Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?

Background : Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods : Between May 2007 and January 2018, patients admitted with ACS were included. The patients' demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion : This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.

Ethnic Differences in the Risk Factors and Severity of Coronary Artery Disease: a Patient-Based Study in Iran.

BACKGROUND: Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups. METHODS: In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal-Wallis test, and multivariable regression analysis. RESULTS: The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (ß 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (ß 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (ß -0.087, 95% CI -0.146 to -0.027; P = 0.004). CONCLUSIONS: This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country.

BACKGROUND: Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters. MATERIALS AND METHODS: The sample consisted of 347 congenital heart disease patients in the age group of 18­64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires. RESULTS: The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect. CONCLUSION: Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients' knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

Symptoms of depression, anxiety, and somatization in female victims and perpetrators of intimate partner violence in Maputo City, Mozambique.

BACKGROUND: Little knowledge exists in Mozambique and sub-Saharan Africa about the mental health (symptoms of depression, anxiety, and somatization) of women victims and perpetrators of intimate partner violence (IPV) by type of abuse (psychological aggression, physical assault without/with injury, and sexual coercion). This study scrutinizes factors associated with mental health among women victims and perpetrators of IPV over the 12 months prior to the study. METHODS AND MATERIALS: Mental health data were analyzed with bivariate and multiple regression methods for 1442 women aged 15-49 years who contacted Forensic Services at Maputo Central Hospital (Maputo City, Mozambique) for IPV victimization between April 1, 2007 and March 31, 2008. RESULTS: In bivariate analyses, victims and perpetrators of IPVs scored higher on symptoms of mental health than their unaffected counterparts. Multiple regressions revealed that controlling behaviors, mental health comorbidity, social support, smoking, childhood abuse, sleep difficulties, age, and lack of education were more important in explaining symptoms of mental health than demographics/socioeconomics or life-style factors. Victimization and perpetration across all types of IPV were not associated with symptoms of mental health. CONCLUSION: In our sample, victimization and perpetration were not important factors in explaining mental ill health, contrary to previous findings. More research into the relationship between women's IPV victimization and perpetration and mental health is warranted as well as the influence of controlling behaviors on mental health.

Burnout among foreign-born and native Swedish women: a longitudinal study.

The authors of this study addressed burnout experiences (generally defined as chronic depletion of an individual's energetic resources') over time in relation to other factors (e.g., distress, sleep difficulties, job demands, etc.) among foreign-born women and Swedish native women living in Stockholm. The study design was a longitudinal panel survey with two waves one year apart. In the first wave, 3,616 of 6,000 randomly selected women took part, and 2,300 of the initial 3,616 women also participated in the second wave; 427 were foreign-born women, and 1,873 were Swedish native women. Baseline/emerging distress, emerging sleep difficulties, worsening general social support, job demands at baseline/escalating during the assessment period, emerging unemployment, constraints in social support at work, and sustained/emerging financial strain were associated with future burnout, regardless of background. More foreign-born women than Swedish native women reported burnout, with these differences maintained at one-year follow-up. The factors related to burnout were largely the same in both groups, but smoking and cardiovascular disease were related to burnout only among foreign-born women. Younger age, job demands, and working hours were associated with burnout among Swedish native women. The authors found that the women had concurrent problems such as burnout, distress, and sleep problems, but foreign background was not independently related to burnout.

Quality of life among lifetime victimized men.

Quality of life was compared for lifetime victimized (n = 353) and nonvictimized men (n = 167) for demographic and quality of life variables by a cross-sectional design. The univariate analyses showed that victims compared to nonvictims had a lower quality of life, were younger, more often had upper secondary school education, and were more often blue-collar/low white-collar workers, on student allowances, on unemployment, financially strained, and smokers. The regressions revealed that unemployment, financial strain, smoking, depression, and home/public abuse were associated with reduced quality of life among victimized men. Being a blue-collar/low/intermediate white-collar worker and social support were related to increased quality of life. This study may have provided new insights into the experiences of quality of life of victimized men.