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PubMed2006

The emotional impact and ease of recall of warning signs for suicide: a controlled study.

In light of concerns about potential iatrogenic effects of information about suicide, in the current study we examined the emotional impact of reading a list of warning signs for suicide in comparison to comparable lists for heart attacks and diabetes. All participants read two sets of warning signs, with the experimental group reading the suicide warning signs. Results confirm no difference in emotional impact across groups, along with providing evidence that warning signs for suicide are as easy to recall after exposure as warning signs for heart attack. Implications for pubic health campaigns are discussed.

Adolescent↗
PubMed1982

Cardiac and pulmonary anaphylaxis in guinea pigs and rabbits induced by glycoprotein isolated from tobacco leaves and cigarette smoke condensate.

Cigarette smoking is a major risk factor for heart attack. The pathologic mechanisms responsible for this association are obscure. It has been reported that approximately one-third of human volunteers, smokers and nonsmokers, exhibit immediate cutaneous hypersensitivity to a glycoprotein antigen (TGP) purified from cured tobacco leaves and present in cigarette smoke. It is also known that the heart is a primary target organ for anaphylactic reaction in many animals, including primates. In experiments described herein anaphylaxis was induced in the isolated hearts and lungs of rabbits and guinea pigs previously sensitized by immunization with TGP and challenged with TGP isolated from either tobacco leaf or cigarette smoke condensate. Cardiac anaphylaxis was characterized by sinus tachycardia, decreased contractility, decreased coronary perfusion accompanied by hypoxic electrocardiographic changes, and a variety of rhythm disturbances, including idioventricular tachyarrhythmias. These observations suggest that allergic reactions to tobacco constituents may initiate cardiac arrhythmia and sudden death in some smokers and may, in part, underly the association between cigarette smoking and heart attack.

Anaphylaxis↗
PubMedDate not supplied

Counting the uninsured using state-level hospitalization data.

OBJECTIVE: To assess the appropriateness of using state-level data on uninsured hospitalizations to estimate the uninsured population. METHODS: The authors used 1992-1996 data on hospitalizations of newborns and of appendectomy and heart attack patients in Florida to estimate the number of people in the state without health insurance coverage. These conditions were selected because they usually require hospitalization and they are common across demographic categories. RESULTS: Adjusted for the gender and ethnic composition of the population, the percentages of uninsured hospitalizations for appendectomies and heart attacks produced estimates of the state's uninsured population 1.6 percentage points lower than those reported for 1996 in the US Census March Current Population Survey. CONCLUSION: Data reported by hospitals to state agencies can be used to monitor trends in health insurance coverage and provides an alternative data source for a state-level analysis of the uninsured population.

Adolescent↗
PubMed1997

Daily time series for cardiovascular hospital admissions and previous day's air pollution in London, UK.

OBJECTIVE: To test for a significant association between air pollution and emergency hospital admissions for circulatory diseases (international classification of diseases-9 390-459) in London, England, that would be consistent with a causal effect of pollution on the previous day. METHODS: Long term concurrent trends, temperature, humidity, day of the week, influenza epidemic of 1989, and cyclical covariations with periodicity > 20 days in daily measures of pollution and admissions for 1987-94 were allowed for. RESULTS: There were 373556 admissions. No association was found between O3 and circulatory diseases. Four other pollutants were associated with acute myocardial infarction and circulatory diseases combined. P values and attributable cases (95% confidence intervals) for acute myocardial infarction were: black smoke P = 0.003, 2.5% (0.8% to 4.3%); NO2 P = 0.002, 2.7% (0.8% to 4.6%); CO P = 0.001, 2.1% (0.7% to 3.5%); and SO2 P = 0.0006, 1.7% (0.7% to 2.6%). There were also associations between black smoke and angina (P = 0.02), NO2 and arrhythmia (P = 0.04), and CO and other circulatory diseases (P = 0.004), but none with heart failure. Acute myocardial infarction was the only diagnosis for which there were significant associations with and without adjustment for cyclical terms. The associations with acute myocardial infarction were significant only in the cool season. CONCLUSION: Population data were consistent with 1 in 50 heart attacks currently presenting at London hospitals being triggered by outdoor air pollution. Further research is now needed to investigate whether background concentrations of black smoke, NO2, CO, and SO2 are a preventable cause of myocardial infarction. These results, if applied to all myocardial infarctions in the United Kingdom, indicate a potential saving of 6000 heart attacks a year.

Air Pollutants↗
PubMed1999

Reducing patient delay in seeking treatment for acute myocardial infarction.

Although there have been tremendous strides in therapies for acute myocardial infarction (AMI), patients still do not receive these treatments in a timely manner, or sometimes not at all. One major reason is inadvertent delays by patients and by those with whom they consult about their symptoms. One of the National Heart Attack Alert Program's (NHAAP) goals is to reduce the morbidity and mortality associated with AMI through the rapid identification and treatment of at-risk individuals. Medical-surgical nurses can play a crucial role in ensuring that patients and their family members know how to recognize the signs and symptoms of a heart attack, what steps to take to get early and appropriate evaluation and treatment, and the potentially lifesaving benefits of this information.

Algorithms↗
PubMed1993

Maintaining mobility in late life. I. Demographic characteristics and chronic conditions.

To assess the role of demographic factors and chronic conditions in maintaining mobility in older persons, this study utilized longitudinal data collected as part of the Established Populations for Epidemiologic Studies of the Elderly between 1981 and 1987 on 6,981 men and women aged 65 years and older in East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. Results are presented for those who at baseline reported intact mobility, defined as the ability to climb stairs and walk a half mile without help, and who were followed annually for up to 4 years for changes in mobility status. Age, income, education, and chronic conditions present at baseline and occurring during follow-up were evaluated for their association with loss of mobility. Over the follow-up period, 55.1% of subjects maintained mobility, 36.2% lost mobility, and 8.7% died without evidence of mobility loss prior to death. In both men and women, increasing age and lower income levels were associated with increased risk of losing mobility, even after controlling for the presence of chronic conditions at baseline. After adjustment for age, income, and chronic conditions, lower education levels were a significant risk factor for mobility loss in men, but not in women. Baseline reports of previous heart attack, stroke, high blood pressure, diabetes, dyspnea, and exertional leg pain were associated with small but significant risks for mobility loss. There was a stepwise increase in the risk of mobility loss according to the number of chronic conditions present at baseline that was very consistent between men and women. The occurrence during the study of a new heart attack, stroke, cancer, or hip fracture was associated with a substantially greater risk of mobility loss than was associated with the presence of these conditions at baseline.

Activities of Daily Living↗
PubMed2006

Factors that influence the decision of military dependents to decline smallpox vaccination during an outbreak.

OBJECTIVE: To examine factors that influence the decision of military dependents to decline smallpox vaccination in the event of an outbreak. METHODS: A total of 373 military dependents, 18 to 65 years of age, were surveyed in December 2003, at Fort Hood, Texas, and Fort Sill, Oklahoma, concerning smallpox vaccine knowledge, adverse reactions, and willingness to receive the vaccine. RESULTS: A total of 89% of respondents were willing to receive the vaccine. Respondents were less willing if the vaccine was unsafe during pregnancy or caused blood clots and heart attacks. African American and Hispanic respondents were less willing to be vaccinated than were Caucasian respondents (p < 0.0079), as were respondents with lower vaccine knowledge scores (p < 0.0029). CONCLUSIONS: The majority of military dependents would want to receive the vaccine in the event of an outbreak. Vaccine safety in pregnancy and an unproven link to blood clots and heart attacks may influence vaccine refusal. African American respondents, Hispanic respondents, and respondents with lower vaccine knowledge scores were less willing to receive the vaccine.

Adolescent↗
PubMed1976

Importance of patient selection in evaluating a cardiac ambulance service.

All patients brought to hospital by a special cardiac ambulance were followed up and compared with patients carried by routine ambulances to assess the effectiveness of a cardiac ambulance service. The overall mortality of patients with heart attacks was 51% among those carried by an ordinary ambulance and 40% among those carried by the cardiac ambulance. The apparently low mortality in the latter group was balanced, however, by a high mortality (68%) among patients carried by ordinary ambulances when the cardiac ambulance was available but not used; these patients tended to have a short duration of symptoms and heart attacks away from home, and their ambulance was more often called by a member of the public than a general practitioner. It seems therefore that low-risk cases were inadvertently selected for transport by the cardiac ambulance; such unintentional selection makes it difficult to evaluate a cardiac ambulance service.

Ambulances↗
PubMed1989

Rose Questionnaire angina among United States black, white, and Mexican-American women and men. Prevalence and correlates from The Second National and Hispanic Health and Nutrition Examination Surveys.

The prevalence of Rose Questionnaire angina and its association with coronary heart disease risk factors and manifestations were investigated in representative samples of the US population. The study populations included 1,135 black and 8,323 white subjects aged 25-74 years examined in the Second National Health and Nutrition Examination Survey, 1976-1980, and 2,775 Mexican-American subjects aged 25-74 years examined in the Hispanic Health and Nutrition Examination Survey, Mexican-American portion, 1982-1983. Age-adjusted prevalence rates of Rose angina were similar among black, white, and Mexican-American women (6.8%, 6.3%, and 5.4%, respectively). An excess in the prevalence of Rose angina was observed in women compared with men for white and Mexican-American persons under age 55 years, but not for those over age 55. Electrocardiographic evidence of myocardial infarction and self-reported heart attack were strongly associated with prevalent Rose angina among white men and women aged 55 years and over, but not among those below age 55. Serum cholesterol, body mass index (weight (kg)/height (m)2), current cigarette smoking, and dyspnea were independently associated with an increased risk of prevalent angina in multivariate logistic models for white women, excluding those with a prior heart attack. Because many younger women with chest pain who may consult physicians are likely to have elevations in cardiovascular risk factors, their self-reported chest pain can be used as an opportunity to intervene and reduce their future risk of cardiovascular disease.

Adult↗
PubMed1998

Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial.

BACKGROUND: Studies of underlying differences in adult mortality between black and white individuals in the USA have been constrained by limitations of data or small study size. We investigated the extent to which differences in socioeconomic position between black and white men contribute to differences in all-cause and cause-specific mortality. METHODS: 361,662 men were screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, in 22 sites. Median family income of households by zipcode (postal) area of residence was available for 20,224 black and 300,685 white men as well as data on age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and treatment for diabetes. We classified deaths during 16 years of follow-up into specific causes and compared differences in death rates between black men and white men, before and after adjustment for differences in income and other risk factors. FINDINGS: Age-adjusted relative risk of death (black vs white) was 1.47 (95% CI 1.42-1.53). Adjustment for diastolic blood pressure, serum cholesterol, cigarette smoking, medication for diabetes, and previous admission to hospital for heart attack decreased the relative risk to 1.40 (1.35-1.46). Adjustment for income but not the other risk factors decreased the risk to 1.19 (1.14-1.24) and adjustment for other risk factors did not alter this estimate. For cardiovascular death, relative risk on adjustment for income was decreased from 1.36 to 1.09; for cancer from 1.47 to 1.25; and for non-cardiovascular and non-cancer deaths from 1.71 to 1.26. For some specific causes of death, including prostate cancer, myeloma, and hypertensive heart disease, the higher death rates among black men did not seem to reflect differences in income. Rates of death for suicide and melanoma were lower among black than white men, as were those for coronary heart disease after adjustment for income. INTERPRETATION: Socioeconomic position is the major contributor to differences in death rates between black and white men. Differentials in mortality from some specific causes do not simply reflect differences in income, however, and more detailed investigations are needed of how differences are influenced by environmental exposures, lifetime socioeconomic conditions, lifestyle, racism, and other sociocultural and biological factors.

Adult↗
PubMedDate not supplied

How women label and respond to symptoms of acute myocardial infarction: responses to hypothetical symptom scenarios.

OBJECTIVE: To investigate how women label and intend to respond to common and less common symptoms of acute myocardial infarction (AMI). DESIGN: Telephone interviews were conducted with 862 women older than age 50 years in the state of Washington. OUTCOME MEASURES: Intended coping strategies, labeling of hypothetical symptoms, perceived risk of AMI, knowledge of AMI symptoms, medical and family history of AMI and demographics. RESULTS: Women who labeled common or less common symptoms as a heart attack (65% and 36%, respectively) were more likely to report they would call 911 or go to a hospital right away than women who labeled these symptoms as something else. The results of a multiple logistic regression analysis suggests that knowledge of less common AMI symptoms, AMI information seeking, and personal risk perceptions were significant predictors of labeling less common symptoms as a heart attack. CONCLUSIONS: The findings suggest that many women might be in danger of mislabeling their symptoms and not taking appropriate action. Women need to be educated about the less common symptoms of AMI and need to be encouraged to seek out information regarding AMI.

Adaptation, Psychological↗
PubMed2004

Clinical phenotype of families with longevity.

OBJECTIVES: To determine whether offspring of centenarians acquired protection from age-related diseases. DESIGN: Case-control study. SETTING: The study was part of the Longevity Genes Project at Albert Einstein College of Medicine. PARTICIPANTS: Centenarians (n=145), offspring of centenarians (n=180), and spouses of the offspring of centenarians (n=75) as a control group. Two additional groups served as controls: age-matched Ashkenazi Jews, and an age-matched control group from the Third National Health and Nutrition Examination Survey. MEASUREMENTS: Self-reported family history of longevity; prevalence of hypertension, diabetes mellitus, heart attacks, and strokes; and objective measurements of body mass index and fat mass. RESULTS: Parents of centenarians (born in approximately 1870) had a markedly greater ( approximately sevenfold) "risk" for longevity (reaching ages 90-99), supporting the notion that genetics contributed to longevity in these families. The offspring of long-lived parents had significantly lower prevalence of hypertension (by 23%), diabetes mellitus (by 50%), heart attacks (by 60%), and strokes (no events reported) than several age-matched control groups. CONCLUSION: Offspring of centenarians may inherit significantly better health. The authors suggest that a cohort of these subjects and their spouses is ideal to study the phenotype and genotype of longevity and its interaction with the environment.

Aged↗
PubMed1990

Carotid endarterectomy for elderly patients: predicting complications.

OBJECTIVE: To determine whether the complication or death rate from carotid endarterectomy can be predicted from hospital and physician structural variables, such as the hospital's teaching status or the number of endarterectomies done by the surgeon per year. DESIGN: Survey of medical records. After controlling for the severity of the patient's condition on the basis of data in the medical record at the time of the endarterectomy, regression analyses were used to predict the postoperative stroke, heart attack, and 30-day death rate as a function of patient, physician, and hospital characteristics. SETTING: Three geographic areas (states or large parts of states; average population, 3 million) in the United States. PATIENTS: Random sample of 1302 patients 65 years of age or older having carotid endarterectomy in 1981. INTERVENTION: Carotid endarterectomy. MEASUREMENTS AND MAIN RESULTS: Of 1302 patients, 11.3% had a postoperative stroke or heart attack or died within 30 days of the operation. Patient age, race, income, and gender; physician volume, board certification status, and age; and hospital size, for-profit status, ownership, and teaching status were not significantly related to the postoperative complication or death rate. If the surgeon was a graduate of a foreign, but not a Western European or Canadian, medical school, however, the average complication or death rate rose from 10.4% to 19.6% (P less than 0.05). CONCLUSIONS: The effectiveness of carotid endarterectomy depends heavily on its complication rate. Because complications after surgery cannot, in general, be predicted from structural variables, referring physicians cannot rely solely on the surgeon's experience and qualifications when recommending a carotid endarterectomy. The surgeon's and the hospital's actual postoperative complication and death rate should be considered.

Age Factors↗
PubMed1993

Oral anticoagulant therapy in the chronic phase of myocardial infarction.

A causal role of coronary thrombosis in evolving myocardial infarction is now widely accepted. Patients recovering from an acute heart attack have a higher risk of dying, or suffering another infarction, than an age-matched non-coronary population. Thrombosis plays a major part in this additional mortality and morbidity. The use of oral anticoagulants in the secondary prophylaxis of acute myocardial infarction is controversial. This article reviews the role of oral anticoagulant drugs in the prevention of secondary events in patients who have survived a heart attack.

Administration, Oral↗
PubMed2003

Hormone Replacement Therapy for Primary and Secondary Prevention of Heart Disease.

Cardiovascular disease is the leading cause of death in women. In pooled analysis, observational studies have shown a 50% reduction in death and myocardial infarction among users of hormone replacement therapy (HRT) for the primary and secondary prevention of cardiovascular disease. The first randomized trial of HRT for secondary prevention of heart disease found no benefit to therapy (Heart and Estrogen/progestin Replacement Study ). Even after 6.8 years of follow-up, there was still no cardiovascular benefit from the use of HRT (HERS II). HRT was associated with a 50% increased risk of heart attacks within the first year as well as an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) (relative risk 2.89) and gallbladder disease (RR 1.38). The Estrogen Replacement and Atherosclerosis trial found no evidence that HRT slowed the progression of subclinical angiographic disease either. This was despite a favorable effect on high-density lipoprotein and low-density lipoprotein. The first randomized trial of HRT for the primary prevention of heart disease found no overall benefit (Women's Health Initiative). The combination of estrogen and progestin resulted in a 29% increase in heart attacks, 41% increase in stroke, a doubling of thrombotic events (DVT and PE), as well as a 26% increase in breast cancer. The risk for thrombotic events was greatest in the first year whereas the risk of breast cancer increased progressively with duration of therapy. HRT is no longer recommended for the primary or secondary prevention of cardiovascular disease or stroke. It may still be considered for short-term relief of menopausal symptoms in women without high-risk conditions, but alternatives exist.

Journal Article↗
PubMed1985

Tracking of serum lipids and lipoproteins in children over an 8-year period: the Bogalusa Heart Study.

Although children initially identified as having elevated levels of coronary heart disease risk factors tend to have elevated follow-up levels (track), a substantial proportion show regression to the mean. Relationships of both genetic and environmental factors to tracking of serum lipids and lipoproteins over an 8-year period were examined in children from a biracial community. Associations between initial and follow-up levels were similar at 3, 5, and 8 years of follow-up; however, differences between the race-sex groups were observed. Two initial measurements reduced the number of nontrackers (children with high initial and decreased follow-up levels). Fathers of children showing persistently elevated levels of either serum total cholesterol or triglycerides were more likely to have diabetes mellitus or to have had heart attacks than were fathers of nontrackers. Children tracking for elevated low-density lipoprotein cholesterol levels had larger increases in triceps skinfold thickness than did the nontrackers. Children consuming alcohol tended to have elevated levels of high-density and decreased levels of low-density lipoprotein cholesterol at follow-up. These observations indicate that the use of repeated serum lipid and lipoprotein determinations, along with measurements of obesity and information concerning family history of heart attack and diabetes mellitus, can aid in the prediction of future elevated serum lipid and lipoprotein levels.

Adolescent↗
PubMed2004

[The gender approach in health-related newspaper articles].

OBJECTIVES: To use a gender approach to analyze the content of health-related articles affecting both sexes (cancer, heart attack and smoking) or mainly women (anorexia, domestic violence and abortion), published in newspapers in the 1990s. To provide recommendations for writing news with a gender-sensitive approach. MATERIAL AND METHODS: Analysis of the above-mentioned topics in articles published in the national Spanish daily newspapers El País, ABC and El Mundo (1991-1999). DATA SOURCES: computerized databases of the newspapers. Sample of 1358 articles published in the national edition containing selected terms (battering [57], anorexia [79], heart attack [118], abortion [330], smoking [350], cancer [422]). Concepts studied: visibility, empowerment and equality. Interview with key informers. RESULTS: Thirty-eight percent of newspaper articles that identified the sex of journalists were signed by women. As the main protagonists of the feature, men (73%) were more visible than women (40%). Women mainly appeared as patients (14%) whereas men mainly appeared as politicians (29%) and physicians (24%). CONCLUSIONS: Despite the efforts made in the 1990s, the gender approach in health-related newspaper articles should be increased.

Female↗
PubMed1996

The effect of medical conditions on the functional limitations of Mexican-American elderly.

We examined the relationship of self-reported functional status to common medical conditions using a probability sample of 3050 noninstitutionalized Mexican-American men and women aged 65 or older and residing in the Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas). All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. The questionnaire obtained information on self-reported functional status and prevalence of arthritis, cancer, diabetes, stroke, heart attack, and hip fracture. The prevalence of medical conditions ranged from 4.1% for hip fracture to 40.8% for arthritis. Prevalence of impairments in seven activities of daily living ranged from 5.4% for eating to 11.7% for bathing, while 25.1% could not walk up and down stairs, and 28.9% could not walk a half mile without help. In multiple logistic regression analyses, previous diagnoses of stroke and hip fracture were most predictive of functional limitations, though all conditions examined (arthritis, cancer, diabetes, stroke, heart attack, and hip fracture) were independently associated with increased odds of impairment in some activities of daily living. In general, the odds for functional impairment associated with specific medical conditions were higher than those previously published for non-Hispanic white populations. The fact that Mexican-American elderly who live in the community and who have medical conditions, especially stroke and hip fracture, are at high risk for functional impairment probably reflects the low rate of institutionalization in this population and has implications for the provision of community-based long-term care services for Mexican-American elderly.

Activities of Daily Living↗