Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994.
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OBJECTIVE: To estimate the fall in coronary heart disease (CHD) mortality in Scotland attributable to medical and surgical treatments, and risk factor changes, between 1975 and 1994. DESIGN: A cohort model combining effectiveness data from meta-analyses with information on treatment uptake in all patient categories in Scotland. SETTING AND PATIENTS: The whole Scottish population of 5.1 million, including all patients with recognised CHD. INTERVENTIONS: All cardiological, medical, and surgical treatments, and all risk factor changes between 1975 and 1994. Data were obtained from epidemiological surveys, routine National Health Service sources, and local audits. MAIN OUTCOME MEASURES: Deaths from CHD in 1975 and 1994. RESULTS: There were 15 234 deaths from CHD in 1994, 6205 fewer deaths than expected if there had been no decline from 1975 mortality rates. In 1994, the total number of deaths prevented or postponed by all treatments and risk factor reductions was estimated at 6747 (minimum 4790, maximum 10 695). Forty per cent of this benefit was attributed to treatments (initial treatments for acute myocardial infarction 10%, treatments for hypertension 9%, for secondary prevention 8%, for heart failure 8%, aspirin for angina 2%, coronary artery bypass grafting surgery 2%, and angioplasty 0.1%). Fifty one per cent of the reduction in deaths was attributed to measurable risk factor reductions (smoking 36%, cholesterol 6%, secular fall in blood pressure 6%, and changes in deprivation 3%). Other, unquantified factors apparently accounted for the remaining 9%. These proportions remained relatively consistent across a wide range of assumptions and estimates in a sensitivity analysis. CONCLUSIONS: Medical treatments and risk factor changes apparently prevented or postponed about 6750 coronary deaths in Scotland in 1994. Modest gains from individual treatments produced a large cumulative survival benefit. Reductions in major risk factors explained about half the fall in coronary mortality, emphasising the importance and future potential of prevention strategies. (+info)
Patterns of smoking in Bulgaria.
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BACKGROUND: Although the rate of smoking-related deaths in Bulgaria is still relatively low, in international terms, it has been rising rapidly. This is likely to become worse in the future as Bulgaria faces growing pressure from transnational tobacco companies. There is, however, little information on patterns of smoking, which is necessary for development of effective policies to tackle tobacco consumption. OBJECTIVE: To describe the pattern of smoking in Bulgaria and its relationship with sociodemographic factors. DESIGN: Multivariate analysis of data on patterns of tobacco consumption from a multi-stage nationwide survey of 1550 adults. SETTING: Bulgaria, in 1997. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: 38.4% of men and 16.7% of women smoke. Smoking rates are strongly associated with age, with 58% of men and 30% of women aged 30-39 smoking whereas only 5% of men aged 70 years and older and almost no women of this age smoke. Smoking is more common in cities, among those who are widowed or divorced, or who do not own their home. There is no clear association with household income or, for men, with education, although there is a suggestion that smoking may be more common among more highly educated women. CONCLUSIONS: The observed pattern of smoking indicates the need for a robust policy to tackle smoking in Bulgaria, especially among the young in large cities, informed by a better understanding of why smoking rates vary among different groups. (+info)
Psychosocial factors related to adolescent smoking: a critical review of the literature.
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OBJECTIVE: To extend the analysis of psychosocial risk factors for smoking presented in the United States surgeon general's 1994 report on smoking and health, and to propose a theoretical frame of reference for understanding the development of smoking. DATA SOURCES: General Science Index, Medline, PsycLIT, Sociofile, Sociological Abstracts, and Smoking and Health. Holdings of the Addiction Research Foundation of Ontario Library as well as the authors' personal files. STUDY SELECTION: Reviewed literature focused on studies that examined the association of sociodemographic, environmental, behavioural, and personal variables with smoking. DATA SYNTHESIS: Adolescent smoking was associated with age, ethnicity, family structure, parental socioeconomic status, personal income, parental smoking, parental attitudes, sibling smoking, peer smoking, peer attitudes and norms, family environment, attachment to family and friends, school factors, risk behaviours, lifestyle, stress, depression/distress, self-esteem, attitudes, and health concerns. It is unclear whether adolescent smoking is related to other psychosocial variables. CONCLUSIONS: Attempts should be made to use common definitions of outcome and predictor variables. Analyses should include multivariate and bivariate models, with some attempt in the multivariate models to test specific hypotheses. Future research should be theory driven and consider the range of possible factors, such as social, personal, economic, environmental, biological, and physiological influences, that may influence smoking behaviour. The apparent inconsistencies in relationships between parental socioeconomic status and adolescent disposable income need to be resolved as does the underlying constructs for which socioeconomic status is a proxy. (+info)
Factors associated with pharyngeal carriage of Neisseria meningitidis among Israel Defense Force personnel at the end of their compulsory service.
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In this 1 year cross-sectional study of personnel being discharged from compulsory military service, an available database of health-related information was used to examine the association of meningococcal carriage with socio-demographic factors. A representative, systematic sample of 1632 personnel was interviewed and had throat cultures taken. The overall meningococcal carriage rate was 16%. Serogroups B and Y accounted for 76% and 13% of the isolates respectively. In univariate analysis, carriage was associated with male gender (P < 0.0001), < 12 years school education (P = 0.002), smoking (P = 0.014), and service at a 'closed' base, reflecting greater interpersonal contact (P < 0.0001). In multivariate analysis, only service on a closed base and male gender retained significance. School education of < 12 years remained significant for females only. Variables not associated with carriage included number of siblings, intensity of smoking, and use of the contraceptive pill. In this setting, meningococcal carriage was associated with the type of base on which soldiers served; and smoking was not an independent risk factor for carriage. (+info)
Active infection with Helicobacter pylori in healthy couples.
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The mode of spread of Helicobacter pylori infection is subject to ongoing debate. Recent studies among patients with gastrointestinal disorders suggest a potential role of conjugal transmission. In this study, the clustering of H. pylori infection was assessed among 110 employees of a health insurance company and their partners. Active infection with H. pylori was measured by the 13C-urea breath test. Information on potential confounders was collected by a standardized questionnaire. Overall, 16 employees (14.5%) and 24 partners (21.8%) were infected. While only 7% (6/86) of employees with an uninfected partner were infected, this applied to 42% (10/24) of employees with an infected partner. A very strong relation between partners' infection status persisted after control for age and other potential confounders (adjusted odds ratio, 7.0; 95% confidence interval, 1.8-26.7). Furthermore, the risk of infection increased with the number of years lived with an infected partner. These results support the hypothesis of a major role of spouse-to-spouse transmission of H. pylori infection. (+info)
Epidemiology of Chlamydia pneumoniae infection in a randomly selected population in a developed country.
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This cross-sectional study of 400 sera from a randomly selected adult population in Northern Ireland, using a microimmunofluorescence assay, demonstrated high overall seropositivity (70%) for IgG Chlamydia pneumoniae antibodies in developed populations. Seropositivity was shown to be unrelated to gender, age or smoking but there was an inverse trend between infection and educational level achieved as a measure of socio-economic status. IgG levels were also higher during the winter months suggesting seasonal variation of Chlamydia pneumoniae infection. The high prevalence of evidence of exposure to Chlamydia pneumoniae as described in this study may have implications for prevention of cardiovascular disease if further evidence conclusively determines that infection with this organism is a risk factor for cardiovascular disease. (+info)
Total tooth loss among persons aged > or =65 years--selected states, 1995-1997.
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Loss of all natural permanent teeth (edentulism) substantially reduces quality of life, self-image, and daily functioning. Although loss of teeth results from oral diseases such as dental caries and periodontitis, it also reflects patient and dentist attitudes, availability and accessibility of dental care, and the prevailing standard of care. One of the national health objectives for 2000 is to reduce to no more than 20% the proportion of persons aged > or =65 years who have lost all their natural teeth (objective 13.4). Edentulism has been declining in the United States since the 1950s, but few state-specific data are available on adult tooth loss. To estimate the prevalence of edentulism among persons aged > or =65 years, CDC analyzed data from the 46 states that participated in the oral health module of the 1995-1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the findings from this analysis, which indicate a large state-specific variation in edentulism and that many states have not yet achieved the national health objective for preventing total tooth loss. (+info)
The public/private mix and human resources for health.
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This paper examines the general question of the public/private mix in health care, with special emphasis on its implications for human resources. After a brief conceptual exercise to clarify these terms, we place the problem of human resources in the context of the growing complexity of health systems. We next move to an analysis of potential policy alternatives. Unfortunately, a lot of the public/private debate has looked only at the pragmatic aspects of such alternatives. Each of them, however, reflects a specific set of values--an ideology--that must be made explicit. For this reason, we outline the value assumptions of the four major principles to allocate resources for health care: purchasing power, poverty, socially perceived priority, and citizenship. Finally, the last section discusses some of the policy options that health care systems face today, with respect to the combinations of public and private financing and delivery of services. The conclusion is that we need to move away from false dichotomies and dilemmas as we search for creative ways of combining the best of the state and the market in order to replace polarized with pluralistic systems. The paper is based on a fundamental premise: The way we deal with the question of the public/private mix will largely determine the shape of health care in the next century. (+info)