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Najar H, Karanti A, Pålsson E, Landén M. Cardiometabolic risk indicators in individuals with bipolar disorders: a replication study. Diabetol Metab Syndr 2023; 15:69. [PMID: 37009884 PMCID: PMC10069119 DOI: 10.1186/s13098-023-01044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/26/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVES We recently conducted the first longitudinal study comparing cardiometabolic risk indicators (CMRIs) between a cohort of individuals with bipolar disorders (BDs) and controls from the general population. Here, we sought to validate the findings in that study using an independent case-control sample. METHODS We used data from the St. Göran project's Gothenburg cohort. The BDs group and the control group were examined at baseline and after a median of eight and seven years, respectively. Data collection occurred between March 2009 and June 2022. We used multiple imputation to handle missing data and linear mixed effects model to examine the annual change in CMRIs over the study period. RESULTS The baseline cohort included 407 individuals with BDs (mean age 40 years, 63% women) and 56 controls (mean age 43 years, 54% women). Of those, 63 persons with BDs and 42 controls participated at follow-up. At baseline, individuals with BDs had significantly higher mean values of body mass index (β = 0.14, p = 0.003) than controls. Over the study period, the difference in average annual change between the patient and the control group indicated an increase in patients relative to controls in waist-to-hip ratio (0.004 unit/year, p = 0.01), diastolic (0.6 mm Hg/year, p = 0.048), and systolic (0.8 mm Hg/year, p = 0.02) blood pressure. CONCLUSIONS This study replicated the main findings from our previous study and showed that central obesity and measures of blood pressure worsened over a relatively short time in individuals with BDs relative to controls. It is vital for clinicians to monitor CMRIs in persons with BDs and to be proactive in preventing cardiometabolic diseases in this high-risk group.
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Affiliation(s)
- Hemen Najar
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Blå stråket 15, Gothenburg, 413 45, Sweden.
| | - Alina Karanti
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Blå stråket 15, Gothenburg, 413 45, Sweden
| | - Erik Pålsson
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Blå stråket 15, Gothenburg, 413 45, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Blå stråket 15, Gothenburg, 413 45, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Zhu J, Kodali H, Wyka KE, Huang TTK. Perceived neighborhood environment walkability and health-related quality of life among predominantly Black and Latino adults in New York City. BMC Public Health 2023; 23:127. [PMID: 36653809 PMCID: PMC9847133 DOI: 10.1186/s12889-022-14973-1] [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: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Measures of the built environment such as neighborhood walkability have been associated with health behaviors such as physical activity, the lack of which in turn may contribute to the development of diseases such as obesity, diabetes, cardiovascular disease, and cancer. However, limited research has examined these measures in association with health-related quality of life (HR-QoL), particularly in minoritized populations. We examined the relationship between perceived neighborhood environment and HR-QoL in a sample of mostly Black and Latino residents in New York City (NYC). METHODS This study utilized the baseline survey data from the Physical Activity and Redesigned Community Spaces (PARCS) Study among 1252 residents [34.6% Black, 54.1% Latino, 80.1% female, mean(±SD) age = 38.8 ± 12.5) in 54 park neighborhoods in NYC. Perceived built environment was measured using Neighborhood Environment and Walkability Survey, and mental and physical HR-QoL was estimated using Short Form (SF)-12. Using factor analysis, we identified two subscales of neighborhood walkability: enablers (e.g., trails, sidewalks, esthetics) vs. barriers (e.g., high crime and traffic). In addition, we included a third subscale on neighborhood satisfaction. Generalized Estimating Equation models adjusted for demographics and BMI and accounted for the clustering effect within neighborhood. Multiple imputation was used to account for missing data. RESULTS Mental HR-QoL was associated with barriers of walkability (β ± SE = - 1.63 ± 0.55, p < 0.01) and neighborhood satisfaction (β ± SE = 1.55 ± 0.66, p = 0.02), after adjusting for covariates. Physical HR-QoL was associated with only barriers of walkability (β ± SE = - 1.13 ± 0.57, p < 0.05). CONCLUSIONS Among NYC residents living in minoritized neighborhoods, mitigating negative aspects of the neighborhood environment may be more crucial than adding positive features in terms of HR-QoL. Our study points to the need to investigate further the role of the built environment in urban, minoritized communities.
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Affiliation(s)
- Jiaqi Zhu
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), 55 West 125th Street, New York, NY, 10027, USA
| | - Hanish Kodali
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), 55 West 125th Street, New York, NY, 10027, USA
| | - Katarzyna E Wyka
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), 55 West 125th Street, New York, NY, 10027, USA
| | - Terry T-K Huang
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), 55 West 125th Street, New York, NY, 10027, USA.
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Stellefson M, Ford CD, Wang MQ, Cline I, Kinder C. Role of Socioeconomic Factors on Physical and Mental Distress Reported by Alabama Adults with COPD. South Med J 2022; 115:374-380. [PMID: 35649523 DOI: 10.14423/smj.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Educational attainment, income, and race play significant roles in managing and treating patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the impact of these socioeconomic factors and others on the physical and mental distress reported by patients with COPD living in Alabama. METHODS A cross-sectional analysis was completed of Alabama Behavioral Risk Factor Surveillance System 2015-2019 data collected from 4123 respondents who reported that a health professional told them they had COPD, chronic bronchitis, or emphysema. Univariate analyses examined descriptive differences in physical and mental distress among racial groups. Multivariable logistic regression models were used to assess physical and mental distress as a function of race and demographic variables (age, sex, employment status, household income, education level), controlling for dichotomous healthcare access variables (enrollment in a health insurance plan, having a usual source of care, routine check-up in the past 2 years). RESULTS Most Alabama adults with COPD from 2015 to 2019 were female (64%) and older than 45 years (88%). Annual incomes were low, with >40% of respondents (43.84%) earning <$20,000/year; adults making between $35,000 and $49,999 were less likely (odds ratio 0.60, 95% confidence interval 0.38-0.96) to experience mental distress. Younger Alabama adults with COPD (25-64 years) were approximately two times more likely than respondents ages 65 and older to report mental distress. African Americans were less likely to report physical distress as compared with Whites (odds ratio 0.61, 95% confidence interval 0.44-0.83). Alabama adults who could not work were more likely than those with COPD who were employed/self-employed, out of work, retired, or identified as homemakers to report physical distress. CONCLUSIONS Public health and healthcare practitioners across Alabama should use these analyses to direct more targeted, high-yield interventions that will address existing health disparities among state residents living with COPD.
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Affiliation(s)
- Michael Stellefson
- From the Department of Health Science, the Capstone College of Nursing, the College of Arts and Sciences, and the College of Education, The University of Alabama, Tuscaloosa, and the Department of Behavioral and Community Health, University of Maryland, College Park
| | - Cassandra D Ford
- From the Department of Health Science, the Capstone College of Nursing, the College of Arts and Sciences, and the College of Education, The University of Alabama, Tuscaloosa, and the Department of Behavioral and Community Health, University of Maryland, College Park
| | - Min Qi Wang
- From the Department of Health Science, the Capstone College of Nursing, the College of Arts and Sciences, and the College of Education, The University of Alabama, Tuscaloosa, and the Department of Behavioral and Community Health, University of Maryland, College Park
| | - Isabella Cline
- From the Department of Health Science, the Capstone College of Nursing, the College of Arts and Sciences, and the College of Education, The University of Alabama, Tuscaloosa, and the Department of Behavioral and Community Health, University of Maryland, College Park
| | - Caitlin Kinder
- From the Department of Health Science, the Capstone College of Nursing, the College of Arts and Sciences, and the College of Education, The University of Alabama, Tuscaloosa, and the Department of Behavioral and Community Health, University of Maryland, College Park
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Relationship Between Cardiovascular Disease Risk Factors and Quality of Life in Patients with Metabolic-Associated Fatty Liver Disease. HEPATITIS MONTHLY 2022. [DOI: 10.5812/hepatmon-124229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: Metabolic-associated fatty liver disease (MAFLD) is a common cause of liver-related mortality and morbidity worldwide. However, there is a paucity of literature on the relationship between cardiovascular disease (CVD) risk factors and quality of life (QoL) in patients with MAFLD. Objectives: This study aimed to examine the association between QoL and CVD risk factors in an Iranian MAFLD population. Methods: This study was conducted on MAFLD patients, referred to the gastroenterology clinic of a general hospital from September 2017 until September 2018. The QoL and Framingham Risk Score (FRS) were determined using the WHOQOL-BREF questionnaire and an online web calculator, respectively. A hierarchical multiple linear regression model was developed to evaluate the association between QoL and FRS after adjusting for the sociodemographic characteristics. Results: This study was performed on 200 participants. All domains of QoL were associated with older age, hypertension, smoking, diabetes mellitus, higher systolic blood pressure, and lower high-density lipoprotein levels in the univariate regression analysis (P < 0.05 for all). Meanwhile, FRS was adversely correlated with the total QoL score (correlation coefficient: -0.49; 95% CI: -0.61, -0.35; P < 0.001). After adjusting for the sociodemographic variables, the results of the hierarchical multiple linear regression model showed that age, smoking, diabetes mellitus, hypertension, and FRS were correlated with the overall QoL score (P < 0.05 for all). Hypertension was the main predictor of the total QoL score (B = -5.51, 95% CI: -7.18, -3.68; P < 0.05). A higher FRS was inversely associated with the physical domain of QoL (B = -0.05, 95% CI: -0.09, -0.01; P < 0.05), the environment domain of QoL (B = -0.04, 95% CI: -0.09, -0.01; P < 0.05), and the total score of QoL (B = -0.04, 95% CI: -0.08, -0.02; P < 0.05). Conclusions: According to the results of this study, a higher risk of developing CVD may reduce QoL in patients with MAFLD. Hypertension, diabetes mellitus, and smoking were the key predictive determinants of QoL in this population. Further studies are suggested to determine if modification of the mentioned risk factors can improve QoL in MAFLD patients.
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Broekharst DSE, Bloem S, Groenland EAG, van Raaij WF, van Agthoven M. Differences between expert reported and patient reported burden of disease rankings. Sci Rep 2022; 12:895. [PMID: 35042859 PMCID: PMC8766519 DOI: 10.1038/s41598-021-04070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022] Open
Abstract
Many attempted to develop burden of disease rankings for the purpose of resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare. As this proved difficult the World Health Organization commissioned expert panels to develop internally consistent burden of disease rankings. Although these rankings provide valuable insight in the biomedical burden of different diseases, they do not yet provide insight in the psychological burden of different diseases experienced and reported by patients on a daily basis. Since expert reported and patient reported burden of disease could differ, deviations between expert reported and patient reported burden of disease rankings are likely. To explore how these rankings differ, it is important to develop patient reported burden of disease rankings and compare these to expert reported burden of disease rankings. In this study patient reported burden of disease rankings were developed by ranking the subjective health experience of patients. To measure subjective health experience an online questionnaire was administered to a large panel of Dutch citizens. The final sample consisted of 58,490 panel members. This final sample contained 36 diseases and was largely representative of the Dutch population. The data were analysed by using reliability tests, descriptive statistics and Spearman rank-order correlation coefficients. This study shows that expert reported and patient reported burden of disease rankings could differ. Burden of cardiovascular diseases ranks low on patient reported burden of disease rankings, while it ranks higher on expert reported burden of disease rankings. Burden of psychiatric diseases and gastrointestinal diseases ranks high on patient reported burden of disease rankings, while it ranks lower on expert reported burden of disease rankings. Burden of pain diseases ranks high on patient reported burden of disease rankings, while it is still overlooked in expert reported burden of disease rankings. This study suggests that it can be beneficial to develop and utilize patient reported burden of disease rankings in addition to the already existing expert reported burden of disease rankings in order to establish a more comprehensive perspective on burden of disease. This could improve decision-making on resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare.
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Affiliation(s)
- Damien S E Broekharst
- Center for Marketing and Supply Chain Management, Nyenrode Business University, Breukelen, The Netherlands.
| | - Sjaak Bloem
- Center for Marketing and Supply Chain Management, Nyenrode Business University, Breukelen, The Netherlands
- Janssen-Cilag B.V., Johnson and Johnson, Breda, The Netherlands
| | - Edward A G Groenland
- Center for Marketing and Supply Chain Management, Nyenrode Business University, Breukelen, The Netherlands
| | - W Fred van Raaij
- Department of Social Psychology, Tilburg University, Tilburg, The Netherlands
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A strategy for exploring subgroup-specific effects in nutrition science. J Nutr Sci 2022. [DOI: 10.1017/jns.2022.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract
Nutrients are an essential part of building and maintaining optimal health. Certain nutrient exposure has been shown to be associated with many important health outcomes, although there is variability among studies. Despite the scientific efforts of many, it is unclear why some well-hypothesised nutrients lack sufficient evidence for clear association with health outcomes. One potential reason for conflicting results is that certain subgroups of patients benefit or are harmed more by adequate or inadequate exposure to certain nutrients. These subgroup-specific effects have historically not been studied, or if they are, it is often in a one-off type of approach where the investigator believes that a subgroup effect could exist based on limited previous data. In the era of big data, improvements can be made in efforts to generate new hypotheses for subgroups of patients and recommendations for precision nutrition can be made. In the present paper, we present a strategy for exploring subgroup-specific effects in nutrient-related studies. This data-driven method can be useful in secondarily exploring which subgroups are harmed/helped most by inadequate/adequate nutrient exposure and could suggest target groups for future clinical trials to test the identified hypotheses. We then present an example study utilizing the National Health and Nutrition Examination Survey (NHANES) data from the years 2001–2006. In this example, a limited selection of nutrients is protective in subgroups of participants with diabetes on their self-reported number of poor mental health days.
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Wu X, Liu X, Liao W, Kang N, Sang S, Abdulai T, Niu M, He Y, Zhai Z, Pan M, Wang C, Li Y. The Association Between Ideal Cardiovascular Health and Health-Related Quality of Life in Adults: A Population-Based Cross-Sectional Study. Int J Public Health 2021; 66:592043. [PMID: 34744561 PMCID: PMC8565252 DOI: 10.3389/ijph.2021.592043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The study aimed to explore the association between Ideal cardiovascular health (ICH) and health-related quality of life (HRQoL) using the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) among rural population. Methods: This study included 20,683 participants aged 18–79 years from “the Henan Rural Cohort study”. Generalized linear and Tobit regression models were employed to explore the associations of ICH with EQ-5D-5L utility scores and visual analogue scale (VAS) scores, respectively. Results: The mean EQ-5D-5L utility scores and VAS scores were 0.962 ± 0.095 and 79.52 ± 14.02, respectively. Comparing with poor CVH participants (EQ-5D-5L utility scores and VAS scores: 0.954 ± 0.111 and 78.44 ± 14.29), people with intermediate and ideal CVH had higher EQ-5D-5L utility scores (0.969 ± 0.079 and 0.959 ± 0.099) and VAS scores (80.43 ± 13.65 and 79.28 ± 14.14). ICH scores were positively correlated with EQ-5D-5L utility scores (0.007 (0.004, 0.009)) and VAS scores (0.295 (0.143, 0.446)), respectively. Conclusions: Higher ICH scores is positive associated with better HRQoL in rural population, which suggests that improvement of cardiovascular health may help to enhance HRQoL among rural population.
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Affiliation(s)
- Xueyan Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shengxiang Sang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Tanko Abdulai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Miaomiao Niu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yaling He
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhihan Zhai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Mingming Pan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, China
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Stellefson M, Wang MQ, Balanay JAG, Wu R, Paige SR. Latent Health Risk Classes Associated with Poor Physical and Mental Outcomes in Workers with COPD from Central Appalachian U.S. States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186798. [PMID: 32957739 PMCID: PMC7558335 DOI: 10.3390/ijerph17186798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 02/01/2023]
Abstract
Adults who work in the Central Appalachian region of the United States (U.S.) are disproportionately affected by Chronic Obstructive Pulmonary Disease (COPD). While there is a socio-demographic profile of adults with COPD who are at increased risk for physical and mental distress, the risk factors that uniquely affect the health-related quality of life (HRQoL) of Central Appalachian workers with COPD are unknown. Therefore, we conducted a latent class analysis of 2016 and 2017 Behavioral Risk Factor Surveillance System data from 1326 currently employed adults with COPD living in four U.S. states (KY, NC, TN, and WV) within the Central Appalachian Region. Drawing from the social ecological model, we identified associations between theoretically informed risk indicators-comorbid health conditions, substance use and abuse, and limited access to healthcare-on three HRQoL variables, including infrequent (0-13 days) or frequent (≥14 days) physical distress, mental distress, and limited activity due to poor health over the past 30 days. Workers at high risk for comorbid conditions reported more frequent physical distress, mental distress, and activity limitations as compared to those at low risk. Workers reporting difficulty accessing healthcare were no more likely to report physical or mental distress when compared to workers with adequate access to healthcare; however, those with limited healthcare access did report more frequent activity limitation due to poor health. Interestingly, workers with COPD at high risk for substance use and abuse were no more likely to report poor HRQoL outcomes compared to those at low risk. Our findings have important implications for addressing indicators of poor health among Central Appalachian workers with COPD, especially those living with multiple comorbidities.
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Affiliation(s)
- Michael Stellefson
- Department of Health Science, The University of Alabama, Tuscaloosa, AL 35487, USA
- Correspondence:
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland, College Park, MD 20742, USA;
| | - Jo Anne G. Balanay
- Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA;
| | - Rui Wu
- Department of Computer Science, East Carolina University, Greenville, NC 27858, USA;
| | - Samantha R. Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA;
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Stellefson M, Wang MQ, Balanay JAG, Wu R. Health Risk Disparities among Employed Adults with COPD Living in Central Appalachian U.S. States. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1802373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lee CJ, Park WJ, Suh JW, Choi EK, Jeon DW, Lim SW, Kim DH, Cha KS, Lee BR, Kim NH, Kang TS, Ha JW. Relationship between health-related quality of life and blood pressure control in patients with uncontrolled hypertension. J Clin Hypertens (Greenwich) 2020; 22:1415-1424. [PMID: 32652901 DOI: 10.1111/jch.13941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 11/27/2022]
Abstract
We sought to investigate the psychosocial characteristics of patients with uncontrolled hypertension and examine factors that influence blood pressure (BP) control. A total of 1011 patients with uncontrolled hypertension were enrolled in 13 tertiary hospitals. Uncontrolled hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg despite on antihypertensive therapy. Socio-demographics, anthropometrics, behavioral risk factors, medication pattern, adherence, and measures of health-related quality of life (HRQoL; EuroQol 5D visual analog scale [EQ-5D VAS]) were assessed at baseline and during follow-up visits (3 and 6 months). Patients were divided into 2 groups based on BP control status at 6 months (controlled group [n = 532] vs uncontrolled group [n = 367]). There were no differences in clinical characteristics except the proportion of smokers and baseline BP between patients with controlled BP and uncontrolled BP. At 6 months, the adherence of antihypertensive medication did not differ between the groups but the proportion of combination therapy with ≥3 antihypertensives was significantly higher in patients with uncontrolled BP. EQ-5D VAS at follow-up was significantly lower in patients with uncontrolled BP despite similar baseline values. Multivariate logistic regression analysis revealed that EQ-5D VAS at follow-up significantly correlated with BP control. Patients with worse HRQoL had higher Charlson Comorbidity Index and higher proportion of taking ≥3 antihypertensives, but medication adherence was similar to those with better HRQoL. These findings suggest that along with pharmacologic intervention of hypertension, management of comorbid conditions or psychological support might be helpful for optimizing BP control in patients with uncontrolled hypertension.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Pyeongchon Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Woon Jeon
- Department of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sang-Wook Lim
- Division of Cardiology, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Dae-Hyeok Kim
- Department of Cardiology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Bong-Ryeol Lee
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Nam-Ho Kim
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Tae-Soo Kang
- Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, Kouretas D, Spandidos DA, Tsatsakis A. Obesity ‑ a risk factor for increased COVID‑19 prevalence, severity and lethality (Review). Mol Med Rep 2020; 22:9-19. [PMID: 32377709 PMCID: PMC7248467 DOI: 10.3892/mmr.2020.11127] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Coronaviruses (CoVs), enveloped positive-sense RNA viruses, are a group of viruses that cause infections in the human respiratory tract, which can be characterized clinically from mild to fatal. The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is the virus responsible. The global spread of COVID‑19 can be described as the worst pandemic in humanity in the last century. To date, COVID‑19 has infected more than 3,000,000 people worldwide and killed more than 200,000 people. All age groups can be infected from the virus, but more serious symptoms that can possibly result in death are observed in older people and those with underlying medical conditions such as cardiovascular and pulmonary disease. Novel data report more severe symptoms and even a negative prognosis for the obese patients. A growing body of evidence connects obesity with COVID‑19 and a number of mechanisms from immune system activity attenuation to chronic inflammation are implicated. Lipid peroxidation creates reactive lipid aldehydes which in a patient with metabolic disorder and COVID‑19 will affect its prognosis. Finally, pregnancy‑associated obesity needs to be studied further in connection to COVID‑19 as this infection could pose high risk both to pregnant women and the fetus.
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Affiliation(s)
- Demetrios Petrakis
- Laboratory of Toxicology, Medical School, University of Crete, 71409 Heraklion, Greece
| | - Denisa Margină
- ‘Carol Davila’ University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Biochemistry, 020956 Bucharest, Romania
| | | | - Fotios Tekos
- Department of Biochemistry-Biotechnology, University of Thessaly, 41500 Larissa, Greece
| | - Miriana Stan
- ‘Carol Davila’ University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Toxicology, 020956 Bucharest, Romania
| | - Dragana Nikitovic
- Laboratory of Histology-Embryology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios Kouretas
- Department of Biochemistry-Biotechnology, University of Thessaly, 41500 Larissa, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, 71409 Heraklion, Greece
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Terada T, Chirico D, Tulloch HE, Scott K, Pipe AL, Reed JL. Sex differences in psychosocial and cardiometabolic health among patients completing cardiac rehabilitation. Appl Physiol Nutr Metab 2019; 44:1237-1245. [DOI: 10.1139/apnm-2018-0876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Current programs of cardiac rehabilitation (CR) typically provide a standardized approach to all patients. We examined whether CR would produce similar improvements in psychosocial and cardiometabolic health indicators in women compared with men. The records of patients who completed a 3-month outpatient CR program were examined. We compared health-related quality of life (i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS) scores), anxiety, depression, and cardiometabolic health indicators between women and men completing CR. Of the 591 participants who completed CR, 155 (26.2%) were women and 436 (73.8%) were men. At baseline, women were older (64 ± 9 vs. 62 ± 9 years, p = 0.045), had lower PCS (39.5 ± 8.1 vs. 43.9 ± 7.8 points, p < 0.001), and MCS (46.6 ± 10.8 vs. 49.4 ± 9.8 points, p = 0.003) scores, experienced elevated levels of anxiety (6.4 ± 4.0 vs. 5.2 ± 4.0 points, p = 0.001) and depression (4.7 ± 3.5 vs. 3.6 ± 3.3 points, p = 0.001), and had higher low-density lipoprotein cholesterol (2.1 ± 0.9 vs. 1.7 ± 0.7 mmol/L, p < 0.001) and high-density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.1 ± 0.3 mmol/L, p < 0.001) concentrations when compared with men. Following CR, women showed smaller improvements in percent body mass (+1.1% ± 10.1% vs. −2.1% ± 9.7%, p = 0.002) and PCS scores (3.0 ± 8.1 vs. 6.3 ± 7.5 points, p < 0.001) when compared with men. Considering poorer psychosocial health at baseline and smaller improvements in health-related quality of life in women when compared with men, more specific CR strategies addressing the particular needs of women are required to improve their health status and reduce the risk of secondary cardiac events.
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Affiliation(s)
- Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Heather E. Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Kyle Scott
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Andrew L. Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jennifer L. Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Mitchell UA, Ailshire JA, Kim JK, Crimmins EM. Black-White Differences in 20-year Trends in Cardiovascular Risk in the United States, 1990-2010. Ethn Dis 2019; 29:587-598. [PMID: 31641326 DOI: 10.18865/ed.29.4.587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective Improvements in the Black-White difference in life expectancy have been attributed to improved diagnosis and treatment of cardiovascular diseases and declines in cardiovascular disease mortality. However, it is unclear whether race differences in total cardiovascular risk and the prevalence of cardiovascular risk factors have improved in the United States since the 1990s. Design Serial cross-sectional design. Setting Data from the 1988-1994, 1999-2002, and 2009-2012 National Health and Nutrition Examination Survey (NHANES). Methods We estimated total cardiovascular risk levels, the prevalence of high-risk cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs among US Black and White men and women to determine whether differential changes occurred from 1990-2010. Results Total cardiovascular risk declined for all races from 1990-2010. The Black-White difference was only significant in 2000 and sex-specific analyses showed that trends seen in the total population were driven by changes among women. Black and White men did not differ in risk at any time during this period. Conversely, Black women had significantly higher risk than White women in 1990 and 2000; this difference was eliminated by 2010. Improved diagnosis and treatment of high blood pressure and high cholesterol reduced risk in the total population; improved blood pressure and lipid profiles among Black women and increasing obesity prevalence among White women specifically contributed to the narrowing of the Black-White difference in risk among women. Conclusion Cardiovascular risk and racial disparities in risk declined among US Whites and Blacks due to greater use and effectiveness of lipid-lowering and antihypertensive medications.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Jennifer A Ailshire
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Jung Ki Kim
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Eileen M Crimmins
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
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Negesa LB, Magarey J, Rasmussen P, Hendriks JM. Cardiovascular risk behaviour is an emerging health issue in developing countries: a cross-sectional study. Eur J Cardiovasc Nurs 2019; 18:679-690. [PMID: 31269808 DOI: 10.1177/1474515119861772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Low and middle-income countries are facing a high burden of cardiovascular disease while there is limited availability of resources and evidence to educate and modify lifestyle behaviours in the population as well as to guide policy making. AIM The goal of the present study was to quantify the prevalence of different cardiovascular risk behaviours among patients with known cardiovascular conditions in a developing country. METHODS A hospital-based cross-sectional survey was conducted in two referral hospitals in eastern Ethiopia. Outpatients who had a confirmed diagnosis of cardiovascular disease were recruited for the study. Data were collected through face-to-face interviews with patients using validated tools. RESULTS A total of 287 cardiovascular disease patients was recruited, of which 56.4% were women and 90.2% were urban residents. Most patients had inadequate consumption of fruit and vegetables, 51.6% were physically inactive, 20% were current khat chewers, 19% were current alcohol drinkers and only 1% were current smokers. Approximately one-third (30%) of the patients had one of these risk behaviours, more than half (51.9%) had two, 15% had three and 3.1% had four risk behaviours. The majority (70%) of the patients had multiple (more than two) risk behaviours. The prevalence of multiple risk behaviours did not significantly vary with sex, residence and educational level differences (P>0.05). CONCLUSION Cardiovascular disease patients continue to follow unhealthy lifestyles although they attend follow-up care with a specific focus on risk management. The findings of this study provide evidence for policy makers that health services reform is required to promote healthy lifestyle behaviours for the patients.
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Affiliation(s)
- Lemma B Negesa
- Adelaide Nursing School, The University of Adelaide, Australia.,College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Judy Magarey
- Adelaide Nursing School, The University of Adelaide, Australia
| | | | - Jeroen Ml Hendriks
- Centre for Heart Rhythm Disorders, Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia.,Department of Medical and Health Sciences, Linköping University, Sweden
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Stellefson M, Paige SR, Barry AE, Wang MQ, Apperson A. Risk factors associated with physical and mental distress in people who report a COPD diagnosis: latent class analysis of 2016 behavioral risk factor surveillance system data. Int J Chron Obstruct Pulmon Dis 2019; 14:809-822. [PMID: 31040659 PMCID: PMC6462160 DOI: 10.2147/copd.s194018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Challenges associated with COPD increase patients’ risk of physical immobility and emotional distress, perpetuating a cycle of symptomatic living that hinders patients’ self-management and adherence to a treatment regimen. There is limited evidence available on how discrete behavioral and health risk factors contribute to the physical and mental distress experienced by people living with COPD. Purpose This secondary data analysis of 2016 Behavioral Risk Factor Surveillance System (BRFSS) sought to identify subgroups of people with COPD who were at the highest risk for physical and mental distress. Methods We selected 16 relevant risk indicators in four health-related domains – 1) health risk behaviors, 2) lack of preventive vaccinations, 3) limited health care access, and 4) comorbidities – as predictors of physical and mental health-related quality of life (HRQoL) in the COPD population. Latent class modeling (LCM) was applied to understand how various health-related indicators in these four health domains influenced reports of physical and/or mental distress. Results The majority of BRFSS respondents who reported a COPD diagnosis experienced physical (53.76%) and/or mental (58.23%) distress in the past 14 days. Frequent physical and mental distress were more common in females with COPD in the 45–64 years age group, who were also identified as white and in the lower socioeconomic group. Respondents with intermediate- to high-risk behaviors, intermediate to multiple comorbidities, limited access to health care, and intermediate to low use of preventive vaccinations were more likely to report frequent physical distress compared to the low-risk respondents. Similarly, respondents with high-risk behaviors, intermediate to multiple comorbidities, and low use of preventive vaccinations were more likely to report frequent mental distress than the low-risk group. Discussion This analysis of updated 2016 BRFSS data identified high-risk Americans with COPD who could benefit from disease management and secondary/tertiary health promotion interventions that may improve HRQoL. Future research should address noted disparities in risk factors, particularly among low socioeconomic populations living with COPD.
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Affiliation(s)
- Michael Stellefson
- Department of Health Education & Promotion, East Carolina University, Greenville, NC, USA,
| | - Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Avery Apperson
- Department of Health Education & Promotion, East Carolina University, Greenville, NC, USA,
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Terada T, Chirico D, Tulloch HE, Scott K, Doucet É, Pipe AL, Reed JL. Psychosocial and Cardiometabolic Health of Patients With Differing Body Mass Index Completing Cardiac Rehabilitation. Can J Cardiol 2019; 35:712-720. [PMID: 31151706 DOI: 10.1016/j.cjca.2019.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND It remains unclear whether cardiac rehabilitation (CR) provides similar benefits to patients with varying levels of body mass index (BMI). We assessed the psychosocial and cardiometabolic health of patients with increased BMI who completed CR. METHODS The records of 582 patients who completed a 3-month outpatient CR program were analyzed. On the basis of their BMI at baseline, patients were categorized as normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), or severely obese (≥ 35.0 kg/m2). Analysis of covariance was used to compare health-related quality of life (ie, Physical Component Summary [PCS] and Mental Component Summary scores), anxiety, depression, and cardiometabolic health indicators between BMI categories after CR. RESULTS At baseline, patients with severe obesity, when compared with those with normal BMI, had lower PCS scores (39.7 ± 8.5 vs 44.4 ± 8.4, P < 0.001), elevated levels of anxiety (7.0 ± 3.7 vs 4.8 ± 3.2, P = 0.001) and depression (5.5 ± 4.4 vs 3.4 ± 3.7, P < 0.001), higher glycated hemoglobin A1C (6.5 ± 1.1 vs 5.6 ± 0.7%, P < 0.001) and triglycerides (1.6 ± 0.5 vs 1.1 ± 0.4 mmol/L, P < 0.001), and lower high-density lipoprotein cholesterol (1.1 ± 0.3 vs 1.2 ± 0.4 mmol/L, P = 0.006). After CR, notwithstanding a greater percent weight reduction in obesity (-3.5% ± 6.9% vs +1.1% ± 7.0%, P = 0.002) and severe obesity (-6.5% ± 6.9% vs +1.1% ± 7.0%, P < 0.001), smaller improvements in PCS scores were seen in the obese (4.1 ± 7.4 vs 6.9 ± 7.6, P = 0.011) and severely obese (4.1 ± 7.6 vs 6.9 ± 7.6, P = 0.039) when compared with those with normal BMI. CONCLUSIONS Poorer psychosocial and cardiometabolic health at baseline coupled with smaller improvements in the PCS score suggest that patients with obesity and severe obesity will benefit from enhanced care in the CR setting.
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Affiliation(s)
- Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather E Tulloch
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kyle Scott
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Éric Doucet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
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Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S. Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. Circulation 2017; 136:1840-1850. [PMID: 29109195 DOI: 10.1161/circulationaha.117.029400] [Citation(s) in RCA: 318] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive and central sleep apnea associated with Cheyne-Stokes respiration. Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation. Central sleep apnea associated with Cheyne-Stokes respiration predicts incident heart failure and atrial fibrillation; among patients with heart failure, it strongly predicts mortality. Thus, a strong literature provides the mechanistic and empirical bases for considering obstructive sleep apnea and central sleep apnea associated with Cheyne-Stokes respiration as potentially modifiable risk factors for cardiovascular disease. Data from small trials provide evidence that treatment of obstructive sleep apnea with continuous positive airway pressure improves not only patient-reported outcomes such as sleepiness, quality of life, and mood but also intermediate cardiovascular end points such as blood pressure, cardiac ejection fraction, vascular parameters, and arrhythmias. However, data from large-scale randomized controlled trials do not currently support a role for positive pressure therapies for reducing cardiovascular mortality. The results of 2 recent large randomized controlled trials, published in 2015 and 2016, raise questions about the effectiveness of pressure therapies in reducing clinical end points, although 1 trial supported the beneficial effect of continuous positive airway pressure on quality of life, mood, and work absenteeism. This review provides a contextual framework for interpreting the results of recent studies, key clinical messages, and suggestions for future sleep and cardiovascular research, which include further consideration of individual risk factors, use of existing and new multimodality therapies that also address adherence, and implementation of trials that are sufficiently powered to target end points and to support subgroup analyses. These goals may best be addressed through strengthening collaboration among the cardiology, sleep medicine, and clinical trial communities.
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Affiliation(s)
- Luciano F Drager
- From Hypertension Unit (L.F.D.) and Sleep Laboratory, Pulmonary Division (G.L.-F.), Instituto do Coracao, and Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil; Adelaide Institute for Sleep Health, College of Medicine and Public Health, and School of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Australia (R.D.M.); Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Australia (R.D.M.); Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain (F.B.); and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.R.).
| | - R Doug McEvoy
- From Hypertension Unit (L.F.D.) and Sleep Laboratory, Pulmonary Division (G.L.-F.), Instituto do Coracao, and Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil; Adelaide Institute for Sleep Health, College of Medicine and Public Health, and School of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Australia (R.D.M.); Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Australia (R.D.M.); Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain (F.B.); and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.R.)
| | - Ferran Barbe
- From Hypertension Unit (L.F.D.) and Sleep Laboratory, Pulmonary Division (G.L.-F.), Instituto do Coracao, and Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil; Adelaide Institute for Sleep Health, College of Medicine and Public Health, and School of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Australia (R.D.M.); Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Australia (R.D.M.); Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain (F.B.); and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.R.)
| | - Geraldo Lorenzi-Filho
- From Hypertension Unit (L.F.D.) and Sleep Laboratory, Pulmonary Division (G.L.-F.), Instituto do Coracao, and Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil; Adelaide Institute for Sleep Health, College of Medicine and Public Health, and School of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Australia (R.D.M.); Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Australia (R.D.M.); Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain (F.B.); and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.R.)
| | - Susan Redline
- From Hypertension Unit (L.F.D.) and Sleep Laboratory, Pulmonary Division (G.L.-F.), Instituto do Coracao, and Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil; Adelaide Institute for Sleep Health, College of Medicine and Public Health, and School of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Australia (R.D.M.); Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Australia (R.D.M.); Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain (F.B.); and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.R.).
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Assari S. Number of Chronic Medical Conditions Fully Mediates the Effects of Race on Mortality; 25-Year Follow-Up of a Nationally Representative Sample of Americans. J Racial Ethn Health Disparities 2017; 4:623-631. [PMID: 27440120 PMCID: PMC6662183 DOI: 10.1007/s40615-016-0266-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the well-established literature on the effects of race and socioeconomic status (SES) on mortality, limited information exists on mediators of these effects. Taking a life-course epidemiology approach, and using a nationally representative sample of adults in the USA, the current study has two aims: (1) to assess the effects of race and SES at baseline on all-cause mortality over a 25-year follow-up and (2) to test whether the number of chronic medical conditions (CMCs) as a time-varying covariate mediates the effects of race and SES on all-cause mortality. METHODS Data came from the Americans' Changing Lives (ACL) Study, a nationally representative longitudinal cohort of US adults 25 and older. The study followed 3361 Blacks or Whites for all-cause mortality for up to 25 years from 1986 to 2011. The predictors of interest were race and SES (education and family income) at baseline measured in 1986. Confounders included baseline age and gender. CMC was the potential time-varying mediator measured in 1986, 1989, 1991, 2001, and 2011. We ran Cox proportional hazard models with and without CMC as time-varying covariates. RESULTS In separate models, race and SES were predictors of all-cause mortality. In the model that tested the combined effect of race and SES, SES but not race was predictive of all-cause mortality. We also found evidence suggesting that CMC fully mediates the effect of race on all-cause mortality. Number of CMC only partially mediated the effect of SES on mortality. CONCLUSION The number of CMC fully mediates the effects of race and partially mediates the effects of SES on all-cause mortality in the USA. Mortality prevention for minority populations will benefit tremendously from elimination of CMC disparities as well as enhancement of CMC management by minority populations. Elimination of the gap due to SES may be more challenging than the elimination of the racial gap in mortality.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, USA.
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Zhao YY, Wang R, Gleason KJ, Lewis EF, Quan SF, Toth CM, Morrical M, Rueschman M, Weng J, Ware JH, Mittleman MA, Redline S. Effect of Continuous Positive Airway Pressure Treatment on Health-Related Quality of Life and Sleepiness in High Cardiovascular Risk Individuals With Sleep Apnea: Best Apnea Interventions for Research (BestAIR) Trial. Sleep 2017; 40:3737623. [PMID: 28419387 PMCID: PMC5806548 DOI: 10.1093/sleep/zsx040] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives The long-term effect of continuous positive airway pressure (CPAP) on health-related quality of life (HRQOL) in patients with high cardiovascular disease risk and obstructive sleep apnea (OSA) without severe sleepiness is uncertain. We aimed to determine the effect of CPAP treatment on HRQOL in individuals with moderate or severe OSA and cardiovascular disease (CVD) or multiple CVD risk factors without severe sleepiness. Methods In this randomized, controlled, parallel group study, 169 participants were assigned to treatment with CPAP or the control group (conservative medical therapy [CMT] or CMT with sham CPAP). Analyses were based on an intention-to-treat approach. Linear mixed effect models were fitted to compare the changes in the Medical Outcomes Study Short Form-36 (SF-36) and in subjective sleepiness (Epworth Sleepiness Scale [ESS]) between groups from baseline to the average of 6- and 12-month measurements. Results CPAP improved several domains of HRQOL including bodily pain (treatment effect 9.7 [95% confidence interval, CI 3.9 to 15.4]; p = .001), vitality (5.7 [95% CI 1.5 to 9.9]; p = .008), general health (8.2 [95% CI 3.7 to 12.7]; p < .001), physical functioning (5.5 [95% CI 1.1 to 10.0]; p = .016), and the physical health summary score (3.3 [95% CI 1.4 to 5.3]; p = .001). CPAP also resulted in less daytime sleepiness (mean change in ESS -1.0 point [95% CI -2.0 to -0.0]; p = .040). Conclusions In patients with moderate-severe OSA at high risk of cardiovascular events and without severe sleepiness, CPAP improved daytime sleepiness and multiple domains of HRQOL over 6 to 12 months of follow-up, with the largest improvement observed for bodily pain.
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Affiliation(s)
- Ying Y Zhao
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rui Wang
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kevin J Gleason
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Eldrin F Lewis
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Stuart F Quan
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Claudia M Toth
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael Morrical
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael Rueschman
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jia Weng
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - James H Ware
- Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Murray A Mittleman
- Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Redline
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Manczuk M, Vaidean G, Dehghan M, Vedanthan R, Boffetta P, Zatonski WA. Ideal cardiovascular health is associated with self-rated health status. The Polish Norwegian Study (PONS). Int J Cardiol 2017; 230:549-555. [DOI: 10.1016/j.ijcard.2016.12.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/25/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022]
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Odom EC, Fang J, Zack M, Moore L, Loustalot F. Associations Between Cardiovascular Health and Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, 2013. Prev Chronic Dis 2016; 13:E99. [PMID: 27468158 PMCID: PMC4975178 DOI: 10.5888/pcd13.160073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction The American Heart Association established 7 cardiovascular health metrics as targets for promoting healthier lives. Cardiovascular health has been hypothesized to play a role in individuals’ perception of quality of life; however, previous studies have mostly assessed the effect of cardiovascular risk factors on quality of life. Methods Data were from the 2013 Behavioral Risk Factor Surveillance System, a state-based telephone survey of adults 18 years or older (N = 347,073). All measures of cardiovascular health and health-related quality of life were self-reported. The 7 ideal cardiovascular health metrics were normal blood pressure, cholesterol, body mass index, not having diabetes, not smoking, being physically active, and having adequate fruit or vegetable intake. Cardiovascular health was categorized into meeting 0–2, 3–5, or 6–7 ideal cardiovascular health metrics. Logistic regression models examined the association between cardiovascular health, general health status, and 3 measures of unhealthy days per month, adjusting for age, sex, race/ethnicity, education, and annual income. Results Meeting 3 to 5 or 6 to 7 ideal cardiovascular health metrics was associated with a 51% and 79% lower adjusted prevalence ratio (aPR) of fair/poor health, respectively (aPR = 0.49, 95% confidence interval [CI] [0.47–0.50], aPR = 0.21, 95% CI [0.19–0.23]); a 47% and 72% lower prevalence of ≥14 physically unhealthy days (aPR = 0.53, 95% CI [0.51–0.55], aPR = 0.28, 95% CI [0.26–0.20]); a 43% and 66% lower prevalence of ≥14 mentally unhealthy days (aPR = 0.57, 95% CI [0.55–0.60], aPR = 0.34, 95% CI [0.31–0.37]); and a 50% and 74% lower prevalence of ≥14 activity limitation days (aPR = 0.50, 95% CI [0.48–0.53], aPR = 0.26, 95% CI [0.23–0.29]) in the past 30 days. Conclusion Achieving a greater number of ideal cardiovascular health metrics may be associated with less impairment in health-related quality of life.
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Affiliation(s)
- Erika C Odom
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, Bldg 102, Mail Stop F-77, Atlanta, GA 30341.
| | - Jing Fang
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Zack
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Latetia Moore
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mamudu HM, Paul TK, Wang L, Veeranki SP, Panchal HB, Alamian A, Sarnosky K, Budoff M. The effects of multiple coronary artery disease risk factors on subclinical atherosclerosis in a rural population in the United States. Prev Med 2016; 88:140-6. [PMID: 27090918 DOI: 10.1016/j.ypmed.2016.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The risk factors for cardiovascular disease (CVD) are associated with coronary atherosclerosis and having multiple risk factors potentiates atherosclerosis. This study examined the prevalence of multiple biological and lifestyle/behavioral risk factors and their association with coronary artery calcium (CAC), a marker for subclinical coronary atherosclerosis. METHODS This is a cross-sectional study of 1607 community-dwelling asymptomatic individuals from central Appalachia who participated in CAC screening between January 2011 and December 2012. Data on demographics (sex and age) and 7 traditional risk factors for coronary artery disease (CAD) were collected and categorized into 5 groups (0-1, 2, 3, 4, and ≥5). Prevalence of these risk factors and CAC scores (0, 1-99, 100-399, ≥400) were assessed, and the impact of the number of risk factors on CAC scores were delineated using multiple logistic regression. RESULTS Over 98% of participants had ≥1 risk factor. While obesity, diabetes, hypertension, and family history of CAD significantly increased the odds of having CAC, CAC scores significantly increased with number of risk factors. After adjusting for demographic factors, having 3, 4, and ≥5 risk factors was significantly associated with increased odds of having higher CAC scores when compared to zero CAC score by more than one and half times [OR=1.65, CI (1.20-2.25)], two times [OR=2.32, CI (1.67-3.23)] and three times [OR=3.45, CI (2.42-4.92)], respectively. CONCLUSION The high prevalence of multiple risk factors in the study population suggests the need for aggressive multiple risk factors interventions for primary prevention of CAD, which could address CVD health disparities.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN, United States.
| | - Timir K Paul
- Division of Cardiology, James. H. Quillen College of Medicine, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN 37604, United States.
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States.
| | - Hemang B Panchal
- Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37604, United States.
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Kamrie Sarnosky
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, United States.
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Crews JE, Chou CF, Zack MM, Zhang X, Bullard KM, Morse AR, Saaddine JB. The Association of Health-Related Quality of Life with Severity of Visual Impairment among People Aged 40-64 Years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System. Ophthalmic Epidemiol 2016; 23:145-53. [PMID: 27159347 DOI: 10.3109/09286586.2016.1168851] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years. METHODS We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001). CONCLUSION Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years.
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Affiliation(s)
- John E Crews
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Chiu-Fang Chou
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Matthew M Zack
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Xinzhi Zhang
- b University of Alabama at Birmingham , Birmingham , AL , USA
| | - Kai McKeever Bullard
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | | | - Jinan B Saaddine
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
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The association between physical activity, sitting time, sleep duration, and sleep quality as correlates of presenteeism. J Occup Environ Med 2016; 57:321-8. [PMID: 25742538 PMCID: PMC5585235 DOI: 10.1097/jom.0000000000000355] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: This study aims to examine the relationship of lifestyle behaviors (physical activity, work and non-work sitting time, sleep quality, and sleep duration) with presenteeism while controlling for sociodemographics, work- and health-related variables. Methods: Data were collected from 710 workers (aged 20 to 76 years; 47.9% women) from randomly selected Australian adults who completed an online survey. Linear regression was used to examine the relationship between lifestyle behaviors and presenteeism. Results: Poorer sleep quality (standardized regression coefficients [B] = 0.112; P < 0.05), suboptimal duration (B = 0.081; P < 0.05), and lower work sitting time (B = −0.086; P < 0.05) were significantly associated with higher presenteeism when controlling for all lifestyle behaviors. Engaging in three risky lifestyle behaviors was associated with higher presenteeism (B = 0.150; P < 0.01) compared with engaging in none or one. Conclusions: The results of this study highlight the importance of sleep behaviors for presenteeism and call for behavioral interventions that simultaneously address sleep in conjunction with other activity-related behaviors.
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Allen NB, Badon S, Greenlund KJ, Huffman M, Hong Y, Lloyd-Jones DM. The association between cardiovascular health and health-related quality of life and health status measures among U.S. adults: a cross-sectional study of the National Health and Nutrition Examination Surveys, 2001-2010. Health Qual Life Outcomes 2015; 13:152. [PMID: 26396070 PMCID: PMC4580297 DOI: 10.1186/s12955-015-0352-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/15/2015] [Indexed: 12/29/2022] Open
Abstract
Background This study was conducted to examine the association between ideal cardiovascular health (CVH) and health-related quality of life and health status indicators. Methods This cross-sectional study included adult NHANES participants from 2001 to 2010 without CVD (N = 7115). CVH was defined according to AHA definitions with poor, intermediate and ideal levels of the seven factors (diet, BMI, physical activity, smoking, blood pressure, glucose, and cholesterol) assigned scores of 0, 1, and 2, respectively. A CVH score (CVHS) was calculated as the sum of the scores from each individual health factor (range 0–14; higher score indicating greater CVH). CVHS was categorized as poor (0–7), intermediate (8–10), and ideal (11–14). Linear regression models examined the association between CVHS category with health status and number of unhealthy days per month, adjusted for socio-demographic characteristics and disability. Results Among US adults 20–79 years, 14, 46 and 40 % had ideal, intermediate and poor CVHS, respectively. Compared to those with poor CVH, individuals in intermediate and ideal CVH were 44 and 71 % less likely to report being in fair/poor health. Participants with ideal CVH scores reported a mean of 2.4 fewer unhealthy days over the past month, including one less day in which their physical health was not good and two fewer days in which their mental health was not good. Conclusions Ideal CVH is associated with greater overall health status and fewer physically and mentally unhealthy days. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0352-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Dr., Suite 1400, Chicago, IL, 60611, USA.
| | - Sylvia Badon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Dr., Suite 1400, Chicago, IL, 60611, USA.
| | - Kurt J Greenlund
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mark Huffman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Dr., Suite 1400, Chicago, IL, 60611, USA.
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Dr., Suite 1400, Chicago, IL, 60611, USA.
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Tan MC, Ng OC, Wong TW, Hejar AR, Anthony J, Sintonen H. The association of cardiovascular disease with impaired health-related quality of life among patients with type 2 diabetes mellitus. Singapore Med J 2015; 55:209-16. [PMID: 24763837 DOI: 10.11622/smedj.2014054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the health-related quality of life (HRQoL) of Malaysian patients with type 2 diabetes mellitus (T2DM) who have cardiovascular disease (CVD), as well as identify the determinants of HRQoL among this cohort of patients. METHODS This study was an analytical cross-sectional study involving 313 patients aged 30-78 years (150 men, 163 women; mean age 55.7 ± 9.2 years) who were diagnosed with T2DM (mean duration of T2DM 10.1 ± 8.1 years) at two tertiary Malaysian government hospitals. The patients' sociodemographic, lifestyle, clinical and laboratory data were collected prospectively from medical records and via face-to-face interviews. HRQoL was assessed using the 15D instrument - a generic, 15-dimensional and standardised measure of HRQoL that can be used as both a profile and a single index score measure. RESULTS T2DM patients with CVD were found to have significantly lower 15D HRQoL scores than their nonCVD counterparts (p < 0.001). The HRQoL of T2DM patients with CVD was significantly lower than those without CVD (p < 0.05) in all of the 15 dimensions of the 15D instrument. Multinomial logistic regression analysis using backward stepwise method revealed a significant association between CVD and impaired HRQoL (odds ratio [OR] 11.746, 95% confidence interval [CI] 4.898-28.167). Age (OR 1.095, 95% CI 1.054-1.137), duration of T2DM (OR 1.085, 95% CI 1.032-1.140), ethnicity (OR 0.411, 95% CI 0.187-0.903), body mass index (OR 1.074, 95% CI 1.006-1.148), and physical activity level (OR 3.506, 95% CI 1.415-8.689) were also significant predictors of HRQoL. CONCLUSION In T2DM patients, the presence of CVD was significantly associated with a lower HRQoL. Therefore, the importance of tertiary prevention to minimise the potential deterioration of the HRQoL of T2DM patients with CVD should be highly emphasised.
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Affiliation(s)
- Mun Chieng Tan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia.
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Crews JE, Chou CF, Zhang X, Zack MM, Saaddine JB. Health-related quality of life among people aged ≥65 years with self-reported visual impairment: findings from the 2006-2010 behavioral risk factor surveillance system. Ophthalmic Epidemiol 2014; 21:287-96. [PMID: 24955821 PMCID: PMC4924345 DOI: 10.3109/09286586.2014.926556] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years. METHODS We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart attack, body mass index, leisure time activity, smoking, and medical care cost concerns) and comparing to those with no self-reported visual impairment, people reporting a little visual impairment were more likely to have fair/poor health (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1-1.3), life dissatisfaction (OR 1.6, 95% CI 1.3-2.0), and disability (OR 1.5, 95% CI 1.3-1.6), and those with self-reported moderate/severe visual impairment had more fair/poor health (OR 1.8, 95% CI 1.6-2.0), life dissatisfaction (OR 2.3, 95% CI 1.8-2.9), and disability (OR 2.0, 95% CI 1.8-2.2). They also had more frequent physically unhealthy days (OR 1.9, 95% CI 1.7-2.1), mentally unhealthy days (OR 1.8, 95% CI 1.5-2.1), and activity limitations days (OR 1.9, 95% CI 1.6-2.2). CONCLUSION Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years.
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Affiliation(s)
- John E Crews
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, GA , USA
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Herman R, Liebergall M, Rott D. Correlation between Participation in a Cardiac Rehabilitation Program and Quality of Life of Patients with Coronary Artery Disease. Rehabil Nurs 2014; 39:192-7. [DOI: 10.1002/rnj.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/12/2022]
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Smith KJ, Schmitz N. Association of depression and anxiety symptoms with functional disability and disability days in a community sample with type 2 diabetes. PSYCHOSOMATICS 2014; 55:659-67. [PMID: 25497504 DOI: 10.1016/j.psym.2014.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a well-documented association between depression and disability in people with diabetes. However, less is known about the possible association of co-occurring anxiety on these associations. OBJECTIVE The objective of this study was to assess the association of elevated anxiety or depression symptoms or both with functional disability and frequent disability days in a community sample with type 2 diabetes. METHODS The participants were 1999 people with diabetes who completed the baseline portion of the Evaluation of Diabetes Treatment study. Functional disability was assessed using the World Health Organization Disability Assessment Schedule II. Frequent disability days were assessed using a cutoff score ≥14 on a question assessing functional disability in the past month from the Healthy Days Core Module. Depression and anxiety were assessed with the Patient Health Questionnaire and General Anxiety Questionnaire with cutoff scores ≥10 applied to create groups. Additional questions examined diabetes complications, chronic conditions, and sociodemographic characteristics. RESULTS Fully adjusted logistic regression analyses demonstrated an increased likelihood of reporting functional disability for all groups with high anxiety or depressive symptoms or both. Groups with high depressive symptoms with and without high anxiety symptoms were also more likely to report frequent disability days. CONCLUSIONS Results indicate that elevated anxiety and depression symptoms are important factors associated with increased functional disability and frequent disability days in people with diabetes.
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Affiliation(s)
- Kimberley J Smith
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Montréal Diabetes Research Centre, Montreal, Quebec, Canada
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Duncan MJ, Kline CE, Vandelanotte C, Sargent C, Rogers NL, Di Milia L. Cross-sectional associations between multiple lifestyle behaviors and health-related quality of life in the 10,000 Steps cohort. PLoS One 2014; 9:e94184. [PMID: 24714564 PMCID: PMC3979761 DOI: 10.1371/journal.pone.0094184] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/04/2014] [Indexed: 12/11/2022] Open
Abstract
Background The independent and combined influence of smoking, alcohol consumption, physical activity, diet, sitting time, and sleep duration and quality on health status is not routinely examined. This study investigates the relationships between these lifestyle behaviors, independently and in combination, and health-related quality of life (HRQOL). Methods Adult members of the 10,000 Steps project (n = 159,699) were invited to participate in an online survey in November-December 2011. Participant socio-demographics, lifestyle behaviors, and HRQOL (poor self-rated health; frequent unhealthy days) were assessed by self-report. The combined influence of poor lifestyle behaviors were examined, independently and also as part of two lifestyle behavior indices, one excluding sleep quality (Index 1) and one including sleep quality (Index 2). Adjusted Cox proportional hazard models were used to examine relationships between lifestyle behaviors and HRQOL. Results A total of 10,478 participants provided complete data for the current study. For Index 1, the Prevalence Ratio (p value) of poor self-rated health was 1.54 (p = 0.001), 2.07 (p≤0.001), 3.00 (p≤0.001), 3.61 (p≤0.001) and 3.89 (p≤0.001) for people reporting two, three, four, five and six poor lifestyle behaviors, compared to people with 0–1 poor lifestyle behaviors. For Index 2, the Prevalence Ratio (p value) of poor self-rated health was 2.26 (p = 0.007), 3.29 (p≤0.001), 4.68 (p≤0.001), 6.48 (p≤0.001), 7.91 (p≤0.001) and 8.55 (p≤0.001) for people reporting two, three, four, five, six and seven poor lifestyle behaviors, compared to people with 0–1 poor lifestyle behaviors. Associations between the combined lifestyle behavior index and frequent unhealthy days were statistically significant and similar to those observed for poor self-rated health. Conclusions Engaging in a greater number of poor lifestyle behaviors was associated with a higher prevalence of poor HRQOL. This association was exacerbated when sleep quality was included in the index.
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Affiliation(s)
- Mitch J. Duncan
- Centre for Physical Activity Studies, Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Queensland, Australia
- * E-mail:
| | - Christopher E. Kline
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Corneel Vandelanotte
- Centre for Physical Activity Studies, Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Queensland, Australia
| | - Charli Sargent
- Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia
| | - Naomi L. Rogers
- School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia
| | - Lee Di Milia
- School of Business and Law and Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Queensland, Australia
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Unhealthy days and quality of life in Irish patients with diabetes. PLoS One 2013; 8:e81102. [PMID: 24349036 PMCID: PMC3862478 DOI: 10.1371/journal.pone.0081102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/15/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To study the determinants of health-related quality of life (HRQoL) in Irish patients with diabetes using the Centres for Disease Controls' (CDC's) 'Unhealthy Days' summary measure and to assesses the agreement between this generic HRQoL measure and the disease-specific Audit of Diabetes Dependant Quality of Life (ADDQoL) measure. RESEARCH DESIGN AND METHODS Data were analysed from the Diabetes Quality of Life Study, a cross-sectional study of 1,456 people with diabetes in Ireland (71% response rate). Unhealthy days were assessed using the CDC's 'Unhealthy days' summary measure. Quality of life (QoL) was also assessed using the ADDQoL measure. Analyses were conducted primarily using logistic regression. The agreement between the two QoL instruments was measured using the kappa co-efficient. RESULTS Participants reported a median of 2 unhealthy days per month. In multivariate analyses, female gender (P = 0.001), insulin use (P = 0.030), diabetes complications (P = <0.001) were significantly associated with more unhealthy days. Older patients had fewer unhealthy days per month (P = 0.003). Agreement between the two measures of QoL (unhealthy days measure and ADDQoL) was poor, Kappa = 0.234. CONCLUSIONS The findings highlight the determinants of HRQoL in patients with diabetes using a generic HRQoL summary measure. The 'Unhealthy Days' and the ADDQoL have poor agreement, therefore the 'Unhealthy Days' summary measure may be assessing a different construct. Nonetheless, this study demonstrates that the generic 'Unhealthy Days' summary measure can be used to detect determinants of HRQoL in patients with diabetes.
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Pulmonary function, chronic respiratory symptoms, and health-related quality of life among adults in the United States--National Health and Nutrition Examination Survey 2007-2010. BMC Public Health 2013; 13:854. [PMID: 24040892 PMCID: PMC3848467 DOI: 10.1186/1471-2458-13-854] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 09/10/2013] [Indexed: 11/26/2022] Open
Abstract
Background We examined the association of impaired lung function and respiratory symptoms with measures of health status and health-related quality of life (HRQOL) among US adults. Methods The sample included 5139 participants aged 40–79 years in the National Health and Nutrition Examination Survey 2007–2010 who underwent spirometric testing and responded to questions about respiratory symptoms, health status, and number of physically unhealthy, mentally unhealthy, or activity limitation days in the prior 30 days. Results Among these adults, 7.2% had restrictive impairment (FEV1/FVC ≥ 70%; FVC < 80% of predicted), 10.9% had mild obstruction (FEV1/FVC < 70%; FEV1 ≥ 80% predicted), and 9.0% had moderate–severe obstruction (FEV1/FVC < 70%; FEV1 < 80% predicted). Individuals with restrictive impairment or moderate–severe obstruction were more likely to report fair/poor health compared to those with normal lung function (prevalence ratio (PR) =1.5 [95% CI: 1.2-1.9] and 1.5 [1.3-1.8]), after controlling for sociodemographics, non-respiratory chronic diseases, body mass index, smoking, and respiratory symptoms. Frequent mental distress (FMD; ≥14 mentally unhealthy days), frequent physical distress (FPD; ≥14 physically unhealthy days), and frequent activity limitation (FAL; ≥14 activity limitation days) did not differ by lung function status. Adults who reported any respiratory symptoms (frequent cough, frequent phlegm, or past year wheeze) were more likely to report fair/poor health (PR = 1.5 [1.3-1.7]), FPD (PR = 1.6 [1.4-1.9]), FMD (PR = 1.8 [1.4-2.2]), and FAL (PR = 1.4 [1.1-1.9]) than those with no symptoms. Conclusions These results suggest the importance of chronic respiratory symptoms as potential risk factors for poor HRQOL and suggest improved symptom treatment and prevention efforts would likely improve HRQOL.
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Health related quality of life in coronary patients and its association with their cardiovascular risk profile: Results from the EUROASPIRE III survey. Int J Cardiol 2013. [DOI: 10.1016/j.ijcard.2012.10.053] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wang J, Sereika SM, Styn MA, Burke LE. Factors associated with health-related quality of life among overweight or obese adults. J Clin Nurs 2013; 22:2172-82. [PMID: 23829404 PMCID: PMC4041707 DOI: 10.1111/jocn.12280] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES To identify factors associated with health-related quality of life among overweight or obese adults. BACKGROUND The obesity epidemic presents a global challenge. Obesity is associated with lower health-related quality of life; however, no study has comprehensively examined correlates of health-related quality of life in this population. DESIGN A cross-sectional design. METHODS The physical component score, mental component score and eight domain scores of the Short Form-36 v2 were used to assess health-related quality of life. We identified 23 possible correlates of health-related quality of life, including age, body mass index, health and weight histories, perceived stress, cholesterol-lowering diet self-efficacy, problem-solving, binge eating, dietary intake and physical activity. Correlational analyses were used to examine the bivariate associations between correlates and health-related quality of life variables. All possible subsets regression was used to develop predictive models of health-related quality of life. RESULTS The sample (n = 210) was predominantly White (84·8%), female (78·1%) and middle-aged (average age = 46·80 years). Age, body mass index, education, having children at home, and being hypertensive were identified as the best predictors of physical component score, explaining about 9% of the variance. Age, marital status, having hyperlipidaemia, perceived stress, problem-solving, self-efficacy, binge eating and barriers to healthy eating predicted mental component score, explaining approximately 48% of the variance. Physical functioning and role physical domains of health-related quality of life had similar sets of predictors, with 15% and 13% of the variance explained, respectively, while similar predictors were identified for bodily pain (6%), general health (26%), vitality (40%), social functioning (32%), role emotional (42%) and mental health (46%) domains. CONCLUSIONS Psychosocial factors were associated with the mental-related quality of life. Further exploration of factors related to physical-related quality of life is warranted in this population. RELEVANCE TO CLINICAL PRACTICE When working with overweight/obese adults who are trying to lose weight, nurses need to consider socio-demographic and psychosocial factors in the development of a treatment plan that will improve health-related quality of life in this population.
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Affiliation(s)
- Jing Wang
- Department of Nursing Systems, University of Texas Health Science Center at Houston School of Nursing, Houston, TX 77030, USA.
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Liberato SC, Maple-Brown L, Bressan J, Hills AP. The relationships between body composition and cardiovascular risk factors in young Australian men. Nutr J 2013; 12:108. [PMID: 23902697 PMCID: PMC3750304 DOI: 10.1186/1475-2891-12-108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 07/26/2013] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Cardiovascular (CV) disease is a leading cause of global mortality. Despite clear evidence of the coexistence of several risk factors in young people as children and an understanding of the importance of the health behaviors in controlling CV disease, there are limited data on the relationships between risk factors and CV disease in young people. Therefore further study is required. OBJECTIVE This study aimed to investigate associations among body composition, health behaviors and CV risk factors in young Australian men. METHODS Thirty five healthy men aged 18-25 years had their blood pressure (BP), blood lipids, body composition, resting metabolic rate (RMR), physical activity, dietary intake and cardiorespiratory fitness assessed. RESULTS Participants were categorised according to the percentage of body fat into two groups: lean and overweight men. There were no between-group differences in the biochemical indicators except that overweight men had lower HDL-C compared to lean men. Both groups had similar mean energy, protein, fat, carbohydrate and alcohol intake, RMR, physical activity level (PAL) and energy expenditure (EE). Most of the participants (65.7%) had LDL≥2.5 mmol/L. Other common individual risk factors were body fat≥20% (42.9%), waist circumference≥88 cm (28.6%), PAL<1.8 (22.9%) and systolic BP≥130 mmHg (20%). The mean number of CV risk factors was lower among men having a high intake of monounsaturated fatty acids (MUFA, >12% of the energy intake) regardless of whether they were overweight or lean and did not seem to differ according to the source of MUFA consumed. CONCLUSIONS It is a serious concern to observe such a high percentage of CV risk factors in a group of apparently healthy young men. The likelihood of multiple CV risk factors is greater among those with high body fatness and low MUFA intake. Intake of MUFA favorably affects CV risk factors regardless of the source.
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Affiliation(s)
- Selma C Liberato
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Josefina Bressan
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Andrew P Hills
- Mater Mother’s Hospital/Mater Medical Research Institute, Griffith Health Institute/Griffith University, Brisbane, QLD, Australia
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The impact of work nature, lifestyle, and obesity on health-related quality of life in Chinese professional drivers. J Occup Environ Med 2013; 54:989-94. [PMID: 22772952 DOI: 10.1097/jom.0b013e3182535d7d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the association of work nature, lifestyle and obesity with health-related quality of life (HRQOL) in professional drivers. METHODS A total of 3376 Chinese professional drivers aged 18 to 70 years were recruited to assess the HRQOL by SF-12 summary scores (Physical Component Summary [PCS]; Mental Component Summary [MCS]), and collect data for work nature, lifestyle, and body mass index. Factors associated with HRQOL were examined by multiphase regression analyses. RESULTS Professional drivers reported poorer physical and mental HRQOL than the general population. Shift work and lorry driving had significant negative effect on HRQOL. Obesity was associated with lower PCS but higher MCS. CONCLUSIONS HRQOL of professional drivers tended to be low, especially among lorry drivers and shift drivers. Health intervention programs should promote regular exercise, healthy eating, no smoking, and weight control, which are modifiable factors improving HRQOL.
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Longitudinal predictors of health-related quality of life in middle-aged and older adults with hypertension. J Hypertens 2012; 30:1364-72. [DOI: 10.1097/hjh.0b013e328353d81b] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Clinical and Functional Predictors of Health-Related Quality of Life During Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2011; 31:223-9. [DOI: 10.1097/hcr.0b013e31820333b3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Henry-Okafor Q, Cowan PA, Wicks MN, Rice M, Husch DS, Khoo MSC. Effect of obesity on cardiovascular disease risk factors in African American women. Biol Res Nurs 2011; 14:171-9. [PMID: 21586497 DOI: 10.1177/1099800411405031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Obesity is a growing health care concern with implications for cardiovascular disease (CVD). Obesity and CVD morbidity and mortality are highly prevalent among African American women. This pilot study examined the association between obesity and the traditional and emerging CVD risk factors in a sample of African American women. Participants comprised 48 women (27 obese, 21 normal weight) aged 18-45. with no known history of CVD. The women completed demographic and 7-day physical activity recall questionnaires. Height and weight were used to determine body mass index (BMI). Hypertension risk was assessed using the average of two resting blood pressure (BP) measurements. Lipid profile, blood glucose, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), soluble intercellular adhesion molecule-1 (sICAM-1), and E-selectin (eSel) levels were assessed using fasting blood samples. Laboratory findings were interpreted using the American Diabetes Association (ADA) and Adult Treatment Panel (ATP) III reference guidelines as well as manufacturers' reference ranges for the novel CVD risk factors. The most common traditional risk factors were physical inactivity (72.9%), positive family history of CVD (58.3%), and obesity (56.3%). Obese individuals had elevated systolic BP (p = .0002), diastolic BP (p = .0007) and HDL-cholesterol (p = .01), triglyceride (p = .02), hs-CRP (p = .002), and fibrinogen (p = .01), when compared with normal-weight women. The findings suggest an association between obesity and higher prevalence of both traditional and emerging CVD risk factors in young African American women.
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Affiliation(s)
- Queen Henry-Okafor
- Cardiovascular Medicine, Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Dabhadkar KC, Kulshreshtha A, Ali MK, Venkat Narayan K. Prospects for a Cardiovascular Disease Prevention Polypill. Annu Rev Public Health 2011; 32:23-38. [DOI: 10.1146/annurev-publhealth-031210-101214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kaustubh C. Dabhadkar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30306
| | - Ambar Kulshreshtha
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30306
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30306;
| | - K.M. Venkat Narayan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30306
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30306;
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Multiple healthy behaviors and optimal self-rated health: findings from the 2007 Behavioral Risk Factor Surveillance System Survey. Prev Med 2010; 51:268-74. [PMID: 20647019 DOI: 10.1016/j.ypmed.2010.07.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/21/2010] [Accepted: 07/13/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal self-rated health (SRH) among U.S. adults or adults with cardiovascular diseases (CVDs) or diabetes. METHODS We estimated the age-standardized prevalence of optimal SRH among a total of 430,912 adults who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using number of healthy behaviors as a predictor; status of optimal SRH was used as an outcome variable while controlling for sociodemographic and health risk factors. RESULTS The age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3% among adults overall, and adults with CVDs or diabetes, respectively. Also in the aforementioned order, adults who reported having four healthy behaviors had 33%, 85%, and 87% increased likelihoods of reporting optimal SRH, when compared to their counterparts who reported none of these behaviors. CONCLUSION The findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple healthier lifestyle behaviors among adults.
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Soni RK, Porter AC, Lash JP, Unruh ML. Health-related quality of life in hypertension, chronic kidney disease, and coexistent chronic health conditions. Adv Chronic Kidney Dis 2010; 17:e17-26. [PMID: 20610351 DOI: 10.1053/j.ackd.2010.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/08/2010] [Accepted: 04/12/2010] [Indexed: 01/12/2023]
Abstract
With the increasing prevalence of hypertension, there has been a growing interest in understanding the health-related quality of life (HRQOL) of patients with hypertension. Although hypertension is often perceived as asymptomatic, it is associated with impaired HRQOL because of complications or comorbidities, awareness of the diagnosis, and adverse effects from antihypertensive medications. This article focuses on the literature published since 2000, on HRQOL in elderly hypertensive individuals as well as hypertensives with co-existent diseases, including chronic kidney disease, cardiovascular disease, and diabetes mellitus. Most of the studies found that hypertensive individuals with co-existent co-morbidities tend to have lower HRQOL than those with hypertension alone, and identified the number of co-morbid illnesses as an independent determinant of HRQOL. The most pronounced effect was noted in the physical function domains of HRQOL. Studies have also examined the effects on HRQOL of specific classes of antihypertensive drugs without specific demonstration of superiority of one drug class over another in terms of HRQOL measures. Although there is evidence in favor of angiotensin-converting enzyme-inhibition for improving renal and cardiovascular outcomes in hypertensive patients, its role in ameliorating HRQOL outcomes remains to be established.
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Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121:586-613. [PMID: 20089546 DOI: 10.1161/circulationaha.109.192703] [Citation(s) in RCA: 3216] [Impact Index Per Article: 229.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This document details the procedures and recommendations of the Goals and Metrics Committee of the Strategic Planning Task Force of the American Heart Association, which developed the 2020 Impact Goals for the organization. The committee was charged with defining a new concept, cardiovascular health, and determining the metrics needed to monitor it over time. Ideal cardiovascular health, a concept well supported in the literature, is defined by the presence of both ideal health behaviors (nonsmoking, body mass index <25 kg/m(2), physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, and fasting blood glucose <100 mg/dL). Appropriate levels for children are also provided. With the use of levels that span the entire range of the same metrics, cardiovascular health status for the whole population is defined as poor, intermediate, or ideal. These metrics will be monitored to determine the changing prevalence of cardiovascular health status and define achievement of the Impact Goal. In addition, the committee recommends goals for further reductions in cardiovascular disease and stroke mortality. Thus, the committee recommends the following Impact Goals: "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." These goals will require new strategic directions for the American Heart Association in its research, clinical, public health, and advocacy programs for cardiovascular health promotion and disease prevention in the next decade and beyond.
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Abstract
PURPOSE OF REVIEW To present current perspectives on the mediators and mechanisms of cyto-lipotoxic events and their relevance to human health. RECENT FINDINGS The relatively recent isolation of lipid acyltransferase genes from yeast to mice and humans has resulted in a paradigm shift that now establishes all fatty acids as toxic, albeit in tissue specific patterns and by different mechanisms. Furthermore, the dysregulation of glucose homeostasis in combination with excess fatty acids provides a synergistic effect leading to glucolipotoxicity and cell death. These findings are relevant to the development of disease states associated with the pathogenesis of the metabolic syndrome. SUMMARY In an era when an astounding number of people are diagnosed with metabolic disorders, it is imperative that we understand the consequences of a chronic metabolic surplus. Excessive fat, saturated or otherwise, has to be accommodated. Multiple aspects of this homeostasis are emerging, some of which are described here.
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Affiliation(s)
- Jeanne Garbarino
- Institute of Human Nutrition, Columbia University Medical Center, New York, New York 10032, USA
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Diabetes and associated risk factors in patients referred for physical therapy in a national primary care electronic medical record database. Phys Ther 2008; 88:1408-16. [PMID: 18801850 DOI: 10.2522/ptj.20080129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The prevalence of diabetes (type 2) in the general population has increased dramatically over the last decade, yet patients with diabetes are rarely referred for physical therapy management of their condition. The majority of patients referred for outpatient physical therapy have musculoskeletal-related conditions. Secondary conditions, such as diabetes, may be prevalent in this population, and physical therapists need to be aware of this to adjust interventions and treatment. The purpose of this article is to describe the prevalence of diabetes and the associated risk factors in adults referred for physical therapy in a primary care outpatient setting. SUBJECTS AND METHODS Patients aged 18 years or older referred for physical therapy were identified from the Centricity Electronic Medical Records database during the period of December 13, 1995, to June 30, 2007. Patients were evaluated on the basis of clinical (height, weight, blood pressure, laboratory values), treatment (prescriptions), and diagnostic (ICD-9 codes) criteria to identify the presence of diabetes or associated risk factors (eg, hypertension, elevated triglycerides, low high-density lipoprotein, body mass index, and prediabetes). RESULTS There were 52,667 patients referred for physical therapy, the majority of whom were referred for a musculoskeletal-related condition. Approximately 80% of the total study population had diabetes, prediabetes, or risk factors associated with diabetes. The prevalence of diabetes in the study population was 13.2%. Of the diabetes-associated risk factors evaluated, hypertension was the most prevalent (70.4%), and less than half (39.1%) of the study population had an elevated body mass index. Only 20% of the study population had values within normal limits for all clinical, treatment, and diagnostic criteria. Clinical and treatment measurements available to physical therapists identified the majority of associated risk factors. CONCLUSIONS Although not the primary indications for referral, diabetes and associated risk factors were identified in a high proportion of the study population. The evaluation of associated conditions in the outpatient orthopedic setting needs to be considered for treatment planning adjustments and to optimize care.
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