The incidence of cardiovascular events remains high in patients with myocardial infarction (MI) despite advances in current therapies. New and better methods for identifying patients at high risk of recurrent cardiovascular (CV) events are needed. This study aimed to analyze the predictive value of an oral glucose tolerance test (OGTT) in patients with acute myocardial infarction without known diabetes mellitus (DM).
The prospective cohort study consisted of 123 men and women aged between 31-80 years who had suffered a previous MI 3-12 months before the examinations. The exclusion criteria were known diabetes mellitus. Patients were followed up over 6.03???1.36 years for CV death, recurrent MI, stroke and unstable angina pectoris. A standard OGTT was performed at baseline.
The Finnish National Programme for Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) 1998-2007 was set up to reduce the prevalence of COPD, improve COPD diagnosis and care, reduce the number of moderate to severe cases of the disease, and reduce hospitalisations and treatment costs due to COPD. Over 900 events for 25,000 participating healthcare workers were arranged. The major strengths of this programme included multidisciplinary strategies and web-based guidelines in nearly all primary health care centres around the country.
Data from national registries, epidemiological studies and questionnaires were used to measure whether the goals had been reached.
The prevalence of COPD remained unchanged. Smoking decreased in males from 30% to 26% (p
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Comment In: Prim Care Respir J. 2011 Jun;20(2):109-1021603847
The objective of this study was to evaluate the impact of the 2005 British Columbia Ministry of Health Smoking Cessation Mass Media Campaign on short-term smoking behavior.
National cross-sectional data are used with a quasi-experimental approach to test the impact of the campaign.
Findings indicate that prevalence and average number of cigarettes smoked per day deviated upward from trend for the rest of Canada (P = .08; P = .01) but not for British Columbia. They also indicate that British Columbia smokers in lower risk groups reduced their average daily consumption of cigarettes over and above the 1999-2004 trend (-2.23; P = .10), whereas smokers in the rest of Canada did not, and that British Columbia smokers in high-risk groups did not increase their average daily consumption of cigarettes over and above the 1999-2004 trend, whereas smokers in the rest of Canada did (2.97; P = .01).
The overall poorer performance of high-risk groups is attributed to high exposure to cigarette smoking, which reduces a smoker's chances of successful cessation. In particular, high-risk groups are by definition more likely to be exposed to smoking by peers, but are also less likely to work in workplaces with smoking bans, which are shown to have a substantial impact on prevalence. Results suggest that for mass media campaigns to be more effective with high-risk groups, they need to be combined with other incentives, and that more prolonged interventions should be considered.
Abstention from smoking extends life and compresses morbidity: a population based study of health expectancy among smokers and never smokers in Denmark.
OBJECTIVE: To estimate health expectancy--that is, the average lifetime in good health--among never smokers, ex-smokers, and smokers in Denmark. DESIGN: A method suggested by Peto and colleagues in 1992 for estimating smoking attributable mortality rates was used to construct a life table for never smokers. This life table and relative risks for death for ex-smokers and smokers versus never smokers were used to estimate life tables for ex-smokers and smokers. Life tables and prevalence rates of health status were combined and health expectancy was calculated by Sullivan's method. SETTING: The Danish adult population. MAIN OUTCOME MEASURES: The expected lifetime in self rated good health or without longstanding illness for never smokers and smokers. RESULTS: The expected lifetime of a 20 year old man who will never begin to smoke is 56.7 years, 48.7 (95% confidence interval (CI), 46.8 to 50.7) years of which are expected to be in self rated good health. The corresponding figures for a man who smokes heavily are 49.5 years, 36.5 (95% CI 35.0 to 38.1 ) years of which are in self rated good health. A 20 year old woman who will never begin to smoke can expect to live a further 60.9 years, with 46.4 (95% CI 44.9 to 47.8) years in self rated good health; if she is a lifelong heavy smoker, her expected lifetime is reduced to 53.8 years, 33.8 (95% CI 31.7 to 35.9) years of which are in self rated good health. Health expectancy based on long standing illness is reduced for smokers when compared with never smokers. CONCLUSIONS: Smoking reduces the expected lifetime in good health and increases the expected lifetime in poor health.
International studies have found that smoking is increasingly concentrated among lesser-privileged individuals and marginalised groups, indicating a possible rise in daily smokers' accumulated problem burden. The study asks whether material shortages and occurrence of behaviours related to poor health are increasing among daily smokers in Norway, and whether the time trends differ between daily smokers on the one hand, and occasional and non-smokers on the other.
The study used data acquired by biennial cross-sectional surveys from 1999 to 2013 of the adult (i.e. over 15) Norwegian population. Time trends in individual and accumulated material and lifestyle problems among daily smokers and non-daily and non-smokers combined were assessed using logistic regression analyses for men and women separately.
The accumulation of problems in any isolated survey is higher among daily smokers than other respondents. Over the longer term, however, there are few signs of decline in any group, except in regards to frequent alcohol drinking, which increased in all studied groups. The only problem factor differentiating daily smokers from occasional smokers/non-smokers that did change during the period was quality of diet. While problem accumulation declined in all but one group, i.e., male daily smokers, the difference between them and the group of occasional smokers and non-smokers was not significant.
Daily smokers are generally worse off than occasional smokers and non-smokers combined. However, the accumulation of material problems and health-risk behaviours by daily smokers and occasional smokers/non-smokers did not change significantly and all groups had fewer problems in 2013 than in 1999.
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Cites: J Public Health (Oxf). 2012 Aug;34(3):390-622375070
Cites: Am J Clin Nutr. 1998 Feb;67(2):231-99459370
Low back pain (LBP) is common already in adolescence, and many risk indicators including both psychosocial and lifestyle factors have been recognized. Our purpose was to assess whether the co-occurrence of psychosocial (externalizing and internalizing) problems and lifestyle factors (leisure time physical activity, sedentary behaviour, sleep, smoking, and overweight/obesity) associate with LBP at 16 years cross-sectionally or with new LBP at 18-year follow-up.
The study population, drawn from the Northern Finland Birth Cohort 1986, consisted of 1625 participants (712 boys and 913 girls) who completed a questionnaire on potential explanatory factors at 16 years and on LBP at 16 and 18 years. The outcome measure was 'reporting LBP' or 'consultation for LBP' during the past 6 months. Latent Class Analysis (LCA) was utilized to study the co-occurrence of the explanatory factors.
Among both genders, four clusters were found. Externalizing behaviour problems were associated with 'reporting LBP' (RR 1.5, boys 1.4, girls) and 'consultation for LBP' (RR 1.6 for both genders) at baseline among both genders. In addition, the cluster of multiple risk behaviours was associated with both 'reporting LBP' (RR 1.3) and 'consultation for LBP' (RR 2.5) and the obese cluster with 'consultation for LBP' (RR 1.7) among girls. Externalizing behaviour problems at 16 years predicted 'consultation for LBP' at 18 years among girls (RR 3.6).
Our results stress the role of psychosocial factors in reporting and seeking care for adolescent LBP.
Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, 120 Colonnade Road 6702A, AL: 6702A, Ottawa, Ontario, Canada K1A 0K9. jinfu_hu@hc-sc.gc.ca
This study aimed to assess the role of active and passive smoking in the development of renal cell carcinoma (RCC). Mailed questionnaires were completed by 1279 incident RCC cases and 5370 population controls between 1994 and 1997 in eight Canadian provinces. Data were collected on socio-economic status, smoking habits, diet and passive smoking status, as well as residential and occupational history. The study found an increased risk of RCC associated with active smoking. Elevated risk of RCC was also observed with passive smoking; compared with those never exposed to either passive or active smoking, men and women with 43 or more years of passive residential and/or occupational exposure had respective adjusted Odds Ratios (ORs) of 3.9 (95% Confidence Interval (CI) 1.4-10.6) and 1.8 (95% CI 1.0-3.3) (P=0.001 and P=0.09, respectively). Both active and passive smoking might play a role in the aetiology of RCC.
Active smoking is a well-established risk factor for myocardial infarction, but less is known about the impact of passive smoking, and possible sex differences in risk related to passive smoking. We investigated active and passive smoking as risk factors for myocardial infarction in an 11-year follow-up of 11,762 men and 13,206 women included in the Tromsø Study. There were a total of 769 and 453 incident cases of myocardial infarction in men and women, respectively. We found linear age-adjusted relationships between both active and passive smoking and myocardial infarction incidence in both sexes. The relationships seem to be stronger for women than for men. Age-adjusted analyses indicated a stronger relationship with passive smoking in ever-smokers than in never-smokers. After adjustment for important confounders (body mass index, blood pressure, total cholesterol, HDL cholesterol and physical activity) the associations with active and passive smoking were still statistically significant. Adjusting for active smoking when assessing the effect of passive smoking and vice versa, indicated that the effect of passive smoking in men may be explained by their own active smoking. In women, living with a smoker =30 years after the age of 20 increased the myocardial infarction risk by 40 %, even after adjusting for active smoking. Passive smoking is a risk factor for myocardial infarction on its own, but whereas the effect for men seems to be explained by their own active smoking, the effect in females remains statistically significant.
Among inner-city populations in Canada, the use of crack cocaine by inhalation is prevalent. Crack smoking is associated with acute respiratory symptoms and complications, but less is known about chronic respiratory problems related to crack smoking. There is also a gap in the literature addressing the management of respiratory disease in primary health care among people who smoke crack. The purpose of our study was to assess the prevalence of acute and chronic respiratory symptoms among patients who smoke crack and access primary care. We conducted a pilot study among 20 patients who currently smoke crack (used within the past 30 days) and who access the "drop-in clinic" at an inner-city primary health care center. Participants completed a 20- to 30-min interviewer-administered survey and provided consent for a chart review. We collected information on respiratory-related symptoms, diagnoses, tests, medications, and specialist visits. Data were analyzed using frequency tabulations in SPSS (version 19.0). In the survey, 95 % (19/20) of the participants reported having at least one respiratory symptom in the past week. Thirteen (13/19, 68.4 %) reported these symptoms as bothersome. Chart review indicated that 12/20 (60 %) had a diagnosis of either asthma or chronic obstructive pulmonary disease (COPD), and four participants (4/20, 20 %) had a diagnosis of both asthma and COPD. Majority of the participants had been prescribed an inhaled medication (survey 16/20, 80 %; chart 12/20, 60 %). We found that 100 % (20/20) of the participants currently smoked tobacco, and 16/20 (80 %) had smoked both tobacco and marijuana prior to smoking crack. Our study suggests that respiratory symptoms and diagnoses of asthma and COPD are prevalent among a group of patients attending an inner-city clinic in Toronto and who also smoke crack. The high prevalence of smoking tobacco and marijuana among our participants is a major confounder for attributing respiratory symptoms to crack smoking alone. This novel pilot study can inform future research evaluating the primary health care management of respiratory disease among crack smokers, with the aim of improving health and health care delivery.
While acute myocardial infarction  (AMI) mostly is a disease of the elderly it also affects younger individuals, often with serious consequenses. In 1980-1984 a study was carried out on the incidence, risk factors, infarct location and distribution of atherosclerosis among Icelanders forty years and younger with AMI. Here we present the results of a similar study carried out for the five year period 2005-2009.
Medical and autopsy records of all individuals, forty years and younger, diagnosed with AMI (I21 in ICD-10) at Landspitali, National University Hospital 2005-2009, or suffering sudden cardiac death in Iceland during the same period were reviewed. Blood tests, electrocardiograms, echocardiograms, coronary angiograms and autopsy results were reviewed with respect to AMI-criteria. Statistical comparisons of ratios and means were carried out using Chi-square test and T-test, respectively.
38 individuals 40 years and younger, 32 males and 6 females, fulfilled the diagnostic criteria of AMI. Calculated incidence for the population at risk was 10/100.000/year (14/100.000/year in 1980-1984) and the mean age ±S.D. was 36.7±3.9. Three (7.9%) died suddenly before reaching hospital but of the 35 hospitalised patients 30 day mortality was zero, compared to nine (23.7%) pre-hospital deaths and two (6.9%) hospital deaths in 1980-1984. Thus, combined pre-hospital and in-hospital (30 day) mortality was 28.9% and 7.9% in the previous and recent time periods, respectively (p=0.02). In 2005-2009, 77.1% had a smoking history and 31.4% were hypertensive compared to 97% and 6.9% in 1980-85 (p=0.026 and p=0.015, respectively). Body mass index (BMI) was higher in the later period, 28.6±4,8 kg/m2 compared to 26.1±3.6 (mean±S.D.; p=0.04) but s-cholesterol was lower, 5.1±1.4 mmol/L compared to 6.3±1.16 ( mean±S.D.; p
