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Lu F, Wong CKH, Ng APP, Li L, Fong DYT, Ip P, Tse ETY, Lam CLK. Effectiveness of a 5-year health empowerment programme on promoting cardiovascular health for adults from low-income families in Hong Kong. PATIENT EDUCATION AND COUNSELING 2024; 124:108240. [PMID: 38547639 DOI: 10.1016/j.pec.2024.108240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of a health empowerment programme (HEP) to enhance cardiovascular health for adults from low-income families. METHODS A prospective cohort study (N = 219, Intervention group: n = 103, comparison group: n = 116) was conducted with participants recruited from January 2013 to November 2015 and followed up until January 2022. Throughout the study duration, intervention group were invited to participate in the HEP. The cardiovascular health status of both groups at baseline and follow-up were assessed using the adapted Ideal Cardiovascular Health Index (ICHI) defined by the American Heart Association. After inverse propensity score weighting, multiple linear regression and Poisson regression were employed to examine the effects of the HEP. RESULTS The HEP was associated with a greater increase in ICHI total score (B = 0.33, p < 0.001), and the increase of proportion of people achieving a normal blood pressure (Incidence rate ratio: 3.39, p < 0.05). CONCLUSION HEP can be an effective and sustainable strategy to reduce social disparities in cardiovascular health of adults from low-income families, as indicated by improvement in the ICHI total score and blood pressure status. PRACTICAL IMPLICATIONS The sustainable HEP in the community setting has potential for generalizability and scalability to other financially challenged families.
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Affiliation(s)
- Fangcao Lu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China
| | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lanlan Li
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Willy K, Meyer T, Eckardt L, Morina N. Selection of social comparison standards in cardiac patients with and without experienced defibrillator shock. Sci Rep 2024; 14:5551. [PMID: 38448440 PMCID: PMC10917798 DOI: 10.1038/s41598-024-51366-3] [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: 08/03/2023] [Accepted: 01/04/2024] [Indexed: 03/08/2024] Open
Abstract
Patients with an implantable cardioverter-defibrillator (ICD) often report psychological distress. Literature suggests that patients with physical disease often compare their well-being and coping to fellow patients. However, we lack knowledge on social comparison among patients with ICD. In this study, we examined psychological distress and social comparison selection in patients with (ICD+) and without experienced ICD shocks (ICD-). We theorized that relative to ICD- patients, those with ICD+ display higher levels of psychological distress and thereby compare more frequently with fellow patients with more severe disease, but better disease coping and try to identify more strongly with these standards to improve their own coping. We recruited 92 patients with (ICD+, n = 38) and without an experienced ICD shock (ICD-, n = 54), who selected one of four comparison standards varying in disease severity and coping capacity. Relative to ICD-, ICD+ patients reported higher levels of device-related distress, but there were no significant differences in anxiety, depression, or quality of life. ICD+ patients selected more often comparison standards with poor coping and, irrespective of standard choice, displayed more negative mood following comparison. Our results show that ICD+ patients tend to perform unfavorable comparisons to fellow patients, which might explain higher psychological distress and worse coping. These findings warrant further research into social comparison as a relevant coping mechanism in ICD patients.
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Affiliation(s)
- Kevin Willy
- Institute of Psychology, University of Münster, Münster, Germany.
- Department of Cardiology II, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Thomas Meyer
- Institute of Psychology, University of Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Moad D, Tapley A, Fielding A, van Driel ML, Holliday EG, Ball JI, Davey AR, FitzGerald K, Spike NA, Magin P. Socioeconomic status of practice location and Australian GP registrars' training: a cross-sectional analysis. BMC MEDICAL EDUCATION 2022; 22:285. [PMID: 35428305 PMCID: PMC9011937 DOI: 10.1186/s12909-022-03359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is a major determinant of health. In Australia, areas of socioeconomic disadvantage are characterised by complex health needs and inequity in primary health care provision. General Practice (GP) registrars play an important role in addressing workforce needs, including equitable health care provision in areas of greater socioeconomic disadvantage. We aimed to characterize GP registrars' practice location by level of socioeconomic disadvantage, and establish associations (of registrar, practice, patient characteristics, and registrars' clinical behaviours) with GP registrars training being undertaken in areas of greater socioeconomic disadvantage. METHODS A cross-sectional analysis from the Registrars' Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, multi-centre, cohort study that documents 60 consecutive consultations by each GP registrar once in each of their three six-monthly training terms. The outcome factor was the practice location's level of socioeconomic disadvantage, defined using the Index of Relative Socio-economic Disadvantage (SEIFA-IRSD). The odds of being in the lowest quintile was compared to the other four quintiles. Independent variables related to the registrar, patient, practice, and consultation. RESULTS A total of 1,736 registrars contributed 241,945 consultations. Significant associations of training being in areas of most disadvantage included: the registrar being full-time, being in training term 1, being in the rural training pathway; patients being Aboriginal or Torres Strait Islander, or from a non-English-speaking background; and measures of continuity of care. CONCLUSIONS Training in areas of greater social disadvantage, as well as addressing community need, may provide GP registrars with richer learning opportunities.
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Affiliation(s)
- Dominica Moad
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Amanda Tapley
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Alison Fielding
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Mieke L. van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Brisbane, QLD Australia
| | - Elizabeth G. Holliday
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
| | - Jean I. Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW Australia
| | - Andrew R. Davey
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Kristen FitzGerald
- University of Tasmania, School of Medicine, Hobart, TAS Australia
- General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS Australia
| | - Neil A. Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122 Australia
- Monash University, School of Rural Health, Churchill, VIC 3842 Australia
- Department of General Practice, The University of Melbourne, Carlton, VIC 3053 Australia
| | - Parker Magin
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
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Rosenblatt AM, Crews DC, Powe NR, Zonderman AB, Evans MK, Tuot DS. Association between neighborhood social cohesion, awareness of chronic diseases, and participation in healthy behaviors in a community cohort. BMC Public Health 2021; 21:1611. [PMID: 34479522 PMCID: PMC8414876 DOI: 10.1186/s12889-021-11633-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Neighborhood social cohesion (NSC) is the network of relationships as well as the shared values and norms of residents in a neighborhood. Higher NSC has been associated with improved cardiovascular health, largely among Whites but not African Americans. In a bi-racial cohort, we aimed to study the association between NSC and chronic disease awareness and engagement in healthy self-management behaviors, two potential mechanisms by which NSC could impact cardiovascular health outcomes. METHODS Using the Healthy Aging in Neighborhoods of Diversity Across the Lifespan Study (HANDLS), we cross-sectionally examined the association between NSC and awareness of three chronic conditions (diabetes, chronic kidney disease (CKD), and hypertension) and engagement in healthy self-management behaviors including physical activity, healthy eating, and cigarette avoidance. RESULTS Study participants (n = 2082) had a mean age of 56.5 years; 38.7% were White and 61.4% African American. Of the participants, 26% had diabetes, 70% had hypertension and 20.2% had CKD. Mean NSC was 3.3 (SD = 0.80) on a scale of 1 (lowest score) to 5 (highest score). There was no significant association between NSC and any chronic disease awareness, overall or by race. However, each higher point in mean NSC score was associated with less cigarette use and healthier eating scores, among Whites (adjusted odds ratio [aOR], 95% confidence interval [CI]: =0.76, 0.61-0.94; beta coefficient [βc]:, 95% CI: 1.75; 0.55-2.97, respectively) but not African Americans (aOR = 0.95, 0.79-1.13; βc: 0.46, - 0.48-1.39, respectively; Pinteraction = 0.08 and 0.06). Among both Whites and African Americans, higher NSC scores were associated with increases in self-reported physical activity (βc: 0.12; 0.08-0.16; Pinteraction = 0.40). CONCLUSIONS Community engagement and neighborhood social cohesion may be important targets for promotion of healthy behaviors and cardiovascular disease prevention. More research is needed to understand the different associations of NSC and healthy behaviors by race.
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Affiliation(s)
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neil R Powe
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Science National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Science National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Delphine S Tuot
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
- Division of Nephrology, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Ave. Building 100, Room 342, San Francisco, CA, 94110, USA.
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Batra A, Kong S, Cheung WY. Associations of Socioeconomic Status and Rurality With New-Onset Cardiovascular Disease in Cancer Survivors: A Population-Based Analysis. JCO Oncol Pract 2021; 17:e1189-e1201. [PMID: 34242068 DOI: 10.1200/op.20.01053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Patients with cancer are predisposed to develop new-onset cardiovascular disease (CVD). We aimed to assess if rural residence and low socioeconomic status modify such a risk. METHODS Patients diagnosed with solid organ cancers without any baseline CVD and on a follow-up of at least 1 year in a large Canadian province from 2004 to 2017 were identified using the population-based registry. We performed logistic regression analyses to examine the associations of rural residence and low socioeconomic status with the development of CVD. RESULTS We identified 81,418 patients eligible for the analysis. The median age was 62 years, and 54.3% were women. At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD diagnosis was 29 months. Rural patients (32.3% v 28.5%; P < .001) and those with low income (30.4% v 25.9%; P < .001) or low educational attainment (30.7% v 27.6%; P < .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio [OR], 1.07; 95% CI, 1.04 to 1.11; P < .001), low income (OR, 1.17; 95% CI, 1.12 to 1.21; P < .001), and low education (OR, 1.08; 95% CI, 1.04 to 1.11; P < .001) continued to be associated with higher odds of CVD. A multivariate Cox regression model showed that patients with low socioeconomic status were more likely to die, but patients residing rurally were not. CONCLUSION Despite universal health care, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs for the growing number of cancer survivors.
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Affiliation(s)
- Atul Batra
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
| | | | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
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Cundiff JM, Jennings JR, Matthews KA. Social Stratification and Risk for Cardiovascular Disease: Examination of Emotional Suppression as a Pathway to Risk. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2018; 45:1202-1215. [PMID: 30526318 DOI: 10.1177/0146167218808504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines whether emotional suppression is associated with socioeconomic position (SEP) in a community sample of Black and White men, and whether emotional suppression may help explain the aggregation of multiple biopsychosocial risk factors for cardiovascular disease at lower SEP (social support, depression, cardiovascular stress reactivity). Aim 1 tests whether multiple indicators of SEP show a consistent graded association with self-reported trait suppression, and whether suppression mediates associations between SEP and perceived social support and depressive affect. Aim 2 tests whether suppression during a laboratory anger recall task mediates associations between SEP and cardiovascular reactivity to the task. All measures of higher SEP were associated with lower suppression. Findings in this racially diverse sample of adult men suggest that socioeconomic disparities in emotional suppression may be more likely to confer cardiovascular risk through disruption of affect and social relationships, than through direct and immediate physiological pathways.
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Kareem H, Shetty PN, Devasia T, Karkala YR, Paramasivam G, Guddattu V, Singh A, Chauhan S. Impact of socioeconomic status on adverse cardiac events after coronary angioplasty: a cohort study. HEART ASIA 2018; 10:e010960. [PMID: 29942357 DOI: 10.1136/heartasia-2017-010960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 12/29/2022]
Abstract
Background Socioeconomic status (SES) has been associated with adverse cardiovascular events in coronary atherosclerotic disease. However, it is unclear how SES impacts adverse cardiac events in patients treated with percutaneous coronary intervention (PCI). Methods We determined SES based on educational, economic and occupational parameters for 630 consecutive patients who underwent PCI at our centre between 01 June 2015 and 01 June 2016. The patients were divided into low and high SES groups, and they were followed up for 12 months. Patients were matched at baseline for demographic and procedural characteristics; multivariate analysis was used to adjust for baseline and procedural variables. Postprocedure compliance to medications was analysed. At 12 months, the primary composite end point of major adverse cardiac events (MACE) - consisting of death, non-fatal myocardial infarction, target lesion revascularisation, target vessel revascularisation - was compared between the groups. Results The high SES group had a higher prevalence of diabetes mellitus (p=0.03; OR 0.74%, 95% CI 0.53% to 1.03%) and a stronger family history of ischaemic heart disease (p=0.003; OR 0.53%, 95% CI 0.33% to 0.84%). Low SES was associated with lower compliance with medication (p=0.01; OR 2.22%, 95% CI 1.19% to 4.15%). At 12 months, the primary composite end point of MACE was found to be higher in the low SES group (p=0.01); higher MACE was primarily driven by cardiac mortality (p<0.001). Low SES was found to be an independent predictor of MACE (HR 1.84%, 95% CI 1.16% to 2.96%). Conclusion Low SES was associated with a higher incidence of major adverse cardiac events in patients undergoing PCI and was an independent predictor of MACE at 12 months.
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Affiliation(s)
- Hashir Kareem
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Prasad Narayana Shetty
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Yeshwanth Rao Karkala
- Department of Pharmacology, Melaka Manipal Medical College, Manipal University, Manipal, India
| | - Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Vasudev Guddattu
- Department of Statistics Prasanna school of Public Health, Manipal University, Manipal, India
| | - Ajit Singh
- Department of Cardiology, Kasturba Medical College and Hospital, Manipal University, Manipal, India
| | - Sheetal Chauhan
- Department of Pharmacology, Melaka Manipal Medical College, Manipal University, Manipal, India
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Park W, Park HY, Lim K, Park J. The role of habitual physical activity on arterial stiffness in elderly Individuals: a systematic review and meta-analysis. J Exerc Nutrition Biochem 2017; 21:16-21. [PMID: 29370669 PMCID: PMC5772073 DOI: 10.20463/jenb.2017.0041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 12/05/2022] Open
Abstract
[Purpose] Physical inactivity behavior at middle age or older is a major risk factor for cardiovascular disease. However, the effects of levels of habitual physical activity on arterial stiffness in elderly population remain unclear currently. Therefore, the purpose of this study was to demonstrate whether the effects of habitual physical activity could attenuate arterial stiffness in elderly individuals via a meta-analysis. [Methods] We searched the Medline and Embase databases from January 1997 through November 2017, using the medical subject headings “older population”, “physical activity” (e.g., walking, cycling, climbing, and any participation in sports), “arterial stiffness”, “pulse wave velocity”, and “cardiovascular health” published in English. Six articles (2,932 participants) were included in this meta-analysis. We investigated the effects of habitual physical activity on arterial stiffness, which was measured by the pulse wave velocity. [Results] Results confirmed heterogeneity (Q-value = 160.691, p = 0.000, I2 = 96.888) between individual studies. The effect size was calculated using random effect model. It has shown that physically active individuals have significantly lower arterial stiffness than their sedentary peers do (standardized mean difference: -1.017 ± 0.340, 95% confidence interval: -1.684 ~ -0.350, p = 0.003). [Conclusion] Findings of our systematic review and meta-analysis indicate that habitual physical activity can significantly ameliorate arterial stiffness in the elderly population.
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Jardim TV, Reiger S, Abrahams-Gessel S, Crowther NJ, Wade A, Gómez-Olivé FX, Salomon J, Tollman S, Gaziano TA. Disparities in Management of Cardiovascular Disease in Rural South Africa: Data From the HAALSI Study (Health and Aging in Africa: Longitudinal Studies of International Network for the Demographic Evaluation of Populations and Their Health Communities). Circ Cardiovasc Qual Outcomes 2017; 10:e004094. [PMID: 29150535 PMCID: PMC5777525 DOI: 10.1161/circoutcomes.117.004094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/18/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Optimal secondary prevention is critical for the reduction of repeated cardiovascular events, and the control of cardiovascular risk factors in this context is essential. Data on secondary prevention of cardiovascular disease (CVD) in sub-Saharan Africa are needed to inform intervention strategies with a particular focus on local disparities. The aim of this study was to assess CVD management in a rural community in northeast South Africa. METHODS AND RESULTS We recruited adults aged ≥40 years residing in the Agincourt subdistrict of Mpumalanga province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure, human immunodeficiency virus status, and point-of-care glucose and lipid levels. CVD was defined as self-report of myocardial infarction and stroke or angina diagnosed by Rose Criteria. A linear regression model was built to identify variables independently associated with the number of cardiovascular risk factors controlled. Of 5059 subjects, 592 (11.7%) met CVD diagnostic criteria. Angina was reported in 77.0% of these subjects, stroke in 25.2%, and myocardial infarction in 3.7%. Percent controlled of the 5 individual risk factors assessed were as follows: tobacco 92.9%; blood pressure 51.2%; body mass index 33.8%; low-density lipoprotein 31.4%; and waist-to-hip ratio 29.7%. Only 4.4% had all 5 risk factors controlled and 42.4% had ≥3 risk factors controlled. Male sex (β coefficient=0.44; 95% confidence interval, 0.25-0.63; P<0.001), absence of physical disability (β coefficient=0.40; 95% confidence interval, 0.16-0.65; P=0.001), and socioeconomic status (β coefficient=0.10; 95% confidence interval, 0.01-0.19; P=0.035) were directly associated with the number of risk factors controlled. CONCLUSIONS Currently, CVD is not being optimally managed in this rural area of South Africa. There are significant disparities in control of CVD risk factors by sex, socioeconomic status, and level of disability. Efforts to improve secondary prevention in this population should be focused on females, subjects from lower socioeconomic status, and those with physical disabilities.
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Affiliation(s)
- Thiago Veiga Jardim
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Sheridan Reiger
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Shafika Abrahams-Gessel
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Nigel J Crowther
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Alisha Wade
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - F Xavier Gómez-Olivé
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Joshua Salomon
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Stephen Tollman
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Thomas A Gaziano
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.).
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Daoulah A, Elkhateeb OE, Nasseri SA, Al-Murayeh M, Al-Kaabi S, Lotfi A, Alama MN, Al-Faifi SM, Haddara M, Dixon CM, Alzahrani IS, Alghamdi AA, Ahmed W, Fathey A, Haq E, Alsheikh-Ali AA. Socioeconomic Factors and Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography: A Multicentre Study of Arabian Gulf States. Open Cardiovasc Med J 2017; 11:47-57. [PMID: 28553410 PMCID: PMC5427707 DOI: 10.2174/1874192401711010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is a leading cause of death worldwide. The association of socioeconomic status with CAD is supported by numerous epidemiological studies. Whether such factors also impact the number of diseased coronary vessels and its severity is not well established. MATERIALS AND METHODS We conducted a prospective multicentre, multi-ethnic, cross sectional observational study of consecutive patients undergoing coronary angiography (CAG) at 5 hospitals in the Kingdom of Saudi Arabia and the United Arab Emirates. Baseline demographics, socioeconomic, and clinical variables were collected for all patients. Significant CAD was defined as ≥70% luminal stenosis in a major epicardial vessel. Left main disease (LMD) was defined as ≥50% stenosis in the left main coronary artery. Multi-vessel disease (MVD) was defined as having >1 significant CAD. RESULTS Of 1,068 patients (age 59 ± 13, female 28%, diabetes 56%, hypertension 60%, history of CAD 43%), 792 (74%) were from urban and remainder (26%) from rural communities. Patients from rural centres were older (61 ± 12 vs 58 ± 13), and more likely to have a history of diabetes (63 vs 54%), hypertension (74 vs 55%), dyslipidaemia (78 vs 59%), CAD (50 vs 41%) and percutaneous coronary intervention (PCI) (27 vs 21%). The two groups differed significantly in terms of income level, employment status and indication for angiography. After adjusting for baseline differences, patients living in a rural area were more likely to have significant CAD (adjusted OR 2.40 [1.47, 3.97]), MVD (adjusted OR 1.76 [1.18, 2.63]) and LMD (adjusted OR 1.71 [1.04, 2.82]). Higher income was also associated with a higher risk for significant CAD (adjusted OR 6.97 [2.30, 21.09]) and MVD (adjusted OR 2.49 [1.11, 5.56]), while unemployment was associated with a higher risk of significant CAD (adjusted OR 2.21, [1.27, 3.85]). CONCLUSION Communal and socioeconomic factors are associated with higher odds of significant CAD and MVD in the group of patients referred for CAG. The underpinnings of these associations (e.g. pathophysiologic factors, access to care, and system-wide determinants of quality) require further study.
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Affiliation(s)
- Amin Daoulah
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Osama E Elkhateeb
- Cardiac Center, King Abdullah Medical City in Holy Capital Makkah, Kingdom of Saudi Arabia
| | - S Ali Nasseri
- Politecnico di Torino, Italy Armed Forces Hospital Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia
| | - Mushabab Al-Murayeh
- Cardiovascular Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia
| | - Salem Al-Kaabi
- Cardiology Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | - Mohamed N Alama
- Cardiology unit, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Salem M Al-Faifi
- Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Mamdouh Haddara
- Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ciaran M Dixon
- Emergency Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim S Alzahrani
- College of medicine, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah A Alghamdi
- Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Ahmed
- Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Adnan Fathey
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ejazul Haq
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE. Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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11
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Daoulah A, Al-kaabi S, Lotfi A, Al-Murayeh M, Nasseri SA, Ahmed W, Al-Otaibi SN, Alama MN, Elkhateeb OE, Plotkin AJ, Malak MM, Alshali K, Hamzi M, Al Khunein S, Abufayyah M, Alsheikh-Ali AA. Inter-ethnic marriages and severity of coronary artery disease: A multicenter study of Arabian Gulf States. World J Cardiol 2017; 9:371-377. [PMID: 28515856 PMCID: PMC5411972 DOI: 10.4330/wjc.v9.i4.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease (CAD) in men undergoing angiography.
METHODS We conducted a prospective multicenter, multi-ethnic, cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates, in which we used logistic regression analysis with and without adjustment for baseline differences.
RESULTS Data were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1st, 2013 to March 30th, 2014. Ethnicities of spouses were available only for male patients. Of those enrolled, 687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences, inter-ethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52 (95%CI: 0.33, 0.81)] or multi-vessel disease (MVD) [adjusted odds ratio 0.57 (95%CI: 0.37, 0.86)]. The adjusted association with left main disease showed a similar trend, but was not statistically significant [adjusted odds ratio 0.74 (95%CI: 0.41, 1.32)]. The association between inter-ethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives (P interaction > 0.05 for both).
CONCLUSION Among married men undergoing coronary angiography, inter-ethnic, as compared to intra-ethnic, marriage is associated with lower odds of significant CAD and MVD.
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Cundiff JM, Smith TW. Social status, everyday interpersonal processes, and coronary heart disease: A social psychophysiological view. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2017. [DOI: 10.1111/spc3.12310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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13
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Brown SL, Whiting D. The ethics of distress: toward a framework for determining the ethical acceptability of distressing health promotion advertising. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2013; 49:89-97. [PMID: 24811879 DOI: 10.1002/ijop.12002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/21/2013] [Indexed: 11/06/2022]
Abstract
Distressing health promotion advertising involves the elicitation of negative emotion to increase the likelihood that health messages will stimulate audience members to adopt healthier behaviors. Irrespective of its effectiveness, distressing advertising risks harming audience members who do not consent to the intervention and are unable to withdraw from it. Further, the use of these approaches may increase the potential for unfairness or stigmatization toward those targeted, or be considered unacceptable by some sections of the public. We acknowledge and discuss these concerns, but, using the public health ethics literature as a guide, argue that distressing advertising can be ethically defensible if conditions of effectiveness, proportionality necessity, least infringement, and public accountability are satisfied. We do not take a broad view as to whether distressing advertising is ethical or unethical, because we see the evidence for both the effectiveness of distressing approaches and their potential to generate iatrogenic effects to be inconclusive. However, we believe it possible to use the current evidence base to make informed estimates of the likely consequences of specific message presentations. Messages can be pre-tested and monitored to identify and deal with potential problems. We discuss how advertisers can approach the problems of deciding on the appropriate intensity of ethical review, and evaluating prospective distressing advertising campaigns against the conditions outlined.
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Affiliation(s)
- Stephen L Brown
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Factors Associated with Perceived Cognitive Problems in Children and Adolescents with Congenital Heart Disease. J Clin Psychol Med Settings 2012; 20:192-8. [DOI: 10.1007/s10880-012-9326-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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