RESUMO
BACKGROUND: Although acetylsalicylic acid is the most commonly used antithrombotic agent for the secondary prevention of cardiovascular events, residual atherothrombotic risk has prompted a guideline recommendation for the addition of dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) in high vascular risk patients. Accordingly, the CONNECT CVD quality enhancement initiative provides a contemporary "snapshot" of the clinical features and antithrombotic management of atherosclerotic cardiovascular disease (ASCVD) patients in Canada. METHODS: Canadian cardiologists (49 cardiologists from six provinces) undertook a retrospective chart audit of 10 ASCVD patients in their outpatient practice who met the Cardiovascular Outcomes for People Using Anticoagulation Strategy-like criteria from May 2018 to April 2019. RESULTS: Of the 492 (two cardiologists provided 11 patients) enroled, average age was 70 years, 25% were female, 39% had diabetes and 20% had atrial fibrillation. Prior revascularisation was common (percutaneous coronary artery intervention 61%, coronary artery bypass graft 39%), with 31% having multivessel disease. A total of 47% of patients had a Reduction of Atherothrombosis for Continued Health bleeding score of ≥11 (~2.8% risk of serious bleeding at 2 years). Single antiplatelet therapy (SAPT) alone was most commonly used (62%), while 22% were on DAPT alone. In total, 22% were on oral anticoagulation (OAC), with 16% being on non-vitamin K oral anticoagulant alone, 5% on DPI and 1% received triple therapy. CONCLUSIONS: In contemporary Canadian clinical practice of stable ASCVD patients, a large number of patients receive antithrombotic therapy other than SAPT. Further efforts are required to guide the appropriate selection of patients in whom more potent antithrombotic therapies may safely reduce residual risk.
Assuntos
Fibrilação Atrial , Cardiologistas , Doenças Cardiovasculares , Intervenção Coronária Percutânea , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Canadá , Doenças Cardiovasculares/tratamento farmacológico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos Retrospectivos , Prevenção SecundáriaRESUMO
BACKGROUND: Healthcare systems and public health agencies use different methods to measure the impact of substance use (SU) on population health. We studied the ability of systems to accurately capture data on drug use-associated infective endocarditis (DUA-IE). METHODS: We conducted a retrospective analysis of patients with IE discharge diagnosis from an academic medical center, 2011-2017, comparing data from hospital Electronic Health Record (EHR) to State Uniform Hospital Discharge Data Set (UHDDS). To identify SU we developed a composite measure. RESULTS: EHR identified 472 IE discharges (430 of these were captured in UHDDS); 406 (86.0%) were correctly coded based on chart review. IE discharges increased from 57 to 92 (62%) from 2012 to 2017. Hospitalizations for the subset of DUA-IE identified by any measure of SU increased from 10 to 54 (440%). Discharge diagnosis coding identified 128 (60.7%) of total DUA-IE hospitalizations. The composite measure identified an additional 65 (30.8%) DUA-IE hospitalizations and chart review an additional 18 (8.5%). CONCLUSIONS: The failure of discharge diagnosis coding to identify DUA-IE in 40% of hospitalizations demonstrates the need for better systems to capture the impact of SU. Collaborative data sharing could help improve surveillance responsiveness to address an emerging public health crises.
Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Endocardite/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , United States Dept. of Health and Human Services/estatística & dados numéricos , Conjuntos de Dados como Assunto , Usuários de Drogas/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Endocardite/etiologia , Endocardite/terapia , Feminino , Troca de Informação em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire/epidemiologia , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , Estados UnidosRESUMO
AIMS: To estimate the rate of non-vitamin K oral anticoagulant (NOAC) dosing that is lower- and higher-than-recommended and to describe the reasons for NOAC dose discordance with Health Canada prescribing information. METHODS: The OPTIMAL AF Programme was an observational cohort quality assessment initiative in which primary and specialty care physicians in eight provinces provided a snapshot of their anticoagulated non-valvular atrial fibrillation (NVAF) patients through either an electronic medical record (EMR) system or standardised, paper-based data collection methods. RESULTS: Data on 1681 NVAF patients receiving oral anticoagulation (OAC) for stroke prevention was provided by 102 physicians. A NOAC was prescribed in 1379 patients (8%). The standard recommended dose was prescribed in 849 (76%) and reduced dose in 264 (24%). Concordance of the reduced dose with Health Canada prescribing information occurred in 154 patients (58%). The standard dose was concordant in 805 (95%). The main reasons for the use of discordant reduced doses were age of 80 years or more, elevated creatinine, prior bleeding or dose recommended by specialist. DISCUSSION AND CONCLUSION: The vast majority of Canadian patients meeting the Canadian Cardiovascular Society (CCS) guideline recommendations for OAC to decrease AF-related stroke risk were receiving product monograph-concordant NOAC dosing (85%). Nonetheless, this highlights the fact that an important proportion of patients were prescribed doses that are discordant and opportunities remain to improve NOAC dosing to optimise stroke prevention.
Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Uso Off-Label/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Canadá , Estudos de Coortes , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Padrões de Prática Médica , Vitamina K/antagonistas & inibidoresRESUMO
The purpose of our research is to compare sexual violence prevalence rates from three sources of state level data. Public health officials, legislators and other policymakers often require state-level sexual assault prevalence estimates to justify funding and rationalize both new and ongoing sexual violence prevention programs, as well as programs for victims. We compared survey design and resulting prevalence rates of the three surveys frequently used at the state level: the Behavioral Risk Factor Surveillance System (BRFSS), the National Violence Against Women Survey (NVAWS) extrapolations, and replications of the NVAWS. Although the specificity of the questions used in the NVAWS provides a clearer picture of the prevalence of sexual assault than the BRFSS questions, the sexual violence module on the BRFSS survey has the advantage that it is used regularly by some states. Currently available female sexual assault prevalence estimates differ widely at the state level but can be used when interpreted with informed caution. The new National Intimate Partner and Sexual Violence Surveillance System holds promise for providing better estimates in the future.
Assuntos
Vítimas de Crime/estatística & dados numéricos , Coleta de Dados/métodos , Violência Doméstica/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Violência Doméstica/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Parceiros Sexuais , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: We examined whether self-reported racial discrimination was associated with mental health status and whether this association varied with race/ethnicity or immigration status. METHODS: We performed secondary analysis of a community intervention conducted in 2002 and 2003 for the New Hampshire Racial and Ethnic Approaches to Community Health 2010 Initiative, surveying African descendants, Mexican Americans, and other Latinos. We assessed mental health status with the Mental Component Summary (MCS12) of the Medical Outcomes Study Short Form 12, and measured discrimination with questions related to respondents' ability to achieve goals, discomfort/anger at treatment by others, and access to quality health care. RESULTS: Self-reported discrimination was associated with a lower MCS12 score. Additionally, the strength of the association between self-reported health care discrimination and lower MCS12 score was strongest for African descendants, then Mexican Americans, then other Latinos. These patterns may be explained by differences in how long a respondent has lived in the United States. Furthermore, the association of health care discrimination with lower MCS12 was weaker for recent immigrants. CONCLUSIONS: Discrimination may be an important predictor of poor mental health status among Black and Latino immigrants. Previous findings of decreasing mental health status as immigrants acculturate might partly be related to experiences with racial discrimination.
Assuntos
População Negra , Hispânico ou Latino , Saúde Mental , Grupos Minoritários , Preconceito , Ira , Atenção à Saúde , Emigração e Imigração , Inquéritos Epidemiológicos , Humanos , New HampshireRESUMO
The relationship between perceived racial discrimination and both blood pressure and perceived physical health has been documented among African Americans. However, this association has not been well-studied for Black or Latino immigrants. We used multiple regression analysis with a cross-sectional sample of 666 African Americans, Black immigrants, and Latino immigrants from the New Hampshire Racial and Ethnic Approaches to Community Health 2010 Initiative to assess the relationship between discrimination and measures of physical health and blood pressure. The study found evidence of a significant U-shaped relationship between discrimination and systolic blood pressure for all three cohorts. Evidence was also found supporting a negative linear relationship between discrimination and physical health. In addition, the association between discrimination and physical health was attenuated for Latinos compared with the other groups. Future research should evaluate how factors associated with acculturation or cumulative exposure to discriminatory stressors may affect the protective resources of immigrants.
Assuntos
Atitude Frente a Saúde/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Indicadores Básicos de Saúde , Hispânico ou Latino/estatística & dados numéricos , Hipertensão/etnologia , Aptidão Física , Preconceito , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Idoso , Emigração e Imigração , Feminino , Programas Gente Saudável , Hispânico ou Latino/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire/epidemiologia , Pobreza/etnologia , Autoavaliação (Psicologia) , Saúde da População Urbana/estatística & dados numéricosRESUMO
OBJECTIVE: We examined the need for genetic counseling services (GCS) for families of children with autism spectrum disorder (ASD), Down syndrome (DS), and/or mental retardation (MR) and factors that influence the receipt of needed GCS for those children relative to other children with special health care needs (CSHCN). METHODS: Analysis was conducted on the 2005-2006 National Survey of Children With Special Health Care Needs, a nationally representative sample. Bivariate analyses were conducted by examining need for and receipt of GCS for children with ASD, DS, and/or MR and other CSHCN as well as differences by contextual variables using the health belief model (HBM). Logistic regression analyses were conducted to assess the relative impact of receipt of needed GCS by HBM constructs. RESULTS: Families of children with diagnoses of ASD, DS, and/or MR perceive significantly higher need for GCS than other CSHCN. The presence of a medical home is the single most important factor in facilitating access to GCS, together with the presence of insurance, particularly private or a combination of private and public insurance. As income and education attainment decrease, barriers to GCS rise. CONCLUSIONS: This analysis supports strategies for improving linkages between specialty providers and the medical home at which primary care is delivered. Increased effort should be made to attend to those who experience barriers that result from lack of insurance, poverty, low education, or racial or ethnic differences. Health professionals need to collaborate in developing solutions to underinsurance or lack of insurance for CSHCN.