Coronary Heart Disease Prevention Programme Research Articles

Acceptability of a computer-tailored and pedometer-based socio-cognitive intervention in a secondary coronary heart disease prevention program: A qualitative study.

When developing an innovative intervention, its acceptability to patients, health care professionals and managers must be considered to ensure the implementation into practice. This study aims to identify factors influencing the acceptability of a computer-tailored and pedometer-based socio-cognitive intervention for patients with heart disease. Focus group interviews were conducted in two outlying regions of the province of Quebec (Canada). The Theory of Planned Behavior formed the theoretical basis of the interview guide. Two researchers performed verbatim analysis independently until consensus was achieved. The sample included 44 participants divided into six groups (patients n = 7 + 8, health care professionals n = 8 + 8, managers n = 6 + 7). Health care professionals and managers mentioned benefits concerning partners’ opportunity to improve assessment and monitoring. Patients believed the intervention could be useful to improve adherence to physical activity. Additional benefits indicated were self-monitoring behavior and improved health-related outcomes. However, patients expressed concern about the online security, fearing possible data breach. Some clinicians felt the pedometer may not be able to evaluate physical activities other than walking. With regard to behavioral control, a web application and pedometer must be easy to use and compatible with services already in place. Further barriers include level of literacy, cost and the various difficulties associated with wearing a pedometer. Findings suggest that, to improve the acceptability of a computer-tailored and pedometer-based socio-cognitive intervention, users must be assured of a secure website, validated, affordable and easy-to-use pedometers, and an intervention adapted to their level of literacy.

Outcomes of a multidisciplinary coronary heart disease prevention programme in southern India

ObjectiveCoronary heart disease (CHD) is a major cause for mortality and morbidity in India but the focus on lifestyle interventions is very low. This study aims to evaluate the role...

Results of a comprehensive coronary heart disease prevention program in South India

Results of a comprehensive coronary heart disease prevention program in South India

The excess health care costs of KardioPro, an integrated care program for coronary heart disease prevention

Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were €131 per person (95% confidence interval: [€−36.5; €296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon.

Improving Overall Health Status Through the CHIP Intervention

To evaluate the efficacy of a coronary heart disease prevention program at improving selected health indicators. A randomized controlled health intervention study was used, with 348 participants from metropolitan Rockford, Illinois, followed for 6 months; ages ranged from 24 to 81 years. Health indicators were based on the SF-36v2. Those in the intervention group showed significantly greater increases in scale scores for physical functioning, role-physical, bodily pain, general health perceptions, vitality, social functioning, role-emotional, and mental health. The prevention program improved functional health and well-being scores as well as psychometrically based physical and mental health summary measures.

Population-level interventions for coronary heart disease prevention: what have we learned since the North Karelia project?

The prevalence of coronary heart disease (CHD) risk factors in the population necessitates investment in the design and delivery of effective population-level interventions to prevent and enhance the management of CHD. This review examines the approaches that have been central to the design and delivery of previous, seminal population-level CHD prevention programs; it offers recommendations for the design and evaluation of the next generation of population-level CHD prevention trials. Almost 50% of the decline in the rates of CHD mortality in the developed world can be attributed to population-level declines in CHD risk factors, including cholesterol, hypertension, and smoking. There is evidence that community-based CHD prevention interventions can have a positive impact on these risk factors within a distinct population. More recent community-based CHD trials have focused on discrete populations including the socioeconomically deprived, ethnic minorities, and rural communities. There has been large variability in the success experienced by population-level CHD prevention trials. Best practices have emerged which may be used to inform the design of future trials. These include the need for multisectoral partnerships, coordination of multi-level interventions (programs and policy), and delivering a sufficient intervention dose to targeted populations.

The realization of a project aimed at reducing the plasmatic lipid level in a large Italian population improves the mean calcium daily intake: the Brisighella Study.

Evaluation of the impact of a coronary heart disease prevention program on calcium, magnesium, phosphorus and vitamin D dietary intake in respect of recommended daily allowances in a large Italian rural population. Retrospective analysis of the Brisighella Study dietary data. The Brisighella Study started in 1972 as a longitudinal study on atherosclerosis risk factors. Brisighella, a rural North Italian village. The Brisighella population's dietary habits were monitored from 1980 every 4 h through a dietary record sheet. 1,350 constantly tested subjects were subdivided according to NHI Consensus Conference on Calcium RDA. In 1986, the studied subjects were invited to reduce their consumption of animal fats and cholesterol through a Nutrition Educational Program (NEP). Before NEP, calcium intake was low in each sex and age category: 20-40% of the populatioin had a daily intake < 550 mg. In 1988, among the 1350 subjects who constantly completed the questionnaire (M = 651, F = 699), the mean calcium intake significantly rose in all age categories: M = 1,003 (25-65 y) and 877 ( > 65) mg/24h (P < 0.001 vs 1984); F = 923 (25-50), 860 (51-65) and 767 (> 65)mg/24h (P < 0.05). In 1992, 3y after the NEP conclusion, calcium intake dropped in each sex and age category. The NEP influenced vitamin D, phosphorus and magnesium intakes less. A collective NEP aimed at lowering saturated fats and cholesterol intakes, improves the calcium intake; in order to maintain their efficacy on nutritional habit changes, these programs must become an ongoing item.

Exploring the use of action research to stimulate and evaluate workplace health promotion

This article describes a health authority's approach to setting up and evaluating a coronary heart disease prevention programme through the workplace. The Bedfordshire Healthy Workplace Project was set up in 1992 'to stimulate interest and activity in workplace health promotion' and has developed an action research model to evaluate the impact of working with local employers on coronary heart disease risk behaviour. Action research as a methodology for health promotion research, and some of the main benefits and barriers are discussed.

Fibrinogen and Factor Vllag in Healthy Adolescents: The Floren-teen (Florence Teenager) Study

At least five studies based on more than twenty thousand healthy subjects indicated that fibrinogen is an independent risk factor for cardiovascular events; less clear-cut is the relation between factor VII and risk for arterial thrombotic disorders, which was demonstrated in two of the three studies investigating this association. However, no study has investigated the behaviour of fibrinogen and factor VII in an adolescent population. In a study of Preventive Medicine and Education Program, fibrinogen (clotting method) and factor VIIag (ELISA), in addition to other metabolic parameters, life-style and familial history, were investigated in 451 students (313 females and 138 males, age 15-17 years) from two high schools of Florence. Fibrinogen levels were significantly higher in women than in men, whereas factor VIIag levels did not significantly differ. Both fibrinogen and factor VIIag significantly correlated with total cholesterol (p < 0.05) while only fibrinogen correlated with body mass index (p < 0.01). Factor VIIag was significantly correlated with systolic blood pressure (p < 0.001). This study provides information on coagulation risk factors in a population of adolescents which may be of importance in planning coronary heart disease prevention programs.

Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. Semistructured interviews of health promotion managers. Wales and two reference health regions in England. Nine health promotion managers in Wales and 18 in England. Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended.

Awareness of high blood pressure influences on psychological and sympathetic responses

The aim of the present study was to examine the effects of awareness of hypertension on psychological factors and whether there was an association between psychological and sympathetic responses. To avoid self-selection bias 32 19-yr old white men, all with mean blood pressure of 116 mm Hg were randomized into two groups. One group was informed that the blood pressure was elevated and asked to come to a second examination while the other was invited to take part in a coronary heart disease prevention program. A cold pressor test was undertaken and the subjects completed the Karolinska Scale of Personality (KSP). Assessed by the KSP, the informed group showed lower verbal aggression ( p < 0.01), irritability ( p < 0.05), monotony avoidance ( p < 0.05) and impulsiveness ( p < 0.05), higher detachment ( p < 0.05) but no significant differences in the other subscales like anxiety, psychasthenia or factors of hostility. Information significantly increased resting blood pressure and increments in heart rate and plasma adrenaline responses to cold pressor test. Thus, both psychological and sympathetic responses were influenced by awareness of high blood pressure. There were significant correlations between less assertive behaviour and increased plasma catecholamines.

The role of behavioral change procedures in multifactorial coronary heart disease prevention programs.

Coronary risk factor screening and health education programs have constituted the mainstay of intervention in the large-scale community and clinic-based multifactorial CHD intervention trials which have been conducted in recent years. Community-based trials involving intervention along these lines have generally reported significant improvements in self-reported smoking patterns, slight improvements in blood pressure and serum lipid levels, and negligible changes in weight and physical fitness. The findings of controlled clinic-based trials involving nonbehavioral intervention have generally been only slightly more encouraging. Of note are the impressive findings of the Oslo Study (52), in which intervention involving brief personalized counseling and coronary risk factor assessment at 6-monthly intervals resulted in markedly greater improvements in mean serum cholesterol levels (13%) and the prevalence of smoking (15%) than was a case for the "no treatment" control group. The greater improvements in cigarette smoking were validated using serum thiocianate levels. The findings of both the North Karelia project and the MRFIT suggest behavioral intervention to be superior to traditional "exhortative" (i.e., screening; health education; medical counseling) procedures in achieving lasting improvements in the primary coronary risk factors (i.e., blood pressure, serum cholesterol, and cigarette smoking), but to be similarly ineffectual in changing the secondary risk factors (i.e., body weight, physical fitness). The issues of cost effectiveness, and the role of particular behavioral techniques in achieving lasting improvements in target coronary risk-related behaviors remain to be researched.

Developing an Elementary School CHD Prevention Program

In brief: Sixty-three students aged 7 to 12 years (32 boys, 31 girls) were assessed for coronary heart disease (CHD) risk factors, including family history of CHD, blood pressure, VO2 max, serum lipids, body composition, and history of diabetes mellitus and cigarette smoking. Forty-two percent of the children had one risk factor, and 12% and 3% had two and three risk factors, respectively. This information was used to encourage school administrators and faculty to modify the physical education program, teach health and fitness concepts in the classroom, and develop a rehabilitation program for children at risk.

Is authoritarianism the main element of the coronary-prone personality?

Clients at the Sydney Coronary Heart Disease Prevention Programme were screened for actual CHD and sufferers were compared with non-suffers on four personality scales to measure, respectively, A-B, dominance, achievement motivation and 'freneticism'. There were 112 sufferers and 201 controls. Sufferers were found to have significantly higher scores on dominance-the Ray (1976) Directiveness scale-but also to have significantly lower scores on the A-B measure. This latter reversal of the usual relationship was an artifact of the fact that older people are both more CHD prone and get lower A-B scores. When age was controlled for there was no relationship between A-B type and CHD. This left the authoritarian style of dominance measured by the Directiveness scale as the sole predictor of CHD. This was held to be a belated vindication of claims made in the pioneering work of Dunbar (1943).

A survey of haematological values in Sydney

A survey of haematological values in Sydney was conducted in conjunction with the Sydney Coronary Heart Disease Prevention Programme. The sample consisted of 4374 'self-referred' Sydney inhabitants between 11-90 yr of age. Comparison of the haemoglobin concentrations with those obtained in 2 previous Australian surveys suggested that the haemoglobin values in Australia have not varied in the last 25 yr.

Coronary risk factor screening and long-term follow up: year 1 of the Sydney Coronary Heart Disease Prevention Programme.

Ten thousand self-referred Sydney inhabitants were screened for major coronary risk factors over one year. Individual "problems" were referred to general practitioners for further assessment and treatment. Seventy-four per cent of subjects have attended a general practitioner where relevant. For subjects under 65 years, 29% had unsuspected hyperlipidaemia, 11% had unsuspected hypertension, and 0.6% had unsuspected diabetes. Nineteen per cent of subjects reported a past history of hypertension, of whom 46% appeared to be well-controlled (diastolic blood pressure less than 95 mmHg). The numbers of cigarette smokers fell with increasing age. Considering hyperlipidaemia, hypertension and cigarette smoking in subjects under 40 years of age, 10.4% of males and 4.9% of females had two or more coronary risk factors. Three hundred and fifty-four subjects selected at random, who claimed to be receiving treatment as a result of initial screening were invited for retesting eight and 15 months later. Significant falls were noted in body weight, blood pressure, and plasma cholesterol readings.

SYDNEY CORONARY HEART DISEASE PREVENTION PROGRAMME

Medical Journal of AustraliaVolume 1, Issue 15 p. 516-516c COMMENTS SYDNEY CORONARY HEART DISEASE PREVENTION PROGRAMME First published: 01 July 1962 https://doi.org/10.5694/j.1326-5377.1976.tb140813.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue15April 1976Pages 516-516c RelatedInformation