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- Framke, Elisabeth, et al.
(författare)
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Contribution of income and job strain to the association between education and cardiovascular disease in 1.6 million Danish employees
- 2020
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 41:11, s. 1164-1178
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Tidskriftsartikel (refereegranskat)abstract
- Aims: We examined the extent to which associations between education and cardiovascular disease (CVD) morbidity and mortality are attributable to income and work stress.Methods and results: We included all employed Danish residents aged 30–59 years in 2000. Cardiovascular disease morbidity analyses included 1 638 270 individuals, free of cardiometabolic disease (CVD or diabetes). Mortality analyses included 41 944 individuals with cardiometabolic disease. We assessed education and income annually from population registers and work stress, defined as job strain, with a job-exposure matrix. Outcomes were ascertained until 2014 from health registers and risk was estimated using Cox regression. During 10 957 399 (men) and 10 776 516 person-years (women), we identified 51 585 and 24 075 incident CVD cases, respectively. For men with low education, risk of CVD was 1.62 [95% confidence interval (CI) 1.58–1.66] before and 1.46 (95% CI 1.42–1.50) after adjustment for income and job strain (25% reduction). In women, estimates were 1.66 (95% CI 1.61–1.72) and 1.53 (95% CI 1.47–1.58) (21% reduction). Of individuals with cardiometabolic disease, 1736 men (362 234 person-years) and 341 women (179 402 person-years) died from CVD. Education predicted CVD mortality in both sexes. Estimates were reduced with 54% (men) and 33% (women) after adjustment for income and job strain.Conclusion: Low education predicted incident CVD in initially healthy individuals and CVD mortality in individuals with prevalent cardiometabolic disease. In men with cardiometabolic disease, income and job strain explained half of the higher CVD mortality in the low education group. In healthy men and in women regardless of cardiometabolic disease, these factors explained 21–33% of the higher CVD morbidity and mortality.
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- Hofman-Bang, Claes, et al.
(författare)
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Two year results of a controlled study of a residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty : A randomized study of a multifactorial programme
- 1999
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 20:20, s. 1465-1474
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Tidskriftsartikel (refereegranskat)abstract
- Aims In a multifactorial lifestyle behaviour programme, of 2 years duration, to study the maintenance of achieved behaviour and risk factor-related changes. Methods and Results Out of a consecutive population of 151 patients treated with percutaneous transluminal angioplasty under 65 years of age, 87 were randomly allocated to an intervention group (n=46) or to a control group (n=41). The programme started with a 4 week residential stay, which was focused on health education and the achievement of behaviour change. During the first year of follow-up, a maintenance programme included regular contacts with a nurse, while no further rehabilitative efforts were offered during the second year. One patient died (control). During the second year the proportion of hospitalized patients was lower in the intervention group (4% vs 20%;P<0·05). Patients in the intervention group improved several lifestyle dependent behaviours: diet (index at 0, 12 and 24 months): 10·5±3·4, 12·9±2·5 and 12·4±2·6 in the intervention group (I) vs 10·1±3·2, 10·7±3·0 and 11·8±3·2 in the control group (C);P<0·05, exercise sessions per week: 2·5±2·3, 4·5±1·9 and 4·4±2·1 (I) vs 3·1±2·2, 3·5±2·3 and 3·7±2·7 (C);P<0·05, and smoking; 18%, 6% and 9% (I) vs 12%, 21% and 18% (C);P<0·05. This corresponded to improvement in exercise capacity (0, 12 and 24 months): 156±42, 174±49 and 165±47W (I) vs 164±40, 163±49 and 156±48 watts (C);P<0·05. There were no significant differences between the two groups with regard to serum cholesterol levels at 0 and 24 months: 5·4±0·8 and 5·2±0·9mmol.l–1(I) vs 5·4±1·0 and 4·9±0·9mmol.l–1(C); ns, low density lipoprotein cholesterol level: 3·6±0·8 and 3·4±0·8mmol.l–1(I) vs 3·7±0·9 and 3·3±0·7mmol.l–1(C); ns, triglyceride level: 2·2±1·6 and 1·8±1·3mmol.l–1(I) vs 2·2±1·4 and 1·6±0·6mmol.l–1(C); ns, body mass index (0, 12 and 24 months): 27·5±4·5, 27·0±4·3 and 27·4± 4·5kg.m–2(I) vs 26·8±2·8, 26·9±2·7 and 26·9± 3·2kg.m–2(C); ns, waist/hip ratio or blood pressure. The two groups did not differ in quality of life, or psychological factors. Return to work after 12 and 24 months was 74% and 78% (I) vs 68% and 61% (C); ns. Conclusion This rehabilitation programme influenced important lifestyle behaviour and reduced some, but not all, important risk factors Key Words: Rehabilitation, risk factors
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- Bax, J, et al.
(författare)
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The future of continuing medical education: the roles of medical professional societies and the health care industry
- 2019
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 40:21, s. 1720-1727
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Tidskriftsartikel (refereegranskat)abstract
- In recent years, wide ranging biomedical innovation has provided powerful new approaches for prevention, diagnosis and management of diseases. In order to translate such innovation into effective practice, physicians must frequently update their knowledge base and skills through continuing medical education and training. Medical Professional Societies, run as not-for-profit organizations led by peers, are uniquely placed to deliver balanced, disease oriented and patient centred education. The medical industry has a major role in the development of new, improved technology, devices and medication. In fact, the best innovations have been achieved through collaboration with scientists, clinical academics and practicing physicians. Industry has for many years been committed to ensure the optimal and safe application of its products by providing unrestricted support of medical education developed and delivered by international and national learned societies. Recently adopted Codes of Practice for the Pharmaceutical and Device industry were intended to enhance public trust in the relationship between biomedical industry and physicians. Unexpectedly, changes resulting from adoption of the Codes have limited the opportunity for unconditional industry support of balanced medical education in favour of a more direct involvement of industry in informing physicians about their products. We describe the need for continuing medical education in Cardiovascular Medicine in Europe, interaction between the medical profession and medical industry, and propose measures to safeguard the provision of high quality, balanced medical education.
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- Östman-Smith, Ingegerd, 1947, et al.
(författare)
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Age- and gender-specific mortality rates in childhood hypertrophic cardiomyopathy.
- 2008
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 29:9, s. 1160-7
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Hypertrophic cardiomyopathy (HCM) is the commonest inherited cause of sudden cardiac death in children; current guidelines suggest HCM screening after 12-15 years of age. The study aims to establish the age range at highest risk. METHODS AND RESULTS: Cohort study from six regional centres of paediatric cardiology, including children presenting with sudden death; n = 150 (59% = male; 39% familial HCM). Age- and gender-specific mortality was calculated, and compared with rates calculated from the Swedish National Cause of Death Registry. There were 56 deaths within the cohort, 39 were sudden arrhythmia deaths, with 31 at <19 years of age. Between 9-13.9 years of age annual sudden death mortality averages 7.2%, vs. 1.7% after 16 years of age; P = 0.025, odds ratio for proportions 3.75 [95% confidence intervals (CI) 1.18-11.91], similar in both familial and idiopathic HCM. The risk for sudden death peaks earlier in girls (10-11 years), with male preponderance after the age of 15. National cause of death statistics confirm that the mortality rate from HCM is significantly higher in the 8-16 year olds (0.112 per 100,000 age-specific population) than in the 17-30 year olds (0.055 per 100,000; 95% CI 0.011-0.099). CONCLUSION: In families with HCM, children should be screened at an early age.
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