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Morales-Suárez-Varela M, Peraita-Costa I, Guerrero Cervera B, Llopis-Morales A, Botella Juan L, Marcos Puig B. Arterial hypertension and smoking in pregnant women in the Valencian Community: maternal and neonatal outcomes. Semergen 2024; 50:102171. [PMID: 38159344 DOI: 10.1016/j.semerg.2023.102171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn. MATERIALS AND METHODS An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case-control nested in a retrospective cohort corresponding to pregnancy. RESULTS A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a "U" shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed. CONCLUSIONS Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension.
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Affiliation(s)
- M Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - I Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - B Guerrero Cervera
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; Department of Cardiology, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
| | - A Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain
| | - L Botella Juan
- Area of Preventive Medicine and Public Health, Department of Biomedical Sciences, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; The Research Group in Gene-Environment and Health Interactions (GIIGAS), Institute of Biomedicine (IBIOMED), Universidad de León, 24071 León, Spain
| | - B Marcos Puig
- Department of Obstetrics, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
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Kilindimo SS, Abdulkarim A, Simbila AN, Harrison R, Shirima L, Abdallah F, Mukhtar AG, Mfinanga J, Saika J, Kisanga E, Sawe HR. The burden and management strategies of hypertensive crisis in adult patients presenting to emergency departments of district and regional hospitals in Sub-Saharan Africa. Clin Hypertens 2023; 29:27. [PMID: 37777812 PMCID: PMC10544116 DOI: 10.1186/s40885-023-00251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/03/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Hypertensive crisis is among the causes of morbidity and mortality in adult patients with hypertension in Sub-Saharan Africa. We aimed to determine the burden, risk factors and describe the management strategies of hypertensive crisis among adult patients seen at emergency departments of district and regional hospitals in Tanzania. METHODS This was a prospective multicenter longitudinal study which included all 162 district and regional hospitals in Tanzania. It was part of the Tanzania Emergency Care Capacity Survey (TECCS), a large assessment of burden of acute illness and emergency care capacity in Tanzania. Adult patients who presented to emergency departments with blood pressure ≥ 180/110mmHg were enrolled. Demographics, clinical presentation, management, and 24-hours outcomes were recorded using a structured case report form. Descriptive statistics were summarized in frequency and median, while logistic regression was used to evaluate the association between risk factors and presence of hypertensive crisis. RESULTS We screened 2700 patients and enrolled 169 adults, henceforth proportion of adult patients with hypertensive crisis was 63 per 1000. Median age was 62 years (IQR 50-70 years) and predominantly females, 112 (66.3%). Majority 151(89.3%) were self-referred with two-wheel motorcycle being the commonest 46 (27.2%) mode of arrival to the hospital. Hypertensive emergency was found in over half 96 (56.8%) of the patients with hypertensive crisis, with oral medications administered in more than half of them, 71 (74%) as means to control the high blood pressure, and one-third 33 (34.4%) were discharged home. On multivariate analysis increasing age (AOR 4.53, p < 0.001), use of illicit drug (AOR 4.14, p-0.04) and pre-existing hypertension (AOR 8.1, p < 0.001) were independent risk factors for hypertensive crisis occurrence. CONCLUSION Hypertensive crisis among adult patients attending district and regional hospitals is common (63 patients per every 1000 patients). Increasing age, use of illicit drug and pre-existing hypertension are independent associated factors for developing hypertensive crisis.
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Affiliation(s)
- Said S Kilindimo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Ahmed Abdulkarim
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Alphonce N Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Raynald Harrison
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Lucy Shirima
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Farida Abdallah
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Aliasghar G Mukhtar
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Juma Mfinanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Joseph Saika
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Emanuel Kisanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Yu G, Gong X, Xu Y, Sun H, Liu Y, Zhai C, Hu W, Zong Q, Hu D, Yan Z, Wang Y, Wang L, Zhang T, Wang F, Zou Y. The global burden and trends of four major types of heart disease, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Public Health 2023; 220:1-9. [PMID: 37182373 DOI: 10.1016/j.puhe.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The global burden of heart disease is severe and increasing in the coming years. This study aims to analyze the global burden of heart disease. STUDY DESIGN Rheumatic heart disease (RHD), ischemic heart disease (IHD), hypertensive heart disease (HHD), and non-rheumatic valvular heart disease (NRVHD) were selected and analyzed from the Global Burden of Disease Study 2019. METHODS The prevalence, deaths, disability-adjusted life years and their corresponding age-standardized rates were obtained from the Global Burden of Disease Study 2019. In addition, estimated annual percentage change was calculated to better assess epidemiological trends. In addition, we performed an age-period-cohort analysis using the Nordpred package in R program to predict death trends over the next 20 years. RESULTS Globally, the prevalence of four heart diseases (RHD, IHD, HHD, and NRVHD) increased by 70.5%, 103.5%, 137.9%, and 110.0% compared with 1990, respectively. The deaths cases of RHD decreased by 15.6%, whereas IHD, HHD, and NRVHD increased by 60.4%, 76.6%, and 110.6%. Compared with absolute values, their corresponding age-standardized rates only showed a slight increase trend or even decreased in some areas with high sociodemographic index. In the next 20 years, the absolute values of deaths will continue to increase, whereas their age-standardized rates of deaths will flatten out. CONCLUSIONS Globally, the absolute values of heart disease have increased over the past 30 years and will continue to increase over the next 20 years. Targeted prevention and control strategies and measures need to be developed and improved to reduce this burden.
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Affiliation(s)
- Guanghui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xingyu Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ying Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Hongyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqi Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Chunxia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanqin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qiqun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Dingtao Hu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Clinical Cancer Institute, Center for Translational Medicine, Naval Medical University, Shanghai, China
| | - Ziye Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuhua Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Linlin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tingyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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Flora GD, Nayak MK. A Brief Review of Cardiovascular Diseases, Associated Risk Factors and Current Treatment Regimes. Curr Pharm Des 2020; 25:4063-4084. [PMID: 31553287 DOI: 10.2174/1381612825666190925163827] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of premature death and disability in humans and their incidence is on the rise globally. Given their substantial contribution towards the escalating costs of health care, CVDs also generate a high socio-economic burden in the general population. The underlying pathogenesis and progression associated with nearly all CVDs are predominantly of atherosclerotic origin that leads to the development of coronary artery disease, cerebrovascular disease, venous thromboembolism and, peripheral vascular disease, subsequently causing myocardial infarction, cardiac arrhythmias or stroke. The aetiological risk factors leading to the onset of CVDs are well recognized and include hyperlipidaemia, hypertension, diabetes, obesity, smoking and, lack of physical activity. They collectively represent more than 90% of the CVD risks in all epidemiological studies. Despite high fatality rate of CVDs, the identification and careful prevention of the underlying risk factors can significantly reduce the global epidemic of CVDs. Beside making favorable lifestyle modifications, primary regimes for the prevention and treatment of CVDs include lipid-lowering drugs, antihypertensives, antiplatelet and anticoagulation therapies. Despite their effectiveness, significant gaps in the treatment of CVDs remain. In this review, we discuss the epidemiology and pathology of the major CVDs that are prevalent globally. We also determine the contribution of well-recognized risk factors towards the development of CVDs and the prevention strategies. In the end, therapies for the control and treatment of CVDs are discussed.
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Affiliation(s)
- Gagan D Flora
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, United States
| | - Manasa K Nayak
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, United States
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He H, Pan L, Cui Z, Sun J, Yu C, Cao Y, Wang Y, Shan G. Smoking Prevalence, Patterns, and Cessation Among Adults in Hebei Province, Central China: Implications From China National Health Survey (CNHS). Front Public Health 2020; 8:177. [PMID: 32596196 PMCID: PMC7300263 DOI: 10.3389/fpubh.2020.00177] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022] Open
Abstract
As part of the China National Health Survey, the objective of this study was to explore the prevalence, patterns, and influencing factors of smoking, and understand reasons for smoking cessation among adults in Hebei Province, central China. Using a multi-stage stratified cluster sampling method, 6,552 adults (2,594 males) aged 20–80 were selected in 2017. Demographic, socioeconomic, and tobacco use information were collected by questionnaire interview. The prevalence of ever-smoking, current smoking, and ex-smoking was 28.94, 21.08, and 7.86%, respectively. Male participants had a much higher prevalence of ever-smoking and current smoking (67.39 and 48.77%) than females (3.74 and 2.93%). In male participants, the daily cigarette consumption was 16.61, and the mean age of smoking initiation was 20.95, decreasing with birth year (27.50 in people born before 1946 vs. 17.9 for those born after 1985, p for trend < 0.001). Over 40% of male ever-smokers initiated regular smoking before 20. Compared with never drinking, the ORs (95% CI) of ever-smoking for low, moderate, and high alcohol consumption in male participants were 1.44 (1.11–1.86), 2.80 (1.91–4.11), and 2.40 (1.72–3.33), respectively. Among 479 male ex-smokers, 50.94% stopped smoking because of illness and 49.06% by choice. Among male ex-smokers, hypertensive men were more likely to quit smoking than the normotensive individuals (OR: 1.48, 95% CI: 1.13–1.96). For CVD patients, this effect was estimated as 2.27 (95% CI: 1.56–3.30). This study revealed a high prevalence of ever-smoking, especially in men, in a representative population in central China. Health education focus on tobacco control could be integrated with alcohol consumption reduction to achieve additional benefit.
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Affiliation(s)
- Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Ze Cui
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Jixin Sun
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Chengdong Yu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Yajing Cao
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Ye Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College Beijing, China
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Milanova MH, Naydenov SN, Runev NM, Manov EI, Krastev PK. Analysis of prehospital care of patients with acute myocardial infarction in Bulgaria. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918765842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Acute myocardial infarction is one of the most devastating cardiovascular diseases and about 50% of all deaths due to it occur prior to hospitalization. Our study aimed to evaluate the prehospital delay in patients with acute myocardial infarction. Methods: We enrolled 682 consecutive patients with acute myocardial infarction from May 2008 to December 2014, with a mean age of 66.6 ± 12.9 years. Detailed information was collected about the symptoms, first medical contact, concomitant clinical conditions, and the socioeconomic data. We analyzed the following prehospital times: (1) onset of symptoms to emergency call, (2) onset of symptoms to first medical contact, (3) first medical contact to hospital admission, and (4) onset of symptoms to hospital admission. Results: The first medical contact was with the National Emergency Medical Service in 266 (39.0%) patients, another emergency unit 106 (15.6%), cardiologist 41 (6%), general practitioner 36 (5.3%), and others 233 (34.1%). The median time from the onset of symptoms till emergency call was 190 min, from the first contact with a team of the National Emergency Medical Service till hospital admission 60 min, and from the onset of symptoms till hospital admission 4.8 h. Conclusion: The total prehospital delay in our study was unacceptably prolonged, with patient’s decision time as the major contributor. The delay could be substantially shortened by (1) increased awareness of the general population, particularly of individuals at high cardiovascular risk and (2) continuous medical education and regular practical training of the primary care providers about coping with medical emergencies.
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Affiliation(s)
| | - Stefan Naydenov Naydenov
- Department of Internal Diseases, “Prof. St. Kirkovich,” Medical University of Sofia, Sofia, Bulgaria
| | - Nikolay Margaritov Runev
- Department of Internal Diseases, “Prof. St. Kirkovich,” Medical University of Sofia, Sofia, Bulgaria
| | - Emil Ivanov Manov
- Department of Internal Diseases, “Prof. St. Kirkovich,” Medical University of Sofia, Sofia, Bulgaria
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Campbell DJ, Manns BJ, Leblanc P, Hemmelgarn BR, Sanmartin C, King-Shier K. Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease. Medicine (Baltimore) 2016; 95:e5561. [PMID: 27930562 PMCID: PMC5266034 DOI: 10.1097/md.0000000000005561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 11/26/2022] Open
Abstract
Patients with chronic diseases often face financial barriers to optimize their health. These financial barriers may be related to direct healthcare costs such as medications or self-monitoring supplies, or indirect costs such as transportation to medical appointments. No known framework exists to understand how financial barriers impact patients' lives or their health outcomes.We undertook a grounded theory study to develop such a framework. We used semistructured interviews with a purposive sample of participants with cardiovascular-related chronic disease (hypertension, diabetes, heart disease, or stroke) from Alberta, Canada. Interview transcripts were analyzed in triplicate, and interviews continued until saturation was reached.We interviewed 34 participants. We found that the confluence of 2 events contributed to the perception of having a financial barrier-onset of chronic disease and lack of income or health benefits. The impact of having a perceived financial barrier varied considerably. Protective, predisposing, or modifying of factors determined how impactful a financial barrier would be. An individual's particular set of factors is then shaped by their worldview. This combination of factors and lens determines one's degree of resiliency, which ultimately impacts how well they cope with their disease.The role of financial barriers is complex. How well an individual copes with their financial barriers is intimately tied to resiliency, which is related to the composite of a personal circumstances and their worldview. Our framework for understanding the experience of financial barriers can be used by both researchers and clinicians to better understand patient behavior.
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Affiliation(s)
- David J.T. Campbell
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine
| | - Braden J. Manns
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine
| | | | - Brenda R. Hemmelgarn
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine
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