Change in public perspective on cholesterol and heart disease. Results from two national surveys

The National Heart, Lung and Blood Institute, Bethesda, Md, and the Food and Drug Administration, Washington, DC, sponsored two national probability telephone surveys (N = 4000) of adults to assess attitudes and knowledge about heart disease risk from high blood cholesterol levels and the public's efforts to lower blood cholesterol levels. The first survey was conducted in 1983, before release of the results from the Lipid Research Clinics Coronary Primary Prevention Trial, which showed that a reduction in the blood cholesterol level reduced coronary heart disease; the second survey was conducted in 1986. The percentage of adults who believed that reducing high blood cholesterol levels would have a large effect on heart disease increased from 64% in 1983 to 72% in 1986, so that the importance attached to reducing high blood cholesterol levels approached that attributed to reducing smoking and high blood pressure. In 1983, 35% of adults reported that they had their cholesterol level checked vs 46% in 1986. In both years, diet changes were most frequently chosen (greater than 60%) as ways to control the blood cholesterol level; reducing dietary fat was believed to be as important as reducing dietary cholesterol. By 1986, 23% of adults reported that they made dietary changes specifically to lower their blood cholesterol level, up from 14% in 1983. These comparative data show gains in public awareness and action relating to high blood cholesterol level risk. The data can be used to develop education programs.     

Blood pressure measurement in an Australian population

A postal survey of a random sample of 1200 persons who lived in the Hunter Region of New South Wales was undertaken in order to determine their experiences of blood pressure measurement and treatment for hypertension. The corrected response rate was 89%. Ninety per cent of the 962 respondents had visited a doctor in the previous year and 69% of them reported a blood pressure measurement at their last visit. Eighty-nine per cent of the 962 respondents reported that they had undergone a blood pressure measurement in the past three years. Although 79% of the respondents reported a blood pressure measurement in the past year, only 59% of men who were aged 45 years or less had experienced such a measurement during that period. Women were more likely than were men to have had their blood pressure measured and to report a knowledge of and treatment for hypertension. As these findings suggest that a large proportion of the population has experienced a blood pressure measurement in the past three years, it appears that most of the hypertension in the community has already been detected. The value of blood pressure screening is questioned, although it would appear that a need remains for an improvement in the detection of hypertension in men under 45 years of age. The prevalence of hypertension in the community remains high in spite of the degree of attention that is paid to it by the medical profession. It is imperative to explore the possibilities for the primary prevention of hypertension.     

The North Coast Cholesterol Check Campaign. Results of the first three years of a large-scale public screening programme

Although cardiovascular disease (CVD) mortality has been declining, CVD is still the major cause of death in Australia and an elevated blood cholesterol level is considered a major contributor. Large-scale community-based screening programmes in other countries have demonstrated that a population approach can be effective in reducing cholesterol levels and the risk of CVD. The North Coast Cholesterol Check Campaign is the largest community-based cholesterol intervention programme in Australia. Since its inception in 1987, 13% of the Region's adult population (over 29,000 persons) have been screened. About half had elevated blood cholesterol levels (greater than or equal to 5.5 mmol/L) and were given dietary counselling to reduce fat intake. Mean blood cholesterol levels were significantly reduced between initial screening and follow-up in all three years. Reductions, after correction for regression, were 8%, 6% and 10%, respectively, in 1987, 1988 and 1989. There was also a consistent and significant 1.5% to 2% reduction in weight. All age/sex cohorts above age 35 were well represented each year although self-referral did bias both initial and follow-up samples towards women and the aged. Nevertheless, the proportion of men and men in their middle age increased during the three years. The proportion of participants with elevated cholesterol levels increased in each successive year while the proportion of participants who complied with referrals to visit their general practitioner and with requests to return for follow-up decreased. Over half of the North Coast adult population has now had a cholesterol test. The rate of increase in testing since the inception of the Campaign has been approximately four times the national rate. North Coast general practitioners have played a major role by catering for the increased community demand for cholesterol testing and by providing an effective referral service for the Campaign. Community-based screening programmes in Australia can detect and beneficially influence large numbers of persons with elevated cholesterol levels. Interventions like the North Coast Cholesterol Check Campaign, when conducted over a number of years, do attract higher risk and less compliant people.(ABSTRACT TRUNCATED AT 250 WORDS)     

Patient attitudes to donation of embryos for research in Western Australia

OBJECTIVE: To ascertain patients' attitudes to embryo donation for research purposes. DESIGN: Anonymous questionnaire survey. PARTICIPANTS AND SETTING: 235 couples who had embryos in storage at Concept Fertility Centre on 30 March 2003 that had been cryopreserved between 1 January 2000 and 30 June 2002. MAIN OUTCOME MEASURES: Participants' choices with regard to donating embryos to another couple, to research to improve in-vitro fertilisation (IVF) techniques or to stem-cell research, and the likelihood of couples choosing to use a range of sources to help them with their decision. RESULTS: The response rate was 57%. Twenty-nine per cent of respondents (36/126) reported they would donate their embryos to research that would improve IVF techniques and 27% (34/126) reported they would donate their embryos to stem-cell research. Fifteen per cent (19/126) would donate their embryos to another infertile couple. Willingness to donate to research was not influenced by whether the couple had previous children, or age. Women and men with moderate to strong religious beliefs were less likely to donate to research. Over 90% of respondents indicated they would seek outside help to decide the fate of their embryos. CONCLUSION: This study suggests that about 30% of couples would donate their embryos to research, and highlights the need to provide support and information to help couples through their decision-making process.     

Attitudes and practices of primary care physicians in the management of elevated serum cholesterol levels.

We conducted a telephone survey of 102 randomly selected Ottawa family physicians to determine their attitudes and practices regarding the treatment of hypercholesterolemia. Of the 102, 56% routinely measured serum cholesterol levels in all their patients over the age of 30 years, and 24% did so for patients in more restricted age ranges. The level at which they started dietary therapy averaged 6.95 mmol/L (270 mg/dl); for 25% it was less than 6.22 mmol/L (240 mg/dl). The level at which they started drug therapy averaged 8.9 mmol/L (345 mg/dl); for only 15% was it 7.23 mmol/L (280 mg/dl) or less. Two-thirds were unable to give numerical values to the serum cholesterol levels at which they started diet therapy, and 38% used the upper limits of laboratory normal values as an indication to start therapy. Our findings contrast markedly with results reported for US family physicians, who treat hypercholesterolemia much more aggressively. The variability in practices must be addressed if public campaigns to lower serum cholesterol levels are to be undertaken.     

Management of insulin-treated diabetes in Tasmania.

OBJECTIVE: To evaluate patterns of self-management, healthcare utilisation and screening for major complications among Tasmanians with insulin-treated diabetes. MAIN OUTCOME MEASURES: Frequency of self-monitoring of blood glucose, health care utilisation and screening for diabetic complications. DESIGN AND SETTING: A questionnaire survey of 1517 people listed on the Tasmanian Diabetes Register in 1995-1997. RESULTS: Response rate was 79.5%. Self-monitoring of blood glucose was reported by 98% of respondents, daily self-monitoring by 74%. About 41% of respondents were being managed jointly by GPs and diabetes specialists, 29% solely by GPs and 25% solely by diabetes specialists. Over 96% visited the doctor treating their diabetes more than once a year, but 21% reported they had never visited a diabetes educator and 43% reported they had never visited a dietitian. Most respondents aged > or = 25 years (90%) reported having an eye examination within the past two years, almost all by an eye specialist. Blood pressure was commonly assessed, but most adults indicated that the doctor treating their diabetes did not routinely examine their feet. Nearly 19% of respondents smoked cigarettes. CONCLUSIONS: Some aspects of diabetes self-care and medical care have improved in Tasmania since the 1984 survey (eg, frequency of self-monitoring of blood glucose rose from 50% to 98%). However, our findings suggest that further improvements are needed to increase daily self-monitoring of blood glucose, attendance at diabetes educator and dietitian services, and foot examinations by doctors. Additional efforts are also needed to lower the prevalence of smoking.     

Notifying patients exposed to blood products associated with Creutzfeldt-Jakob disease: theoretical risk for real people

BACKGROUND: In July 1995 the Canadian Red Cross Society recalled blood products because of the hypothetical risk of transmission of Creutzfeldt-Jakob disease (CJD) through those blood products. The authors undertook a survey to determine the views of patients and parents of patients about being notified that they or their child had received such blood products. METHODS: The study population consisted of 528 transfusion recipients, of whom 453 (85.8%) were under 16 years of age, notified by the Hospital for Sick Children, Toronto, of the CJD recalls in 1995 and 1996. Families attending an information session were asked to complete a self-administered questionnaire (85 cases). Ninety-seven families randomly selected from those who did not attend the session were interviewed by telephone. The questionnaire was adapted from a questionnaire used to evaluate families' responses to notification of transfusion and risk of HIV infection. RESULTS: More than 80% of the respondents said they wanted to be notified and would want to be notified if there were another recall. On initial receipt of the notification about two-thirds of the respondents had been anxious, fearful or angry. There was no one method of conveying the information that suited all, but a personalized letter was seen as the most acceptable method. INTERPRETATION: Most parents of children who have received blood products are in favour of being informed about the risk of CJD, despite the uncertainty of the information on risk and the anxiety that such information causes.     

The use of portable blood glucose monitors by trained lay operators.

OBJECTIVE: To evaluate the use of Reflolux II blood glucose reflectance meters by trained lay operators in a community survey. DESIGN: A random household survey involving assessment of participants' blood glucose levels by Reflolux II. For a random subsample of participants an additional sample of blood was placed onto filter paper strips and stored for later examination and assay. SETTING: The survey was conducted in the Newcastle and Lake Macquarie areas of New South Wales. PARTICIPANTS: Of the 1275 participants 15 years and over, 1229 consented to have their blood glucose assessed and 163 of these also had blood stored on filter paper strips. Data were collected by 25 interviewers. MAIN OUTCOME MEASURES: Application of blood spots to filter paper assessed the interviewers' capacity to collect samples of minimal acceptability for Reflolux II operation. Samples were considered adequate if they covered at least a 6 mm soaked disk and there was no evidence that they had been smeared or applied from both sides of the paper. The Reflolux II readings obtained by the interviewers were compared with the blood glucose values from assay of the filter paper samples. RESULTS: Only 63% of the 163 samples collected on filter paper were of acceptable quality for adequate Reflolux II operation. The overall correlation between Reflolux II blood glucose values and those determined from the blood collected on filter paper was good (r = 0.893). However, three of the eight interviewers who had five or more readings for comparison achieved correlation coefficients of < r = 0.20. Of the survey participants identified as having elevated blood glucose levels (> 8 mmol/L) by the filter paper assay, 58% (7 of 12) were not detected by the lay operated reflectance meters. Twenty-two per cent of the individuals assessed by the reflectance meter, compared with 0.5% of a population sample surveyed by the National Heart Foundation, had blood glucose values of less than 3.5 mmol/L. CONCLUSION: It would appear that there may be a considerable error rate in blood glucose values obtained by lay operators using reflectance meters, resulting in underestimation of blood glucose levels. The findings have implications for community awareness programs for diabetes and highlight the need for careful training and monitoring of lay operators in their obtaining of finger-prick blood samples and their use of reflectance meters.     

Results of the Massachusetts Model Systems for Blood Cholesterol Screening Project

OBJECTIVE.--To evaluate the effectiveness of a model blood cholesterol screening program. DESIGN.--Principal components included physician education, community-based screenings, and follow-up. A lay or professional educator provided counseling and referral advice. Half of the subjects with high blood cholesterol levels received a reminder to see their physician. SETTING.--135 sites in four Massachusetts communities. PARTICIPANTS.--10,428 adults. Males, the young, the poor, the less educated, and minorities were underrepresented. MAIN OUTCOME MEASURES.--Referral completion rates, blood cholesterol changes. RESULTS.--51.5% of those referred had visited their physicians within 2 to 4 months, increasing to 65.6% within 6 to 12 months. Older age (odds ratio [OR], 1.17 per additional decade), more education (OR, 1.17 per additional level), higher blood cholesterol levels (OR, 1.19 per additional 0.51 mmol/L), previous knowledge of level (OR, 1.34), and receiving a reminder (OR, 1.24) were significantly associated with greater likelihood of referral completion, whereas the type of educator providing counseling was not. Physicians had remeasured the blood cholesterol level of 76% of those seen, given dietary counseling to 70%, and prescribed medication to 15%. Significant changes in dietary fat were reported by both compliers and noncompliers with advice to follow up with their physicians. Six months after screening, blood cholesterol levels were 3.6% lower in noncompliers, 4.4% lower in compliers not taking cholesterol-lowering medications, and 8.8% in compliers taking such medications. CONCLUSIONS.--An effective, community-based blood cholesterol screening program can attract diverse populations and can result in most participants with high levels following up with their physicians, making dietary changes, and lowering their cholesterol levels. Additional strategies may be needed to attract underrepresented groups and to reduce the apparent overuse of cholesterol-lowering medications.     

单中心就诊2~18岁儿童胆固醇水平异常发生率及病因分析

目的: 探讨单中心就诊患儿血浆胆固醇水平异常情况及分布规律。方法: 回顾性分析2016年6月至2019年6月在北京大学第一医院有胆固醇检测结果的2~18岁儿童血浆胆固醇水平。总胆固醇(total cholesterol, TC)采用胆固醇氧化酶法,低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)采用清除法检测,计数资料比较应用卡方检验。结果: 调查有效数据11 829例,其中男性7 087例, 女性4 742例。TC升高儿童1 822例(15.4%), LDL-C升高儿童1 371例(11.6%),HDL-C降低儿童2 798例(23.7%), 胆固醇水平异常儿童总和4 427例(37.4%)。非常见继发性高脂血症病因就诊儿童7 835人,其中TC升高儿童731例(9.3%), LDL-C升高儿童561例(7.2%), HDL-C降低儿童1 886例(24.1%),胆固醇水平异常儿童总和2 576例(32.9%)。不同疾病就诊儿童中,胆固醇异常发生率差异有统计学意义(P<0.05)。TC升高及LDL-C升高发生率的前三位主要就诊原因均分别为“血脂异常”“泌尿系统疾病”“营养性疾病”。除小儿内科外,其他科室送检的1 257例患儿血脂检测样本中,300例存在胆固醇水平异常(23.8%), 其中高胆固醇血症患儿 70例(5.6%), 高低密度脂蛋白血症患儿44例(3.5%), 低高密度脂蛋白血症患儿224例(17.8%)。在非常见继发性高脂血症病因就诊儿童中,因LDL-C≥140 mg/dL (3.6 mmol/L) 需要进一步排除家族性高胆固醇血症的患儿共365例,占该部分患儿的4.6%。结论: 就诊儿童胆固醇异常发生率高,在原发病诊治的同时加强胆固醇管理不仅有助于控制继发性高胆固醇血症,也为及时发现家族性高胆固醇血症提供可能。     

Limited knowledge of kidney disease in a survey of AusDiab study participants

OBJECTIVES: To explore awareness of the causes of kidney disease and recollection of kidney function testing in a cohort of Australian adults. DESIGN, SETTING AND PARTICIPANTS: An interviewer-administered cross-sectional survey, conducted from October to December 2004 as a nested study within the 5-year follow-up phase of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab); 852 subjects who attended a testing site in New South Wales were interviewed. MAIN OUTCOME MEASURES: Responses to the questions "What sort of things do you think may lead to a person developing kidney disease?" and "Has a doctor or health care worker ever tested your kidney function, outside of the AusDiab study?" RESULTS: Respondents most commonly believed that kidney disease was caused by alcohol misuse or poor diet, with few identifying diabetes or high blood pressure. Awareness of risk factors was no greater in respondents identified as having chronic kidney disease (CKD). A third of respondents with CKD recalled having undergone a test of kidney function within the previous 2 years, while another third replied they had never had their kidney function tested. Of participants with previously diagnosed diabetes or treated hypertension, 54.1% and 32.0%, respectively, reported having their kidney function tested within the previous 2 years. CONCLUSIONS: Knowledge of risk factors for kidney disease and recall of kidney function testing were both limited, even among subgroups of the cohort who were at greatest risk of CKD. Prevention efforts may benefit from public and patient education to improve recognition of risk factors for CKD.     

Cardiac risk factor management. Experience of an outpatient hypertension clinic

OBJECTIVE: To describe the outcome of the management of cardiovascular risk factors in the hypertension clinic of a teaching hospital over a five-year period. DESIGN: Retrospective analysis of risk factor data (blood pressure, plasma cholesterol level, body weight, smoking and drinking habits) obtained from computerised hypertension clinic progress report forms. SETTING: Public teaching hospital. PATIENTS: One hundred and thirty-one patients referred to the clinic from both general practice and from within the hospital who attended the clinic regularly during the five-year study period. INTERVENTION: Long term management of hypertension and coexisting coronary risk factors by dietary, medical and lifestyle intervention. RESULTS: There was a significant improvement in diastolic blood pressure control in 1990 versus 1986 in both men and women, while systolic blood pressure improved in women only. The number of patients controlled with monotherapy increased from 38% in 1986 to 45% in 1990. Eighty-nine per cent of the men and 85% of women remained above their maximum desirable weight. Reported levels of alcohol consumption were low and the proportion of smokers was below that of the general population. A significant decline in plasma total cholesterol levels was observed in the women. Despite dietary advice and a limited use of lipid lowering drugs, 53.2% of the men and 66.1% of the women continued to have total plasma cholesterol levels above 5.5 mmol/L in 1990. High density lipoprotein levels increased significantly in the women only. CONCLUSION: A high proportion of our clinic patients have well controlled hypertension, but the clinic program produced little evidence of improvement in risk factors in men stabilised by long term therapy. More intensive methods of achieving lifestyle modification and a wider use of lipid lowering drugs may be needed if we are to achieve satisfactory body weights and lipid profiles in hypertensive patients.     

Relationship of cardiovascular risk factors and serum ferritin with C-reactive protein

BACKGROUND: Serum iron plays an important role in the oxidation of low-density lipoprotein (LDL) cholesterol, it induces inflammatory reactions and it is positively related to coronary heart disease. An increase of the inflammatory marker, C-reactive protein (CRP), is a risk factor for future cardiac events. Hence, we examined the association of the cardiovascular disease risk factors and serum ferritin with CRP. METHODS: This study was performed on 808 subjects (465 males and 343 females). CRP levels >3.0 mg/L, serum ferritin levels >200 ng/mL, total cholesterol levels >200 mg/dL and LDL-cholesterol levels >160 mg/dL were all considered as elevated. High-density lipoprotein cholesterol levels <40 mg/dL were considered as low. RESULTS: In the group with low LDL-cholesterol, no correlation was detected between serum ferritin and hsCRP [odds ratio (OR) = 1.68, 95% confidence interval (CI) = 0.81-3.48, p = 0.144]. However, a correlation was detected in the group with elevated LDL-cholesterol (OR = 11.21, 95% CI = 1.14-110.27, p = 0.032). In addition, when the interaction term was added to the assessment of the correlation between the elevated hsCRP and LDL-cholesterol, the strong correlation of hsCRP and serum ferritin was confirmed (p = 0.002). CONCLUSIONS: Oxidation of LDL-cholesterol by serum ferritin may play a role in the inflammatory reaction and for the increased hsCRP. Future prospective studies may be required to assess whether reducing the serum ferritin and CRP levels via medical intervention and life style modification would be helpful for preventing cardiovascular disease.     

Public awareness of organ donation.

A telephone survey of public attitudes toward organ donation and transplantation was conducted in a community in southwestern Ontario. The subjects were selected at random; the response rate was 57%. Of the 50 respondents 62% stated that they had signed the organ donor card accompanying their driver's licence. These respondents were more likely than those who did not sign it to have discussed organ donation with their families. At least 80% of the respondents said they would agree to donate their organs and those of their next-of-kin, and 80% said that the organ donor card should be considered a legal document. Organ transplantation was regarded by all but one respondent as an acceptable medical procedure. Also discussed were concerns about organ donation and possible strategies to improve the availability of organs for transplantation.     

Research letter: Intentions of smokers to use free nicotine replacement therapy

Public health initiatives to distribute nicotine replacement therapy free of charge as a means of promoting smoking cessation are ongoing. Are there enough smokers interested in using nicotine replacement therapy to have a substantial impact on the prevalence of smoking if this aid were distributed free to all interested smokers? We conducted a telephone survey of 825 randomly selected daily smokers aged 18 years or older who had smoked at least 10 cigarettes per day at some point in their lives. Overall, 58.9% of the respondents said they would be interested in nicotine replacement therapy if it were offered for free. Of those interested, almost all (93.8%) said that they would use the nicotine replacement therapy to help them quit for good. There were differences in the levels of interest: smokers who intended to quit were more interested in using the nicotine replacement therapy than those who planned to reduce or maintain their smoking.     

Habitual physical activity and cardiovascular risk factors

The relationships between different levels of participation in physical activity and biological indices of cardiovascular risk were examined in a sample of 6814 male and female adults who took part in a national risk factor prevalence survey. Participation in physical activity was classified as "aerobic" (14.6% of total), "moderate" (53.6%) or "inactive" (31.8%). Bivariate analyses found significant associations between level of exercise participation and diastolic blood pressures in men, but not in women; significant associations were found between reported physical activity and systolic blood pressure, total serum cholesterol, high-density lipoprotein (HDL) cholesterol, HDL/total cholesterol ratio and triglycerides for both men and women. Further analyses were controlled for age, education, and the survey site, which were potential confounders of the association between physical activity and other coronary heart disease risk factors. After adjustment, significant associations remained between levels of exercise participation and HDL cholesterol level, HDL/total cholesterol ratio and serum triglyceride levels for both sexes. In women, there was also a significant relationship between activity level and body mass index. In addition, for men only, there was a significant inverse relationship between physical activity and total cholesterol, and, for older men, between physical activity and systolic blood pressure. It is well recognised that physical activity has an independent effect on reducing the risk of coronary heart disease. The results of this study suggest that there may be small supplementary effects mediated through the relationship between exercise and other biological cardiovascular risk factors.     

Determinants of consistent condom use among adolescents and young adults attending a tertiary educational institution in Ile-Ife, Nigeria

OBJECTIVES: This study evaluated the determinants of consistent condom use among adolescents and young adults aged 15 - 29 years. METHODS: This was a cross-sectional survey to which 600 (300 of each gender) adolescents/young adults who had never married were recruited. Information was collected from respondents by means of a purpose-designed, self-administered questionnaire. Information sought includes the respondents' social and demographic characteristics, sexual practices and issues relating to condom use. RESULTS: Five hundred and thirty-six (89.3%) of the 600 questionnaires were suitable for analysis; 372 (69.4%) had had sexual intercourse. A third reported that they were having sex frequently or fairly frequently; 145 (41.7%) had more than one partner while 74 (19.9%) were aware that their partners had other sexual partners. Two-thirds of currently sexually active respondents reported that condoms were readily available and cheap although only 90 (24.2%) reported using condoms consistently. The factors that were statistically significant predictors of consistent condom use among the males were age; younger respondents were more likely to be consistent users (p = 0.015), having more than one sexual partner (p = 0.030) and ability to refuse sex with a partner who would not want to use condom (p = 0.008). Among the females, statistically significant predictors were frequency of sexual intercourse; respondent who had sex frequently were more likely to use condoms consistently (p = 0.018) and having more than one partner (p=0.018). CONCLUSION: Inconsistent condom use is rampant and females were probably disadvantaged as far as condom negotiation is concerned.     

Terminal care at home: perspective from general practice

A survey of general practitioners in north west London was undertaken by questionnaire to elicit information about problems that they had had in looking after patients at home who were terminally ill and about their perceived needs for both training and support services. The response rate was 73% (196 of 268 doctors). Thirty two per cent of respondents frequently or always had problems in controlling pain in such patients, and 45% frequently or always had difficulties in coping with the emotional distress of patients or relatives, or both. Between 20 and 30% of respondents often had problems with inadequate support services, poor communication with support services and hospital specialists, and difficulty in admitting patients who were terminally ill. Roughly half of the respondents thought that more training in managing pain and other symptoms that are associated with terminal illness would be of great help, and a similar response was noted for bereavement counselling. About 40% of respondents indicated that training in communicating with dying patients would be a great help in improving care and three quarters that more home nursing support was necessary.     

Baseline,Cross-sectional Survey of Knowledge,Attitudes, and Practices Related to Efficient Use of Government Resources in the Health Sector in Malawi

BackgroundMisuse of government resources is a challenge within the health sector that can be addressed by increasing public demand for accountability, reporting suspected misuse of resources, and other client-driven changes. This study was led by the USAID/Health Communication for Life Project to inform the design of social accountability communication messages and interventions. The study also established baseline data on Malawians'' knowledge, attitudes, and practices related to efficient use of government resources in the health sector.MethodsThis baseline, formative research study used a non-experimental, cross sectional survey design. Sampling for the mobile survey was conducted using the random digit dialing technique. Data were collected via mobile phone using interactive voice response technology. Our sample included 1,425 respondents, 67% of whom were male and 33% were female. Respondents were mostly 35 years old or younger, with more than half of female respondents reporting their age as 18–24 years.ResultsOur findings indicate that Malawians believe misuse of government resources is pervasive in Malawi. Seventy percent of men and nearly 60% of women reported having noticed, found, or seen drugs believed to be from a government health facility being sold elsewhere. Few respondents who had observed or experienced misuse of government health sector resources reported the incident. When asked the likelihood that they would report a request for a bribe, gift, or favor in exchange for health services in the future, 68% of respondents said they would report it.ConclusionsSocial and behavior change communication could serve a key role in motivating those who are aware of misuse of public sector health resources to report the issues they observe and providing them with the information needed to follow through. Further research is needed to understand the best approaches to mitigate underlying factors that drive misuse of resources and underreporting.     

基于弗明翰风险评分与血管内皮功能分类的心血管疾病危险因素研究

目的　探讨基于弗明翰风险评分（FRS）与血管内皮功能分类的心血管疾病危险因素。方法　于2015年8—9月在广西融安县泗顶镇和融水县安陲乡现场招募752例成年人为研究对象。使用FRS评估研究对象10年内心血管疾病发生风险,将其分为FRS正常（FRS≤20%）和FRS高（FRS>20%）两类;采用肱动脉血流介导的血管舒张功能（FMD）测定血管内皮功能,将其分为血管内皮功能正常（FMD≥6%）和血管内皮功能受损（FMD<6%）两类。采用Logistic回归分析不同FRS与血管内皮功能分组的心血管疾病的危险因素。结果　多因素Logistic逐步回归分析结果显示,男性、年龄大、吸烟、收缩压高、低密度脂蛋白胆固醇（LDL-C）高、三酰甘油（TG）高为FRS高但血管内皮功能正常的危险因素;男性、年龄大是FRS正常但血管内皮功能受损的危险因素;男性、年龄大、吸烟、体力活动水平中低、收缩压高、总胆固醇（TC）高、高密度脂蛋白胆固醇（HDL-C）低、C反应蛋白（CRP）高、空腹血糖高是FRS高和血管内皮功能受损的危险因素。结论　不同心血管疾病群体的危险因素存在差异,应采取针对性的个体化措施防治不同特征群体的心血管疾病。