A framework for addressing disparities in cardiovascular health

Health disparities are pervasive in the United States. Life expectancy remains higher in women than in men and higher in whites than in blacks by approximately 5 years. In general, the health of racial and ethnic minorities, poor and uneducated people, and those without health insurance is worse than the health of the overall population. The care of these vulnerable groups tends to be of worse overall quality because they have trouble accessing the system, because standards of care are applied to them unevenly, and because health professionals are not consistently trained in culturally sensitive approaches. These disparities have been demonstrated in all aspects of health and healthcare for cardiovascular diseases, including the use of diagnostic and therapeutic interventions, prevalence of cardiovascular risk factors, and access to health information. Examination of national surveys revealed disparities in all cardiovascular disease risk factors, hospitalizations for major cardiovascular disease, overall mortality, and quality of life. Eliminating these disparities is a major public health challenge in the United States. Their causes and underlying mechanisms, however, remain incompletely understood. The healthcare delivery system itself, access to care, quality of care received, communication barriers, individual behaviors, culture and lifestyles, and discrimination and bias all play a part. The pursuit of systems and policy changes to address these determinants remains crucial. We present a strategic framework for eliminating health disparities that takes these determinants into account and provides an opportunity for cardiovascular nurses to make an impact on this important issue.     

The Russian health care system today: can American-Russian CME programs help?

The health of the Russian people has deteriorated dramatically since the fall of communism, due particularly to cardiovascular disease. The Eurasian Medical Education Program was developed in response to provide continuing medical education for Russian physicians. Programs are directed mainly toward primary care physicians and focus on outpatient management of diseases that cause high rates of mortality and morbidity. This experience provides an opportunity to assess the structure and functioning of the Russian health care system and emphasizes the importance of general internal medicine training in detection, management, and prevention of disease complications.     

Medical co-morbidity risk factors and barriers to care for people with schizophrenia

The management of risk is a fundamental component of the work of mental health nurses and is most commonly associated with aggressive, violent and suicidal behaviours exhibited by those suffering from mental illness. However, people with severe mental illness are increasingly at risk of experiencing a number of related and complex health problems that include obesity, diabetes and cardiovascular disease. This group also has much higher rates of morbidity and mortality than that of the general population resulting in high social, economic and individual costs. Some of the barriers to receiving prompt and appropriate physical health care include lack of recognition by health professionals and the difficulties faced by consumers of mental health services in negotiating the health care system. Establishment of comprehensive (addressing both physical and mental health issues) programmes of care can address this need and offer additional opportunities for closer and more collaborative nurse-patient relationships. This paper explores risk factors for medical co-morbidity for people living with schizophrenia and suggests strategies that can facilitate better health outcomes.     

Adapting the severe mental illness physical Health Improvement Profile for use in primary care

People with severe mental illness (SMI) have a higher incidence of long-term physical conditions, including diabetes and cardiovascular disease. This can dramatically reduce their life expectancy. In the UK, it is the duty of health-care professionals in primary care to monitor the physical health of this group of people. However, these professionals have been given no specific training in order to do this effectively. The Northampton Physical Health and Well-Being Project has been developed in order to reduce the mortality of people with SMI, improve their physical and emotional health, and increase their support network. We have adapted the Health Improvement Profile (a tool to help mental health nurses profile the physical health of people with SMI) for use in primary care by creating a manual and website and will provide bespoke training in its use to the health-care professionals.     

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: Protocol for a randomised controlled trial

Background

People with a serious mental illness are at significantly greater risk of poor cardiometabolic health with recent studies showing a greater than two-fold increase in the risk of obesity, infectious diseases, diabetes and cardiovascular disease. Contributing factors to this disparity include poorer health behaviours such as suboptimal physical activity, poor diet, smoking, alcohol and illicit drug misuse. In particular, the limited access to primary health care experienced by people with a serious mental illness has been highlighted. Persons with a serious mental illness are around 30% less likely than those without serious mental illness to receive health assessments, hospital admissions or procedures for cardiovascular disease and diabetes, and are less likely to undergo cancer screening or receive vaccinations. Studies show that mental health consumers may be more likely to use mental health services rather than primary care for contact with the health care system. However mental health nurses report several barriers to their capacity to provide cardiometabolic health care crucial for the treatment of people with a serious mental illness.

Objectives

To assess the impact of a specialist Cardiometabolic Health Nurse on the physical health care of community based mental health consumers.

Setting

Community mental health facility in a large regional centre in Central Queensland, Australia.

Design/methods

Community based mental health consumers will be randomised to receive either usual care, or consultations with a Cardiometabolic Health Nurse. The Cardiometabolic Health Nurse will be responsible for assessing the client and coordinating cardiometabolic health care as required. Post intervention review of health records will be performed with the primary outcome measure being self-reported physical health. Secondary outcomes include the utilisation of primary care services and changes in health behaviours. We hypothesise that the Cardiometabolic Health Nurse will increase the utilisation of health care services for mental health consumers.

Results

Data collection commenced in March 2013 and will conclude September 2013. Preliminary finding are expected in December 2013.     

Nurse views on the cardiometabolic health nurse as an approach to improving the physical health of people with serious mental illness in Australia

People with serious mental illness (SMI) die prematurely from common physical illnesses such as cardiovascular disease and diabetes. These cardiometabolic risks are preventable and manageable yet these aspects of health care have been neglected in mental health services. A potential nurse‐based strategy to decisively improve cardiometabolic health of people with SMI is to introduce a cardiometabolic health nurse (CHN) into mental health services. The current study aimed to establish the views of nurses working in mental health care on the potential benefits and limits of CHN to improve physical health‐care standards in Australia. All members of the Australian College of Mental Health Nurses were invited to participate in an online survey and 643 participated. Nurses generally agreed that a CHN role would provide a range of improvements to physical health care, such as increased detection, assessment on, and follow up of cardiometabolic risks, and decreased workload for other nurses. While participants were generally supportive of such a role, they felt it would not be suitable in all health‐care settings in Australia.     

Current and future applications of genetics in primary care medicine

Individualized medical treatment and prevention based on one's genetic makeup are promises likely to be fulfilled over decades.Already family history is taking a more prominent role in preventive care. Primary care clinicians and geneticists will increasingly collaborate to diagnose and manage genetic conditions: both single-gene disorders and multifactorial diseases such as infections,cancers, cardiovascular disease and mental illness. This will require society, with primary care clinicians in the forefront, to implement means for efficient family history-taking; maintaining private, personally accessible genetic health records; safeguarding people from genetic discrimination; distributing access to scarce genetic specialists and expensive technologies; rectifying lay misconceptions about inheritance; managing emotional responses and family dynamics related to genetic diagnosis; and motivating people at increased familial risk to take preventive action.     

Optimal healing environments for chronic cardiovascular disease

A substantial increase in chronic cardiovascular disease is projected for the next several decades. This is attributable to an aging population and accelerated rates of obesity and diabetes. Despite technological advances that have improved survival for acute events, there is suboptimal translation of research knowledge for prevention and treatment of chronic cardiovascular illness. Beginning with a brief review of the demographics and pathogenesis of atherosclerotic cardiovascular disease, this paper discusses the obstacles and approaches to optimal care of patients with chronic cardiovascular disease. The novel concept of an optimal healing environment (OHE) is defined and explored as a model for integrative cardiac health care. Aspects generally underexamined in cardiac care such as intrapersonal/interpersonal characteristics of the health care provider and patient, mind/body/spirit wholeness and healing versus curing are discussed, as is the impact psychosocial factors may have on atherosclerosis and cardiovascular health. Information from research on the impact of an OHE might renew the healing mission in medicine, reveal new approaches for healing the heart and establish the importance of a heart-mind-body connection.     

Special feature: an approach to cardiac care in rural settings

Rural people with cardiovascular disease-and the nurses caring for them-face unique health care challenges. Obstacles facing patients living in small rural communities include lack of critical care specialists, inadequate technological support, and inconsistent or variable levels of 24-hour patient care services requiring patients to travel to distant tertiary centers for advanced cardiac care. Rural critical care nurses face reduced access to continuing education and inservice presentations, professional isolation, and lack of anonymity. This article introduces "Mr Smith," a rancher with cardiovascular disease living in a rural Western state. In so doing, it reviews the issues and challenges faced by rural patients and nurses. In addition, the article describes a continuing education course developed to enhance collaboration between nurses working in rural settings and a tertiary medical center.     

The prevention of heart failure in minority communities and discrepancies in health care delivery systems

This article discusses risk factors for cardiovascular disease in the minority community, including hypertension, obesity, diabetes,and diet. The minority community exhibits important population differences regarding risk and outcomes for cardiovascular disease.The complete explanation for these differential outcomes is lacking and likely to be multifactorial in origin; however, disparities in health care (differences in the quality of health care that are not due to access-related factors or clinical needs, to preferences, or to the appropriateness of the intervention) may emanate from decisions made by the patient, provider, or health care system. Hypertension as a disease entity is strikingly pathologic in African Americans. Correspondingly, the incidence of cardiovascular mortality due to hypertensive heart disease is fourfold higher in African Americans than in non-Hispanic whites. Hypertension and heart failure can be treated effectively in the minority community with a regimen of agents not dissimilar from that used for the general population. Treatment regimens should be individualized based on the disease presentation, associated comorbidity, and disease severity and not on something as arbitrary as race.     

Chest pain. How serious is it?

The very thought of chest pain often brings terror to patients and health care providers. Chest pain typically invokes a "worst case" scenario of massive myocardial infarction (MI) resulting from cardiovascular disease (CD) and requiring immediate medical attention. However, chest pain is a common complaint suffered by most people at some time in their lives. People complaining of chest pain may be young, middle-aged, or elderly, and they may or may not be under a health care provider's care. Chest pain may be a symptom of a variety of disorders other than CD. Therefore it is helpful to differentiate quickly between the types of chest pain to determine whether immediate assistance is necessary.     

我国各省心血管疾病相关健康资源分布评价

目的评价当前我国各省与人群心血管疾病密切相关的健康资源的分布现状。方法资料与数据来源于中国心血管健康指数（CHI）（2017）研究结果。 选取CHI（2017） 公共卫生政策与服务能力维度的相关指标进行测算和分析全国31个省（自治区、直辖市，不含港澳台地区）的具体情况，并对全国不同地区和分省的公共卫生政策与服务能力CHI得分进行排名比较。 CHI （2017）公共卫生政策与服务能力维度和各指标满分为100分，分数越高说明公共卫生政策与服务能力越好。结果2017年我国心血管病防控领域卫生政策与服务能力的得分平均分为50.96分。 南方地区公共卫生政策与服务能力得分（53.09分）高于北方地区（48.10分）；东部地区得分（60.52分）高于中部地区（41.51分）和西部地区（45.75分）。 上海得分最高（79.54分），其次是北京（77.09分）、江苏（75.62分）、浙江（68.93分）和天津（65.63分）。 黑龙江、山西、贵州、西藏自治区、内蒙古自治区得分较低。 2015年我国心血管疾病费用政府投入占比为29.96%，我国居民健康素养水平为10.25%，配有疾控人员1.39名/万人、全科医生1.37名/万人。 北京、天津、山东、上海和河北降压、降脂、降糖三类药物的每100万人口的消费量较高。 心血管病8类基本药物在基层医疗卫生机构的平均配备率全国平均水平为61.50%。 平均配备率最高为上海（96.95%），其次是北京（89.32%）、江苏（88.53%）、山东（84.20%）和浙江（80.32%）。结论我国区域间心血管防治健康资源分布不均，表现为东部地区优于中部和西部地区、南方优于北方的特点，体现出东部沿海地区公共卫生政策和卫生服务资源优于其他地区的特点。 基本药物在基层医疗机构的配备率和人均全科医生数量与降低心血管疾病负担相关。     

Epidemiology of diabetes and diabetes-related complications

In 2005, it was estimated that more than 20 million people in the United States had diabetes. Approximately 30% of these people had undiagnosed cases. Increased risk for diabetes is primarily associated with age, ethnicity, family history of diabetes, smoking, obesity, and physical inactivity. Diabetes-related complications--including cardiovascular disease, kidney disease, neuropathy, blindness, and lower-extremity amputation--are a significant cause of increased morbidity and mortality among people with diabetes, and result in a heavy economic burden on the US health care system. With advances in treatment for diabetes and its associated complications, people with diabetes are living longer with their condition. This longer life span will contribute to further increases in the morbidity associated with diabetes, primarily in elderly people and in minority racial or ethnic groups. In 2050, the number of people in the United States with diagnosed diabetes is estimated to grow to 48.3 million. RESULTS: from randomized controlled trials provide evidence that intensive lifestyle interventions can prevent or delay the onset of diabetes in high-risk individuals. In addition, adequate and sustained control of blood sugar levels, blood pressure, and blood lipid levels can prevent or delay the onset of diabetes-related complications in people with diabetes. Effective interventions, at both the individual and population levels, are desperately needed to slow the diabetes epidemic and reduce diabetes-related complications in the United States. This report describes the current diabetes epidemic and the health and economic impact of diabetes complications on individuals and on the health care system. The report also provides suggestions by which the epidemic can be curbed.     

2004-2008年贵州省独山县住院死亡病例根本死因分析

目的了解2004-2008年贵州省独山县住院死亡病例的死因模式。方法对独山县人民医院2004-2008年296例死亡病例进行根本死因统计分析。结果住院死亡病例占同期出院病例（39 465例）的0.75%;男性死亡193例,女性103例,男女性别比为1.87∶1;5岁以下69例（23.31%）,其中新生儿34例（占5岁以下的49.28%）;5～19岁25例（8.45%）;20～49岁96例（32.43%）;50～69岁59例（19.93%）;70岁以上47例（15.88%）。根本病因以伤害而死亡的人数位居各系统疾病死亡之首,其次是神经系统疾病、呼吸系统疾病、起源于围生期某些情况、循环系统疾病等。结论伤害对人类健康影响日益突出,心脑血管疾病死亡逐年增多,呼吸系统疾病、起源于围生期某些情况不可忽视,针对住院死亡主要成因,积极开展伤害防范、慢性病三级预防、加强妇幼保健工作和提高新生儿疾病诊治水平,是当地当前卫生工作的主要任务。     

Cardiovascular Health Promotion in Children: Program and Policy Implications

Abstract Cardiovascular disease is the leading cause of death in the United States; it is also a major factor in rising health care costs. Risk factors for the disease are present in childhood, at the time when lifelong health habits are forming. Thus, strategies for improving the cardiovascular health of children through programs and policy may be expected to have a maximum effect. The cardiovascular health in children study identified the prevalence of cardiovascular risk factors in 2209 children age 8 to 11 years, attending 21 rural and urban public schools in North Carolina. Schools were randomly selected from three regions of the state (coastal, piedmont, mountain) in which the frequency of cardiovascular disease differs. Initial results of the study demonstrate the use of such findings in formulating health policy and in designing intervention programs.     

Training practice nurses to improve the physical health of patients with severe mental illness: effects on beliefs and attitudes

Annual health checks are recommended for patients with severe mental illness (SMI) as they are at high risk of cardiovascular disease. Ideally, these health checks should be carried out in primary care. Practice nurses are already competent in carrying out physical health checks, but might have misconceptions about mental illness, which is a barrier to offering the service. We used a mirror imaging study to establish the effectiveness of a training package for practice nurses that aims to address common misconceptions about the physical health of people with SMI. This 2-hour training package (Northampton Physical Health and Wellbeing Project) was delivered to eight practice nurses. Their misconceptions and beliefs were assessed before and after training. Motivation to work with community mental health workers was assessed after training. The practice nurses involved in the study rejected commonly held misconceptions about the physical health of people with SMI after training. Their attitudes towards their role in providing health checks appeared to be modified in a positive direction. Their motivation to work with community mental health workers also seemed to be enhanced. The Northampton Physical Health and Wellbeing Project training was effective in modifying practice nurses' misconceptions about physical health in people with SMI.     

军队离退休干部健康状况和卫生保健需求的调查与分析

目的探讨离退休老干部健康状况和卫生保健需求。方法采用问卷调查法对老干部的卫生保健需求进行调查分析,依据2005年军队离退休老干部健康查体资料数据,探讨老干部的健康状况。结果被调查的1100名老干部中,无慢性疾病者占4.2%,患1种慢性疾病者占9.8%,患2种及以上慢性疾病者占86.0%;生活自理能力方面,完全自理者占51.6%,部分自理者占39.1%,不能自理者占9.3%;有卫生保健需求(康复治疗、健康认知)者占86.0%,其中,有12.0%的老干部有降低医疗费用的需求。结论老干部的健康状况值得关注;加强医院外健康教育的延续性、广泛性及完善、适宜的老干部健康社区管理和社区整体服务体系,是提高老干部生活质量的关键。     

Gene therapy for the treatment of cardiovascular disease

Although still experimental at the present time, gene therapy for the treatment of cardiovascular disease is on the horizon. Numerous clinical trials in patients with flow-limiting coronary artery disease are in progress. In order to keep up with advances in gene therapy, critical care nurses must develop a background in this discipline. This challenge rests in the hands of nursing educators to incorporate a sufficient amount of genetic content into the curriculum. Genetics in the curriculum is essential because it is the central science of health care. Genetic discoveries are changing our understanding of the mechanisms of disease and the diagnosis, treatment, and prevention of cardiovascular disease in particular. Gene therapy is likely to influence our daily nursing practice, and nurses must have an adequate knowledge of genetics to provide accurate information to patients and families so that they can make informed decisions about their health care.     

Nurse practitioners and traditional healers: an alliance of mutual respect in the art and science of health practices

The indigenous people of Hawaii have had difficulty adapting to the Western diet and stressful lifestyle of today's mixed cultural and economic development. This has left a health toll of high rates of diabetes, hypertension, hypercholesterolemia, cardiovascular problems, asthma, and obesity. To promote a healthy lifestyle and promote the U.S. Department of Health and Human Services (DHHS) goal of 100% access to health care and 0% disparity (no one will be denied health care), nurse practitioner/traditional Hawaiian healing clinics have been placed in community settings, which are known to community people and comfortable to access. These clinics provide health care to uninsured and underinsured people in an atmosphere that assures respect for the culture and the health needs. This pilot study examines the perceptions of 30 residents of Hawaii and the type of provider sought. Seventy-five percent of the respondents were generally satisfied with the health care received from both Hawaiian and Western care providers. Back and neck problems and injuries were associated with the use of Hawaiian therapies and appeared to reflect chronic conditions. Western health care is sought for predominantly acute conditions (infections, allergies, and upper respiratory conditions) and for diabetes and hypertension.