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Leahy N, Wagener M, Shahzad S, Murphy D, McMorrow A, Coen E, Sharif R, Sharif F. Exploring Potential Referral Pathways for Renal Artery Denervation and Developing a Centre of Excellence in Ireland. SN COMPREHENSIVE CLINICAL MEDICINE 2024; 6:32. [PMID: 38500967 PMCID: PMC10944407 DOI: 10.1007/s42399-024-01647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
Arterial hypertension is one of the most significant and prevalent risk factors for cardiovascular disease. Despite widespread awareness of the condition, as well as a multitude of available antihypertensive drug classes, rates of uncontrolled hypertension remain high on a global scale. Frequently, poor compliance with anti-hypertensive medication plays a big role in patients' inability to attain adequate blood pressure control. In individuals with resistant and/or uncontrolled hypertension, renal denervation is an emerging device-based therapy that has shown to be efficacious and safe in reducing blood pressure in several sham controlled trials. Additionally, it represents a treatment option for patients intolerant to oral pharmacotherapy. University Hospital Galway has been performing renal denervation procedures over the past number of years within multicentre, international sham-controlled trials and registries. Representing a novel and emerging antihypertensive treatment option, sources of referral for renal denervation are diverse and multiple; thus, there is an unmet need for standardised referral structures in Ireland. Herein, we review current and developing referral pathways for renal denervation at our institution, and discuss streamlined patient management and requirements to establish a centre of excellence.
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Affiliation(s)
- Niall Leahy
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
- University of Galway, University Road, Galway, Ireland
| | - Max Wagener
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
- University of Galway, University Road, Galway, Ireland
| | - Shirjeel Shahzad
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
| | - Darragh Murphy
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
- University of Galway, University Road, Galway, Ireland
| | - Amy McMorrow
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
- University of Galway, University Road, Galway, Ireland
| | - Eileen Coen
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
- University of Galway, University Road, Galway, Ireland
| | - Ruth Sharif
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
- University of Galway, University Road, Galway, Ireland
| | - Faisal Sharif
- Cardiology Department, University Hospital Galway, Saolta Healthcare Group, Newcastle Road, Galway, H91 YR71 Ireland
- University of Galway, University Road, Galway, Ireland
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Moran V, Suhrcke M, Nolte E. Exploring the association between primary care efficiency and health system characteristics across European countries: a two-stage data envelopment analysis. BMC Health Serv Res 2023; 23:1348. [PMID: 38049793 PMCID: PMC10694950 DOI: 10.1186/s12913-023-10369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Primary care is widely seen as a core component of resilient and sustainable health systems, yet its efficiency is not well understood and there is a lack of evidence about how primary care efficiency is associated with health system characteristics. We examine this issue through the lens of diabetes care, which has a well-established evidence base for effective treatment and has previously been used as a tracer condition to measure health system performance. METHODS We developed a conceptual framework to guide the analysis of primary care efficiency. Using data on 18 European countries during 2010-2016 from several international databases, we applied a two-stage data envelopment analysis to estimate (i) technical efficiency of primary care and (ii) the association between efficiency and health system characteristics. RESULTS Countries varied widely in terms of primary care efficiency, with efficiency scores depending on the range of population characteristics adjusted for. Higher efficiency was associated with bonus payments for the prevention and management of chronic conditions, nurse-led follow-up, and a financial incentive or requirement for patients to obtain a referral to specialist care. Conversely, lower efficiency was associated with higher rates of curative care beds and financial incentives for patients to register with a primary care provider. CONCLUSIONS Our results underline the importance of considering differences in population characteristics when comparing country performance on primary care efficiency. We highlight several policies that could enhance the efficiency of primary care. Improvements in data collection would enable more comprehensive assessments of primary care efficiency across countries, which in turn could more effectively inform policymaking.
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Affiliation(s)
- Valerie Moran
- Socio-Economic and Environmental Health and Health Services Research Group, Department of Precision Health, Luxembourg Institute of Health, Luxembourg City, Luxembourg.
- Socio-Economic and Environmental Health and Health Services Research Group, Living Conditions Department, Luxembourg Institute of Socio-Economic Research (LISER), Belval, Esch-sur-Alzette, Luxembourg.
| | - Marc Suhrcke
- Socio-Economic and Environmental Health and Health Services Research Group, Department of Precision Health, Luxembourg Institute of Health, Luxembourg City, Luxembourg
- Socio-Economic and Environmental Health and Health Services Research Group, Living Conditions Department, Luxembourg Institute of Socio-Economic Research (LISER), Belval, Esch-sur-Alzette, Luxembourg
| | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Fotouhi F, Shahidi A, Hashemi H, Saffarpour M, Yekta A, Esmaieli R, Esteki T, Derakhshan HB, Khabazkhoob M. Hypertension prevalence in Iran's elderly according to new criteria: the Tehran Geriatric Eye Study. J Diabetes Metab Disord 2023; 22:1489-1498. [PMID: 37975137 PMCID: PMC10638178 DOI: 10.1007/s40200-023-01272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/27/2023] [Indexed: 11/19/2023]
Abstract
Purpose To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors. Methods A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications. Results Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension. Conclusion A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.
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Affiliation(s)
- Farid Fotouhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Shahidi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mahshid Saffarpour
- Department of Restorative Dentistry, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roghayeh Esmaieli
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Esteki
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoon Bana Derakhshan
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Choi HY, Kim E. Factors Influencing the Control of Hypertension According to the Gender of Older Adults. Healthcare (Basel) 2023; 11:healthcare11111595. [PMID: 37297736 DOI: 10.3390/healthcare11111595] [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: 02/27/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: This study aimed to identify factors associated with hypertension control among older adults with hypertension based on their socio-demographic and health characteristics. (2) Methods: The sample consisted of a total of 1824 with hypertension and was obtained from the Eighth Korean National Health and Nutrition Examination Survey (VIII-1, VIII-2). (3) Results: As the factors associated with hypertension control among older men, 65-74 years old (OR = 1.76, CI = 1.04-2.96), a lower education level (OR = 2.23, CI = 1.17-4.28), with obesity (OR = 2.05, CI = 1.13-2.05), and under-treatment of hypertension (OR = 22.07, CI = 6.54-7.45) increased the likelihood of rating hypertension control. As the factors associated with hypertension control among older women, trying to weight maintain (OR = 1.70, CI = 1.01-2.85) and under-treatment of hypertension (OR = 12.16, CI = 3.65-40.46) increased the likelihood of rating hypertension control. (4) Conclusion: The factor affecting the control of hypertension differed between the two genders. To improve the control of hypertension, the guidelines for treatment interventions should be gender-specific for the early elderly. There is a need to increase control of hypertension by having health-related behavioral modifications such as reducing obesity for older men and trying weight maintenance for older women.
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Affiliation(s)
- Hye Young Choi
- Department of Nursing, Kangwon National University, Samcheok 25949, Republic of Korea
| | - Eunha Kim
- Department of Nursing, Catholic University of Pusan, Busan 46252, Republic of Korea
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Gottwald-Hostalek U, Sun N. Contribution of single-pill combinations in the management of hypertension: perspectives from China, Europe and the USA. Curr Med Res Opin 2023; 39:331-340. [PMID: 36607599 DOI: 10.1080/03007995.2023.2165812] [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] [Indexed: 01/07/2023]
Abstract
Uncontrolled hypertension is associated with an increased risk of adverse clinical vascular outcomes and death. Hypertension management guidelines from China and the USA recommend initiation of antihypertensive pharmacotherapy with a single drug for patients without severe hypertension at presentation. Current European hypertension guidelines take a different approach and recommend the use of combination therapy from the time of diagnosis of hypertension for most patients. This article reviews the burden of hypertension in these countries and summarises the evidence base for the use of antihypertensive combination therapy contained within a single tablet (single-pill combinations, SPC). Typically, half or less of populations from China, Europe and the USA who were found to have hypertension were aware of their condition, less than half of those receiving treatment, and fewer still achieved adequate blood pressure (BP) control. The reasons for the unaddressed burden of hypertension are complex and multifactorial, with contributions from factors related to patients, healthcare providers and healthcare systems. The use of SPCs of antihypertensive therapies helps to optimise adherence with therapy and is likely to result in superior BP control. There is a strong evidence base to support current European guideline recommendations on the initiation of antihypertensive therapy with SPCs for the majority of people with hypertension.
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Affiliation(s)
| | - Ningling Sun
- Department of Hypertension and Heart Center, Peking University People's Hospital, Beijing, China
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McCarthy K, Laird E, O'Halloran AM, Fallon P, Ortuño RR, Kenny RA. Association between metabolic syndrome and risk of both prevalent and incident frailty in older adults: Findings from The Irish Longitudinal Study on Ageing (TILDA). Exp Gerontol 2023; 172:112056. [PMID: 36526097 DOI: 10.1016/j.exger.2022.112056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Metabolic syndrome (MetS) is a risk factor for cardiovascular disease, diabetes, and all-cause mortality. Frailty is a condition of decreased multi-system physiological reserve where one has increased vulnerability to stressors. This study aimed to examine if MetS is associated with prevalent and incident frailty over a 4-year follow-up period in an aged population. METHODS This study used data from waves 1 (2009-2011) and 3 (2014-2015) of The Irish Longitudinal Study on Ageing. Those aged <50 years or without baseline health assessment data were excluded. Baseline MetS status was determined using the National Cholesterol Education Program Third Adult Treatment Panel criteria. Frailty status was identified at both waves, operationalised using Fried's frailty phenotype (FP) and Rockwood's frailty index (FI). Ordinal logistic regression examined the cross-sectional association between MetS and prevalent frailty status. Those with prevalent pre-frailty or frailty were excluded and ordinal logistic regression models examined the association between MetS and incident frailty. Lastly, MetS' longitudinal associations with the five individual components of Fried's FP were examined. Models were adjusted for age, sex, education, smoking, chronic disease history and renal function. RESULTS Ordinal logistic regression models (n > 5100), showed MetS was associated with prevalent frailty as assessed by both FP (odds ratio (OR) 1.29, p < 0.001) and FI (OR 1.65, p < 0.001). Of those who were non-frail at baseline, 2247 participants had longitudinal FP data, while 3546 participants had longitudinal FI data. Models demonstrated that MetS was associated with an increased likelihood of incident frailty for both FP (OR 1.57, p < 0.001) and FI (OR 1.29, p = 0.014). MetS was found to be associated with incident low physical activity (OR 1.57, p = 0.001) and incident unintentional weight loss (OR 1.59, p = 0.025). CONCLUSIONS MetS in those ≥50 years was found to be associated with an increased likelihood of incident frailty over a 4-year period, by 57 % when measured by FP and 29 % by FI. MetS should be considered a risk factor for frailty and be taken into considered in any comprehensive geriatric assessment given frailty's dynamic nature and MetS being potentially modifiable.
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Affiliation(s)
- Kevin McCarthy
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland.
| | - Eamon Laird
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | | | - Padraic Fallon
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Román Romero Ortuño
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
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Dukelow T, Lawrence EG, Jacobson L, Vassilev P, Koychev I, Muhammed K, Kennelly SP. Modifiable risk factors for dementia, and awareness of brain health behaviors: Results from the Five Lives Brain Health Ireland Survey (FLBHIS). Front Psychol 2023; 13:1070259. [PMID: 36710802 PMCID: PMC9879702 DOI: 10.3389/fpsyg.2022.1070259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Up to 40% of dementias globally are attributable to modifiable risk factors. Many existing studies examining attitudes to brain health are limited by a failure to consider a range of pertinent risk factors and associated barriers to protective behaviors. In Ireland, self-reported knowledge of dementia is poor compared to other conditions. In this context, the current study aimed to explore exposure to and awareness of specific modifiable risk factors for dementia. We also aimed to investigate whether exposure to these risk factors is associated with demographic and socioeconomic factors. A cross-sectional survey was administered to 555 voluntary participants in February 2022. The survey captured the following information: (1) Sociodemographic factors; (2) Exposure to, as well as knowledge of modifiable risk factors for dementia, namely diet, social interaction, exercise, hypertension, sleep, depression, smoking, alcohol consumption, cognitive stimulation, hearing impairment, diabetes, air pollution, and head injury. The study population comprised 551 participants (50.3% male; 49.6% female). Mean age was 59.7 years. Modifiable risk factors for dementia were prevalent. Relative to females, male gender was significantly associated with multiple risk factors. Whilst 65.6% of participants believed that lifestyle improvements can decrease a person's risk of developing dementia, only 31.4% believed that dementia could be prevented. Head injury (90.9%, n = 500), low mental stimulation (85.3%, n = 469), and alcohol consumption (77.8%, n = 428) were the three most commonly recognized risk factors. Awareness was significantly greater in both university groups (undergraduate and postgraduate) for multiple risk factors. Our findings demonstrate that the distribution of exposure to modifiable risk factors for dementia is unequal across gender and age groups, and that awareness levels vary across risk factors. These findings highlight that focus surrounding dementia prevention should shift toward individual risk profiling and should be tailored toward an individual's specific needs.
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Affiliation(s)
- Tim Dukelow
- Cork University Hospital (CUH), Cork, Ireland,*Correspondence: Tim Dukelow,
| | - Erin Grace Lawrence
- Unit of Psychological Medicine, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom,Five Lives SAS, Tours, France
| | | | | | - Ivan Koychev
- Five Lives SAS, Tours, France,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kinan Muhammed
- Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Sean P. Kennelly
- Tallaght University Hospital, Dublin, Ireland,Trinity College Dublin, Dublin, Ireland
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Elnaem MH, Mosaad M, Abdelaziz DH, Mansour NO, Usman A, Elrggal ME, Cheema E. Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114571. [PMID: 36361453 PMCID: PMC9655663 DOI: 10.3390/ijerph192114571] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/16/2022] [Accepted: 10/31/2022] [Indexed: 05/29/2023]
Abstract
Controlling hypertension (HTN) remains a challenge, as it is affected by various factors in different settings. This study aimed to describe the disparities in the prevalence and barriers to hypertension control across countries of various income categories. Three scholarly databases-ScienceDirect, PubMed, and Google Scholar-were systematically examined using predefined search terms to identify potentially relevant studies. Original research articles published in English between 2011 and 2022 that reported the prevalence and barriers to HTN control were included. A total of 33 studies were included in this systematic review. Twenty-three studies were conducted in low and middle-income countries (LMIC), and ten studies were from high-income countries (HIC). The prevalence of hypertension control in the LMIC and HIC studies ranged from (3.8% to 50.4%) to (36.3% to 69.6%), respectively. Concerning barriers to hypertension control, patient-related barriers were the most frequently reported (n = 20), followed by medication adherence barriers (n = 10), lifestyle-related barriers (n = 8), barriers related to the affordability and accessibility of care (n = 8), awareness-related barriers (n = 7), and, finally, barriers related to prescribed pharmacotherapy (n = 6). A combination of more than one category of barriers was frequently encountered, with 59 barriers reported overall across the 33 studies. This work reported disparities in hypertension control and barriers across studies conducted in LMIC and HIC. Recognizing the multifactorial nature of the barriers to hypertension control, particularly in LMIC, is crucial in designing and implementing customized interventions.
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Affiliation(s)
- Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia
- Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia
| | - Manar Mosaad
- Department of Internal Medicine, Ministry of Health, Alexandria Governorate 5517176, Egypt
| | - Doaa H Abdelaziz
- Pharmacy Practice & Clinical Pharmacy Department, Faculty of Pharmacy, Future University in Egypt, Cairo 4740011, Egypt
| | - Noha O. Mansour
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura 7650030, Egypt
| | - Abubakar Usman
- Discipline of Clinical Pharmacy, Universiti Sains Malaysia, Penang 11800, Malaysia
| | | | - Ejaz Cheema
- School of Pharmacy, University of Management and Technology, Lahore 54770, Pakistan
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McCarthy K, Laird E, O’Halloran AM, Fallon P, O’Connor D, Ortuño RR, Kenny RA. An examination of the prevalence of metabolic syndrome in older adults in Ireland: Findings from The Irish Longitudinal Study on Ageing (TILDA). PLoS One 2022; 17:e0273948. [PMID: 36103469 PMCID: PMC9473442 DOI: 10.1371/journal.pone.0273948] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Metabolic syndrome (MetS) consists of the cluster of central obesity, insulin resistance, hypertension and atherogenic dyslipidaemia. It is a risk factor for cardiovascular disease, diabetes, and mortality. The prevalence of MetS has not been described in older adults from a population-representative sample in a European country before. This study aimed to determine the prevalence of MetS in older adults in Ireland and examine the association between MetS and socio-demographic, health, and lifestyle factors. This study used data from a population aged ≥50 years from waves 1 and 3 of the Irish Longitudinal Study on Ageing. The prevalence of MetS using the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria were determined. Weighted logistic regression examined the association between MetS and age, sex, education, and physical activity. MetS status was determined at both waves with transitions examined. 5340 participants had complete data for MetS criteria at wave 1. 33% had MetS according to the ATPIII criteria (32.5%; 95% CI: 31.1, 34.0), with 39% according to the IDF criteria (39.3%; 95% CI: 37.8, 40.8). MetS was more prevalent with advancing age, among males, those with lower educational attainment and lower physical activity. 3609 participants had complete data for both waves– 25% of those with MetS at wave 1 did not have MetS at wave 3 but the overall number of participants with MetS increased by 19.8% (ATPIII) and 14.7% (IDF). MetS is highly prevalent in older adults in Ireland. 40% of the 1.2 million population aged ≥50 years in Ireland meet either the ATPIII or IDF criteria. Increasing age, male sex, lower educational attainment, and lower physical activity were all associated with an increased likelihood of MetS.
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Affiliation(s)
- Kevin McCarthy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
- * E-mail:
| | - Eamon Laird
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Padraic Fallon
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Román Romero Ortuño
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
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Nutrition policy: developing scientific recommendations for food-based dietary guidelines for older adults living independently in Ireland. Proc Nutr Soc 2022; 81:49-61. [DOI: 10.1017/s0029665122001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.
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Donoghue OA, O’Connell MDL, Bourke R, Kenny RA. Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing (TILDA). PLoS One 2021; 16:e0252212. [PMID: 34043698 PMCID: PMC8158994 DOI: 10.1371/journal.pone.0252212] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Orthostatic hypotension (OH) often co-exists with hypertension. As increasing age affects baroreflex sensitivity, it loses its ability to reduce blood pressure when lying down. Therefore, supine hypertension may be an important indicator of baroreflex function. This study examines (i) the association between OH and future falls in community-dwelling older adults and (ii) if these associations persist in those with co-existing OH and baseline hypertension, measured supine and seated. Data from 1500 community-dwelling adults aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) were used. Continuous beat-to-beat blood pressure was measured using digital photoplethysmography during an active stand procedure with OH defined as a drop in systolic blood pressure (SBP) ≥20 mmHg and/or ≥10 mm Hg in diastolic blood pressure (DBP) within 3 minutes of standing. OH at 40 seconds (OH40) was used as a marker of impaired early stabilisation and OH sustained over the second minute (sustained OH) was used to indicate a more persistent deficit, similar to traditional OH definitions. Seated and supine hypertension were defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Modified Poisson models were used to estimate relative risk of falls (recurrent, injurious, unexplained) and syncope occurring over four year follow-up. OH40 was independently associated with recurrent (RR = 1.30, 95% CI = 1.02,1.65), injurious (RR = 1.43, 95% CI = 1.13,1.79) and unexplained falls (RR = 1.55, 95% CI = 1.13,2.13). Sustained OH was associated with injurious (RR = 1.55, 95% CI = 1.18,2.05) and unexplained falls (RR = 1.63, 95% CI = 1.06,2.50). OH and co-existing hypertension was associated with all falls outcomes but effect sizes were consistently larger with seated versus supine hypertension. OH, particularly when co-existing with hypertension, was independently associated with increased risk of future falls. Stronger effect sizes were observed with seated versus supine hypertension. This supports previous findings and highlights the importance of assessing orthostatic blood pressure behaviour in older adults at risk of falls and with hypertension. Observed associations may reflect underlying comorbidities, reduced cerebral perfusion or presence of white matter hyperintensities.
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Affiliation(s)
- Orna A. Donoghue
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Matthew D. L. O’Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Robert Bourke
- Mercer’s Institute for Successful Ageing (MISA), St James’s Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing (MISA), St James’s Hospital, Dublin, Ireland
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12
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O'Brien F, McCallion P, Carroll R, O'Dwyer M, Burke E, McCarron M. Reflections about hypertension in older adults with an intellectual disability: the importance of Home Blood Pressure Monitoring (HBPM)-Authors' reply. Eur J Cardiovasc Nurs 2021; 20:391. [PMID: 33942049 DOI: 10.1093/eurjcn/zvab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Frances O'Brien
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, D02 T283, Ireland.,IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Philip McCallion
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland.,School of Social Work, Temple University, Philadelphia, PA 19122-6091, USA
| | - Rachel Carroll
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Marine O'Dwyer
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland.,School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, DO2 PN40, Ireland
| | - Eilish Burke
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, D02 T283, Ireland.,IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, D02 T283, Ireland.,IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
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13
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Referrals to, and characteristics of patients attending a specialist hypertension clinic. J Hum Hypertens 2021; 36:315-324. [PMID: 33686210 DOI: 10.1038/s41371-021-00514-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/08/2022]
Abstract
The management of hypertension is suboptimal in Ireland and internationally. The role of a specialist hypertension clinic is not always defined but an analysis of the reasons for referral are likely informative. Also, a description of the clinical characteristics of patients with hypertension will inform requirements for comprehensive hypertension management in the community and secondary care. Patients were recruited at consecutive hypertension clinics at St James Hospital, Dublin from July to September 2019. Reasons for referral, clinical characteristics of patients, their investigations and treatment were analyzed. 236 patients were included in the study. The majority of patients, 83%, were obese or overweight. A family history of hypertension was a frequent finding with 70.8% of patients reporting same. 26.7% of patients were under the age of 40. 78% of referrals were from primary care and the most referrals were to investigate secondary causes of hypertension or because the patient was ≤40 years of age. Calcium channel blockers were the treatment most frequently prescribed (51.7%). Clinic blood pressure for the cohort was 137/81 mmHg and this was replicated by their ambulatory BP. This insight into the contemporary management of hypertension highlights the frequency of obesity and a positive family history in those with hypertension. Most referrals were consistent with international guidance though deviations were evident. Findings suggest a national program for hypertension with greater focus on public health interventions and better resourcing of primary care is required.
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14
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Smith JP. THE HRS AROUND THE WORLD SURVEYS-A REVIEW. JOURNAL OF THE ECONOMICS OF AGEING 2021; 18:100295. [PMID: 33282674 PMCID: PMC7709960 DOI: 10.1016/j.jeoa.2020.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- James P Smith
- SENIOR ASSOCIATE/ECONOMIST, ROSE LI & ASSOCIATES, INC
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15
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O’Brien F, McCallion P, Carroll R, O’Dwyer M, Burke E, McCarron M. The prevalence, awareness, treatment, and control of hypertension in older adults with an intellectual disability in Ireland: a cross sectional study. Eur J Cardiovasc Nurs 2021; 20:315-323. [DOI: 10.1093/eurjcn/zvaa019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Hypertension is a leading risk factor for cardiovascular disease, accounting for almost 50% of ischaemic heart disease mortality. This study aims to identify the prevalence, awareness, treatment, and control of hypertension and their predictors in older adults with an intellectual disability (ID).
Methods and results
This cross-sectional study utilized data from the ID Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants were drawn from the nationally representative sample and included those who completed the self/informant report measures, in addition to objective blood pressure (BP) measurement. From the 551 individuals with ID, aged ≥40 years, hypertension prevalence was 35.2% [95% confidence interval (CI) 31.2–39.2%]. Of those with hypertension, 44.3% (95% CI 37.1–51.5%) were aware of their hypertensive status, and 64.2% (95% CI 57.3–71.1) were taking antihypertensive medication. Among those on treatment, 70.8% (95% CI 61.8–78.2%) had their BP controlled to below 140/90 mmHg. Significant predictors of awareness were age (P = 0.036) and level of ID (P = 0.004), predictors of treatment were age (P = 0.002), level of ID (P = 0.019), and diabetes (P = 0.001). Both diabetes and female gender were predictors of control of hypertension (P = 0.013 and P = 0.037, respectively).
Conclusion
The prevalence of hypertension in older adults with ID was lower than reports for the general Irish population, with overall levels of treatment and control, when identified, higher in the ID population. There was under-treatment and lower levels of awareness among those with more severe ID, which requires addressing. The finding, that when diagnosed, people with ID respond well to treatment should encourage addressing the under-treatment found here.
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Affiliation(s)
- Frances O’Brien
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, D02 T283, Ireland
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Philip McCallion
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
- School of Social Work, Temple University, Philadelphia, PA 19122-6091, USA
| | - Rachael Carroll
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Máire O’Dwyer
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, DO2 PN40, Ireland
| | - Eilish Burke
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, D02 T283, Ireland
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, D02 T283, Ireland
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
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16
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McBride CM, Morrissey EC, Molloy GJ. Patients' Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e17470. [PMID: 33112251 PMCID: PMC7657730 DOI: 10.2196/17470] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 06/05/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Worldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support. OBJECTIVE The aim of this study is to explore patients' experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension. METHODS A qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data. RESULTS Participants' age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients' experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence. CONCLUSIONS The study's findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study's findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients.
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Affiliation(s)
- Ciara M McBride
- School of Psychology, National Univeristy of Ireland Galway, Galway, Ireland
| | - Eimear C Morrissey
- Health Behaviour Change Research Group, National Univiersity of Ireland Galway, Galway, Ireland
| | - Gerard J Molloy
- Medication Adherence Across the Lifespan Research Group, National University of Ireland Galway, Galway, Ireland
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17
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Muli S, Meisinger C, Heier M, Thorand B, Peters A, Amann U. Prevalence, awareness, treatment, and control of hypertension in older people: results from the population-based KORA-age 1 study. BMC Public Health 2020; 20:1049. [PMID: 32616004 PMCID: PMC7331188 DOI: 10.1186/s12889-020-09165-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/24/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hypertension remains a significant modifiable risk factor for cardiovascular diseases and a major determinant of morbidity and mortality. We aimed to describe sex-stratified age-standardized estimates of prevalence, awareness, treatment and control of hypertension, and their associated factors in older adults. Methods The KORA-Age1 is a population-based cross-sectional survey carried out in 2008/2009 on individuals aged 65–94 years in Augsburg region, Germany. Blood pressure measurements were available for 1052 out of 1079 persons who participated in the physical examination. Factors associated with prevalence, awareness and control of hypertension were investigated by multivariable logistic regression. Results The overall prevalence of hypertension (≥140/90 mmHg) was 73.8% [95% confidence interval (CI), 69.3–77.9], representing 74.8% (95% CI, 68.4–80.2) in men and 73.5% (95% CI, 66.8–79.3) in women. Among those with hypertension, 80.2% (95% CI, 75.3–84.4) were aware of their hypertensive condition and 74.4% (95% CI, 69.2–79.1) were on treatment for hypertension. Among those aware of their hypertension status, 92.8% (95% CI, 88.8–95.6) were on treatment and 53.7% (95% CI, 47.0–60.1) had their blood pressure controlled. Hypertension was more frequent in individuals who were older, obese, or had diabetes. Higher education attainment or presence of comorbidities was associated with higher level of hypertension awareness. Individuals taking three antihypertensive drug classes were more likely to have controlled hypertension compared with those taking one antihypertensive drug class, odds ratio (OR), 1.85 (95% CI, 1.14–2.99). Conclusion Our findings identified high prevalence of hypertension and relevant health gaps on awareness, treatment and suboptimal control of hypertension in older adults in Germany. Screening for hypertension should especially target older adults with low educational attainment and ‘healthy’ elderly with less contact to physicians.
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Affiliation(s)
- Samuel Muli
- Institute for Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany. .,Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Christa Meisinger
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
| | - Margit Heier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany.,University Hospital of Augsburg, KORA Study Centre, Augsburg, Germany
| | - Barbara Thorand
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany
| | - Ute Amann
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Independent Research Group Clinical Epidemiology, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Augsburg, Germany
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18
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Yap LC, Leonard F, Cullen I, Daly P. Renal cell carcinoma in Ireland: rising mortality and survival. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818813784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this study was to evaluate the rising trend in the incidence and mortality of renal cell carcinoma in Ireland. Methods: Data from the National Cancer Registry of Ireland on primary adenocarcinomas of the kidney from 2003 to 2013 were evaluated. Statistical analysis was performed on the data using IBM SPSS statistics V24 software package and Microsoft Excel Software. Results: There were 3801 cases of adenocarcinoma of the kidney with 29% of tumours (n=1103) being found incidentally. The age-adjusted incidence rate of renal cell carcinoma in 2003 was 4.66 per 100,000 women and 8.78 per 100,000 men. These figures have risen to 5.78 and 13.14 in 2013, respectively. There was an annual percentage change of +2.2% for women and +4.1% for men from the years 2003 to 2013. For both sexes the age-standardised all-cause mortality rate for renal adenocarcinoma increased from 1.07 per 100,000 in 2003 to 4.32 ± 0.06 per 100,000 in 2013, an annual percentage change of +15%. Age-adjusted mortality rates in the female population in Ireland increased from 0.78 to 2.66, an annual percentage change of +13.1% and from 1.41 to 6.04 in men, an annual percentage change of +15.8%. Conclusion: There is a paradox emerging in Ireland, with both rising survival rates for renal cell carcinoma and rising mortality rates. While the increased incidence of renal cell carcinoma in Ireland can be attributed somewhat to the increased use of various imaging modalities, it may also be attributed to the significant rise in modifiable risk factors as seen in other developed countries, namely hypertension, obesity, and smoking. Level of evidence: 2c
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Affiliation(s)
- Lee Chien Yap
- Department of Urology, University Hospital Waterford, Ireland
| | - Frank Leonard
- Department of Mathematics, Waterford Institute of Technology, Ireland
| | - Ivor Cullen
- Department of Urology, University Hospital Waterford, Ireland
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Ireland
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19
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Jurić D, Pavličević I, Marušić A, Malički M, Buljan I, Šarotić V, Mrduljaš-Đujić N, Komparak A, Vujević M, De Micheli-Vitturi D, Šušnjar P, Puljiz T, Jerčić M, Leskur D, Marušić M. Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia. BMC FAMILY PRACTICE 2019; 20:10. [PMID: 30642264 PMCID: PMC6330736 DOI: 10.1186/s12875-019-0902-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/02/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95-0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5-201.8) Croatian kunas and was similar across the study sites. CONCLUSION Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.
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Affiliation(s)
- Diana Jurić
- Department of Pharmacology, University of Split School of Medicine, Šoltanska 2, Split, Croatia
| | - Ivančica Pavličević
- Department of Family Medicine, University of Split School of Medicine, Split, Croatia
- Family medicine practice, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Mario Malički
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Ivan Buljan
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | | | - Nataša Mrduljaš-Đujić
- Department of Family Medicine, University of Split School of Medicine, Split, Croatia
- Family medicine practice, Postira, Croatia
| | | | | | | | | | | | | | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Matko Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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20
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Donoghue OA, McGarrigle CA, Foley M, Fagan A, Meaney J, Kenny RA. Cohort Profile Update: The Irish Longitudinal Study on Ageing (TILDA). Int J Epidemiol 2018; 47:1398-1398l. [DOI: 10.1093/ije/dyy163] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Orna A Donoghue
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | | | - Margaret Foley
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Andrew Fagan
- Centre for Advanced Medical Imaging, St James’s Hospital, Dublin, Ireland
| | - James Meaney
- Centre for Advanced Medical Imaging, St James’s Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing (MISA), St James’s Hospital, Dublin, Ireland
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21
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Smith R, Frazer K, Hyde A, O'Connor L, Davidson P. “Heart disease never entered my head”: Women's understanding of coronary heart disease risk factors. J Clin Nurs 2018; 27:3953-3967. [DOI: 10.1111/jocn.14589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/23/2018] [Accepted: 06/24/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Rita Smith
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Kate Frazer
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Abbey Hyde
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Laserina O'Connor
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
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22
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Beer-Borst S, Luta X, Hayoz S, Sommerhalder K, Krause CG, Eisenblätter J, Jent S, Siegenthaler S, Aubert R, Haldimann M, Strazzullo P. Study design and baseline characteristics of a combined educational and environmental intervention trial to lower sodium intake in Swiss employees. BMC Public Health 2018; 18:421. [PMID: 29606103 PMCID: PMC5879608 DOI: 10.1186/s12889-018-5366-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial "Healthful & Tasty: Sure!" in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics. METHODS Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees' average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples. DISCUSSION Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees. TRIAL REGISTRATION German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.
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Affiliation(s)
- Sigrid Beer-Borst
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
| | - Xhyljeta Luta
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Stefanie Hayoz
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Kathrin Sommerhalder
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Corinna Gréa Krause
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Julia Eisenblätter
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Sandra Jent
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Stefan Siegenthaler
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Rafael Aubert
- Federal Food Safety and Veterinary Office, Division of Risk Assessment, Laboratories, Schwarzenburgstrasse 155, 3003, Bern, Switzerland
| | - Max Haldimann
- Federal Food Safety and Veterinary Office, Division of Risk Assessment, Laboratories, Schwarzenburgstrasse 155, 3003, Bern, Switzerland
| | - Pasquale Strazzullo
- Department of Clinical Medicine & Surgery, Federico II University of Naples Medical School, via S. Pansini 5, 80131, Naples, Italy
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Hickey A, Mellon L, Williams D, Shelley E, Conroy RM. Does stroke health promotion increase awareness of appropriate behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. Eur Stroke J 2018; 3:117-125. [PMID: 31008344 DOI: 10.1177/2396987317753453] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/02/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention. We report on post-campaign findings (wave 2) of national surveys to estimate changes in population knowledge following a media-based Face, Arm, Speech, Time stroke awareness campaign, comparing findings to those of a pre-campaign population survey (wave 1).Participants and methods: One thousand and ten randomly selected adults (18+) completed the Stroke Awareness Questionnaire on knowledge of warning signs, risk factors and response to stroke at wave 2 and findings were compared to wave 1 survey results. Logistic regression was used to examine the association between demographic characteristics and self-reported risk factors with knowledge of stroke and emergency response. Results No significant differences existed in the ability of respondents to define stroke or to identify two or more stroke risk factors between waves 1 and 2 surveys (71% and 70%, respectively). Respondents to the wave 2 survey were five times more likely (odds ratio 4.9, p < .001) than those responding at wave 1 to know at least two warning signs of stroke (67% vs. 31%, respectively), specifically those targeted by the Face, Arm, Speech, Time campaign. While significant improvement in intention to call an ambulance was noted (odds ratio 1.5, p < .001, 57% at wave 2 compared to 47% at wave 1), for almost half of respondents (43%) this would not have been their first response to stroke. Less than 5% of respondents to both surveys identified thrombolysis as an emergency treatment for stroke (3.9% at wave 2 compared to 1.8% at wave 1). Discussion Although significant improvements were made in several areas of stroke knowledge and intended response, awareness of acute stroke interventions was poor and intended behavioural response was suboptimal. Conclusion Findings from this study indicate need for targeted campaigns to improve population understanding of the reasons underlying the importance of rapid emergency response to stroke.
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Affiliation(s)
- Anne Hickey
- 1Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Lisa Mellon
- 1Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - David Williams
- 2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Emer Shelley
- 3Department of Epidemiology & Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ronan M Conroy
- 3Department of Epidemiology & Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Markovitz AA, Mack JA, Nallamothu BK, Ayanian JZ, Ryan AM. Incremental effects of antihypertensive drugs: instrumental variable analysis. BMJ 2017; 359:j5542. [PMID: 29273586 PMCID: PMC5736968 DOI: 10.1136/bmj.j5542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To assess the incremental effects of adding extra antihypertensive drugs from a new class to a patient's regimen. DESIGN Instrumental variable analysis of data from SPRINT (Systolic Blood Pressure Intervention Trial). To account for confounding by indication-when treatments seem less effective if they are administered to sicker patients-randomization status was used as the instrumental variable. Patients' randomization status was either intensive (systolic blood pressure target <120 mm Hg) or standard (systolic blood pressure target <140 mm Hg) treatment. Results from instrumental variable models were compared with those from standard multivariable models. SETTING Secondary data analysis of a randomized clinical trial conducted at 102 sites in 2010-15. PARTICIPANTS 9092 SPRINT participants with hypertension and increased cardiovascular risk but no history of diabetes or stroke. MAIN OUTCOMES MEASURES Systolic blood pressure, major cardiovascular events, and serious adverse events. RESULTS In standard multivariable models not adjusted for confounding by indication, addition of an antihypertensive drug from a new class was associated with modestly lower systolic blood pressure (-1.3 mm Hg, 95% confidence interval -1.6 to -1.0) and no change in major cardiovascular events (absolute risk of events per 1000 patient years, 0.5, 95% confidence interval -1.5 to 2.3). In instrumental variable models, the addition of an antihypertensive drug from a new class led to clinically important reductions in systolic blood pressure (-14.4 mm Hg, -15.6 to -13.3) and fewer major cardiovascular events (absolute risk -6.2, -10.9 to -1.3). Incremental reductions in systolic blood pressure remained large and similar in magnitude for patients already taking drugs from zero, one, two, or three or more drug classes. This finding was consistent across all subgroups of patients. The addition of another antihypertensive drug class was not associated with adverse events in either standard or instrumental variable models. CONCLUSIONS After adjustment for confounding by indication, the addition of a new antihypertensive drug class led to large reductions in systolic blood pressure and major cardiovascular events among patients at high risk for cardiovascular events but without diabetes. Effects on systolic blood pressure persisted across all levels of baseline drug use and all subgroups of patients.
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Affiliation(s)
- Adam A Markovitz
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan Center for Evaluating Health Reform, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jacob A Mack
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John Z Ayanian
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Gerald R Ford School of Public Policy, Ann Arbor, MI, USA
| | - Andrew M Ryan
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Center for Evaluating Health Reform, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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25
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Aetiological profile and treatment outcomes of epistaxis at a major teaching hospital: a review of 721 cases. Ir J Med Sci 2017; 187:761-766. [PMID: 29197966 DOI: 10.1007/s11845-017-1721-x] [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: 03/17/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Epistaxis is the most prevalent ENT emergency and a significant burden on ENT services. Our objective was to study the incidence and outcomes of patients presenting with epistaxis at a major teaching hospital. METHODS A retrospective descriptive study of 721 patients, who presented with epistaxis over a 1-year period, was carried out. Data collected was analysed using SPSS software version 20. RESULTS Of the 721 patients, initial treatment consisted of nasal cautery (298), nasal packing (200), or no treatment (223). Fifty-nine patients were admitted. The mean age of admitted patients was 66.8 years and the male to female ratio was 2:1. 69.5% had hypertension and 78% used an antiplatelet/anticoagulation medication. The majority of admitted and return patients were out of hours referrals from ED and the mean admission duration was five nights. Surgical treatment for intractable epistaxis included arterial ligation or endovascular embolisation. Successful treatment was defined as no recurrent epistaxis following pack removal or no readmission with epistaxis within 24 h of hospital discharge. Six hundred forty-four patients had successful treatment. CONCLUSION More return and admitted patients presented at out-of-hours times with less clinical staff on site. Most non-admitted patients received no treatment. These factors possibly lead to increased stress on the ENT casualty service. Cautery and nasal packing are the most common treatment modalities in first-time and admitted patients yet result in considerable rates of representation.
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26
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Outcomes from a community-based hypertension educational programme: the West of Ireland Hypertension study. Ir J Med Sci 2017; 187:675-682. [PMID: 29110187 DOI: 10.1007/s11845-017-1706-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/23/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hypertension is a leading modifiable risk factor for premature cardiovascular disease. Research indicates a growing prevalence of hypertension among adults worldwide, with accompanying low levels of patient knowledge, and sub-optimal clinical management. AIMS This study aims to explore the impact of a structured hypertension educational intervention on patient knowledge, lifestyle behaviours and blood pressure control. DESIGN An observational, prospective cohort design was selected. METHODS Participants were recruited through a public blood pressure screening event in a community-based setting. They were asked to complete a self-report questionnaire followed by an assessment of their blood pressure. Participants with high blood pressure were randomly assigned to either a control group or an intervention group. Those in the intervention group received an educational intervention on hypertension 4 weeks later. Both groups were recalled 4 months later for a repeat of the same initial assessment. RESULTS Eighty-one participants with a mean age of 64 years were included in this study. There were no significant differences in the baseline measures between the two groups. Significant improvements were found in the intervention group compared with the control group in levels of hypertension knowledge and awareness (p = <0.001), exercise levels (p = 0.002) and weight (p = 0.003). Participants who underwent the intervention showed a greater reduction in both systolic (SBP) and diastolic (DBP) blood pressure (SBP 158.8 to 141.6 mmHg, p < 0.0001 and DBP 84.7 to 77.7 mmHg, p < 0.001). CONCLUSION Providing a tailored educational intervention can positively impact on hypertension knowledge, self-care management and control within community-based settings.
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27
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Dillon P, Stewart D, Smith SM, Gallagher P, Cousins G. Group-Based Trajectory Models: Assessing Adherence to Antihypertensive Medication in Older Adults in a Community Pharmacy Setting. Clin Pharmacol Ther 2017; 103:1052-1060. [PMID: 28875569 PMCID: PMC6001422 DOI: 10.1002/cpt.865] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/31/2017] [Accepted: 08/27/2017] [Indexed: 12/31/2022]
Abstract
Antihypertensive medication nonadherence is highly prevalent, leading to uncontrolled blood pressure. Methods that facilitate the targeting and tailoring of adherence interventions in clinical settings are required. Group‐Based Trajectory Modeling (GBTM) is a newer method to evaluate adherence using pharmacy dispensing (refill) data that has advantages over traditional refill adherence metrics (e.g. Proportion of Days Covered) by identifying groups of patients who may benefit from adherence interventions, and identifying patterns of adherence behavior over time that may facilitate tailoring of an adherence intervention. We evaluated adherence to antihypertensive medication in 905 patients over a 12‐month period in a community pharmacy setting using GBTM, identifying three subgroups of adherence patterns: 52.8%, 40.7%, and 6.5% had very high, high, and low adherence, respectively. However, GBTM failed to demonstrate predictive validity with blood pressure at 12 months. Further research on the validity of adherence measures that facilitate interventions in clinical settings is required.
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Affiliation(s)
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, UK
| | - Susan M Smith
- Department of General Practice and HRB Centre for Primary Care Research, Dublin, Ireland
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Sinnott SJ, Whelton H, Franklin JM, Polinski JM. The international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy change. Health Policy 2016; 121:27-34. [PMID: 27916432 DOI: 10.1016/j.healthpol.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 01/01/2023]
Abstract
Copayments for prescriptions may increase morbidity and mortality via reductions in adherence to medications. Relevant data can inform policy to minimise such unintended effects. We explored the generalisability of evidence for copayments by comparing two international copayment polices, one in Massachusetts and one in Ireland, to assess whether effects on medication adherence were comparable. We used national prescription data for public health insurance programmes in Ireland and Medicaid data in the U.S. New users of oral anti-hypertensive, anti-hyperlipidaemic and diabetic drugs were included (total n=14,259 in U.S. and n=43,843 in Ireland). We examined changes in adherence in intervention and comparator groups in each setting using segmented linear regression with generalised estimating equations. In Massachusetts, a gradual decrease in adherence to anti-hypertensive medications of -1% per month following the policy occurred. In contrast, the response in Ireland was confined to a -2.9% decrease in adherence immediately following the policy, with no further decrease over the 8 month follow-up. Reductions in adherence to oral diabetes drugs were larger in the U.S. group in comparison to the Irish group. No difference in adherence changes between the two settings for anti-hyperlipidaemic drugs occurred. Evidence on cost-sharing for prescription medicines is not 'one size fits all'. Time since policy implementation and structural differences between health systems may influence the differential impact of copayment policies in international settings.
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Affiliation(s)
- Sarah-Jo Sinnott
- Department of Epidemiology and Public Health, University College Cork, 4th Floor Western Gateway Building, Cork, Ireland.
| | - Helen Whelton
- School of Dentistry, University of Leeds, England, UK
| | - Jessica Myers Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer Milan Polinski
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Leahy S, O' Halloran AM, O' Leary N, Healy M, McCormack M, Kenny RA, O' Connell J. Prevalence and correlates of diagnosed and undiagnosed type 2 diabetes mellitus and pre-diabetes in older adults: Findings from the Irish Longitudinal Study on Ageing (TILDA). Diabetes Res Clin Pract 2015; 110:241-9. [PMID: 26520567 DOI: 10.1016/j.diabres.2015.10.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 12/11/2022]
Abstract
AIMS The prevalence of type 2 diabetes and pre-diabetes has increased rapidly in recent decades and this trend will continue as the global population ages. This study investigates the prevalence of, and factors associated with, diagnosed and undiagnosed type 2 diabetes mellitus and pre-diabetes in older adults in Ireland. METHODS Cross-sectional data from 5377 men and women aged 50 and over from Wave 1 of the Irish Longitudinal Study on Ageing (TILDA) was analysed. Diagnosed diabetes was defined using self-reported doctors' diagnosis and medications data. Glycated haemoglobin (HbA1c) analysis was used to identify undiagnosed and pre-diabetes. Age and sex-specific prevalence estimates were generated. Logistic regression was used to investigate the association between diabetes classification and the demographic, health and lifestyle characteristics of the population. RESULTS The prevalence of diagnosed and undiagnosed type 2 diabetes was 8.6% (95% confidence interval (CI): 7.6-9.5%) and 0.9% (95% CI: 0.6-1.1%) respectively. Diabetes was more prevalent in men than women and increased with age. The prevalence of pre-diabetes was 5.5% (95% CI: 4.8-6.3%) and increased with age. Diabetes and pre-diabetes were independently associated with male sex, central obesity and a history of hypertension, while undiagnosed diabetes was associated with geographic location and medical costs cover. CONCLUSION Despite high rates of obesity and other undiagnosed health conditions, the prevalence of undiagnosed and pre-diabetes is relatively low in community-dwelling older adults in Ireland. Addressing lifestyle factors in this population may help to further reduce the prevalence of pre-diabetes and improve outcomes for those with a previous diagnosis.
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Affiliation(s)
- S Leahy
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland.
| | - A M O' Halloran
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland
| | - N O' Leary
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland
| | - M Healy
- Department of Biochemistry, Central Pathology Laboratory, St. James' Hospital, Dublin 8, Ireland
| | - M McCormack
- Department of Biochemistry, Central Pathology Laboratory, St. James' Hospital, Dublin 8, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland
| | - J O' Connell
- Blackrock Clinic, Blackrock, Co. Dublin, Ireland
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30
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Murphy C, Bennett K, Fahey T, Shelley E, Graham I, Kenny RA. Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from The Irish Longitudinal Study on Ageing (TILDA). BMJ Open 2015; 5:e008017. [PMID: 26169806 PMCID: PMC4513517 DOI: 10.1136/bmjopen-2015-008017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aims to examine the extent to which statins are used by adults at high risk of cardiovascular disease (CVD) compared to European clinical guidelines. The high-risk groups examined are those with (1) known CVD, (2) known diabetes and (3) a high or very high risk (≥5%) of CVD mortality based on Systematic COronary Risk Evaluation (SCORE). DESIGN This study is cross-sectional in design using data from the first wave (2009-2011) of The Irish Longitudinal Study on Ageing (TILDA). SETTING AND PARTICIPANTS The sample (n=3372) is representative of community living adults aged 50-64 years in Ireland. RESULTS Statins were used by 68.6% (95% CI 61.5% to 75.8%) of those with known CVD, 57.4% (95% CI 49.1% to 65.7%) of those with known diabetes and by 19.7% (95% CI 13.0% to 26.3%) of adults with a SCORE risk ≥5%. Over a third (38.5%, 95% CI 31.0% to 46.0%) of those with known CVD, 46.8% (95% CI 38.4% to 55.1%) of those with known diabetes and 85.2% (95% CI 79.3% to 91.1%) of those with a SCORE risk ≥5% were at or above the low-density lipoprotein cholesterol (LDL-C) target of 2.5 mmol/L specified in the 2007 European guidelines. CONCLUSIONS Despite strong evidence and clinical guidelines recommending the use of statins for secondary prevention, a gap exists between guidelines and practice in this cohort. It is also of concern that a low proportion of adults with a SCORE risk ≥5% were taking statins. A policy response that strengthens secondary prevention, and improves risk assessment and shared decision-making in the primary prevention of CVD is required.
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Affiliation(s)
- Catriona Murphy
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity College, Dublin, Ireland
| | - Tom Fahey
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - Emer Shelley
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - Ian Graham
- Department of Cardiology, Tallaght Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
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