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1.
J Public Health (Oxf) ; 36(4): 635-43, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24277778

RESUMO

BACKGROUND: Cardiovascular disease (CVD) accounts for 30% of UK deaths. It is associated with modifiable lifestyle factors, including insufficient consumption of fruit and vegetables (F&V). Lay health trainers (LHTs) offer practical support to help people develop healthier behaviour and lifestyles. Our two-group pilot randomized controlled trial (RCT) investigated the effectiveness of LHTs at promoting a heart-healthy lifestyle among adults with at least one risk factor for CVD to inform a full-scale RCT. METHODS: Eligible adults (aged 21-78 years), recruited from five practices serving deprived populations, were randomized to health information leaflets plus LHTs' support for 3 months (n = 76) versus health information leaflets alone (n = 38). RESULTS: We recruited 114 participants, with 60% completing 6 month follow-up. Both groups increased their self-reported F&V consumption and we found no evidence for LHTs' support having significant added impact. Most participants were relatively less deprived, as were the LHTs we were able to recruit and train. CONCLUSIONS: Our pilot demonstrated that an LHT's RCT whilst feasible faces considerable challenges. However, to justify growing investment in LHTs, any behaviour changes and sustained impact on those at greatest need should be demonstrated in an independently evaluated, robust, fully powered RCT.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Comportamento Alimentar , Frutas , Comportamentos Relacionados com a Saúde , Verduras , Adulto , Idoso , Análise de Variância , Carência Cultural , Dieta , Inglaterra , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Nível de Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Política Nutricional , Projetos Piloto , Atenção Primária à Saúde , Fatores de Risco , Adulto Jovem
2.
J Bacteriol ; 195(2): 389-98, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23161027

RESUMO

The Sinorhizobium meliloti BacA ABC transporter protein plays an important role in its nodulating symbiosis with the legume alfalfa (Medicago sativa). The Mycobacterium tuberculosis BacA homolog was found to be important for the maintenance of chronic murine infections, yet its in vivo function is unknown. In the legume plant as well as in the mammalian host, bacteria encounter host antimicrobial peptides (AMPs). We found that the M. tuberculosis BacA protein was able to partially complement the symbiotic defect of an S. meliloti BacA-deficient mutant on alfalfa plants and to protect this mutant in vitro from the antimicrobial activity of a synthetic legume peptide, NCR247, and a recombinant human ß-defensin 2 (HBD2). This finding was also confirmed using an M. tuberculosis insertion mutant. Furthermore, M. tuberculosis BacA-mediated protection of the legume symbiont S. meliloti against legume defensins as well as HBD2 is dependent on its attached ATPase domain. In addition, we show that M. tuberculosis BacA mediates peptide uptake of the truncated bovine AMP, Bac7(1-16). This process required a functional ATPase domain. We therefore suggest that M. tuberculosis BacA is important for the transport of peptides across the cytoplasmic membrane and is part of a complete ABC transporter. Hence, BacA-mediated protection against host AMPs might be important for the maintenance of latent infections.


Assuntos
Proteínas de Bactérias/metabolismo , Teste de Complementação Genética , Proteínas de Membrana Transportadoras/deficiência , Proteínas de Membrana Transportadoras/metabolismo , Mycobacterium tuberculosis/genética , Sinorhizobium meliloti/fisiologia , Simbiose , Anti-Infecciosos/farmacologia , Proteínas de Bactérias/genética , Medicago sativa/microbiologia , Medicago sativa/fisiologia , Proteínas de Membrana Transportadoras/genética , Sinorhizobium meliloti/efeitos dos fármacos , Sinorhizobium meliloti/genética , beta-Defensinas/farmacologia
3.
Public Health ; 126(3): 230-232, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22325673

RESUMO

In 2005, the National Institute for Health and Clinical Excellence in England was asked to extend its work from clinical practice to public health. It has since produced 35 pieces of public health guidance on interventions ranging from the specific (such as the use of pedometers to promote exercise) to major public health issues (such as behaviour change and community engagement). The workshop agreed that research on many public health interventions was lacking, particularly for population-level interventions, which might be more powerful than those targeted at individuals. Epidemiology could make a particular contribution to the evaluation of natural experiments, which have great potential for contributing to this evidence base.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Doenças Cardiovasculares/prevenção & controle , Guias como Assunto , Saúde Pública/tendências , Alcoolismo/prevenção & controle , Educação , Inglaterra , Epidemiologia/tendências , Prática Clínica Baseada em Evidências , Promoção da Saúde , Humanos
4.
Vnitr Lek ; 58(12): 943-54, 2012 Dec.
Artigo em Tcheco | MEDLINE | ID: mdl-23427953

RESUMO

BACKGROUND: Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD. DESIGN AND METHODS: Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol). RESULTS: Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life. CONCLUSION: Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Promoção da Saúde , Estilo de Vida , Doenças Cardiovasculares/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Prevenção Primária
5.
J Intern Med ; 269(4): 452-67, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21205025

RESUMO

OBJECTIVES: Between 1986 and 2002, coronary heart disease (CHD) mortality in Sweden fell by more than 50%. Approximately one-third (4800 fewer deaths) of this decline in age-adjusted CHD mortality could be attributed to treatments in patients with CHD and primary prevention medications. High treatment levels were achieved in some cases, but in others, only 50-80% of eligible patients received appropriate therapy. We therefore examined to what extent increasing the use of specific treatments in eligible patients might have reduced CHD mortality rates in Sweden. DESIGN AND METHODS: We used the previously validated IMPACT CHD model to combine data on CHD patient numbers, medical and surgical uptake levels and treatment effectiveness. We estimated the number of deaths prevented or postponed for 2002 (baseline scenario) and for an alternative scenario (if at least 60% of eligible patients were treated). RESULTS: If treatments were increased to consistently cover at least 60% of eligible patients, approximately 8900 deaths could have been postponed or prevented, representing a potential gain of approximately 4100 fewer deaths than actually occurred in 2002. Approximately 45% of the 4100 gain would have come from primary prevention with statins, 23% from acute coronary syndrome treatments, 15% from secondary prevention therapies and 15% from treatments for heart failure. CONCLUSION: Increasing the proportion of eligible patients with CHD who receive evidence-based treatment could have resulted in approximately 4100 fewer deaths in 2002, almost doubling the actual mortality reduction. These findings further emphasize the importance of aggressively identifying and treating patients with CHD and high-risk individuals.


Assuntos
Doença das Coronárias/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Fármacos Cardiovasculares/uso terapêutico , Doença das Coronárias/prevenção & controle , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Revascularização Miocárdica/estatística & dados numéricos , Distribuição por Sexo , Suécia/epidemiologia
8.
PLoS One ; 14(4): e0215392, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30995272

RESUMO

BACKGROUND: Although most countries face increasing population levels of obesity and diabetes their effect on coronary heart disease (CHD) mortality has not been often studied in small island developing states (SIDs) where obesity rates are among the highest in the world. We estimated the relative contributions of treatments and cardiovascular risk factors to the decline in CHD mortality from 1990 to 2012 in the Caribbean island, Barbados. METHODS: We used the IMPACT CHD mortality model to estimate the effect of increased coverage of effective medical/surgical treatments and changes in major CHD risk factors on mortality trends in 2012 compared with 1990. We calculated deaths prevented or postponed (DPPs) for each model risk factor and treatment group. We obtained data from WHO Mortality database, population denominators from the Barbados Statistical Service stratified by 10-year age group (ages 25-34 up to 85 plus), population-based risk factor surveys, Global Burden of Disease and Barbados' national myocardial infarction registry. Monte Carlo probabilistic sensitivity analysis was performed. RESULTS: In 1990 the age-standardized CHD mortality rate was 109.5 per 100,000 falling to 55.3 in 2012. Implementation of effective treatment accounted for 56% DPPs (95% (Uncertainty Interval (UI) 46%, 68%), mostly due to the introduction of treatments immediately after acute myocardial infarction (AMI) (14%) and unstable angina (14%). Overall, risk factors contributed 19% DPPs (95% UI 6% to 34%) mostly attributed to decline in cholesterol (18% DPPs, 95% UI 12%, 26%). Adverse trends in diabetes: 14% additional deaths(ADs) 95% UI 8% to 21% ADs) and BMI (2% ADs 95%UI 0 to 5% ADs) limited potential for risk factor gains. CONCLUSIONS: Given the significant negative impact of obesity/diabetes on mortality in this analysis, research that explores factors affecting implementation of evidenced-based preventive strategies is needed. The fact that most of the decline in CHD mortality in Barbados was due to treatment provides an example for SIDs about the advantages of universal access to care and treatment.


Assuntos
Doença das Coronárias/mortalidade , Complicações do Diabetes/mortalidade , Modelos Cardiovasculares , Obesidade/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
9.
Palliat Med ; 22(6): 744-9, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18715974

RESUMO

The research base of palliative care is growing rapidly, but despite methodological advances, some of the practical challenges of working with people at the end of life will persist. This means that analysis of routine data is arguably more important in studying palliative care than it is in other aspects of health services research. End-of-life researchers have been using the high-quality linked data from cancer registries for many years. This paper explores the value of a less well-known resource for palliative care research: linked mortality and hospital activity data. Two case studies are presented using information from Scotland (population 5.1 million) and the former Oxford region of England (population 2.5 million). The advantages and limitations of linked hospital and mortality data for research and service planning in palliative care are drawn out through analyses investigating hospital bed utilisation by people with cancer and heart failure and the influence of social deprivation on the use of hospital services in the last year of life. The use of such data deserves a higher profile.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Tempo de Internação , Neoplasias/mortalidade , Cuidados Paliativos , Idoso , Inglaterra/epidemiologia , Feminino , Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Masculino , Pesquisa/estatística & dados numéricos , Escócia/epidemiologia , Fatores Socioeconômicos
10.
QJM ; 100(5): 277-89, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17449875

RESUMO

BACKGROUND: Coronary heart disease (CHD) in the UK affects approximately 3 million people, with >100,000 deaths annually. Mortality rates have halved since the 1980s, but annual NHS treatment costs for CHD exceed 2 billion pounds. AIM: To examine the cost-effectiveness of specific CHD treatments in England and Wales. METHODS: The IMPACT CHD model was used to calculate the number of life-years gained (LYG) from specific cardiological interventions from 2000 to 2010. Cost-effectiveness ratios (costs per LYG) were generated for each specific intervention, stratified by age and sex. The robustness of the results was tested using sensitivity analyses. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 25,888 deaths in CHD patients aged 25-84 years, thus generating approximately 194,929 extra life-years between 2000 and 2010 (range 143,131-260,167). Aspirin and beta-blockers for secondary prevention following myocardial infarction or revascularisation, for angina and heart failure were highly cost-effective (< 1000 pounds per LYG). Other secondary prevention therapies, including cardiac rehabilitation, ACE inhibitors and statins, were reasonably cost-effective (1957 pounds, 3398 pounds and 4246 pounds per LYG, respectively), as were CABG surgery (3239 pounds-4601 pounds per LYG) and angioplasty (3845 pounds-5889 pounds per LYG). Primary angioplasty for myocardial infarction was intermediate (6054 pounds-12,057 pounds per LYG, according to age), and statins in primary prevention were much less cost-effective (27,828 pounds per LYG, reaching 69,373 pounds per LYG in men aged 35-44). Results were relatively consistent across a wide range of sensitivity analyses. DISCUSSION: The cost-effectiveness ratios for standard CHD treatments varied by over 100-fold. Large amounts of NHS funding are being spent on relatively less cost-effective interventions, such as statins for primary prevention, angioplasty and CABG surgery. This merits debate.


Assuntos
Doença das Coronárias/economia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Inibidores da Enzima Conversora de Angiotensina/economia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aspirina/economia , Aspirina/uso terapêutico , Ponte de Artéria Coronária/economia , Ponte de Artéria Coronária/mortalidade , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Análise Custo-Benefício , Inglaterra/epidemiologia , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , País de Gales/epidemiologia
12.
Eur J Clin Nutr ; 71(6): 694-711, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27901036

RESUMO

Poor diet generates a bigger non-communicable disease (NCD) burden than tobacco, alcohol and physical inactivity combined. We reviewed the potential effectiveness of policy actions to improve healthy food consumption and thus prevent NCDs. This scoping review focused on systematic and non-systematic reviews and categorised data using a seven-part framework: price, promotion, provision, composition, labelling, supply chain, trade/investment and multi-component interventions. We screened 1805 candidate publications and included 58 systematic and non-systematic reviews. Multi-component and price interventions appeared consistently powerful in improving healthy eating. Reformulation to reduce industrial trans fat intake also seemed very effective. Evidence on food supply chain, trade and investment studies was limited and merits further research. Food labelling and restrictions on provision or marketing of unhealthy foods were generally less effective with uncertain sustainability. Increasingly strong evidence is highlighting potentially powerful policies to improve diet and thus prevent NCDs, notably multi-component interventions, taxes, subsidies, elimination and perhaps trade agreements. The implications for policy makers are becoming clearer.


Assuntos
Dieta Saudável/economia , Apoio ao Planejamento em Saúde/economia , Promoção da Saúde/economia , Doenças não Transmissíveis/prevenção & controle , Política Nutricional/economia , Comércio , Análise de Alimentos , Rotulagem de Alimentos , Abastecimento de Alimentos/economia , Comportamentos Relacionados com a Saúde , Humanos , Marketing , Metanálise como Assunto , Doenças não Transmissíveis/economia , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
QJM ; 99(8): 523-30, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16861717

RESUMO

BACKGROUND: Coronary heart disease (CHD) mortality rates have been decreasing in many industrialized countries since the 1980s. Up to half this decrease can be attributed to evidence-based medical and surgical cardiology interventions. However, recent studies suggest that modern cardiology treatment uptake levels remain disappointingly low in many patient categories. AIM: To determine the potential for further reductions in CHD mortality in Ireland from increasing the number of eligible patients receiving cardiology treatments. METHODS: A previously validated, cell-based IMPACT CHD mortality model was used to integrate large amounts of data describing CHD patient numbers, and the effectiveness and uptake levels of specific medical and surgical treatments. The CHD mortality reductions potentially achievable through the increased use of specific treatments were then calculated, stratified by age and gender and tested using sensitivity analyses. RESULTS: In 2000, medical and surgical coronary disease treatments together prevented or postponed approximately 1950 CHD deaths in the adult population aged 25-84. However, increasing treatment levels to reach 80% of eligible patients might have prevented or postponed a further 2280 CHD deaths in 2000 (minimum estimate 860, maximum estimate 4000). The biggest gain was from maximizing the treatment uptake of eligible heart failure patients, followed by those receiving statins and secondary prevention therapies. DISCUSSION: Many eligible patients are currently not receiving appropriate evidence-based treatments that would reduce CHD mortality and morbidity. Our results suggest that increasing cardiology treatment uptake in Ireland could at least double the current therapeutic reduction in CHD mortality.


Assuntos
Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/cirurgia , Uso de Medicamentos/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Revascularização Miocárdica/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Sensibilidade e Especificidade
14.
Int J Cardiol ; 109(1): 66-73, 2006 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-15993960

RESUMO

OBJECTIVES: To explore patients views of the management of medication of chronic heart failure (CHF); to explore in what circumstances they have difficulties in managing medication. DESIGN: Qualitative analysis of in-depth interviews using a constant comparative approach. PARTICIPANTS: Patients attending an outpatients clinic with a primary diagnosis of CHF due to left ventricular systolic dysfunction, NYHA Class II or III symptoms, and a history of hospital admission for heart failure. RESULTS: 50 patients were recruited, average age 67.1 years with ranges between 41 and 80 years. 26 were classified as NYHA Class II and 24 Class III. Patients reported developing routines and back up strategies to help with the complex task of medication-taking. They also described circumstances in which they were more likely not to take medication. CONCLUSIONS: This study demonstrates, with a large sample of respondents, the complexities of medication-taking and the difficulties of maintaining constant medication over a long period of time. The study provides examples of patients' strategies for so doing. Health care professionals should recognise that concordance may vary but explore ways in which they can help patients establish routines.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Cooperação do Paciente , Adulto , Idoso , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autoadministração
15.
J Telemed Telecare ; 12 Suppl 1: 26-8, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16884571

RESUMO

We analysed the difficulties encountered in recruiting predominantly older patients, suffering from an acute exacerbation of a chronic illness, to a randomized controlled trial of home telecare. Of 653 patients approached for study participation, after full assessment, 80% (519) met the trial eligibility criteria. Of these, 104 (20%) consented to study participation and 415 (80%) refused. A logistic regression model was constructed to examine independent effects of patient factors on probability of trial participation. Only two independent variables were associated with decreased likelihood of consent: increasing age (1 year older: odds ratio [OR] = 0.96); and being on inhaled steroid medication (OR = 0.60). The most common reason for refusal to participate, accounting for almost one-third of respondents, was a stated preference for a face-to-face nurse visiting service rather than a telecare service. Perhaps home telecare services should continue to be targeted at the more stable chronically ill population and not at those suffering from acute illness.


Assuntos
Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Consulta Remota , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Pneumopatias Obstrutivas/terapia , Masculino
16.
J R Coll Physicians Edinb ; 46(1): 32-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27092368

RESUMO

Evidence shows that one of the main causes for rising obesity rates is excessive consumption of sugar, which is due in large part to the high sugar content of most soda and juice drinks and junk foods. Worryingly, UK and global populations are consuming increasing amounts of sugary drinks and junk foods (high in salt, sugar and saturated fats). However, there is raised public awareness, and parents in particular want something to be done to curb the alarming rise in childhood obesity. Population-wide policies (i.e. taxation, regulation, legislation, reformulation) consistently achieve greater public health gains than interventions and strategies targeted at individuals. Junk food and soda taxes are supported by increasing evidence from empirical and modelling studies. The strongest evidence base is for a tax on sugar sweetened beverages, but in order to effectively reduce consumption, that taxation needs to be at least 20%. Empirical data from a number of countries which have implemented a duty on sugar or sugary drinks shows rapid, substantial benefits. In the UK, increasing evidence from recent scientific reports consistently support substantial reductions in sugar consumption through comprehensive strategies which include a tax. Furthermore, there is increasing public support for such measures. A sugar sweetened beverages tax will happen in the UK so the question is not 'If?' but 'When?' this tax will be implemented. And, crucially, which nation will get there first? England, Ireland, Scotland or Wales?


Assuntos
Bebidas , Obesidade/prevenção & controle , Saúde Pública/métodos , Edulcorantes/efeitos adversos , Impostos , Bebidas/efeitos adversos , Bebidas/economia , Programas Gente Saudável/métodos , Humanos , Obesidade/etiologia , Reino Unido
17.
Int J Cardiol ; 207: 286-91, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-26812643

RESUMO

BACKGROUND: Coronary heart disease (CHD) death rates have fallen across most of Europe in recent decades. However, substantial risk factor reductions have not been achieved across all Europe. Our aim was to quantify the potential impact of future policy scenarios on diet and lifestyle on CHD mortality in 9 European countries. METHODS: We updated the previously validated IMPACT CHD models in 9 European countries and extended them to 2010-11 (the baseline year) to predict reductions in CHD mortality to 2020(ages 25-74years). We compared three scenarios: conservative, intermediate and optimistic on smoking prevalence (absolute decreases of 5%, 10% and 15%); saturated fat intake (1%, 2% and 3% absolute decreases in % energy intake, replaced by unsaturated fats); salt (relative decreases of 10%, 20% and 30%), and physical inactivity (absolute decreases of 5%, 10% and 15%). Probabilistic sensitivity analyses were conducted. RESULTS: Under the conservative, intermediate and optimistic scenarios, we estimated 10.8% (95% CI: 7.3-14.0), 20.7% (95% CI: 15.6-25.2) and 29.1% (95% CI: 22.6-35.0) fewer CHD deaths in 2020. For the optimistic scenario, 15% absolute reductions in smoking could decrease CHD deaths by 8.9%-11.6%, Salt intake relative reductions of 30% by approximately 5.9-8.9%; 3% reductions in saturated fat intake by 6.3-7.5%, and 15% absolute increases in physical activity by 3.7-5.3%. CONCLUSIONS: Modest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies.


Assuntos
Doenças Cardiovasculares/mortalidade , Gorduras na Dieta , Estilo de Vida , Modelos Teóricos , Fumar/mortalidade , Cloreto de Sódio na Dieta , Adulto , Idoso , Doenças Cardiovasculares/dietoterapia , Doenças Cardiovasculares/prevenção & controle , Gorduras na Dieta/efeitos adversos , Europa (Continente) , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Fatores de Risco , Fumar/efeitos adversos , Fumar/tendências , Cloreto de Sódio na Dieta/efeitos adversos
18.
Circulation ; 102(13): 1511-6, 2000 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-11004141

RESUMO

BACKGROUND: We sought to determine how much of the recent, substantial fall in coronary heart disease (CHD) mortality rates in New Zealand can be attributed to "evidence-based" medical and surgical treatments and how much can be attributed to cardiovascular risk factor reductions. METHODS AND RESULTS: A cell-based mortality model was developed and refined. This model combined (1) the published effectiveness of cardiological treatments and risk factor reductions with (2) data on all medical and surgical treatments administered to all CHD patients and (3) trends in population cardiovascular risk factors (principally smoking, cholesterol, and hypertension) from 1982 to 1993 in Auckland, New Zealand (population 996 000). Between 1982 and 1993, CHD mortality rates fell by 23.6%, with 671 fewer CHD deaths than expected from baseline mortality rates in 1982. Forty-six percent of this fall was attributed to treatments (acute myocardial infarction 12%, secondary prevention 12%, hypertension 7%, heart failure 6%, and angina 9%), and 54% was attributed to risk factor reductions (smoking 30%, cholesterol 12%, population blood pressure 8%, and other, unidentified factors 4%). These proportions remained relatively consistent after a robust sensitivity analysis. CONCLUSIONS: Approximately half the CHD mortality rate fall in Auckland, New Zealand, was attributed to medical therapies, and approximately half was attributed to reductions in major risk factors. These findings emphasize the importance of a comprehensive strategy that maximizes the population coverage of effective treatments and actively promotes a prevention program, particularly for smoking, diet, and blood pressure reduction.


Assuntos
Doença das Coronárias/mortalidade , Modelos Cardiovasculares , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Fatores de Risco
19.
Circulation ; 102(10): 1126-31, 2000 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-10973841

RESUMO

BACKGROUND: Contemporary survival in unselected patients with heart failure and the population impact of newer therapies have not been widely studied. Therefore, we have documented case-fatality rates (CFRs) over a recent 10-year period. METHODS AND RESULTS: In Scotland, all hospitalizations and deaths are captured on a single database. We have studied case fatality in all patients admitted with a principal diagnosis of heart failure from 1986 to 1995. A total of 66 547 patients (47% male) were studied. Median age was 72 years in men and 78 years in women. Crude CFRs at 30 days and at 1, 5, and 10 years were 19.9%, 44.5%, 76.5%, and 87.6%, respectively. Median survival was 1.47 years in men and 1.39 years in women (2.47 and 2. 36 years, respectively, in those surviving 30 days). Age had a powerful effect on survival, and sex, comorbidity, and deprivation had modest effects. One-year CF was 24.2% in those aged <55 years and 58.1% in those aged >84 years. After adjustment, 30-day CFRs fell between 1986 and 1995, by 26% (95% CI 15 to 35, P<0.0001) in men and 17% (95% CI 6 to 26, P<0.0001) in women. Longer term CFRs fell by 18% (95% CI 13 to 24, P<0.0001) in men and 15% (95% CI 10 to 20, P<0.0001) in women. Median survival increased from 1.23 to 1. 64 years. CONCLUSIONS: Heart failure CF is much higher in the general population than in clinical trials, especially in the elderly. Although survival has increased significantly over the last decade, there is still much room for improvement.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Idoso , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Mortalidade/tendências , Análise Multivariada , Admissão do Paciente , Prognóstico , Isolamento Social
20.
J Am Coll Cardiol ; 38(3): 729-35, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11527625

RESUMO

OBJECTIVES: We tested the hypotheses that the effect of gender on short-term case fatality following a first admission for acute myocardial infarction (AMI) varies with age, and that this effect is offset by differences in the proportion of men and women who survive to reach hospital. BACKGROUND: Evidence is conflicting regarding the effect of gender on prognosis after AMI. METHODS: All 201,114 first AMIs between 1986 and 1995 were studied. Both 30-day and 1-year case fatality were analyzed for the 117,749 patients hospitalized and for all first AMIs, including deaths before hospitalization. The effect of gender and its interaction with age on survival was examined using multivariate modeling. RESULTS: Gender-based differences in survival varied according to age in hospitalized patients, with younger women having higher 30-day case fatality than men (e.g., <55 years, women 6.5% vs. 4.8% men, p < 0.0001). When deaths from first AMI before hospitalization were included in 30-day case fatality, women were less likely to die (adjusted odds ratio 0.9, confidence interval 0.89 to 0.93). Gender was not an independent predictor of one-year survival (p = 0.16). CONCLUSIONS: Female gender increases the probability of surviving to reach hospital, and this outweighs the excess risk of death occurring in younger women following hospitalization. Overall, men have a higher 30-day case fatality than women. Women do not fare worse than men after AMI when age and other factors are taken into account. However, men are more likely to die before hospitalization.


Assuntos
Mortalidade Hospitalar , Infarto do Miocárdio/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Escócia/epidemiologia , Fatores Sexuais
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