.
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San Sebastián M, Mosquera PA, Gustafsson PE. Do cardiovascular disease prevention programs in northern Sweden impact on population health? An interrupted time series analysis. BMC Public Health 2019; 19:202. [PMID: 30770750 PMCID: PMC6377762 DOI: 10.1186/s12889-019-6514-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden. This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987-2013. METHODS An ecological controlled interrupted time series design, with pre-intervention period defined as 1987-1993 and post-intervention period 1994-2013 was carried out. For each year, IHD events, stratified by sex, were retrieved from national registers. RESULTS Impressive reductions on IHD premature morbidity and mortality were observed to a similar degree in both the intervention county and the other comparison counties across the last 27 years. Significant differences in the pre-post intervention trends indicating the intervention group had smaller reductions than expected from its pre-intervention trend and the trend of control counties were found among men for both IHD morbidity and mortality. A similar pattern was observed among women but without significant differences. CONCLUSIONS Taken together, the data do not support that the intervention has contributed to an additional reduction on IHD morbidity and mortality, above and beyond that which is already seen in neighbouring counties without similar programs.
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Affiliation(s)
- Miguel San Sebastián
- Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
| | - Paola A. Mosquera
- Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
| | - Per E. Gustafsson
- Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
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Dahrouge S, Gauthier A, Chiocchio F, Presseau J, Kendall C, Lemonde M, Chomienne MH, Perna A, Toal-Sullivan D, Devlin RA, Timony P, Prud'homme D. Access to Resources in the Community Through Navigation: Protocol for a Mixed-Methods Feasibility Study. JMIR Res Protoc 2019; 8:e11022. [PMID: 30679151 PMCID: PMC6365876 DOI: 10.2196/11022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/07/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Community-based health and social resources can help individuals with complex health and social needs achieve their health goals. However, there is often inadequate access to these resources due to a lack of physician and patient awareness of available resources and the presence of social barriers that limit an individual’s ability to reach these services. Navigation services, where a person is tasked with helping connect patients to community resources, embedded within primary care may facilitate access and strengthen the continuity of care for patients. Objective This study aims to describe the protocol to assess whether the implementation of the Access to Resources in the Community (ARC) navigation model (an innovative approach to navigation services) is feasible, including its potential to achieve its intended outcomes, and to assess the viability of the evaluation approach. Methods The study consists of a single-arm, prospective, explanatory, mixed-methods, pre-post design feasibility study focusing on primary care practice settings with vulnerable populations. Participants include primary care providers and patients. Results Enrollment is closed with 82 patients. Navigation services have ended for 69 patients. Conclusions The study of an innovative complex intervention requires an adequate assessment of the feasibility of the intended approach during which the potential challenges of the planned intervention and need for its adaptation may be uncovered. Undertaking a feasibility study of the ARC navigation model from a conceptually clear and methodologically solid protocol will inform on the practicality and acceptability of the approach, demand for the services, ease of implementation, quality of integration of the new services within primary care, and practicality and potential for efficacy prior to initiating a randomized controlled trial. Trial Registration ClinicalTrials.gov NCT03105635; https://clinicaltrials.gov/ct2/show/NCT03105635 (Archived by WebCite at hhttp://www.webcitation.org/75FrwXORl) International Registered Report Identifier (IRRID) RR1-10.2196/11022
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Affiliation(s)
- Simone Dahrouge
- Bruyere Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alain Gauthier
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | | | - Justin Presseau
- Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Claire Kendall
- Bruyere Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Manon Lemonde
- University of Ontario Institute of Technology, Oshawa, ON, Canada
| | | | | | | | | | - Patrick Timony
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
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Long term outcomes of cluster randomized trial to improve cardiovascular health at population level: The Cardiovascular Health Awareness Program (CHAP). PLoS One 2018; 13:e0201802. [PMID: 30188912 PMCID: PMC6126805 DOI: 10.1371/journal.pone.0201802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/23/2018] [Indexed: 12/21/2022] Open
Abstract
Study question The Cardiovascular Health Awareness Program (CHAP) cardiovascular risk reduction program consisted of sessions run by local volunteers in local pharmacies during which cardiovascular risk was assessed, healthy lifestyle and preventive care was promoted, and the participants were oriented to local resources to support changes in modifiable risk factors. A clustered randomized trial implemented in September 2006 across 39 communities targeting community-dwelling individuals 65 years and older showed a significant reduction in hospitalization one year after its implementation (rate ratio of 91 [95% confidence interval (CI): 86%-97%]). This study explores the impact of CHAP in the first five years. Methods Using health administrative data housed at the Institute for Clinical Evaluative Sciences, we established a closed cohort consisting of all individuals eligible in these communities at the study onset whom we followed over time. We assessed hospitalizations and survival using a negative binomial model for count data and Cox regression to assess time to first event, accounting for the clustered design. The primary outcome was the rate of cardiovascular-related hospitalizations defined as congestive heart failure, stroke or acute myocardial infarction. Results Most estimates pointed to an advantage for the intervention arm, but only all-cause mortality reached statistical significance (hazard ratio [95% CI] = 0.955 [0.914–0.999]). The hospitalization cardiovascular-related hospitalization rate ratio was (0.958, 95% CI: 0.898–1.022) in favour of the intervention communities, translating to an estimated 408 averted hospitalizations over the five-year period. There was no evidence of the effect of time from start of intervention. Conclusions The consistent direction of the outcomes in favour of the intervention arms suggests that CHAP likely had a meaningful impact on reducing cardiovascular-related morbidity and mortality. Given the low cost of the intervention, further development of CHAP should be pursued.
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Verghese B, Kashinath SK, Kiwalkar S, Henderson CM. Rapid Intervention Through Telephone Encounters for Blood Pressure Control by Residents in an Outpatient Resident Clinic. Cureus 2018; 10:e3118. [PMID: 30338193 PMCID: PMC6175199 DOI: 10.7759/cureus.3118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/08/2018] [Indexed: 11/06/2022] Open
Abstract
Introduction Sixty-seven million Americans have hypertensionthat costs the nation $47.5 billion each year. The aim of this study was to determine if regular phone calls by residents helped achieve better blood pressure control. Methods The study was a randomized open-labeled study in a resident-run outpatient clinic in Rochester, New York. A total of 57 poorly controlled hypertensives in the clinic were divided into two groups. All the patients received scheduled phone calls once every two weeks for a total of 24 weeks. In one group, the medications were adjusted over the phone and the other group was referred to be seen in the clinic for elevated blood pressures. Both the groups were compared to the usual standard of care group. Results Fifty-eight patients were recruited for the trial out of which 53 were used for the final data analysis. Eleven patients completed the trial and had a mean drop of systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 28 and 11 mmHg with p < 0.01 and p < 0.03, respectively. Among the patients who did not complete the trial but answered at least one phone call, the mean drop of SBP and DBP was 29 and 8 mmHg with a p < 0.001 and p < 0.008, respectively. When these were compared to the usual standard of care group, the mean drop in SBP was 28.36 (12.36-48.36), 29.85 (11.85-47.85), and 0.76 (8.04-9.56) with a p < 0.02. Conclusions Patients enrolled in the trial had much better blood pressure control compared to the usual standard of care. Residents can take greater ownership of patients to help achieve better blood pressure control. To our knowledge this is the first such study done exclusively by residents in a resident-run clinic.
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Affiliation(s)
| | | | - Sonam Kiwalkar
- Rheumatology, Oregon State Health University, Portland, USA
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Sidebottom AC, Sillah A, Vock DM, Miedema MD, Pereira R, Benson G, Lindberg R, Boucher JL, Knickelbine T, VanWormer JJ. Assessing the impact of the heart of New Ulm Project on cardiovascular disease risk factors: A population-based program to reduce cardiovascular disease. Prev Med 2018; 112:216-221. [PMID: 29634974 DOI: 10.1016/j.ypmed.2018.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/19/2018] [Accepted: 04/06/2018] [Indexed: 12/11/2022]
Abstract
The Heart of New Ulm Project (HONU), is a population-based project designed to reduce modifiable cardiovascular disease (CVD) risk factors in the rural community of New Ulm, MN. HONU interventions address multiple levels of the social-ecological model. The community is served by one health system, enabling the use of electronic health record (EHR) data for surveillance. The purpose of this study was to assess if trends in CVD risk factors and healthcare utilization differed between a cohort of New Ulm residents age 40-79 and matched controls selected from a similar community, using EHR data from baseline (2008-2009) through three follow up time periods (2010-2011, 2012-2013, 2014-2015). Matching, using covariate balance sparse technique, yielded a sample of 4077 New Ulm residents and 4077 controls. We used mixed effects longitudinal models to examine trends over time between the two groups. Blood pressure, total cholesterol, low-density lipoprotein-cholesterol, and triglycerides showed better management in New Ulm over time compared to the controls. The proportion of residents in New Ulm with controlled blood pressure increased by 6.2 percentage points compared to an increase of 2 points in controls (p < 0.0001). As the cohort aged, 10-year ASCVD risk scores increased less in New Ulm (5.1) than the comparison community (5.9). The intervention and control community did not differ with regard to inpatient stays, smoking, or glucose. Findings suggest efficacy for the HONU project interventions for some outcomes.
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Affiliation(s)
| | - Arthur Sillah
- Allina Health, 2925 Chicago Avenue, Minneapolis, MN, United States
| | - David M Vock
- Division of Biostatistics, University of Minnesota School of Public Health, A460 Mayo Building, MMC303, 420 Delaware Street SE. Minneapolis, MN, United States
| | - Michael D Miedema
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN, United States; Minneapolis Heart Institute, 920 East 28th Street, Suite 300, Minneapolis, MN, United States
| | - Raquel Pereira
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN, United States
| | - Gretchen Benson
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN, United States
| | - Rebecca Lindberg
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN, United States
| | - Jackie L Boucher
- Children's HeartLink, 5075 Arcadia Ave, Edina, MN, United States
| | - Thomas Knickelbine
- Minneapolis Heart Institute, 920 East 28th Street, Suite 300, Minneapolis, MN, United States
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, 1000 North Oak Ave, Marshfield, WI, United States
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Skar P, Young L, Gordon C. Changes in blood pressure among users of lay health worker or volunteer operated community-based blood pressure programs over time: a systematic review protocol. ACTA ACUST UNITED AC 2018; 13:30-40. [PMID: 26571280 DOI: 10.11124/jbisrir-2015-1927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify studies reporting on lay health worker- or volunteer-led community-based programs for blood pressure screening and cardiovascular awareness in order to determine if these programs contribute to changes in blood pressure among participants over time.The specific question for this review is: What are the changes in blood pressure among adult users of community-based blood pressure screening and awareness programs operated by lay health workers or volunteers as measured by the differences in systolic and diastolic blood pressure between the user's first visit to the program and their last visit to the program? BACKGROUND Cardiovascular diseases, such as stroke and heart disease, are quickly becoming global diseases manifesting in countries and communities where they traditionally had not been widespread. The World Health Organization (WHO) has reported that "in the Asia/Pacific region, [cardiovascular disease] has become increasingly prevalent in recent decades, and now accounts for about one third of all deaths". One risk factor that can lead to cardiovascular disease is hypertension. Based on WHO data from 2008, hypertension is now a global problem affecting 27% of the population 25 years of age or older.The risk for cardiovascular disease also appears to be higher among people in urban areas. A recent United Nations population report indicates that in the next 40 years we could see an increase in the world's population by 2.3 billion people. The majority of these people will be residing in urban areas, particularly in developing nations. Between 2011 and 2050, "the population living in urban areas is projected to gain 2.6 billion, passing from 3.6 billion in 2011 to 6.3 billion in 2050". Population growth in urban areas is therefore not only projected to include the expected population growth but also expected to include a shift of rural population to urban centers and "most of the population growth expected in urban areas will be concentrated in the cities and towns of the less developed regions". This growth of urban areas has the potential to put enormous pressures on health care systems that are already struggling to cope with the rapid increase in diseases thought to be more prevalent in Western societies, such as cardiovascular diseases.Hypertension may be difficult to treat due to a number of factors. Globally, access to antihypertensive medications, hypertension screening, and access to medical care vary from one country to another. Lifestyle factors, such as salt and alcohol consumption, stress, smoking, body weight, and exercise, are risk factors for hypertension that may be influenced by culture, which can in turn support or hinder lifestyle decisions that could significantly affect blood pressure. Hypertension, however, is easy to detect. A trained person with access to a low-cost sphygmomanometer can detect abnormal blood pressures quickly; however, access to trained personnel is not universally guaranteed. Globally - according to one model of skilled health care worker density and total requirement offered for discussion by the Global Health Workforce Alliance and WHO - there could currently be an estimated shortage of over seven million skilled health care workers (midwifes, nurses and physicians), as measured against a theoretical density of skilled health care workers to population. The shortage of skilled health care workers in this model could grow to over 12 million by 2035 if the assumptions of the model and population growth estimates are valid. Through rapid urbanization the potential for inequities in access to healthcare is also increased.Over the last few years, a number of community-based blood pressure screening and education initiatives have been established. These initiatives have been created either as part of research, as part of community outreach programs by publicly funded agencies, or as part of an outreach by not-for-profit organizations with a particular interest in reducing cardiovascular disease in specific hard-to-reach populations. Several systematic reviews have been conducted to assess different models for delivering services to people living with high blood pressure to assess community-based programs with a focus on cardiovascular disease, and to assess effectiveness of community health workers (CHW) in a variety of settings. These systematic reviews point to the importance of distinguishing between different categories of health care providers, their training and their roles in program delivery when assessing studies for possible inclusion in a systematic review.In a systematic review of studies from the US by Brownstein et al. focusing on the effectiveness of community health workers (CHWs) in the care of people with hypertension, this category of health care providers went under many different names. Community health workers in this review were defined as "any health workers who carried out functions related to health care deliver, were trained as part of an intervention, had no formal paraprofessional or professional designation, and had a relationship with the community being served". One of the findings from this review was the wide variety of formal training of the CHWs. In other parts of the world, a CHW might be defined differently. In their review of CHW-based programs focusing on children's health, Bhattacharyya, Winch, LeBan and Tien found that "in general CHWs are not paid salaries because the MOH (Ministry of Health) or donors do not consider salaries to be sustainable. Yet CHWs are often held accountable and supervised as if they were employees. Community health worker programs must recognize that CHWs are volunteers (emphasis in original), even if they receive small monetary or nonmonetary incentives. They are volunteering their time to serve the community". One Canadian model for delivering a cardiovascular awareness program designed to reach older adults through their primary care provider is based on volunteers with basic training to perform blood pressure measurements and cardiovascular health information.In a global review of a wide range of public health and health promotion initiatives operated by lay health workers from 2005, Lewin et al. identified over 40 different names or terms for a lay health worker. However, the definition of a lay health worker used by Lewin et al. is very similar to the definition of CHWs offered by Brownstein et al. Lewin et al.'s systematic review was the only study with a global focus that was located that reviewed studies of programs with a cardiovascular component using lay health workers. In this study, the sample size of studies focusing on lay health workers and cardiovascular disease was small (N=3) and the results from two of the studies were inconclusive to the point where the authors felt they could not pool the results.While a lay health worker may or may not receive some compensation for their work, volunteers in higher income areas of the world such as in North America typically do not receive any compensation. Volunteers, as observed by Bhattacharyya et al., are common in many parts of the world, and in some areas they provide delivery of programs and services that reach hundreds of thousands of individuals. One challenge for this systematic review will therefore be to isolate those programs that are delivered by lay health workers or volunteers who receive little or no compensation and programs where staff is paid. The importance of this distinction is on one hand related to cost - as observed by Bhattacharyya et al., many organizations responsible for delivery of community-based programs do not have funding for salaried staff. On the other hand there might be other factors in the relationship between a community being served by a program and the staff delivering the program. One such factor could be linked to the role of the person delivering the program as either a paid health care professional or an unpaid lay health worker or volunteer.Through this proposed JBI systematic review, the reviewers will focus on community-based blood pressure screening and health information programs delivered by either lay health workers or volunteers. Previous systematic reviews have indicated that programs focusing on blood pressure reduction delivered in a variety of settings and delivered by a variety of health care professionals might lower blood pressure among program participants over time. This systematic review will be limited to community-based programs rather than hospital or research facility-based programs, and to programs delivered by lay health workers or volunteers rather than programs delivered by paid community health workers, nurses or teams of health care providers under direction of a primary care provider. Compared to other recent systematic reviews which focused on studies with comparison groups and included few studies where lay health workers were involved, this systematic review will attempt to fill this gap in knowledge about programs delivered by lay health workers or volunteers by focusing on non-randomized controlled studies which report blood pressure changes over time in programs targeting the general population. Community-based programs might have a variety of designs with a number of different interventions, and where possible these designs and interventions will be identified and subgroup analysis conducted as appropriate. It is hoped that this systematic review can extend the work by Lewin et al. by identifying additional studies globally, focusing on programs delivered by lay health workers or volunteers but limited to studies reporting changes in blood pressure over time. Where possible, a meta-analysis of the changes in blood pressure over time among participants in these programs will be conducted. (ABSTRACT TRUNCATED)
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Affiliation(s)
- Pål Skar
- 1 School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada2 University of Victoria Libraries, University of Victoria, Victoria, British Columbia, Canada
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Zhang D, Wang G, Joo H. A Systematic Review of Economic Evidence on Community Hypertension Interventions. Am J Prev Med 2017; 53:S121-S130. [PMID: 29153113 PMCID: PMC5819001 DOI: 10.1016/j.amepre.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/24/2017] [Accepted: 05/08/2017] [Indexed: 01/05/2023]
Abstract
CONTEXT Effective community-based interventions are available to control hypertension. It is important to determine the economics of these interventions. EVIDENCE ACQUISITION Peer-reviewed studies from January 1995 through December 2015 were screened. Interventions were categorized into educational interventions, self-monitoring interventions, and screening interventions. Incremental cost-effectiveness ratios were summarized by types of interventions. The review was conducted in 2016. EVIDENCE SYNTHESIS Thirty-four articles were included in the review (16 from the U.S., 18 from other countries), including 25 on educational interventions, three on self-monitoring interventions, and six on screening interventions. In the U.S., five (31.3%) studies on educational interventions were cost saving. Among the studies that found the interventions cost effective, the median incremental costs were $62 (range, $40-$114) for 1-mmHg reduction in systolic blood pressure (SBP) and $13,986 (range, $6,683-$58,610) for 1 life-year gained. Outside the U.S., educational interventions cost from $0.62 (China) to $29 (Pakistan) for 1-mmHg reduction in SBP. Self-monitoring interventions, evaluated in the U.S. only, cost $727 for 1-mmHg reduction in SBP and $41,927 for 1 life-year gained. For 1 quality-adjusted life-year, screening interventions cost from $21,734 to $56,750 in the U.S., $613 to $5,637 in Australia, and $7,000 to $18,000 in China. Intervention costs to reduce 1 mmHg blood pressure or 1 quality-adjusted life-year were higher in the U.S. than in other countries. CONCLUSIONS Most studies found that the three types of interventions were either cost effective or cost saving. Quality of economic studies should be improved to confirm the findings.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia.
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heesoo Joo
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Johnson C, Mohan S, Rogers K, Shivashankar R, Thout SR, Gupta P, He FJ, MacGregor GA, Webster J, Krishnan A, Maulik PK, Reddy KS, Prabhakaran D, Neal B. The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India. Nutrients 2017; 9:E144. [PMID: 28212309 PMCID: PMC5331575 DOI: 10.3390/nu9020144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/16/2022] Open
Abstract
Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants' physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87-9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake-less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55-9.87 g/day) versus less-educated (9.34, 8.57-10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.
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Affiliation(s)
- Claire Johnson
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi 110070, India.
| | - Kris Rogers
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
| | - Roopa Shivashankar
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | | | - Priti Gupta
- Public Health Foundation of India, New Delhi 110070, India.
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Jacqui Webster
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad 500034, India.
- George Institute for Global Health, University of Oxford, Oxford OX1 3PA, UK.
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | - Bruce Neal
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
- Charles Perkins Centre, University of Sydney, Sydney 2050, Australia.
- School of Public Health, Imperial College, London SW7 2AZ, UK.
- Royal Prince Alfred Hospital, Sydney 2050, Australia.
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Mendy VL, Vargas R, El-Sadek L, Short VL. Decreasing prevalence of no known major risk factors for cardiovascular disease among Mississippi adults, Mississippi Behavioral Risk Factor Surveillance System, 2001 and 2009. BMC Public Health 2016; 16:1220. [PMID: 27914466 PMCID: PMC5135807 DOI: 10.1186/s12889-016-3860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/22/2016] [Indexed: 12/05/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in Mississippi. However, the prevalence of no known CVD risk factors among Mississippi adults and the change of prevalence in the past 9 years have not been described. We assess changes in prevalence of no known CVD risk factors during 2001 and 2009. Methods Prevalence of high blood pressure, high cholesterol, diabetes, physical inactivity, smoking, and obesity were investigated. Survey respondents who reported having none of these factors were defined as having no known CVD risk factors. Differences in prevalence and 95% confidence intervals were determined using t-test analysis. Results Overall, age-standardized prevalence of having no known CVD risk factors significantly decreased from 17.3% in 2001 to 14.5% in 2009 (p = 0.0091). The age-standardized prevalence of no known CVD risk factors were significantly lower in 2009 than in 2001 among blacks (8.9% vs. 13.2%, p = 0.008); males (13.5% vs. 17.9%, p = 0.0073); individuals with a college degree (25.2%, vs. 30.8%, p = 0.0483); and those with an annual household income of $20,000–$34,999 (11.6% vs. 16.9%, p = 0.0147); and $35,000–$49,999 (15.2% vs. 23.3%, p = 0.0135). Conclusion The prevalence of no known CVD risk factors among Mississippi adults significantly decreased from 2001 to 2009 with observed differences by race, age group, sex, and annual household income.
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Affiliation(s)
- Vincent L Mendy
- Mississippi State Department of Health, Office Health Data and Research, 570 East Woodrow Wilson, Jackson, MS, 39215, USA.
| | - Rodolfo Vargas
- Mississippi State Department of Health, Office Health Data and Research, 570 East Woodrow Wilson, Jackson, MS, 39215, USA
| | - Lamees El-Sadek
- Mississippi State Department of Health, Office Health Data and Research, 570 East Woodrow Wilson, Jackson, MS, 39215, USA
| | - Vanessa L Short
- Nemours/AI duPont Hospital for Children, 833 Chestnut Street, Suite 1210, Philadelphia, PA, 19107, USA
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Lancarotte I, Nobre MR. Primordial and primary prevention programs for cardiovascular diseases: from risk assessment through risk communication to risk reduction. A review of the literature. Clinics (Sao Paulo) 2016; 71:667-678. [PMID: 27982169 PMCID: PMC5108165 DOI: 10.6061/clinics/2016(11)09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to identify and reflect on the methods employed by studies focusing on intervention programs for the primordial and primary prevention of cardiovascular diseases. The PubMed, EMBASE, SciVerse Hub-Scopus, and Cochrane Library electronic databases were searched using the terms 'effectiveness AND primary prevention AND risk factors AND cardiovascular diseases' for systematic reviews, meta-analyses, randomized clinical trials, and controlled clinical trials in the English language. A descriptive analysis of the employed strategies, theories, frameworks, applied activities, and measurement of the variables was conducted. Nineteen primary studies were analyzed. Heterogeneity was observed in the outcome evaluations, not only in the selected domains but also in the indicators used to measure the variables. There was also a predominance of repeated cross-sectional survey design, differences in community settings, and variability related to the randomization unit when randomization was implemented as part of the sample selection criteria; furthermore, particularities related to measures, limitations, and confounding factors were observed. The employed strategies, including their advantages and limitations, and the employed theories and frameworks are discussed, and risk communication, as the key element of the interventions, is emphasized. A methodological process of selecting and presenting the information to be communicated is recommended, and a systematic theoretical perspective to guide the communication of information is advised. The risk assessment concept, its essential elements, and the relevant role of risk perception are highlighted. It is fundamental for communication that statements targeting other people's understanding be prepared using systematic data.
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Affiliation(s)
- Inês Lancarotte
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração, Equipe de Epidemiologia Clínica e Apoio à Pesquisa, São Paulo/SP, Brazil
- E-mail:
| | - Moacyr Roberto Nobre
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração, Equipe de Epidemiologia Clínica e Apoio à Pesquisa, São Paulo/SP, Brazil
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Michaud TL, Abraham J, Jalal H, Luepker RV, Duval S, Hirsch AT. Cost-Effectiveness of a Statewide Campaign to Promote Aspirin Use for Primary Prevention of Cardiovascular Disease. J Am Heart Assoc 2015; 4:e002321. [PMID: 26702086 PMCID: PMC4845274 DOI: 10.1161/jaha.115.002321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The U.S. Preventive Services Task Force in 2009 recommended increased aspirin use for primary prevention of cardiovascular disease (CVD) in men ages 45 to 79 years and women ages 55 to 79 years for whom benefit outweighs risk. This study estimated the clinical efficacy and cost-effectiveness of a statewide public and health professional awareness campaign to increase regular aspirin use among the target population in Minnesota to reduce first CVD events. METHODS AND RESULTS A state-transition Markov model was developed, adopting a payer perspective and lifetime time horizon. The main outcomes of interest were quality-adjusted life years, costs, and the number of CVD events averted among those without a prior CVD history. The model was based on real-world data about campaign effectiveness from representative state-specific aspirin use and event rates, and estimates from the scholarly literature. Implementation of a campaign was predicted to avert 9874 primary myocardial infarctions in men and 1223 primary ischemic strokes in women in the target population. Increased aspirin use was associated with as many as 7222 more major gastrointestinal bleeding episodes. The cost-effectiveness analysis indicated cost-saving results for both the male and female target populations. CONCLUSIONS Using current U.S. Preventive Services Task Force recommendations, a state public and health professional awareness campaign would likely provide clinical benefit and be economically attractive. With clinician adjudication of individual benefit and risk, mechanisms can be made available that would facilitate achievement of aspirin's beneficial impact on lowering risk of primary CVD events, with minimization of adverse outcomes.
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Affiliation(s)
- Tzeyu L. Michaud
- Center for Reducing Health DisparitiesCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNE
- Department of Health Promotion, Social and Behavioral HealthCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNE
| | - Jean Abraham
- Division of Health Policy and ManagementUniversity of MinnesotaMinneapolisMN
| | - Hawre Jalal
- Department of Health Policy and ManagementUniversity of PittsburghPA
| | - Russell V. Luepker
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMN
- Lillehei Heart Institute and Cardiovascular DivisionUniversity of MinnesotaMinneapolisMN
| | - Sue Duval
- Lillehei Heart Institute and Cardiovascular DivisionUniversity of MinnesotaMinneapolisMN
| | - Alan T. Hirsch
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMN
- Lillehei Heart Institute and Cardiovascular DivisionUniversity of MinnesotaMinneapolisMN
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Zhong X, Potemans B, Zhang L, Oldenburg B. Getting a Grip on NCDs in China: an Evaluation of the Implementation of the Dutch-China Cardiovascular Prevention Program. Int J Behav Med 2015; 22:393-403. [PMID: 25471465 PMCID: PMC4449379 DOI: 10.1007/s12529-014-9453-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose China has experienced a rapid increase in cardiovascular diseases and related chronic conditions over the last 20 years, and there is now an urgent need for new approaches that can effectively reduce the progression of cardiovascular disease in high-risk individuals. This article reports on the evaluation of the implementation of the Dutch-China Cardiovascular Prevention Program. Methods A screening questionnaire, based on the Dutch concept of Prevention-Consultation, was distributed among inhabitants in seven communities in Anhui Province, China. This tool categorizes individuals into being at low or high risk according to their responses to a number of self-administered questions. The “high-risk” individuals were then invited to undergo further clinical and laboratory tests, before being offered lifestyle education and counseling. The program is delivered by primary care professionals from local community health service centers (CHSCs). An evaluation of the program’s implementation was undertaken with both program participants and CHSC staff. Results The screening questionnaire was completed by 9067 participants in seven demonstration communities. Thirty percent of these individuals were categorized as high risk according to their scores. About one third of these individuals returned for further clinical and laboratory tests. Almost half of those re-screened participated in lifestyle education classes. Program participants and community health staff provided mostly positive feedback about the program. Conclusions While the program proved acceptable and feasible for delivery by CHSCs and by program participants, additional strategies are required to improve future uptake of both screening and subsequent lifestyle education by those at high risk.
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Affiliation(s)
- Xuefeng Zhong
- Anhui Provincial Center for Disease Control and Prevention, Anhui, China,
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Mokuno J, Hishida A, Morita E, Sasakabe T, Hattori Y, Suma S, Okada R, Kawai S, Naito M, Wakai K. ATP-binding cassette transporter A1 (ABCA1) R219K (G1051A, rs2230806) polymorphism and serum high-density lipoprotein cholesterol levels in a large Japanese population: cross-sectional data from the Daiko Study. Endocr J 2015; 62:543-9. [PMID: 25877294 DOI: 10.1507/endocrj.ej14-0577] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Among polymorphisms in ATP-binding cassette transporter A1 (ABCA1) gene, the available evidence demonstrates that the ABCA1 R219K polymorphism (G1051A, rs2230806) K allele is associated with a higher high-density lipoprotein cholesterol (HDL- C) level and may play a protective role against coronary artery disease (CAD) risk in Asians and Caucasians. The findings from many underpowered studies from Asian countries (n=71-597), however, still remain inconsistent. The objective of this study was to overcome the limitations of previous studies in Asia and provide solid epidemiologic evidence. Subjects were participants of a cohort study, who visited the Daiko Medical Center in Nagoya, Japan. The cohort study belongs to the Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study). In the Daiko Study, 5,133 participants (1,458 men and 3,675 women) aged 35-69 years enrolled from 2008 through 2010 were eligible for the analyses. The ABCA1 polymorphism was genotyped by the polymerase chain reaction with confronting two-pair primers (PCR-CTPP) method. Among all the subjects, the genotype frequencies were 23.9% (n=1,225) for RR, 49.3% (n=2,532) for RK, and 26.8% (n=1,376) for KK, which was in Hardy-Weinberg's equilibrium (P =0.36). Background characteristics did not significantly differ among the genotypes including alcohol and tobacco use. The mean ± SD of HDL-C concentration was higher in men and women with RK or KK genotype than those with RR, although the difference between these genotypes was not statistically significant in both sexes (P =0.31 in men and 0.26 in women by ANOVA). In the multiple linear regression analysis to estimate the independent effects of the R219K polymorphism on HDL-C level, however, the number of K allele was significantly correlated with an increased level of HDL-C (trend P=0.033). Those with the KK genotype showed a significantly higher HDL-C concentration compared with those with the RR genotype by a mean of 1.18 mg/dL. The R219K polymorphism of ABCA1 independently associated with serum level of HDL-C in a large Japanese population.
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Affiliation(s)
- Junichiro Mokuno
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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Witt S, Leidl R, Becker C, Holle R, Block M, Brachmann J, Silber S, Stollenwerk B. The effectiveness of the cardiovascular disease prevention programme 'KardioPro' initiated by a German sickness fund: a time-to-event analysis of routine data. PLoS One 2014; 9:e114720. [PMID: 25486421 PMCID: PMC4259463 DOI: 10.1371/journal.pone.0114720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022] Open
Abstract
Background Cardiovascular disease is the leading cause of morbidity and mortality in the developed world. To reduce this burden of disease, a German sickness fund (‘Siemens-Betriebskrankenkasse’, SBK) initiated the prevention programme ‘KardioPro’ including primary (risk factor reduction) and secondary (screening) prevention and guideline-based treatment. The aim of this study was to assess the effectiveness of ‘KardioPro’ as it is implemented in the real world. Methods The study is based on sickness fund routine data. The control group was selected from non-participants via propensity score matching. Study analysis was based on time-to-event analysis via Cox proportional hazards regression with the endpoint ‘all-cause mortality, acute myocardial infarction (MI) and ischemic stroke (1)’, ‘all-cause mortality (2)’ and ‘non-fatal acute MI and ischemic stroke (3)’. Results A total of 26,202 insurants were included, 13,101 participants and 13,101 control subjects. ‘KardioPro’ enrolment was associated with risk reductions of 23.5% (95% confidence interval (CI) 13.0–32.7%) (1), 41.7% (95% CI 30.2–51.2%) (2) and 3.5% (hazard ratio 0.965, 95% CI 0.811–1.148) (3). This corresponds to an absolute risk reduction of 0.29% (1), 0.31% (2) and 0.03% (3) per year. Conclusion The prevention programme initiated by a German statutory sickness fund appears to be effective with regard to all-cause mortality. The non-significant reduction in non-fatal events might result from a shift from fatal to non-fatal events.
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Affiliation(s)
- Sabine Witt
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- Ludwig-Maximilians-Universität, Munich Center of Health Sciences, Munich, Germany
| | - Christian Becker
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | | | | | | | - Björn Stollenwerk
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- * E-mail:
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Zaman RT, Kosuge H, Pratx G, Carpenter C, Xing L, McConnell MV. Fiber-optic system for dual-modality imaging of glucose probes 18F-FDG and 6-NBDG in atherosclerotic plaques. PLoS One 2014; 9:e108108. [PMID: 25233472 PMCID: PMC4169475 DOI: 10.1371/journal.pone.0108108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/19/2014] [Indexed: 12/02/2022] Open
Abstract
Background Atherosclerosis is a progressive inflammatory condition that underlies coronary artery disease (CAD)–the leading cause of death in the United States. Thus, the ultimate goal of this research is to advance our understanding of human CAD by improving the characterization of metabolically active vulnerable plaques within the coronary arteries using a novel catheter-based imaging system. The aims of this study include (1) developing a novel fiber-optic imaging system with a scintillator to detect both 18F and fluorescent glucose probes, and (2) validating the system on ex vivo murine plaques. Methods A novel design implements a flexible fiber-optic catheter consisting of both a radio-luminescence and a fluorescence imaging system to detect radionuclide 18F-fluorodeoxyglucose (18F-FDG) and the fluorescent analog 6-(N-(7-Nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-6-Deoxyglucose (6-NBDG), respectively. Murine macrophage-rich atherosclerotic carotid plaques were imaged ex vivo after intravenous delivery of 18F-FDG or 6-NBDG. Confirmatory optical imaging by IVIS-200 and autoradiography were also performed. Results Our fiber-optic imaging system successfully visualized both 18F-FDG and 6-NBDG probes in atherosclerotic plaques. For 18F-FDG, the ligated left carotid arteries (LCs) exhibited 4.9-fold higher radioluminescence signal intensity compared to the non-ligated right carotid arteries (RCs) (2.6×104±1.4×103 vs. 5.4×103±1.3×103 A.U., P = 0.008). Similarly, for 6-NBDG, the ligated LCs emitted 4.3-fold brighter fluorescent signals than the control RCs (1.6×102±2.7×101 vs. 3.8×101±5.9 A.U., P = 0.002). The higher uptake of both 18F-FDG and 6-NBDG in ligated LCs were confirmed with the IVIS-200 system. Autoradiography further verified the higher uptake of 18F-FDG by the LCs. Conclusions This novel fiber-optic imaging system was sensitive to both radionuclide and fluorescent glucose probes taken up by murine atherosclerotic plaques. In addition, 6-NBDG is a promising novel fluorescent probe for detecting macrophage-rich atherosclerotic plaques.
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Affiliation(s)
- Raiyan T. Zaman
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Division of Radiation Physics, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Hisanori Kosuge
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Guillem Pratx
- Division of Radiation Physics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Colin Carpenter
- Division of Radiation Physics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Lei Xing
- Division of Radiation Physics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Michael V. McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
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Chen XJ, Gao XL, You GY, Jiang J, Sun XL, Li X, Chen YC, Liang YJ, Zhang Q, Zeng Z. Higher blood pressure control rate in a real life management program provided by the community health service center in China. BMC Public Health 2014; 14:801. [PMID: 25098940 PMCID: PMC4133080 DOI: 10.1186/1471-2458-14-801] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Community health service center (CHSC) in China is always regarded as a good facility of primary care, which plays an important role in chronic non-communicable disease management. This study aimed to investigate the blood pressure (BP) control rate in a real life CHSC-based management program and its determinants. METHODS The study enrolled 3191 patients (mean age of 70 ± 10 years, 43% males) in a hypertension management program provided by the Yulin CHSC (Chengdu, China), which had been running for 9 years. Uncontrolled BP was defined as the systolic BP of ≥140 mmHg and/or the diastolic BP of ≥90 mmHg, and its associated factors were analyzed by using logistic regression. RESULTS The duration of stay in the program was 33 ± 25 months. When compared with the BP at entry, the recent BP was significantly lowered (147 ± 17 vs. 133 ± 8 mmHg; 83 ± 11 vs. 75 ± 6 mmHg) and the BP control rate was dramatically increased (32 vs. 85%) (all p < 0.001). The age of >70 years [1.40 (odds ratio), 1.15-1.71 (95% confidence interval)], female gender (0.76, 0.63-0.93), longer stay of >33 months (0.77, 0.63-0.94), doctor in charge (0.97, 0.95-0.99), and the use of calcium channel blocker (1.35, 1.09-1.67) were significantly related to uncontrolled BP at the recent follow up (all p < 0.05). CONCLUSIONS This CHSC-run hypertension program provides an ideal platform of multi-intervention management, which is effective in achieving higher BP control rate in community patient population. However, the BP control status could be affected by age, gender and adherence of the patients, as well as practice behavior of the doctors.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Salazar MR, Espeche WG, Aizpurúa M, Leiva Sisnieguez BC, Balbín E, Dulbecco CA, Carbajal HA. Blood pressure response to a community-based program and long-term cardiovascular outcome. Am J Hypertens 2014; 27:1061-8. [PMID: 24390293 DOI: 10.1093/ajh/hpt240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The significance in terms of the cardiovascular outcome of different patterns of blood pressure (BP) response to community-based activities has not been previously studied. The aim of our study was to evaluate the relationship between changes of BP observed during a community-based program and long-term rate of cardiovascular disease (CVD) events. METHODS A program focused on the prevention of CVDs was implemented in a small city in Argentina over a 6-year period (1997-2003). The program was evaluated using a cohort of 1,526 randomly selected individuals. The population's mean systolic BP (SBP) decreased approximately 5mm Hg, but BP changes were heterogeneous. Eight years after the intervention had stopped, 1,124 individuals of the cohort were surveyed to evaluate incident CVD events. The sample was divided into 3 SBP change categories during the intervention: decrease (< -5mm Hg), no change (-5 to 5mm Hg) and increase (> 5mm Hg). Cox models were used to estimate the hazard ratio (HR) of CVD events for each category adjusted for age, sex, and baseline BP. RESULTS At the end of the intervention, individuals who had increased their SBP showed an adjusted HR for CVD that was double those whose SBP levels decreased or did not change. An inverse relationship between baseline SBP and ΔSBP was observed: individuals with an increase in BP during the intervention had lower SBP at the beginning of the study. CONCLUSIONS BP increase during the community-based program was an independent predictor of CVD events.
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Affiliation(s)
- Martin R Salazar
- Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina;
| | - Walter G Espeche
- Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina
| | | | | | - Eduardo Balbín
- Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina
| | - Carlos A Dulbecco
- Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina
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Logan AG. Community hypertension programs in the age of mobile technology and social media. Am J Hypertens 2014; 27:1033-5. [PMID: 24997431 DOI: 10.1093/ajh/hpu125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Alexander G Logan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Donahue J. Coronary artery disease in offender populations: incarceration as a risk factor and a point of intervention. JOURNAL OF CORRECTIONAL HEALTH CARE 2014; 20:302-12. [PMID: 25038141 DOI: 10.1177/1078345814541534] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coronary artery disease (CAD) is a significant health problem and global burden. Research on antisocial behaviors has identified some groups of offenders as vulnerable to the development of cardiovascular disorders. This article reviews the relationship between criminal offending and CAD, with a particular emphasis on incarcerated populations. Existing research supports this link, with incarceration demonstrating substantial associations with numerous cardiac risk factors, development of cardiac problems, and cardiovascular disease mortality. Comprehensive multicomponent prevention programs, while often available in the community, have received little research attention in prison settings. In addition to clarifying the relationship between incarceration and heart disease, this article reviews various treatment and management responses made by prison officials.
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Affiliation(s)
- John Donahue
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center, Portland VA Medical Center, Portland, OR, USA
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