Social inequality and barriers to cardiac rehabilitation in the rehab-North register.

AIM: Barriers to participation in cardiac rehabilitation (CR) may occur at three levels of the referral process (lack of information, declining to participate, and referral to appropriate CR programme). The aim is to analyse the impact of socioeconomic status on barriers to CR and investigate whether such barriers influenced the choice of referral. METHODS: The Rehab-North Register, a cross-sectional study, enrolled 5455 patients hospitalised at Aalborg University Hospital with myocardial infarction (MI) during 2011-2014. Patients hospitalised with ST-elevated MI and complicated non-ST-elevated MI were to be sent to specialized CR, whereas patients with uncomplicated non-ST-elevated MI and unstable angina pectoris were to be sent to community-based CR. Detailed selected socioeconomic information was gathered from statistical registries in Statistics Denmark. Data was assessed using logistic regression. RESULTS: Patients being retired, low educated, and/or with an annual gross income <27.000 Euro/yr were significantly less informed about cardiac rehabilitation programmes. Patients being older than 70 years, retired, low educated and/or with an annual gross income <27.000 Euro were significantly less willing to participate in CR. Further, this patient population were to a higher extent referred to community-based CR. CONCLUSION: Patients with low socioeconomic status received less information about and were less willing to participate in cardiac rehabilitation. The same patient population was to a higher extent referred to community-based CR. Knowledge about barriers at different levels and the impact of social inequality may help in tailoring a better approach in the referral process to CR.

[An algorithm for diagnosis of the floppy infant]. / Algoritme til diagnosticering af slapt spædbarn.

The term "floppy infant" is used for describing children presenting with muscle hypotonia at or shortly after birth. These floppy infants are usually a diagnostic challenge due to the many rare and genetic causes of hypotonia. It is common to start by classifying the hypotonia as peripheral or central, but even from here the path to a diagnosis can be long. This article reviews the literature, mostly retrospective studies done on floppy infants and presents a new simplified algorithm to help guide the diagnostics of the hypotonic children.

[Pontocerebellar hypoplasia is a rare cause of floppy infant syndrome]. / Pontocerebellar hypoplasi er en sjælden årsag til slapt spædbarn.

The hypotone neonate, floppy infant, often proves to be a diagnostic challenge, as the causes of floppy infant syndrome are many and often rare. In this case story a floppy girl was diagnosed with the rare, autosomal recessive disease pontocerebellar hypoplasia type I. The tests for the most common causes of floppy infant syndrome showed nothing abnormal, but an array comparative genomic hybridization test gave information of loss of heterozygosity. This helped to narrow the list of plausible diagnoses and eventually led to the diagnosis of pontocerebellar hypoplasia type I.