健康干预对冠心病患者戒烟、他汀类及阿司匹林使用的影响简

目的：观察健康干预对冠心病患者戒烟,他汀类及阿司匹林使用等行为的改善作用。方法选择有吸烟史的冠心病患者300例,通过多种途径开展健康干预,采取问卷调查评价干预前后吸烟、他汀类和阿司匹林的使用情况以及失败原因。结果干预前后吸烟率、他汀类的使用人数比较差异有统计学意义（P＜0．05）,但阿司匹林的使用人数比较差异无统计学意义（P＞0．05）;戒烟不成功、未使用他汀类及阿司匹林的主要原因分别为缺乏自我控制能力、认为血脂正常不需要服药、合并消化道疾病等。结论健康干预能提高冠心病患者戒烟率,他汀类和阿司匹林的使用率,是基层地区慢性病适宜技术推广的有效途径之一。     

Determinants of health service use and expenditure among the elderly Finnish population

Background: There is a need to identify significant determinantsof physician and public health nurse visits, hospital in-patientand home care, use of prescribed medication and total expenditureamong elderly people for planning of health policy. Methods:The data were obtained from three annual computer-assisted telephoneinterview surveys in 1992–1994. Each year a systematicsample of approximately 2,300 non-institutionalized people aged25-79 years were interviewed. The 60-79 year old respondentswere included in our analysis (n=1,707); the response ratesin this age group were approximately 75% each year. In thisstudy we tested the suitability of four regression models: Poisson,negative binomial, logit plus zero-truncated Poisson and logitplus zero-truncated negative binomial. Results: The use of servicesincreased with age, particularly hospital in-patient and homecare. Although women were more likely to use services, particularlyprimary care, their share of total expenditure was lower thanthat for men. Significant predictors of higher expenditure wereown personal doctor, other specific doctor, perceived healthstatus, psychosomatic symptoms, chronic illness and difficultiesin functional ability. Those living alone had significantlyhigher expenditures. Conclusion: It emerged that, while a largenumber of elderly people had used services, only a small minorityhad accounted for the majority of expenditure. Although thepersonal doctor system may produce high quality of care, itcannot achieve cost savings.     

老年冠心病患者联用他汀对氯吡格雷疗效的影响:回顾性队列研究

目的 比较老年冠心病患者单用氯吡格雷与氯吡格雷联用不同代谢途径他汀的疗效.方法 入选1021例2000年1月至2011年2月服用氯吡格雷的老年冠心病患者,其中单用氯吡格雷178例,氯吡格雷联用他汀843例[经细胞色素P-450家族3A亚家族多肽4(CYP3A4)代谢的他汀636例和非CYP3A4代谢他汀207例).研究主要终点为随访期内全因死亡,次要终点为心绞痛或心肌梗死再入院、血管再通术(冠状动脉介入治疗或冠状动脉搭桥术)、脑卒中和短暂性脑缺血发作.结果 单用氯吡格雷组和氯吡格雷联用他汀组发病密度(全因死亡)分别是6.86‰和3.18‰,RR=2.15 (95％CI:1.39～ 3.33),两组全因死亡率比较差异有统计学意义(x2=3.53,P＜0.01);终点事件发生率比较差异无统计学意义(P＞0.05);对所有混杂因素倾向评分后,按1∶1匹配,氯吡格雷联用他汀组较单用氯吡格雷组明显降低全因死亡率,RR=0.42(95％CI:0.19～ 0.93),差异有统计学意义(x2＝7.23,P＜0.01);不同代谢途径他汀匹配前后全因死亡率及终点事件发生率比较,差异无统计学意义(P＞0.05).结论 老年冠心病患者氯吡格雷联用他汀的全因死亡率明显低于单用氯吡格雷;而不同代谢途径他汀(经CYP3A4途径代谢和不经CYP3A4途径代谢)对死亡率及不良事件发生率影响的差异无统计学意义.     

老年冠心病患者联用他汀对氯吡格雷疗效的影响:回顾性队列研究

目的 比较老年冠心病患者单用氯吡格雷与氯吡格雷联用不同代谢途径他汀的疗效.方法 入选1021例2000年1月至2011年2月服用氯吡格雷的老年冠心病患者,其中单用氯吡格雷178例,氯吡格雷联用他汀843例[经细胞色素P-450家族3A亚家族多肽4(CYP3A4)代谢的他汀636例和非CYP3A4代谢他汀207例).研究主要终点为随访期内全因死亡,次要终点为心绞痛或心肌梗死再入院、血管再通术(冠状动脉介入治疗或冠状动脉搭桥术)、脑卒中和短暂性脑缺血发作.结果 单用氯吡格雷组和氯吡格雷联用他汀组发病密度(全因死亡)分别是6.86‰和3.18‰,RR=2.15 (95％CI:1.39～ 3.33),两组全因死亡率比较差异有统计学意义(x2=3.53,P＜0.01);终点事件发生率比较差异无统计学意义(P＞0.05);对所有混杂因素倾向评分后,按1∶1匹配,氯吡格雷联用他汀组较单用氯吡格雷组明显降低全因死亡率,RR=0.42(95％CI:0.19～ 0.93),差异有统计学意义(x2＝7.23,P＜0.01);不同代谢途径他汀匹配前后全因死亡率及终点事件发生率比较,差异无统计学意义(P＞0.05).结论 老年冠心病患者氯吡格雷联用他汀的全因死亡率明显低于单用氯吡格雷;而不同代谢途径他汀(经CYP3A4途径代谢和不经CYP3A4途径代谢)对死亡率及不良事件发生率影响的差异无统计学意义.     

Networks, resources and risk among women who use drugs

The public health tradition of intervening at the environmental level has not been fully exploited in terms of HIV prevention efforts among drug users. Women who use drugs are at particularly high risk of acquiring HIV and other blood borne and sexually transmitted infections, such as hepatitis B (HBV) and hepatitis C (HCV), and could potentially benefit from environmental level interventions. In a review of the existing literature, we examine the extent to which the linkages among multiple causal levels may contribute to the disease transmission risk experienced by women who use drugs. The multiple causal levels of risk potentially involved in the transmission dynamics of infectious pathogens include biological, behavioral, dyadic relationship, network, and structural levels. Biological and behavioral risk factors have already been examined in depth; yet, little empirical research currently exists for other causal levels. Increasingly, investigators suggest that the character and dynamics of relationships with sex partners may be an important determinant of risk, both for engaging in risk behaviors and for doing so with high-risk partners. The influence of higher-order causal level factors, specifically network and structural factors, are the least well documented, but are posited to be a principal underlying cause of the current differential HIV incidence rates between men and women who use drugs. Future research should focus on these higher-order causal levels, in order to better understand disease transmission dynamics; to better evaluate the limitations, as well as the opportunities, of current intervention efforts; to develop interventions that improve and supplement current HIV prevention efforts among women who use drugs; and to inform public policy debate.     

Smokeless tobacco use among male adolescents: patterns, correlates, predictors, and the use of other drugs

Questionnaire data from a sample of 3,023 adolescents indicated that over 60% of boys have tried smokeless tobacco, and 7% use it daily. Daily users reported an average of 5.3 uses per day. Among boys the prevalence of smokeless tobacco use in the past 6 months (18.8%) was higher than that for cigarette use (10.4%). For 86% of boys, the initial use of smokeless tobacco occurred in a social setting with other boys. Split-sample discriminant analyses identified peer use of smokeless tobacco as a discriminator between users and nonusers. Male triers of smokeless tobacco were discriminated from those who had never tried it by whether they had also tried smoking, intended to smoke, or had peers who used smokeless tobacco. Nine-month longitudinal data indicated that onset of smokeless tobacco use was not well predicted. Among daily users, the initial rate of use was the best prospective predictor of rate of use at follow-up (r = 0.576). Smokeless tobacco use was related to the use of other drugs, with 83% of male daily users indicating concurrent use of alcohol, marijuana, and/or cigarettes (tau = 0.354, 0.210, and 0.284, respectively). The use of smokeless tobacco was a prospective risk factor for the onset or increased use of cigarettes, alcohol, or marijuana.     

Dietary supplementation habits and perceptions of supplement use among elite Finnish athletes

The aim of this study was to evaluate the frequency of dietary supplement (DS) use among elite Finnish athletes in 2002 and 2009. In 2009, the authors also wanted to examine the reasons for athletes' DS use, whether athletes feel they have experienced benefits from their supplement use, and whether athletes had had an opportunity to consult dietary specialists. Cross-sectional studies were conducted in 2002 and 2009 among Finnish Olympic athletes. Data were collected using semistructured questionnaires, mainly in national team camps. The study population in 2002 was 446 athletes, and in 2009 it was 372. The number of DS users was high in both study years (81% in 2002 and 73% in 2009). Vitamin D consumption was low in both 2002 and 2009 (0.7% and 2.0%, respectively). An increase was found in consumption of omega-3 fatty acids between study years (11% in 2002 and 19% in 2009; p = .002), and their regular use nearly doubled (8% and 15%, p = .002). For vitamin and mineral users, the main reason for DS use was to prevent nutritional deficiencies, and for nutritional supplement users the main reason was recovery from exercise. Only 27% of all athletes and 30% of DS users had an opportunity to consult dietary specialists in 2009. This survey shows that supplementation rates among elite Finnish athletes are high and there may be over- and underuse of some micronutrient supplements. There is a need for professional nutritional counseling among national elite athletes.     

Reasons for consultation and explanations of illness among Finnish primary-care patients

The aim of this study is to describe triggers to consultation, and to further understanding of how patients construct explanations for what is wrong with them. Patients consulting a general practitioner were interviewed about the process that had led to their consultation and explanations for the causes of their illness. The results show that the factors which trigger professional consultation are related to the everyday demands of work, home and other people on the one hand, and to the interpretation of bodily symptoms on the other. Characteristically, symptom interpretation often involves a veiled dialogue with the tax-funded municipal health care system about a justification for the lay diagnosis. The results further show a domination of biomedical illness explanations among the patients studied. A third of the explanations concerned infectious, toxic and noxious agents, and a quarter constitutional defects in the body. Ten per cent were philosophical and metaphysical, and 16 per cent psychosocial in nature. The remainder were based on life style and risk behaviour, and on problems of medical care. The results are discussed from the standpoint of lay and professional models of explanation for illness.     

The association between body height and coronary heart disease among Finnish twins and singletons

OBJECTIVE: An inverse association between body height and the incidence of coronary heart disease (CHD) has been observed. However, the mechanisms behind this association are still largely unknown. We will examine the role of genetic and familial factors behind the association in a large twin data set. DESIGN AND SETTING: The data were derived from the Finnish Twin cohort including 2438 singletons, 4073 monozygotic (MZ) twins, and 9202 dizygotic (DZ) twins aged 25-69 years at baseline in 1976. Incident CHD cases were derived from hospital discharge data and cause of death data between 1977 and 1995. Cox regression analysis and conditional logistic regression analysis were used. RESULTS: In population-level analyses no differences in the general risk of CHD between zygosity groups were found. The association between body height and CHD was similar between sexes and zygosity groups. When men and women in all zygosity groups were studied together an increased risk of CHD was found only among the shortest quartile (hazard ratio [HR] = 1.34, 95% CI: 1.14-1.57). Among the twin pairs discordant for CHD a suggestive increased risk for the shorter twin was seen among DZ twins (odds ratio [OR] = 1.19, 95% CI: 0.95-1.48) when men and women were studied together. CONCLUSION: An inverse association between body height and CHD was broadly similar between sexes and twin zygosity groups and was associated with short stature. Among discordant twin pairs we found a weak association among DZ twins but not MZ twins. This may suggest the role of genetic liability behind the association between body height and CHD.     

Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians.

BACKGROUND: Understanding the effectiveness of policies and programs aimed at combating substance abuse in the military requires comparison with the civilian population from which military personnel are drawn. METHODS: Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians were conducted with data from the 1985 Worldwide Survey of Alcohol and Nonmedical Drug Use among Military Personnel and the 1985 National Household Survey on Drug Abuse. The two data sets were equated for age and geographic location of respondents, and civilian substance use rates were standardized to reflect the sociodemographic distribution of the military. RESULTS: Military personnel were significantly less likely than civilians to use drugs, but were significantly more likely to use alcohol and cigarettes and to engage in heavy use of alcohol and cigarettes. Heavy drinking was especially likely among young military men. Military women were similar to military men in their smoking and drug use patterns. CONCLUSIONS: Findings suggest that military policies and programs have been notably effective in reducing drug use, but that efforts to limit alcohol and cigarette use should be intensified. Military efforts directed against alcohol abuse should be targeted toward younger men, while smoking and drug prevention programs should be directed toward both men and women.     

The risk of asthma among Finnish patients with farmer's lung

OBJECTIVES: To assess the incidence and risk of asthma in patients with farmer's lung in comparison with farm workers without farmer's lung. METHODS: The details of farmers and animal-husbandry workers notified in 1988-1999 for farmer's lung ( n=1,272) or other occupational disease ( n=5,045) to the Finnish Register of Occupational Diseases were followed until 31 December 2000 through two national registries of individuals eligible for reimbursement of the cost of asthma medication and the Population Register Center. Incidence rates of asthma were calculated, and a log-linear model adjusted for age, gender and occupation was used to estimate relative risks of asthma among those with farmer's lung compared to those with other occupational disease. RESULTS: Of the patients with farmer's lung, 109 (8.6%) were diagnosed with asthma during the follow-up compared with 202 (4.0%) incident cases of asthma among those in the reference population. The crude relative risk of asthma was 2.1 (95% CI 1.6-2.6) among those with farmer's lung compared with the reference population. The age- and occupation-adjusted relative risk of asthma among patients with farmer's lung was 2.5 (1.8-3.5) in men and 1.4 (1.0-1.9) in women. The rate of asthma was especially high during the first 2 years after notification of farmer's lung. CONCLUSIONS: Patients with farmer's lung have an increased risk of developing asthma in comparison to farm workers in general. Most of the cases of asthma occur relatively shortly after the diagnosis of farmer's lung, which should be taken into account in medical follow-up of patients with farmer's lung.     

Perioperative use of statins in noncardiac surgery

Background

Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) can significantly decrease cardiovascular mortality and morbidity, irrespective of the patients’ cholesterol status. This paper reviews the effects of perioperative statin therapy in patients undergoing noncardiac surgery.

Method

A systematic literature review was undertaken of all published literature on this subject using Medline and cross-referenced. All published relevant papers on the perioperative use of statins were used.

Results

Perioperative statin therapy is associated with a lower perioperative morbidity and mortality in patients undergoing elective or emergency surgery. The effects are due to a combination of lipid-lowering and pleiotropic properties of statins.

Conclusion

Ideally a large scale multi-centre randomized controlled trial of perioperative statin therapy should be performed but this may be difficult to conduct since there is already overwhelming evidence in the literature to suggest perioperative cardiovascular protective properties. Statins may still be under-prescribed in surgical patients.