Prevalence of metabolic syndrome among Vietnamese adult employees.

BACKGROUND AND AIMS: Metabolic syndrome (MtS) is associated with increased risk of many health disorders, especially cardiovascular diseases. In Vietnam, study examining MtS is meager and especially lacking for the workforce. We estimated the prevalence of MtS and its associated factors among Vietnamese employees. METHODS AND RESULTS: We analyzed secondary data of annual health check of employees of 300 Vietnamese companies from the Vinmec Healthcare System. We used three definitions for MtS: International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and NCEP ATP III-Asia. Of 57,997 participants evaluated, 48.5 % were males and 66.2 % were younger than 40 years old. The unadjusted MtS prevalence was 8.4 % (IDF), 10.2 % (NCEP ATP III), and 16.0 % (NCEP ATP III-Asia). The age-sex adjusted prevalence of MtS (NCEP ATP III-Asia) was 21.8 % (95 % confidence interval (CI): 21.4 %, 22.2 %). MtS prevalence increased with age, reached 49.6 % for age ≥60. The aging related increase was more remarkable in females than males (prevalence ratio (PR) (95 % CI) for age ≥60 comparing to age <30 years old in males vs. females was 4.0 (3.6, 4.3) vs. 20.1 (17.7, 22.9)). High blood triglyceride (83.4 %) and abdominal obesity (74.5 %) were the predominant contributors to MtS. CONCLUSION: In this relatively young Vietnamese working population, 16 % had MtS with high triglyceride and abdominal obesity being the predominant contributors. These findings emphasize the need for developing effective high triglyceride and abdominal obesity prevention and control programs to curb the emerging epidemic of metabolic disorders in the workforce.

Interest in and Use of Smoking Cessation Support Across Pregnancy and Postpartum.

BACKGROUND: Limited research exists on interest in and use of smoking cessation support in pregnancy and postpartum. METHODS: A longitudinal cohort of pregnant smokers and recent ex-smokers were recruited in Nottinghamshire, United Kingdom (N = 850). Data were collected at 8-26 weeks gestation, 34-36 weeks gestation, and 3 months postpartum and used as three cross-sectional surveys. Interest and use of cessation support and belief and behavior measures were collected at all waves. Key data were adjusted for nonresponse and analyzed descriptively, and multiple regression was used to identify associations. RESULTS: In early and late pregnancy, 44% (95% CI 40% to 48%) and 43% (95% CI 37% to 49%) of smokers, respectively, were interested in cessation support with 33% (95% CI 27% to 39%) interested postpartum. In early pregnancy, 43% of smokers reported discussing cessation with a midwife and, in late pregnancy, 27% did so. Over one-third (38%) did not report discussing quitting with a health professional during pregnancy. Twenty-seven percent of smokers reported using any National Health Service (NHS) cessation support and 12% accessed NHS Stop Smoking Services during pregnancy. Lower quitting confidence (self-efficacy), higher confidence in stopping with support, higher quitting motivation, and higher age were associated with higher interest in support (ps ≤ .001). A recent quit attempt and greater interest in support was associated with speaking to a health professional about quitting and use of NHS cessation support (ps ≤ .001). CONCLUSIONS: When asked in early or late pregnancy, about half of pregnant smokers were interested in cessation support, though most did not engage. Cessation support should be offered throughout pregnancy and after delivery. IMPLICATIONS: There is relatively high interest in cessation support in early and late pregnancy and postpartum among smokers; however, a much smaller proportion of pregnant or postpartum women access any cessation support, highlighting a gap between interest and engagement. Reflecting women's interest, offers of cessation support should be provided throughout pregnancy and after delivery. Increasing motivation to quit and confidence in quitting with assistance may enhance interest in support, and promoting the discussion of stopping smoking between women and health practitioners may contribute to higher support engagement rates.

Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort.

OBJECTIVES: Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women's smoking and quitting behaviour throughout pregnancy and after delivery. DESIGN: Longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. SETTING: Two maternity hospitals in one National Health Service hospital trust, Nottingham, England. PARTICIPANTS: 850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012. OUTCOME MEASURES: Self-reported smoking behaviour, quit attempts and quitting intentions. RESULTS: Smoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95% CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95% CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95% CI 24.6 to 61.3). CONCLUSIONS: Many pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation.

Visualising and quantifying 'excess deaths' in Scotland compared with the rest of the UK and the rest of Western Europe.

BACKGROUND: Scotland has higher mortality rates than the rest of Western Europe (rWE), with more cardiovascular disease and cancer among older adults; and alcohol-related and drug-related deaths, suicide and violence among younger adults. METHODS: We obtained sex, age-specific and year-specific all-cause mortality rates for Scotland and other populations, and explored differences in mortality both visually and numerically. RESULTS: Scotland's age-specific mortality was higher than the rest of the UK (rUK) since 1950, and has increased. Between the 1950s and 2000s, 'excess deaths' by age 80 per 100 000 population associated with living in Scotland grew from 4341 to 7203 compared with rUK, and from 4132 to 8828 compared with rWE. UK-wide mortality risk compared with rWE also increased, from 240 'excess deaths' in the 1950s to 2320 in the 2000s. Cohorts born in the 1940s and 1950s throughout the UK including Scotland had lower mortality risk than comparable rWE populations, especially for males. Mortality rates were higher in Scotland than rUK and rWE among younger adults from the 1990s onwards suggesting an age-period interaction. CONCLUSIONS: Worsening mortality among young adults in the past 30 years reversed a relative advantage evident for those born between 1950 and 1960. Compared with rWE, Scotland and rUK have followed similar trends but Scotland has started from a worse position and had worse working age-period effects in the 1990s and 2000s.

Quantifying the effect of complications on patient flow, costs and surgical throughputs.

BACKGROUND: Postoperative adverse events are known to increase length of stay and cost. However, research on how adverse events affect patient flow and operational performance has been relatively limited to date. Moreover, there is paucity of studies on the use of simulation in understanding the effect of complications on care processes and resources. In hospitals with scarcity of resources, postoperative complications can exert a substantial influence on hospital throughputs. METHODS: This paper describes an evaluation method for assessing the effect of complications on patient flow within a cardiac surgical department. The method is illustrated by a case study where actual patient-level data are incorporated into a discrete event simulation (DES) model. The DES model uses patient data obtained from a large hospital in Oman to quantify the effect of complications on patient flow, costs and surgical throughputs. We evaluated the incremental increase in resources due to treatment of complications using Poisson regression. Several types of complications were examined such as cardiac complications, pulmonary complications, infection complications and neurological complications. RESULTS: 48 % of the patients in our dataset experienced one or more complications. The most common types of complications were ventricular arrhythmia (16 %) followed by new atrial arrhythmia (15.5 %) and prolonged ventilation longer than 24 h (12.5 %). The total number of additional days associated with infections was the highest, while cardiac complications have resulted in the lowest number of incremental days of hospital stay. Complications had a significant effect on perioperative operational performance such as surgery cancellations and waiting time. The effect was profound when complications occurred in the Cardiac Intensive Care (CICU) where a limited capacity was observed. CONCLUSIONS: The study provides evidence supporting the need to incorporate adverse events data in resource planning to improve hospital performance.