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Zahra SA, Choudhury RY, Naqvi R, Boulton AJ, Chahal CAA, Munir S, Carrington M, Ricci F, Khanji MY. Health inequalities in cardiopulmonary resuscitation and use of automated electrical defibrillators in out-of-hospital cardiac arrest. Curr Probl Cardiol 2024; 49:102484. [PMID: 38401825 DOI: 10.1016/j.cpcardiol.2024.102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
Out of hospital cardiac arrest (OHCA) outcomes can be improved by strengthening the chain of survival, namely prompt cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED). However, provision of bystander CPR and AED use remains low due to individual patient factors ranging from lack of education to socioeconomic barriers and due to lack of resources such as limited availability of AEDs in the community. Although the impact of health inequalities on survival from OHCA is documented, it is imperative that we identify and implement strategies to improve public health and outcomes from OHCA overall but with a simultaneous emphasis on making care more equitable. Disparities in CPR delivery and AED use in OHCA exist based on factors including sex, education level, socioeconomic status, race and ethnicity, all of which we discuss in this review. Most importantly, we discuss the barriers to AED use, and strategies on how these may be overcome.
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Affiliation(s)
- Syeda Anum Zahra
- St Marys Hospital, Imperial College NHS Trust, Praed Street, Paddington, London W2 1NY, UK; Imperial College London, Exhibition Rd, South Kensington, London SW7 2BX, UK
| | - Rozina Yasmin Choudhury
- Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Romsey Rd, Winchester SO22 5DG, UK
| | - Rameez Naqvi
- Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Turner Rd, Colchester CO4 5JL, UK
| | - Adam J Boulton
- Warwick Clinical Trails Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - C Anwar A Chahal
- Centre for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sabrina Munir
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy; Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, Chieti 66100, Italy; Department of Clinical Sciences, Lund University, Malmö 21428, Sweden
| | - Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK; Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London EC1A 7BE, UK.
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Almasri F, Badrasawi M, Zahdeh R, Hahn A, Schuchardt JP, Greupner T. Very low Omega-3 Index in young healthy students from Palestine. Lipids 2023; 58:209-216. [PMID: 37300456 DOI: 10.1002/lipd.12375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
Oily fish is rich in long-chain omega-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have been associated with several health benefits. However, fish consumption is generally low in many countries, including the Middle East, resulting in low omega-3 blood levels. In Palestine, no data on the omega-3 blood status is available. The aim of this cross-sectional study was to assess the omega-3 status and related factors in young healthy subjects from Palestine. Omega-3 status was assessed using the Omega-3 Index-defined as the sum of EPA + DHA in relation to the total fatty acid content of erythrocytes. A total of 149 subjects, 50 males and 99 females (age range: 18-24 years), were included in the study. In addition to the Omega-3 Index, data on anthropometrics, physical activity, smoking status, fish intake, dietary supplement intake, blood lipid profile, and whole erythrocyte fatty acid pattern were collected. The mean (SD) Omega-3 Index was 2.56 (0.57)%, with 97.9% of subjects having an index below 4%. The majority of participants (91.8%) consumed less than two portions of fish per week, and only 4% reported taking omega-3 supplements, mostly irregularly. Our findings show that young Palestinian students have an alarmingly low omega-3 status. Further studies are needed to investigate whether the omega-3 status is also low in the general Palestinian population.
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Affiliation(s)
- Feras Almasri
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Manal Badrasawi
- Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary medicine, An-Najah National University, Nablus, Palestine
| | - Rana Zahdeh
- Department of Chemistry and Applied Sciences, College of Applied Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Jan Philipp Schuchardt
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Theresa Greupner
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
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3
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Leibowitz D, Haberman D, Goland S, George J, Beeri R, Planer D, Wolf R, Kutsher B, Hasin T, Shuvy M. Outcomes following transcatheter repair in patients with functional mitral regurgitation not receiving guideline directed medical therapy in Israel. BMC Cardiovasc Disord 2023; 23:304. [PMID: 37328829 PMCID: PMC10276417 DOI: 10.1186/s12872-023-03344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/13/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Transcatheter edge to edge repair (TEER) improves prognosis in patients with functional mitral regurgitation (FMR) receiving guideline directed medical therapy (GDMT). Many patients with FMR do not receive GDMT and the utility of TEER in this population remains unclear. METHODS We retrospectively studied patients undergoing TEER. Clinical, echocardiographic and procedural variables were recorded. GDMT was defined as use of RAAS inhibitors and MRAs unless GFR was under 30 as well as beta blockers. The primary endpoint of the study was one year mortality. RESULTS 168 patients (mean age 71.3 ± 9.3; 66% males) with FMR who underwent TEER were included of whom 116 (69%) received GDMT at the time of TEER and 52 (31%) did not. There were no significant demographic or clinical differences between the groups. There were no significant differences in procedural success and complications between groups. One year mortality was identical in the two groups (15% vs. 15%; RR 1.06, CI 0.43-2.63, P = 0.90). CONCLUSIONS Our findings suggest that procedural success and one year mortality following TEER was not significantly different in HFREF patients with FMR with or without GDMT. Larger, prospective studies are necessary to define the benefit of TEER in this population.
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Affiliation(s)
- David Leibowitz
- Department of Cardiology, Faculty of Medicine Hadassah, Hebrew University Medical Center, Jerusalem, Israel.
- Coronary Care Unit, Hadassah Medical Center Mount Scopus Jerusalem, Jerusalem, Israel.
| | - Dan Haberman
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel
| | - Sorel Goland
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel
| | - Jacob George
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel
| | - Ronen Beeri
- Department of Cardiology, Faculty of Medicine Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - David Planer
- Department of Cardiology, Faculty of Medicine Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Rafael Wolf
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Becky Kutsher
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tal Hasin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Mony Shuvy
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
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4
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Haskiah F, Khaskia A. Lipid treatment status and goal attainment among patients with premature acute coronary syndrome in Israel. J Clin Lipidol 2023; 17:367-375. [PMID: 37120357 DOI: 10.1016/j.jacl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND There are significant health gaps between Arabs and Jews in Israel. However, there are limited data on the management and treatment of dyslipidemia among Israeli adults who experience premature acute coronary syndrome (ACS). This study aimed to assess the differences between Arabs and Jews with regard to lipid-lowering therapy administration and low-density lipoprotein cholesterol (LDL-C) levels goal attainment at 1 year post-ACS. METHODS This study included patients aged ≤55 years who had been hospitalized for ACS at Meir Medical Center between 2018 and 2019. Outcomes included the rate of use of lipid-lowering medications, LDL-C levels 1 year post-admission, and major adverse cardiovascular and cerebrovascular events (MACCE) during 30 months of follow-up. RESULTS The study population comprised 687 young adults with a median age of 48.5 years. 81.9% of the Arab patients and 79.8% of the Jewish patients were discharged on high intensity statins. At 1 year of follow-up, the proportions of Arab patients who had LDL-C levels <70 mg/dL and <55 mg/dL were lower than those of Jewish patients (43.8% vs. 58%, p < 0.001 and 34.5% vs. 45.3%, p < 0.001, respectively). At 1 year of follow-up, only 25% and 4% of both groups were treated with ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor. The incidence of MACCE was significantly higher among Arab patients. CONCLUSION Our study highlighted the need for a more aggressive lipid-lowering strategy in both Arab and Jewish populations. Culturally adapted interventions are required to reduce gaps between Arab and Jewish patients.
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Affiliation(s)
- Feras Haskiah
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Abid Khaskia
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
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Vishnevsky G, Sinnreich R, Nassar H, Merom D, Ish-Shalom M, Kark JD, Levine H. Different Factors Are Associated With Sex Hormones and Leydig Cell Function in Israelis and Palestinians in Jerusalem. Am J Mens Health 2022; 16:15579883221106060. [PMID: 35815720 PMCID: PMC9277445 DOI: 10.1177/15579883221106060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Total testosterone (TT) is known to influence health and virility in men. Among
men from United States and Europe, numerous sociodemographic and lifestyle
factors were reported to be associated with TT. However, associations with TT
and Leydig cell function in the Middle East are poorly described. A
cross-sectional, population-based sample had a structured interview, physical
examinations, and blood tests in two hospitals in Jerusalem, Israel. A subsample
(25- to 44-year-old men, n = 286: 124 Israelis, 162
Palestinians) had sex hormone measurements. The primary outcomes were TT and
free testosterone/luteinizing hormone (FT/LH) ratio, representing Leydig cell
function. Associations with sociodemographic and lifestyle factors, body mass
index (BMI), and physical activity (PA) were evaluated using multivariable
linear regression. Compared with Palestinians, Israelis had similar TT (4.81 vs.
5.09 ng/mL, p = .405) and higher FT/LH (31.2 vs. 25.8 ng/IU,
p = .002). In ln-transformed values, marital status had a
stronger association in Palestinians (P for interaction = 0.03). Age, BMI, and
PA had a stronger association with TT in Israelis with significant interactions
with ethnicity. BMI <25 and a higher PA quartile were associated with a
higher TT (p < .001). Among Israelis, age
(p = .007), married marital status (p =
.007), and BMI <25 were significantly associated with FT/LH. No associations
of any factors were identified among Palestinians. Associations with several
modifiable factors identified in Western samples were replicated in Israelis and
to a lesser degree in Palestinians. Different relationships of several factors
with TT and FT/LH could result from ethnically diverse genetic,
sociodemographic, and behavioral characteristics that warrant further
research.
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Affiliation(s)
- Guy Vishnevsky
- Braun School of Public Health and Community Medicine, Hadassah University Medical Center, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Sinnreich
- Braun School of Public Health and Community Medicine, Hadassah University Medical Center, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hisham Nassar
- Department of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Maya Ish-Shalom
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy D Kark
- Braun School of Public Health and Community Medicine, Hadassah University Medical Center, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah University Medical Center, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Abu-Much A, Nof E, Bragazzi NL, Younis A, Hochstein D, Younis A, Shlomo N, Fardman A, Goldenberg I, Klempfner R, Beinart R. Ethnic Disparity in Mortality Among Ischemic Heart Disease Patients. A-20 Years Outcome Study From Israel. Front Cardiovasc Med 2021; 8:661390. [PMID: 34277726 PMCID: PMC8277917 DOI: 10.3389/fcvm.2021.661390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Long-term morbidity and mortality data among ischemic heart disease (IHD) patients of different ethnicities are conflicting. We sought to determine the independent association of ethnicity and all-cause mortality over two decades of follow-up of Israeli patients. Methods: Our study comprised 15,524 patients including 958 (6%) Arab patients who had been previously enrolled in the Bezafibrate Infarction Prevention (BIP) registry between February 1, 1990, and October 31, 1992, and subsequently followed-up for long-term mortality. We compared clinical characteristics and outcomes of Israeli Arabs and Jews. Propensity score matching (PSM) (1:2 ratios) was used for validation. Results: Arab patients were significantly younger (56 ± 7 years vs. 60 ± 7 years; p < 0.001; respectively), and had more cardiovascular disease (CVD) risk factors. Kaplan-Meier survival analysis showed that all-cause mortality was significantly higher among Arab patients (67 vs. 61%; log-rank p < 0.001). Multivariate adjusted analysis showed that mortality risk was 49% greater (HR 1.49; 95% CI: 1.37–1.62; p < 0.001) among Arabs. Conclusions: Arab ethnicity is independently associated with an increased 20-year all-cause mortality among patients with established IHD.
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Affiliation(s)
- Arsalan Abu-Much
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, Centre for Disease Modelling, York University, Toronto, ON, Canada
| | - Anan Younis
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hochstein
- St George's Hospital Medical School, University of London, London, United Kingdom
| | - Arwa Younis
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Shlomo
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Fardman
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, United States
| | - Robert Klempfner
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- Leviev Heart Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
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Zalan A, Sheikh-Muhammad A, Khatib M, Sharkia R. The Current and Forecasted Status of Type 2 Diabetes in the Arab Society of Israel. Curr Diabetes Rev 2021; 17:e050421192659. [PMID: 33820521 DOI: 10.2174/1573399817666210405100108] [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: 09/11/2020] [Revised: 01/20/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is considered one of the main causes of mortality, morbidity, and health care expenditures. Effectively treating this disease is of crucial importance and imposes a global challenge. The incidence of Type 2 DM (T2DM) is rapidly rising in both developing and developed countries. The Arab community in Israel is a distinct ethnic group with unique characteristics. Recently, this community has undergone major changes in its lifestyle, adopting the Westernized one, which could have caused an increase in the T2DM incidence rate. OBJECTIVE This review aims to shed light on various studies undertaken to explore the prevalence of diabetes and determine its current status in the Arab society of Israel, resting on previous and current data. It is presented to highlight the status of diabetes globally and to focus on its current situation in the Arab society of Israel, attempting to forecast its direction in the upcoming decade. METHODS Data were obtained from our previous comprehensive socio-economic and health crosssectional surveys for successive periods from 2004 to 2017. These surveys were conducted on the Arab society of Israel by the Galilee Society. RESULTS Our results showed a progressive increase in the prevalence of T2DM from 3.4% to 7.6% in the Arab society of Israel. This trend is expected to continue rising in the coming decade, and based on our predictions, may exceed 12% in 2030. CONCLUSION Substantial and practical health-related actions must be initiated to prevent an increasing number of adults from developing diabetes and its complications.
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Affiliation(s)
- Abdelnaser Zalan
- Unit of Human Biology and Genetics, The Triangle Regional Research and Development Center, Kfar-Qari, Israel
| | - Ahmad Sheikh-Muhammad
- The Galilee Society - The Arab National Society for Research and Health Services, Shefa-Amr, Israel
| | - Mohammad Khatib
- The Galilee Society - The Arab National Society for Research and Health Services, Shefa-Amr, Israel
| | - Rajech Sharkia
- Unit of Human Biology and Genetics, The Triangle Regional Research and Development Center, Kfar-Qari, Israel
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8
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Agbaria N, Nubani-Husseini M, Barakat RA, Leiter E, Greenberg KL, Karjawally M, Keidar O, Donchin M, Zwas DR. Two-Phase Evaluation of a Community-Based Lifestyle Intervention for Palestinian Women in East Jerusalem: A Quasi-Experimental Study Followed by Dissemination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9184. [PMID: 33316905 PMCID: PMC7763328 DOI: 10.3390/ijerph17249184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 01/06/2023]
Abstract
Palestinian-Arab women are at increased risk of cardiovascular disease due to high prevalence of diabetes and other risk factors. The current study investigates the effectiveness of an intensive group-based intervention on lifestyle habits that can prevent diabetes and cardiovascular disease. To that end, we conducted a group-based intervention based on the diabetes prevention program in two consecutive phases. The first phase consisted of a quasi-experimental study and the second phase included community-wide dissemination, with a 6-month follow-up. Findings from the quasi-experiment indicate increased consumption of fruit, vegetables and whole grains, weight reduction (-2.21 kg, p < 0.01), and a significant increase in the average daily steps in the intervention group (from 4456 to 6404). Findings from the dissemination indicate that average daily vegetables consumption increased from 1.76 to 2.32/day as did physical activity and average daily steps (from 4804 to 5827). There was a significant reduction in blood pressure, total cholesterol and LDL. These gains were sustained over 6 months following the intervention. This community-based, culturally adapted, health-promotion intervention led to improved nutrition and physical activity which were maintained after 6 months. Collaboration with community centers and local community partners created an effective channel for dissemination of the program to pre-clinical individuals.
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Affiliation(s)
- Nisreen Agbaria
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Division of Cardiology, Hadassah University Medical Center, Jerusalem 91120, Israel; (M.N.-H.); (E.L.); (K.L.G.); (M.K.); (D.R.Z.)
| | - Maha Nubani-Husseini
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Division of Cardiology, Hadassah University Medical Center, Jerusalem 91120, Israel; (M.N.-H.); (E.L.); (K.L.G.); (M.K.); (D.R.Z.)
| | - Raghda A. Barakat
- The Nutrition Division, The Israeli Ministry of Health, Jerusalem 91011002, Israel;
| | - Elisheva Leiter
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Division of Cardiology, Hadassah University Medical Center, Jerusalem 91120, Israel; (M.N.-H.); (E.L.); (K.L.G.); (M.K.); (D.R.Z.)
| | - Keren L. Greenberg
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Division of Cardiology, Hadassah University Medical Center, Jerusalem 91120, Israel; (M.N.-H.); (E.L.); (K.L.G.); (M.K.); (D.R.Z.)
| | - Mayada Karjawally
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Division of Cardiology, Hadassah University Medical Center, Jerusalem 91120, Israel; (M.N.-H.); (E.L.); (K.L.G.); (M.K.); (D.R.Z.)
| | - Osnat Keidar
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah, Jerusalem 91120, Israel; (O.K.); (M.D.)
| | - Milka Donchin
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah, Jerusalem 91120, Israel; (O.K.); (M.D.)
| | - Donna R. Zwas
- Linda Joy Pollin Cardiovascular Wellness Center for Women, Division of Cardiology, Hadassah University Medical Center, Jerusalem 91120, Israel; (M.N.-H.); (E.L.); (K.L.G.); (M.K.); (D.R.Z.)
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9
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Barham A, Ibraheem R, Zyoud SH. Cardiac self-efficacy and quality of life in patients with coronary heart disease: a cross-sectional study from Palestine. BMC Cardiovasc Disord 2019; 19:290. [PMID: 31835995 PMCID: PMC6909462 DOI: 10.1186/s12872-019-01281-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Psychological factors, such as self-efficacy, are important in understanding the progress and management of coronary heart disease (CHD), and how patients make lifestyle modifications to compensate for the disease. The main objectives of this research are to assess patterns of cardiac self-efficacy (CSE) and quality of life (QoL) among CHD patients, and to determine the factors that affect their QoL. METHODS A cross-sectional descriptive correlational study was carried out between August 2016 and December 2016. We used a structured questionnaire completed by interviewers during face-to-face interviews with patients. Cardiac self-efficacy was evaluated using three scales: 1) the 5-item perceived efficacy in patient- physician interaction scale (PEPPI-5); 2) the self-efficacy for managing chronic diseases 6-item scale (SEMCD-6) and 3) Sullivan's cardiac self-efficacy scale 13-items (SCSES). The 5-level version of the EuroQoL 5-dimensions questionnaire (EQ-5D-5 L), and Euroqol Visual Analogue Scale (EQ VAS) were used to evaluate health-related QoL (HRQoL) among CHD patients. Multiple binary logistic regression was carried out to evaluate the influence on the QoL score of demographic and medical characteristics, and self-efficacy factors. RESULTS A total of 275 patients participated in our study. The patients' mean age was 59.51 ± 1.005 years. The HRQoL was measured by the EQ-5D-5 L index score and EQ-VAS score; their means were 0.62 ± 0.16 and 57.44 ± 1.61, respectively. The QoL showed moderate positive correlations with the PEPPI-5 (r = 0.419; p-value < 0.001), SEMCD-6 (r = 0.419; p-value < 0.001), and SCSES score (r = 0.273; p-value < 0.001). Multiple binary logistic regression showed that only patients with higher PEPPI-5 score (odds ratio (OR) = 1.11; 95% confidence interval (CI) =1.01-1.22; p = 0.036), and higher SCSES score (OR = 1.10; 95% CI = 1.03-1.17; p = 0.004) were significantly associated with a high QoL score. Moreover, multiple binary logistic regression model showed that patients with higher numbers of medications (OR = 0.23; 95% CI = 0.07-0.78); p = 0.018) remained significantly associated with impaired QoL. CONCLUSIONS Lower levels of self-efficacy and poorer patient-physician interactions predicted poor HRQoL. Thus, health providers should be aware of these factors in CHD patients when trying to improve their QoL.
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Affiliation(s)
- Aya Barham
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Reem Ibraheem
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839 Palestine
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10
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Gal G, Munitz H, Levav I. Double disparities in the health care for people with schizophrenia of an ethnic-national minority. Isr J Health Policy Res 2017; 6:47. [PMID: 29031281 PMCID: PMC5641401 DOI: 10.1186/s13584-017-0166-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Studies have shown health care disparities among persons of minority status, including in countries with universal health care. Yet, a dearth of studies have addressed disparities resulting from the combined effect of two minority status groups: severe mental illness and ethnic-national sector filiation. This study aimed to compare the differential health care of Jewish- and Arab-Israelis with schizophrenia in a country with a universal health insurance. METHOD This study builds on a large case-control epidemiological sample (N = 50,499) of Jewish- (92.9%) and Arab-Israelis (7.1%) service users with (n = 16,833) and without schizophrenia (n = 33,666). Health services records were collected in the years 2000-2009. Diabetes and cardiovascular disease (CVD) served as sentinel diseases. We compared annual number of LDL tests and visits to specialists in the entire sample, Hemoglobin-A1C test among people diagnosed with diabetes, and cardiac surgical interventions for those diagnosed with CVD. RESULTS Service users with schizophrenia were less likely to meet identical indexes of care as their study counterparts: 95% of cholesterol tests (p < .001), and 92% visits to specialists (p < .001). These differences were greater among Arab- compared to Jewish-Israelis. Annual frequency of Hemoglobin-A1C test among people diagnosed with diabetes was lower (94%) in people with schizophrenia (p < 0.01), but no ethnic-national differences were identified. Among service users with CVD less surgical interventions were done in people with schizophrenia (70%) compared to their counterparts, with no ethnic-national disparities. CONCLUSIONS In Israel, service users with schizophrenia fail to receive equitable levels of medical and cardiac surgical care for CVD and regular laboratory tests for diabetes. Although disparities in some health indicators were enhanced among Arab-Israelis, schizophrenia was a greater source of disparities than ethnic-national filiation.
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Affiliation(s)
- Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Rabenu Yeruham St, Tel Aviv, Israel.
| | | | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
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11
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Palestinian Arab ethnicity is associated with an adverse metabolic phenotype. Clin Chim Acta 2017; 475:56-63. [PMID: 28987777 DOI: 10.1016/j.cca.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 10/03/2017] [Indexed: 01/16/2023]
Abstract
Urban-dwelling Palestinians have been shown to have higher cardiovascular morbidity and mortality and prevalence of diabetes than urban Israelis. Inflammation is implicated in the etiology of these conditions. We hypothesized that increased inflammatory activation, manifested as increased GlycA, a novel biomarker of global inflammation, would be evident in Palestinians. We compared GlycA concentrations between Palestinians and Israelis and assessed the associations of GlycA with anthropometric, health behavioral and clinical variables in a sample of 1674 Palestinians and Israelis aged 25-74, residing in Jerusalem. The main outcome measure was GlycA concentration. GlycA was higher in Palestinians than Israelis (p<0.001). This finding persisted in young Palestinians with normal glucose tolerance. GlycA, total white blood cell count, the triglyceride to HDL-cholesterol ratio and small LDL-cholesterol particles were all significantly higher in Palestinians compared to Israelis across obesity and glucose tolerance categories. Palestinian women had greater GlycA compared to Israeli women and men of both ethnicities. GlycA as well as adverse cardiovascular biomarkers are all higher in Palestinian Arabs than Israeli Jews, even in young healthy adults. This propensity to inflammation may be a driver of the higher risk of cardiovascular disease, insulin resistance and diabetes observed in this population.
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12
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Turk-Adawi K, Sarrafzadegan N, Fadhil I, Taubert K, Sadeghi M, Wenger NK, Tan NS, Grace SL. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol 2017; 15:106-119. [PMID: 28933782 DOI: 10.1038/nrcardio.2017.138] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.
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Affiliation(s)
- Karam Turk-Adawi
- Public Health Department, College of Health Sciences, Qatar University, Al Jamea Street, Doha, Qatar
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Ibtihal Fadhil
- Noncommunicable Diseases, World Health Organization, East Mediterranean Regional Office, Monazamet El Seha El Alamia Street, extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo, Egypt
| | - Kathryn Taubert
- International Science and Health Strategies, American Heart Association, Aeschengraben 14, Basel 4051, Switzerland
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center. Cardiovascular Research Institute. Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, Georgia 30303, USA
| | - Nigel S Tan
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada
| | - Sherry L Grace
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada.,School of Kinesiology and Health Science, York University, Bethune 368, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
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Benderly M, Chetrit A, Murad H, Abu-Saad K, Gillon-Keren M, Rogowski O, Sela BA, Kanety H, Harats D, Atamna A, Alpert G, Goldbourt U, Kalter-Leibovici O. Cardiovascular health among two ethnic groups living in the same region: A population-based study. Int J Cardiol 2016; 228:23-30. [PMID: 27863357 DOI: 10.1016/j.ijcard.2016.11.079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/05/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Poor cardiovascular health (CVH) among ethnic/racial minorities, studied primarily in the USA, may reflect lower access to healthcare. We examined factors associated with minority CVH in a setting of universal access to healthcare. METHODS AND RESULTS CVH behaviors and factors were evaluated in a random population sample (551 Arabs, 553 Jews) stratified by sex, ethnicity and age. More Jews (10%) than Arabs (3%) had 3 ideal health behaviors. Only one participant had all four. Although ideal diet was rare (≤1.5%) across groups, Arabs were more likely to meet intake recommendations for whole grains, but less likely to meet intake recommendations for fruits/vegetables and fish. Arabs had lower odds of attaining ideal levels for body mass index and physical activity. Smoking prevalence was 57% among Arab men and 6% among Arab women. Having four ideal health factors (cholesterol, blood pressure, glucose, smoking) was observed in 2% and 8% of Arab and Jewish men, respectively, and 13% of Arab and Jewish women. Higher prevalence of ideal total-cholesterol corresponded to lower high-density lipoprotein cholesterol among Arabs. No participant met ideal levels for all 7 metrics and only 1.8% presented with 6. Accounting for age and lower socioeconomic status, Arabs were less likely to meet a greater number of metric goals (odds ratio (95% confidence interval): 0.62 (0.42-0.92) for men, and 0.73 (0.48-1.12) for women). CONCLUSIONS Ideal CVH, rare altogether, was less prevalent among the Arab minority albeit universal access to healthcare. Health behaviors were the main contributors to the CVH disparity.
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Affiliation(s)
- Michal Benderly
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Angela Chetrit
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Havi Murad
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Kathleen Abu-Saad
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Michal Gillon-Keren
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ori Rogowski
- Internal Medicine, Soraski Medical Center, Tel Aviv, Israel
| | - Ben-Ami Sela
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Chemical Pathology, Sheba Medical Center, Ramat-Gan, Israel
| | - Hannah Kanety
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Endocrinology, Sheba Medical Center, Ramat-Gan, Israel
| | - Dror Harats
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Bert W. Strassburger Lipid Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Ahmed Atamna
- Clalit Health Services, Shomron Administration, Hadera, Israel
| | - Gershon Alpert
- Clalit Health Services, Shomron Administration, Hadera, Israel
| | - Uri Goldbourt
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofra Kalter-Leibovici
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Blumstein T, Benyamini Y, Boyko V, Lerner-Geva L. Women's knowledge about heart disease: Differences among ethnic and cultural groups in the Israeli Women's Health in Midlife Study. Women Health 2015. [PMID: 26214539 DOI: 10.1080/03630242.2015.1074639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: long-term Jewish residents (LTR), immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity, and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about "warning signs of a heart attack" and "family history." Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients' personal status by health providers.
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Affiliation(s)
- Tzvia Blumstein
- a Women and Children's Health Research Unit , The Gertner Institute for Epidemiology and Health Policy Research, Ltd ., Tel Hashomer , Ramat Gan , Israel
| | - Yael Benyamini
- b Bob Shapell School of Social Work , Tel Aviv University , Tel Aviv , Israel
| | - Valentina Boyko
- a Women and Children's Health Research Unit , The Gertner Institute for Epidemiology and Health Policy Research, Ltd ., Tel Hashomer , Ramat Gan , Israel
| | - Liat Lerner-Geva
- c Women and Children's Health Research Unit , The Gertner Institute for Epidemiology and Health Policy Research, Ltd. , Tel Hashomer , Ramat Gan , Israel.,d Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Gotsman I, Avishai-Eliner S, Jabara R, Zemora Z, Shauer A, Lotan C, Keren A. Ethnic disparity in the clinical characteristics of patients with heart failure. Eur J Heart Fail 2015; 17:801-8. [PMID: 25994423 DOI: 10.1002/ejhf.285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS The characteristics of heart failure (HF) patients of different ethnic backgrounds in Israel are unknown. The purpose of the present study was to evaluate the clinical characteristics of Arab vs. Jewish patients with chronic HF. METHODS AND RESULTS Patients with a diagnosis of HF at a health maintenance organization in Jerusalem, Israel were evaluated. All patients were followed for cardiac-related hospitalizations and death. The study cohort included 6773 HF patients; 4991 (74%) were Jewish and 1735 (26%) were Arab. The overall prevalence of HF in the Jewish vs. Arab population was similar (women, 4.3% vs. 4.7%, respectively, P = 0.06; men, 5.3% vs. 5.2%, P = 0.61). The prevalence of HF was significantly higher in Arab subjects of younger age groups (50-70 years). Arabs developed HF on average 10 years earlier and had a significantly higher rate of diabetes and obesity. Standard of care based on prescribed medications was similar between the ethnic groups. Glucose and cholesterol levels were higher in the Arab cohort. Mortality was similar between the groups at median follow-up (576 days), with the exception of cardiovascular hospitalizations and death that were higher in Arab men. CONCLUSIONS Arab subjects develop HF at a much younger age compared with their Jewish counterparts and have a higher prevalence of diabetes and obesity. Standard of care and clinical outcome are comparable. Implementation of prevention programmes to reduce risk factors, particularly diabetes and obesity, may help reduce the disparity between Arabs and Jews.
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Affiliation(s)
- Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Clalit Health Services, Jerusalem, Israel
| | | | - Refat Jabara
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Clalit Health Services, Jerusalem, Israel
| | | | - Ayelet Shauer
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Chaim Lotan
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Clalit Health Services, Jerusalem, Israel
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16
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Toperoff G, Kark JD, Aran D, Nassar H, Ahmad WA, Sinnreich R, Azaiza D, Glaser B, Hellman A. Premature aging of leukocyte DNA methylation is associated with type 2 diabetes prevalence. Clin Epigenetics 2015; 7:35. [PMID: 25829970 PMCID: PMC4379765 DOI: 10.1186/s13148-015-0069-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/10/2015] [Indexed: 01/02/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2D) is highly prevalent in Middle-Eastern and North African Arab populations, but the molecular basis for this susceptibility is unknown. Altered DNA methylation levels were reported in insulin-secreting and responding tissues, but whether methylation in accessible tissues such as peripheral blood is associated with T2D risk remains an open question. Age-related alteration of DNA methylation level was reported in certain methylation sites, but no association with T2D has been shown. Here we report on a population-based study of 929 men and women representing the East Jerusalem Palestinian (EJP) Arab population and compare with the findings among Israeli Ashkenazi Jews. This is the first reported epigenetic study of an Arab population with a characteristic high prevalence of T2D. Results We found that DNA methylation of a prespecified regulatory site in peripheral blood leukocytes (PBLs) is associated with impaired glucose metabolism and T2D independent of sex, body mass index, and white blood cell composition. This CpG site (Chr16: 53,809,231-2; hg19) is located in a region within an intron of the FTO gene, suspected to serve as a tissue-specific enhancer. The association between PBL hypomethylation and T2D varied by age, revealing differential patterns of methylation aging in healthy and diabetic individuals and between ethnic groups: T2D patients displayed prematurely low methylation levels, and this hypomethylation was greater and occurred earlier in life among Palestinian Arabs than Ashkenazi Jews. Conclusions Our study suggests that premature DNA methylation aging is associated with increased risk of T2D. These findings should stimulate the search for more such sites and may pave the way to improved T2D risk prediction within and between human populations. Electronic supplementary material The online version of this article (doi:10.1186/s13148-015-0069-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gidon Toperoff
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, 91120 Israel
| | - Jeremy D Kark
- Epidemiology Unit, Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Organization, Jerusalem, Israel
| | - Dvir Aran
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, 91120 Israel ; School of Computer Science and Engineering, Hebrew University, Jerusalem, Israel
| | - Hisham Nassar
- Cardiology Department, Hadassah-Hebrew University Medical Center, Hadassah Medical Organization, Ein Kerem, Jerusalem, Israel ; St Joseph Hospital (East Jerusalem), Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Epidemiology Unit, Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Organization, Jerusalem, Israel
| | - Ronit Sinnreich
- Epidemiology Unit, Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Organization, Jerusalem, Israel
| | - Dima Azaiza
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, 91120 Israel
| | - Benjamin Glaser
- Endocrinology and Metabolism Service, Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Hadassah Medical Organization, Ein Kerem, Jerusalem, Israel
| | - Asaf Hellman
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, 91120 Israel
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Gugliucci A, Caccavello R, Nassar H, Abu Ahmad W, Sinnreich R, Kark JD. Low protective PON1 lactonase activity in an Arab population with high rates of coronary heart disease and diabetes. Clin Chim Acta 2015; 445:41-7. [PMID: 25801214 DOI: 10.1016/j.cca.2015.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/09/2015] [Accepted: 03/02/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recent studies showing that high density lipoproteins (HDL) can effect plaque regression indicate that recent trial failures do not exclude an atheroprotective role of HDL. Instead, they highlight differences between HDL function and measured HDL-cholesterol (HDL-C). PON1 is one key functional activity of HDL. Urban Palestinians have lower HDL-C and a higher incidence and mortality of coronary heart disease than those of Israelis. We hypothesized that the cardioprotective PON1 lactonase and arylesterase activities and PON1 functional genotype may differ between Palestinians and Israelis. METHODS We measured PON1 activities in a cross-sectional population-based study of Palestinian (n=960) and Israeli (n=694) residents in Jerusalem, 1654 participants in all. RESULTS Palestinians had high prevalences of obesity and diabetes and low mean concentrations of HDL-cholesterol (0.97 mmol/l in men and 1.19 mmol/l in women). Lactonase and arylesterase activities were lower by 10.8% (p=1.2∗10(-14)) and 2.7% (p<0.0005), respectively, in Palestinians as compared to Israelis. The functional genotype distribution, demonstrated by plotting paraoxonase vs lactonase activities, showed a modest between-group difference (p=0.024), with 12.1% RR in Palestinian Arabs vs 8.4% in Israeli Jews, but no overall difference in allele frequencies. Lactonase correlated inversely with age (Spearman's rho=-.156), weakly with BMI (-.059), positively with HDL-C (.173) and non-HDL-C (.103), but was not associated with triglycerides or fasting glucose. Palestinians showed consistently lower lactonase activity in logistic regression models adjusted for multiple covariates and for functional genotype (odds ratios of 1.81 and 1.98, respectively, for the lower fifth vs the upper 4 fifths of lactonase activity p<0.0001). CONCLUSION We showed a lower physiologically-significant lactonase PON1 activity in an Arab population, a finding consistent with the high cardiovascular and diabetes risk of Palestinians.
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Affiliation(s)
- A Gugliucci
- Glycation, Oxidation and Disease Laboratory, Department of Research, College of Osteopathic Medicine, Touro University California, Vallejo, CA, United States.
| | - R Caccavello
- Glycation, Oxidation and Disease Laboratory, Department of Research, College of Osteopathic Medicine, Touro University California, Vallejo, CA, United States
| | - H Nassar
- Dept of Cardiology, Hadassah Medical Center, Ein Kerem, Jerusalem, Israel; St Joseph Hospital, Jerusalem, Israel
| | - W Abu Ahmad
- Hebrew University, Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - R Sinnreich
- Hebrew University, Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - J D Kark
- Hebrew University, Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
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Differences in the triglyceride to HDL-cholesterol ratio between Palestinian and Israeli adults. PLoS One 2015; 10:e0116617. [PMID: 25635396 PMCID: PMC4312056 DOI: 10.1371/journal.pone.0116617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 12/11/2014] [Indexed: 12/02/2022] Open
Abstract
Aims To evaluate differences in the triglyceride to HDL-cholesterol ratio (TG/HDL), thought to be a proxy measure of insulin resistance, between Palestinian and Israeli adults in view of the greater incidence of coronary heart disease and high prevalence of diabetes in Palestinian Arabs. Research Methods A population-based observational prevalence study of cardiovascular and diabetes risk factors in Jerusalem. Participants (968 Palestinians, 707 Israelis, sampled at ages 25-74 years) underwent fasting and 2h post-75g oral challenge plasma glucose determinations. Metabolic risk was assessed using the surrogate index TG/HDL. Sex-specific comparisons were stratified by categories of body mass index and sex-specific waist circumference quartiles, adjusted by regression for age, glucose tolerance status and use of statins. Results Prevalence of overweight and obesity was substantially larger in Palestinians (p = 0.005). Prevalence of diabetes was 2.4 and 4 fold higher among Palestinian men and women, respectively (p<0.001). Adjusted TG/HDL was higher in Palestinians than Israelis across BMI and waist circumference categories (p<0.001 for both). Higher TG/HDL in Palestinians persisted in analyses restricted to participants with normal glucose tolerance and off statins. Notably, higher TG/HDL among Palestinians prevailed at a young age (25-44 years) and in normal weight individuals of both sexes. Conclusions Palestinians have a higher TG/HDL ratio than Israelis. Notably, this is evident also in young, healthy and normal weight participants. These findings indicate the need to study the determinants of this biomarker and other measures of insulin resistance in urban Arab populations and to focus research attention on earlier ages: childhood and prenatal stages of development.
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Abed Y, Jamee A. Characteristics and Risk Factors Attributed to Coronary Artery Disease in Women Attended Health Services in Gaza-Palestine Observational Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjcd.2015.51002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Reges O, Vilchinsky N, Leibowitz M, Khaskia A, Mosseri M, Kark JD. Change in health behaviours following acute coronary syndrome: Arab-Jewish differences. Eur J Prev Cardiol 2014; 22:458-67. [PMID: 24470516 DOI: 10.1177/2047487314520924] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health-promoting behaviours after acute coronary syndrome (ACS) are effective in preventing recurrence. Ethnicity impacts on such behaviours. We assessed the independent association of Arab vs. Jewish ethnicity with persistence of smoking and physical inactivity 6 months after ACS in central Israel. DESIGN Prospective cohort study. METHODS During their admission for ACS and subsequently 6 months later, 420 patients were interviewed about their smoking and exercise habits. The association of ethnicity with health-promoting behaviours was assessed by logistic regression adjusting for socio-demographic and clinical covariates. RESULTS Smoking prevalence and physical inactivity were substantially higher among Arab patients than Jewish patients at admission (gender-adjusted prevalence rate ratio (RR) 2.25, 95% CI 1.80-2.81, p < 0.01 and RR 1.46, 95% CI 1.28-1.67, p < 0.001, respectively). The relative differences increased at 6 months (RR 2.94, 95% CI 2.13-4.07, p < 0.001 and RR 3.00, 95% CI 2.24-4.04, p < 0.001, respectively). Excess persistent smoking at 6 months among Arab vs. Jewish patients who were smokers at admission (adjusted OR 2.05, 95% CI 1.00-4.20, p = 0.049) was largely mediated through the 3.5-fold higher participation of Jewish patients in cardiac prevention and rehabilitation program (CPRP) (OR adjusted also for CPRP 1.31, 95% CI 0.59-2.93, p = 0.51). Greater persistent sedentary behaviour at 6 months among nonexercisers at admission among Arab patients (adjusted OR 3.68, 95% CI 1.93-7.02, p < 0.001) was partly mediated through attendance of CPRP (OR adjusted also for CPRP 2.38, 95% CI 1.19-4.76, p = 0.014). CONCLUSIONS Culturally sensitive programmes need to be developed to enhance CPRP participation and favourable health-promoting changes among Arab patients. A comprehensive understanding of the determinants of the Arab-Jewish differences in efficacious health-promoting behaviours is crucial to inform appropriate ethnic-specific health-promoting strategies.
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Affiliation(s)
- Orna Reges
- Hebrew University and Hadassah Medical Center, Jerusalem, Israel Clalit Research Institute, Tel-Aviv, Israel Meir Medical Center, Kfar-Saba, Israel
| | | | - Morton Leibowitz
- Clalit Research Institute, Tel-Aviv, Israel New York University, New York, USA
| | | | | | - Jeremy D Kark
- Hebrew University and Hadassah Medical Center, Jerusalem, Israel
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21
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Leukocyte telomere length and coronary artery calcification in Palestinians. Atherosclerosis 2013; 229:363-8. [PMID: 23880188 DOI: 10.1016/j.atherosclerosis.2013.05.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/08/2013] [Accepted: 05/28/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Shorter leukocyte telomere length (LTL) is associated with higher incidence of coronary heart disease (CHD) and increased mortality. We examined the association of LTL with coronary artery calcification (CAC), which reflects the cumulative burden of coronary atherosclerosis, in an urban Arab sample of Palestinians, a population at high risk of CHD. METHODS Using a cross-sectional design, a random sample of East Jerusalem residents, comprising 250 men aged 45-77 and women aged 55-76 and free of CHD or past stroke, was drawn from the Israel national population register. LTL was measured by Southern blots. CAC was determined by 16-slice multidetector helical CT scanning using Agatston scoring. We applied multivariable logistic modeling to examine the association between sex-specific tertiles of LTL and CAC (comparing scores >100 vs. <100, and the upper third vs. the lower 2 thirds), controlling for age, sex, education and coronary risk factors. RESULTS CAC, evident in 65% of men and 52% of women, was strongly associated with age (sex-adjusted Spearman's rho 0.495). The multivariable-adjusted odds ratios for CAC >100 (found in 30% of men and 29% of women) were 2.92 (95% CI 1.28-6.68) and 2.29 (0.99-5.30) for the lower and mid-tertiles of LTL vs. the upper tertile, respectively (Ptrend = 0.008). Findings were similar for CAC scores in the upper tertile (Ptrend = 0.006), and persisted after the exclusion of patients with diabetes or receiving statins. CONCLUSIONS Shorter LTL was associated with a greater prevalence of asymptomatic coronary atherosclerosis in an urban Arab population-based sample. Mechanisms underlying this association should be sought.
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Al-Lawati J, Sulaiman K, Panduranga P. The Epidemiology of Acute Coronary Syndrome in Oman: Results from the Oman-RACE study. Sultan Qaboos Univ Med J 2013; 13:43-50. [PMID: 23573381 PMCID: PMC3616799 DOI: 10.12816/0003194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/01/2012] [Accepted: 09/02/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the epidemiology and coronary risk factors of acute coronary syndrome (ACS) in Oman. METHODS Data were collected through a prospective, multinational, multicentre survey of consecutive patients, hospitalised over a 5-month period in 2007 with a diagnosis of ACS, in Yemen and five Arabian Gulf countries (Oman, Bahrain, Kuwait, Qatar, United Arab Emirates). Here we present data of Omani patients aged ≥20 years who received a provisional diagnosis of ACS and were consequently admitted to 14 different hospitals. RESULTS There where 1,340 confirmed ACS episodes in 748 men and 592 women (median age 61 years). The overall crude incidence rate of ACS was 338.9 per 100,000 person-years (P-Y). The age-standardised rate (ASR) of ACS was 779 and 674 per 100,000 P-Y for men and women, respectively. The ASR male-to-female rate ratio was highest in the ST-elevation myocardial infarction (STEMI) group (2.26, 95% confidence interval ([CI], 1.63 to 3.15) followed by the non-STEMI (NSTEMI) group (1.68, 95% CI 1.28 to 2.21) and unstable angina (0.79, 95% CI 0.66 to 0.99). Unstable angina accounted for 55%, STEMI for 26% and NSTEMI for 19% of ACS cases. Among the coronary risk factors, there was a high prevalence of hypertension (68%), diabetes mellitus (DM) (36%), hyperlipidaemia (63%), and overweight/obesity (65%), with a relatively low rate of current tobacco use (11%). CONCLUSION Our study confirms a high incidence of ACS in Omanis and supports the notion that the cardiovascular disease epidemic is also sweeping developing countries.
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Affiliation(s)
- Jawad Al-Lawati
- Department of Non-communicable Diseases Surveillance & Control, Ministry of Health, Muscat, Oman
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Reges O, Vilchinsky N, Leibowitz M, Khaskia A, Mosseri M, Kark JD. Arab–Jewish differences in attending cardiac rehabilitation programs following acute coronary syndrome. Int J Cardiol 2013; 163:218-9. [DOI: 10.1016/j.ijcard.2012.06.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 06/24/2012] [Indexed: 10/28/2022]
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Coronary Heart Disease and Metabolic Risk Factors in Israel: Focus on Gender and Ethnicity. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0242-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hussein AS. High prevalence of three prothrombotic polymorphisms among Palestinians: factor V G1691A, factor II G20210A and methylenetetrahydrofolate reductase C677T. J Thromb Thrombolysis 2012; 34:383-7. [PMID: 22528331 DOI: 10.1007/s11239-012-0731-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Merom D, Sinnreich R, Aboudi V, Kark JD, Nassar H. Lifestyle physical activity among urban Palestinians and Israelis: a cross-sectional comparison in the Palestinian-Israeli Jerusalem risk factor study. BMC Public Health 2012; 12:90. [PMID: 22289260 PMCID: PMC3311574 DOI: 10.1186/1471-2458-12-90] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 01/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urban Palestinians have a high incidence of coronary heart disease, and alarming prevalences of obesity (particularly among women) and diabetes. An active lifestyle can help prevent these conditions. Little is known about the physical activity (PA) behavior of Palestinians. This study aimed to determine the prevalence of insufficient PA and its socio-demographic correlates among urban Palestinians in comparison with Israelis. METHODS An age-sex stratified random sample of Palestinians and Israelis aged 25-74 years living in east and west Jerusalem was drawn from the Israel National Population Registry: 970 Palestinians and 712 Israelis participated. PA in a typical week was assessed by the Multi-Ethnic Study of Atherosclerosis (MESA) questionnaire. Energy expenditure (EE), calculated in metabolic equivalents (METs), was compared between groups for moderate to vigorous-intensity physical activity (MVPA), using the Wilcoxon rank-sum test, and for domain-specific prevalence rates of meeting public health guidelines and all-domain insufficient PA. Correlates of insufficient PA were assessed by multivariable logistic modeling. RESULTS Palestinian men had the highest median of MVPA (4740 METs-min*wk-1) compared to Israeli men (2,205 METs-min*wk-1 p < 0.0001), or to Palestinian and Israeli women, who had similar medians (2776 METs-min*wk-1). Two thirds (65%) of the total MVPA reported by Palestinian women were derived from domestic chores compared to 36% in Israeli women and 25% among Palestinian and Israeli men. A high proportion (63%) of Palestinian men met the PA recommendations by occupation/domestic activity, compared to 39% of Palestinian women and 37% of the Israelis. No leisure time PA was reported by 42% and 39% of Palestinian and Israeli men (p = 0.337) and 53% and 28% of Palestinian and Israeli women (p < 0.0001). Palestinian women reported the lowest level of walking. Considering all domains, 26% of Palestinian women were classified as insufficiently active versus 13% of Palestinian men (p < 0.0001) who did not differ from the Israeli sample (14%). Middle-aged and elderly and less educated Palestinian women, and unemployed and pensioned Palestinian men were at particularly high risk of inactivity. Socio-economic indicators only partially explained the ethnic disparity. CONCLUSIONS Substantial proportions of Palestinian women, and subgroups of Palestinian men, are insufficiently active. Culturally appropriate intervention strategies are warranted, particularly for this vulnerable population.
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Affiliation(s)
- Dafna Merom
- School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith NSW 2571, Australia
| | - Ronit Sinnreich
- Epidemiology Unit, Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
| | - Vartohi Aboudi
- St Joseph Hospital, East Jerusalem, Jerusalem, Israel
- IVF Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jeremy D Kark
- Epidemiology Unit, Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
| | - Hisham Nassar
- Cardiology Department, Hadassah-Hebrew University Medical Center and Cardiology Consultant, St Joseph Hospital, East Jerusalem, Jerusalem, Israel
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Reges O, Vilchinsky N, Leibowitz M, Manor D, Mosseri M, Kark JD. Perceptions of cause of illness in acute myocardial infarction patients: a longitudinal study. PATIENT EDUCATION AND COUNSELING 2011; 85:e155-e161. [PMID: 21310582 DOI: 10.1016/j.pec.2010.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 10/31/2010] [Accepted: 12/31/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess change in patient's attributions of illness over the long term in patients with acute myocardial infarction (AMI). METHODS 178 patients were asked during the index hospitalization and 2-2.5 years after discharge whether they thought each of 13 possible factors may have contributed to their illness. Two dichotomous variables, conventional attribution (attribution to traditional risk factors, CA) and psychosocial attribution (PA), were defined and assessed for each patient. RESULTS General stress, cigarette smoking, and heredity were the most commonly mentioned attribution for the AMI. The proportion of individuals with positive CA increased at follow up. There was little congruence between patients' attributions and actual self-reported risk factors, either at baseline or at follow up. Age, education, country of birth, and anxiety were found as independent predictors of illness attribution. The participation in a cardiac prevention and rehabilitation program (CPRP) did not contribute to a significant change in CA attributions. CONCLUSION Substantial proportions of patients have a poor understanding of the causes of their AMI both at onset of the illness and 2-2.5 years later, notwithstanding CPRP. PRACTICE IMPLICATIONS The health care system can ill afford complacency with regards patient education and understanding.
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Affiliation(s)
- Orna Reges
- Meir Medical Center, Department of Cardiology, Kfar Saba, Israel.
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Lammintausta A, Immonen-Räihä P, Lehtonen A, Räihä I, Harald K, Torppa J, Airaksinen JKE, Salomaa V. Myocardial infarction events and cardiovascular risk factor levels in Finnish- and Swedish-speaking populations of Finland. Ann Med 2011; 43:562-9. [PMID: 20964582 DOI: 10.3109/07853890.2010.526136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND. The Swedish-speaking minority of Finland is unique, because it has a higher socioeconomic status (SES) and longer life expectancy than the Finnish-speaking majority. We hypothesized that this minority may have a lower attack rate of coronary events and analysed whether this could be explained by their higher SES. METHODS. The population-based myocardial infarction (MI) registers recorded 4,845 MI events in Turku during 1988-1998. Individual-level indicators of SES were obtained from Statistics Finland. The population-based FINRISK surveys recorded cardiovascular risk factors and native languages of 10,432 people in 1987, 1997, and 2002. RESULTS. The age-standardized attack rate of MI was lower among the 35-64-year-old Swedish-speaking men than among Finnish-speaking men (rate ratio 0.66; 95% confidence interval 0.47-0.85) and the difference remained significant after adjustment for SES. The Swedish-speaking inhabitants had higher age-, sex-, and SES-adjusted high-density lipoprotein cholesterol, and lower triglycerides, body mass index, and diastolic blood pressure. Conclusion. The Swedish-speaking inhabitants of Turku had lower MI morbidity and coronary mortality than the Finnish-speaking inhabitants. After controlling for SES, these differences remained significant among men, suggesting that other factors, such as differences in the risk factor profiles may also play a role.
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Feeling vigorous and the risks of all-cause mortality, ischemic heart disease, and diabetes: a 20-year follow-up of healthy employees. Psychosom Med 2010; 72:727-33. [PMID: 20716713 DOI: 10.1097/psy.0b013e3181eeb643] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate prospectively the effects of vigor at work on the end points of mortality and the prevalence of ischemic heart disease (IHD) and diabetes. METHODS We tested the hypothesized beneficial effects of feeling vigorous at work at baseline on the risks of all-cause mortality, IHD, and diabetes during a 20-year follow-up. Participants were healthy employees (n = 968) who underwent a routine health check at baseline. We calculated the risk of all-cause mortality, IHD, and diabetes, with days as the time scale, using the Cox proportional hazard model. In our analyses, we predicted the above end points by baseline vigor, age, gender, and educational level, adjusting for the physiological risk factors of total cholesterol, glucose, and body mass index, the behavioral risk factors of smoking, alcohol intake, and physical activity, and the psychological risk factors of depressive and anxiety symptoms. RESULTS As hypothesized, we found that, after the above adjustments, baseline vigor decreased the risk of follow-up mortality by 26% (hazard ratio, 0.74; 95% confidence interval, 0.58-0.95) and the risk of diabetes by 17% (hazard ratio, 0.83; 95% confidence interval, 0.68-0.98). However, vigor did not have a significant effect on the risk of IHD. CONCLUSIONS Independently of physiological, behavioral, and psychological risk factors, feeling vigorous at work protected the participants from diabetes and reduced their risk of mortality.
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Ramahi TM. Cardiovascular disease in the Asia Middle East region: global trends and local implications. Asia Pac J Public Health 2010; 22:83S-89S. [PMID: 20566538 DOI: 10.1177/1010539510373034] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide and in most countries outside sub-Saharan Africa. The root causes of this modern epidemic are sedentary stressful urban lifestyles and high-calorie diets rich in saturated fats, salt, and simple sugars. Although the mortality from CVD has long peaked in most developed countries, its prevalence continues to rise because of improved survival and aging of the populations, placing tremendous strains on health care financing in some of these countries. In most Asian and Middle Eastern countries, outside East Asia, prevalence of CVD and its risk factors are high and still rising, while the rising mortality is among the highest in the world. As the predominantly young populations of these countries age, they face inadequate health care systems without assured financial coverage. Effective measures are therefore urgently needed to combat the epidemic of CVD. Comprehensive preventive measures are essential to curb the spread of this epidemic, while health care systems should be structured on the basis of locally derived data to provide adequate affordable care to the ever increasing pools of patients with CVD.
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Affiliation(s)
- Tarik M Ramahi
- Council on Middle East Studies, Yale University, New Haven, CT 06520-8206, USA.
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Ramahi T, Khawaja M, Abu-Rmeileh N, Abdulrahim S. Socio-economic disparities in heart disease in the Republic of Lebanon: findings from a population-based study. HEART ASIA 2010; 2:67-72. [PMID: 27325946 DOI: 10.1136/ha.2009.000851] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2010] [Indexed: 11/04/2022]
Abstract
BACKGROUND Socio-economic inequalities in the incidence of heart disease exist in developed countries. No data are available on the relation between heart disease and socio-economic status in Arab countries. This study examined the relation between heart disease and socio-economic status (income and education) among adults in Lebanon. METHODS The study examined data from 7879 respondents aged 40 years or more in the 2004 Lebanese Survey of Family Health. The dependent variable was reported heart disease. The main independent variables were education and household income. The analysis adjusted for the classic risk factors of coronary heart disease (CHD), namely smoking, diabetes mellitus, hypertension, hypercholesterolaemia, age, sex and other socio-demographic variables. Bivariate associations were calculated using χ(2) tests. Adjusted ORs for heart disease were calculated using multivariate logistic regression models. RESULTS 7.5% of respondents reported cardiac disease, 15.2% hypertension, 10.1% diabetes, 3.2% hypercholesterolaemia and 47.5% smoked at the time or previously. After adjustment for the classic risk factors of CHD, reported heart disease was inversely associated with education (OR=1.53, 95% CI 1.15 to 2.04, for those with less than elementary and OR=1.34, 95% CI 1.00 to 1.80, for those with elementary education). Reported heart disease was also inversely associated with income (OR=1.40, 95% CI 1.09 to 1.80, for those in the lowest income bracket). Past smoking, hypertension, age, male sex, marriage and residence in Beirut were all significantly associated with reported cardiac disease. CONCLUSIONS In Lebanon, adults with lower income and educational levels had a higher prevalence of heart disease independent of the risk factors of CHD.
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Affiliation(s)
- Tarik Ramahi
- Council on Middle East Studies, Yale University, New Haven, Connecticut, USA
| | - Marwan Khawaja
- Council on Middle East Studies, Yale University, New Haven, Connecticut, USA; Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Bir Zeit, Occupied Palestinian Territory
| | - Sawsan Abdulrahim
- Department of Health Behavior and Education, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Epel OB, Kaplan G, Moran M. Perceived discrimination and health-related quality of life among Arabs and Jews in Israel: a population-based survey. BMC Public Health 2010; 10:282. [PMID: 20507564 PMCID: PMC2891650 DOI: 10.1186/1471-2458-10-282] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 05/27/2010] [Indexed: 11/26/2022] Open
Abstract
Background Studies have shown that perceived discrimination may be associated with impaired health. The aim of this study was to assess the levels of perceived discrimination on the basis of origin and ethnicity and measure the association with health in three population groups in Israel: non-immigrant Jews, immigrants from the former Soviet Union, and Arabs. Methods A cross sectional random telephone survey was performed in 2006 covering 1,004 Israelis aged 35-65; of these, 404 were non-immigrant Jews, 200 were immigrants from the former Soviet Union and 400 were Arabs, the final number for regression analysis was 952. Respondents were asked about their perceived experiences with discrimination in seven different areas. Quality of life, both physical and mental were measured by the Short Form 12. Results Perceived discrimination on the basis of origin was highest among immigrants. About 30% of immigrants and 20% of Arabs reported feeling discriminated against in areas such as education and employment. After adjusting for socioeconomic variables, discrimination was associated with poor physical health among non-immigrant Jews (OR = 0.42, CI = 0.19, 0.91) and immigrants (OR = 0.51, CI = 0.27, 0.94), but not among Arabs. Poor mental health was significantly associated with discrimination only among non-immigrant Jews (OR = 0.42, CI = 0.18, 0.96). Conclusions Perceived discrimination seemed high in both minority populations in Israel (Arabs and immigrants) and needs to be addressed as such. However, discrimination was associated with physical health only among Jews (non-immigrants and immigrants), and not among Arabs. These results may be due to measurement artifacts or may be a true phenomenon, further research is needed to ascertain the results.
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Affiliation(s)
- Orna Baron Epel
- The School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Israel.
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A comparison of clinical characteristics, medications, and outcome
between acute stroke and acute myocardial infarction. Glob Heart 2009. [DOI: 10.1016/j.cvdpc.2009.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Husseini A, Abu-Rmeileh NME, Mikki N, Ramahi TM, Ghosh HA, Barghuthi N, Khalili M, Bjertness E, Holmboe-Ottesen G, Jervell J. Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory. Lancet 2009; 373:1041-9. [PMID: 19268350 DOI: 10.1016/s0140-6736(09)60109-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart disease, cerebrovascular disease, and cancer are the major causes of morbidity and mortality in the occupied Palestinian territory, resulting in a high direct cost of care, high indirect cost in loss of production, and much societal stress. The rates of the classic risk factors for atherosclerotic disease-namely, hypertension, diabetes mellitus, tobacco smoking, and dyslipidaemia-are high and similar to those in neighbouring countries. The urbanisation and continuing nutritional change from a healthy Mediterranean diet to an increasingly western-style diet is associated with reduced activity, obesity, and a loss of the protective effect of the traditional diet. Rates of cancer seem to be lower than those in neighbouring countries, with the leading causes of death being lung cancer in Palestinian men and breast cancer in women. The response of society and the health-care system to this epidemic is inadequate. A large proportion of health-care expenditure is on expensive curative care outside the area. Effective comprehensive prevention programmes should be implemented, and the health-care system should be redesigned to address these diseases.
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Affiliation(s)
- Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
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Salameh S, Hochner-Celnikier D, Chajek-Shaul T, Manor O, Bursztyn M. Ethnic gap in coronary artery disease: comparison of the extent, severity, and risk factors in Arab and Jewish middle-aged women. ACTA ACUST UNITED AC 2008; 3:26-9. [PMID: 18326974 DOI: 10.1111/j.1559-4572.2008.07315.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The authors examined risk factors and extent of coronary artery disease (CAD) among Jewish and Arab women in Jerusalem, where Arab women were found to have worse outcome. All angiographically confirmed cases of CAD among women aged 45 to 65 years who were hospitalized during 1990 to 1995 consisted of 40 Arab and 179 Jewish patients. Arab women had more atypical clinical presentations (P<.0001) and more extensive CAD (P=.0016) despite younger age (53+/-3 vs 55+/-5 years; P<.0003) and lesser smoking (P<.0006). The Arab women, however, were more likely to be obese (80% vs 46%; P=.0002), be physically inactive (100% vs 89%; P=.0285), and have diabetes mellitus (73% vs 40%; P=.0004). Moreover, they were more likely to have 3 or more risk factors (45% vs 23%; P=.036). Thus, a combination of an atypical presentation and higher risk (ie, diabetes mellitus combined with hypertension and other risk factors) and much more extensive disease readily explains their worse outcome.
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Affiliation(s)
- Shaden Salameh
- From the Department of Medicine Hadassah-Hebrew University Medical Center, Mount Scopus, Israel; and the School of Public Health, Jerusalem, Israel
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Kayhan C, Daffertshofer M, Mielke O, Hennerici M, Schwarz S. [Comparison between German and Turkish descent in ischemic stroke. Risk factors, initial findings, rehabilitative therapy, and social consequences]. DER NERVENARZT 2007; 78:188-92. [PMID: 17180668 DOI: 10.1007/s00115-006-2233-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Until now no data has been available on possible specific features of the Turkish minority in Germany with respect to stroke. PATIENTS AND METHODS We compared 20 Turkish stroke patients with matched German controls analyzing risk factors, findings at admission, rehabilitative treatments, and psychosocial aspects. RESULTS In the Turkish group the interval between onset of symptoms and admission was longer (532 min vs 255 min, P < 0.01). All other findings during acute treatment and rehabilitation were comparable. At follow-up after 22 months, the Barthel index was 90 for the Turks and 100 for the Germans. The Turkish patients reported more consultations with physicians than their German counterparts (68 vs 12 per year, P < 0.01). Scores for quality of life and outcome did not differ. The Turkish patients more frequently required care and had a higher degree of disability. CONCLUSIONS Turkish stroke patients have a longer time to admission. Risk factors, findings at admission, and treatment in the acute phase and rehabilitation are comparable. Several findings point towards a different health behavior. These results highlight the need for specific education of the Turkish population in Germany.
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Affiliation(s)
- C Kayhan
- Neurologische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg
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