3.3.2015 With the acceptance by Minister Wells and Minister Varadkar of the recommendations of the International Working Group (IWG) report on an all island model for congenital heart disease, a framework of governance which can facilitate the work required and recognise the cross jurisdictional responsibilities is required. An All Island Clinical Network to manage the all-island service delivery model offers a way of doing this which builds on existing services and draws them together in a network of care which is service user focused and locally responsive. Download document here
In the U.K., coronary heart disease has reached epidemic proportions. It is the commonest cause of death after the age of 35 years and the fastest rate of increase is in early middle age. The epidemic is due mainly to our way of life. The most important factors are dietary, with smoking, physical inactivity and stress also contributing. Twenty independent working parties from different countries have reviewed the dietary evidence and reached a strong consensus on dietary recommendations. Little action has been taken in the U.K. The Coronary Prevention Group has been formed to consider the reasons for this inaction and also the implication for research, the government, the Ministry of Agriculture, Fisheries and Food, the Department of Health and Social Security, the food and agriculture industries, caterers, nutrition education and for individuals, of the dietary recommendations.
Abstract Background The cause of coronary disease inframortality in Spain is unknown. The aim of this study is to identify Spanish towns with very low ischemic heart disease mortality, describe their health and social characteristics, and analyze the relationship with a series of contextual factors. Methods We obtained the number of deaths registered for each of 8,122 Spanish towns in the periods 1989-1998 and 1999-2003. Expected deaths, standardized mortality ratio (SMR), smoothed Relative Risk (RR), and Posterior Probability (PP) of RR > 1 were calculated using Bayesian hierarchical models. Inframortality was defined as any town that displayed an RR below the 10 th percentile, an SMR of under 1 for both sexes, and a PP of RR > 1 less than or equal to 0.002 for male and 0.005 for female mortality, during the two periods covered. All the remaining towns, except for those with high mortality classified as "tourist towns", were selected as controls. The association among socioeconomic, health, dietary, lifestyle and vascular risk factors was analyzed using sequential mixed logistic regression models, with province as the random-effects variable. Results We identified 32 towns in which ischemic heart disease mortality was half the national rate and four times lower than the European Union rate, situated in lightly populated provinces spread across the northern half of Spain, and revealed a surprising pattern of geographic aggegation for 23 of the 32 towns. Variables related with inframortality were: a less aged population (OR 0.93, 95% CI 0.89-0.99); a contextual dietary pattern marked by a high fish content (OR 2.13, 95% CI 1.38-3.28) and wine consumption (OR 1.50, 95% CI 1.08-2.07); and a low prevalence of obesity (OR 0.47, 95% CI 0.22-1.01); and, in the case of towns of over 1000 inhabitants, a higher physician-population ratio (OR 3.80, 95% CI 1.17-12.3). Conclusions Results indicate that dietary and health care factors have an influence on inframortality. The geographical aggregation suggests that other factors with a spatial pattern, e.g., genetic or environmental might also be implicated. These results will have to be confirmed by studies in situ , with objective measurements at an individual level.
Background: The cause of coronary disease inframortality in Spain is unknown. The aim of this study is to identify Spanish towns with very low ischemic heart disease mortality, describe their health and social characteristics, and analyze the relationship with a series of contextual factors. Methods: We obtained the number of deaths registered for each of 8,122 Spanish towns in the periods 1989-1998 and 1999-2003. Expected deaths, standardized mortality ratio (SMR), smoothed Relative Risk (RR), and Posterior Probability (PP) of RR > 1 were calculated using Bayesian hierarchical models. Inframortality was defined as any town that displayed an RR below the 10th percentile, an SMR of under 1 for both sexes, and a PP of RR > 1 less than or equal to 0.002 for male and 0.005 for female mortality, during the two periods covered. All the remaining towns, except for those with high mortality classified as "tourist towns", were selected as controls. The association among socioeconomic, health, dietary, lifestyle and vascular risk factors was analyzed using sequential mixed logistic regression models, with province as the random-effects variable. Results: We identified 32 towns in which ischemic heart disease mortality was half the national rate and four times lower than the European Union rate, situated in lightly populated provinces spread across the northern half of Spain, and revealed a surprising pattern of geographic aggegation for 23 of the 32 towns. Variables related with inframortality were: a less aged population (OR 0.93, 95% CI 0.89-0.99); a contextual dietary pattern marked by a high fish content (OR 2.13, 95% CI 1.38-3.28) and wine consumption (OR 1.50, 95% CI 1.08-2.07); and a low prevalence of obesity (OR 0.47, 95% CI 0.22-1.01); and, in the case of towns of over 1000 inhabitants, a higher physician-population ratio (OR 3.80, 95% CI 1.17-12.3). Conclusions: Results indicate that dietary and health care factors have an influence on inframortality. The geographical aggregation suggests that other factors with a spatial pattern, e.g., genetic or environmental might also be implicated. These results will have to be confirmed by studies in situ, with objective measurements at an individual level ; This study was funded by research study grant no. PI06/0656 from Spain's Health Research Fund (Fondo de Investigación Sanitaria)
Twenty patients with stable ischemic heart disease in functional capacity Class II‐IV underwent dental treatment. Scaling was performed in seven patients without local anesthesia. In the remaining 13 patients, pain control for restoration placement was obtained by local anesthesia: in seven patients, the anesthetics contained epinephrine, while In six this drug was omitted. Heart rate, blood pressure, and electrocardiograph were continuously monitored during the dental session. All patients had elevated systolic blood pressure and rate pressure product during treatment. In the patients who received plain local anesthetics only, the elevation In systolic blood and rate pressures was, however, significantly lower than the ischemic threshold. Arrhythmia or ST segment depression of 1 millimeter were not recorded in any of the subjects. In severely compromised ischemic heart disease patients undergoing routine dental procedures of limited chair time, plain local anesthesia seems to be the preferred analgesic modality.
O objetivo deste estudo foi correlacionar as alterações histopatológicas da cardiopatia chagásica crônica com o peso cardíaco (Pca) em homens idosos. Foram selecionados 16 corações com alterações morfológicas e sorologia positiva (idosos cc). Quantificou-se no miocárdio esquerdo as espessuras dos miocardiócitos e seus núcleos, densidade do infiltrado mononuclear e dos núcleos de miocardiócitos e a fibrose miocárdica. O Pca nos homens idosos CC foi 418,7 ±136,3g e apresentou correlação positiva e significativa com a espessura dos miocardiócitos e seus núcleos (rS=0,363 e rS=0,120, respectivamente; p<0,05) e com a fibrose intersticial (rS=0,104; p<0,05). Por outro lado, verificou-se correlação negativa e não significativa entre o Pca e o infiltrado inflamatório (rS=-0,0118 p>0.05). A densidade de núcleos de miocardiócitos apresentou correlação negativa e significativa com o Pca (rS= -0,555 p<0,05). O aumento do Pca nos homens idosos cc foi influenciado pela fibrose intersticial, bem como pela hipertrofia miocárdica e destruição de miocardiócitos.
Long-term treatment of cardiovascular disease may give impact in a high burden of medical cost for the patient. A concern arises whether the health budget allocation prepared by the Indonesian Government through "Jaminan Kesehatan Nasional" program is enough to cover medical cost for the outpatient treatment. This study aims to calculate the direct medical cost of patients with coronary heart disease and heart failure and compare it with the Indonesian Case Base Groups (INA-CBGs) tariff. This is a prospective and observational study carried out in one of the public hospitals in East Java between February and April 2015. All data related to outpatients with coronary heart disease and heart failure were analysed. Direct medical cost analysis in this study calculated from a combination of cost of medication, health professional services, electrocardiography, emergency care services, and laboratory test component, then it was compared with INA-CBGs tariff from ICD 10. Total of 390 patients included were 387 patients with coronary heart disease (99.23%) and three (3) patients with heart failure (0.77%). Average direct medical cost for patients with coronary heart disease and heart failure were IDR 130.593,6 (range IDR 50.282 – IDR 385.911) and IDR 128.587 (range IDR 112.832 – IDR 140.103), respectively. Even though this study showed that budget allocation of INA-CBGs could cover the average direct medical cost of patients with both of diseases, some patients had a direct medical cost higher than the limit of INA-CBGs allocation. Therefore, an optimal interprofessional collaboration between physician and pharmacist needed to provide medical treatment based on patient needs and keep it within budget allocation range.
Valvular heart diseases in Africa affect mainly children and young adults and are a result of rheumatic fever. Rheumatic fever is a preventable disease, but in Africa the combination of a lack of resources, lack of infrastructure, political, social and economic instability, poverty, overcrowding, malnutrition and lack of political will contributes to the persistence of a high burden of rheumatic fever, rheumatic valvular heart diseases and infective endocarditis. Combating and eradicating rheumatic fever and rheumatic heart diseases requires economic development and implementation of best practices of primary and secondary prevention measures. The barriers to achieving this goal in Africa are numerous, but not insurmountable.
<b><i>Background:</i></b> Increasing studies have reported that 5′-nucleotidase cytosolic II (<i>NT5C2</i>) has a strong relationship with coronary heart disease (CHD) development. This study was designed to examine the relationship between <i>NT5C2</i> polymorphisms and CHD in the Chinese Han population. <b><i>Methods:</i></b> We studied 501 CHD patients and 496 healthy controls from the Second Affiliated Hospital of Hainan Medical University in Hainan Province, China. Four single nucleotide polymorphisms (SNPs) in <i>NT5C2</i> were selected and genotyped using Agena MassARRAY technology. Odds ratios and 95% confidence intervals were calculated using logistic regression after adjusting for age and gender. Stratification analysis was performed by age and gender in all individuals; we especially investigated the effects of <i>NT5C2</i> SNPs on hypertension and diabetes among CHD patients. <b><i>Results:</i></b> rs2148198 of <i>NT5C2</i> was strongly associated with an increased risk of CHD (allele: <i>p</i> = 0.045; codominant: <i>p</i> = 0.007; additive: <i>p</i> = 0.016). Stratified analysis revealed that rs2148198 was associated with increased CHD risk in individuals aged ≤61 years and males. For CHD patients, rs2148198 significantly affected the risk of hypertension and diabetes (<i>p</i> < 0.05). Further, rs79237883 of <i>NT5C2</i> was associated with decreased susceptibility to hypertension in multiple genetic models for individuals with CHD (allele: <i>p</i> = 0.007; codominant: <i>p</i> = 0.001; dominant: <i>p</i> = 0.001; additive: <i>p</i> = 0.008). <b><i>Conclusion:</i></b> This study reports the association of <i>NT5C2</i> gene variants and CHD susceptibility in the Chinese Han population. Especially, <i>NT5C2</i> rs2148198 was significantly associated with CHD risk in the subgroups of males, hypertension, and diabetes.
BACKGROUND: The burden of ischemic heart disease (IHD) is high. There is limited information on the burden of IHD in identified high risk areas like Central Asia (CA) which is comprised of Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, Mongolia, Uzbekistan and Tajikistan. This study addresses the burden of IHD in CA at the regional and country levels. METHODS: Using data from the latest iteration of the Global Burden of Disease Study (GBD), this study provides age-adjusted mortality, prevalence, and Disability Adjusted Life Years (DALYs) of IHD by sex in the CA region, and national levels for countries in this region from 1990 to 2017. RESULTS: The CA region has a higher IHD burden than the rest of the world over the studied period. Amongst the countries within this region, age-standardized mortality and DALY rates in Uzbekistan are the highest not only in CA but worldwide, while Armenia consistently has the lowest IHD burden in CA. Unhealthy diet, high systolic blood pressure and LDL-cholesterol are the risk factors with the highest attributable IHD DALYs. CONCLUSION: Increasing burden of IHD over time in CA can be partially explained by the economic crisis in the 1990s. There is considerable variation in IHD DALY rates among countries in the CA region. The reasons for such differences are likely multifactorial such as differences in risk factors distribution, health care effectiveness, political, social and economic factors.
