Incidence Of Heart Disease Research Articles

Use of Hidden Markov Models to Identify Background States Behind Risks of Cerebral Infarction and Ischemic Heart Disease

Cold exposure is often said to trigger the incidence of cerebral infarctions and ischemic heart disease. This association between weather and human health has attracted considerable interest, and has been explored using standard statistical techniques such as regression models. Meteorological factors, such as temperature, are controlled by background systems, notably weather patterns. Therefore, it is reasonable to posit that the incidence of diseases is similarly influenced by a background system. The aim of this paper was to identify and construct these respective background systems. Possible background states or "hidden states", behind the incidence of diseases were derived using the EM and Viterbi algorithms with in the framework of hidden Markov models (HMM). A self-organizing map (SOM) enabled identification of weather patterns, considered as background states behind meteorological factors. These background states were then compared, and the hidden states behind the incidence of diseases were identified by six weather patterns. This finding indicates new evidence of the links between weather and human health, shedding light on the association between changes in the weather and the onset of disease.

Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population.

ObjectiveThis study aimed to investigate the longitudinal effects of anxiety, depression, and their comorbidity on physical disorders and disability in an elderly Korean population.MethodsIn total, 1,204 community-dwelling elders were evaluated at baseline, and of these 909 (75%) were re-assessed two years later. Anxiety and depression were identified at baseline using questions from the community version of the Geriatric Mental State diagnostic schedule (GMS-B3). Participants were assessed for functional disability and for 11 physical disorders both at baseline and at follow-up.ResultsAnxiety alone was associated with the incidence of heart disease, depression alone with the incidence of asthma, and comorbid anxiety and depression with incidence of eyesight problem, persistent cough, asthma, hypertension, heart disease, and gastrointestinal problems. Comorbid anxiety and depression were associated with an increase in the number of physical disorders and the degree of disability during the two-year follow-up, compared to anxiety or depression alone or the absence of anxiety or depression.ConclusionAnxiety, depression, and particularly their comorbidity should be assessed in the elderly population considering their longitudinal effects on physical disorders and disability. Future study is required to determine whether interventions aimed at these disorders can mitigate their impacts.

Physical and psychological characteristics of the community-dwelling elderly with heart disease.

Objectives Although the survival rates of patients with heart diseases, such as myocardial infarction and heart failure, have increased, the incidence of heart disease in elderly individuals has also increased. We compared characteristics of the community-dwelling elderly with heart diseases (heart disease group) and without heart diseases (non-heart disease group).Methods A total of 758 elderly individuals participated in our survey ("Otassha-kensin") in 2014. The heart disease group (47 men, 28 women) and the non-heart disease group (263 men, 420 women) were selected from among these participants. Data on comorbidities, medications, the Kihon check list (KCL), and social background (lifestyle, exercise habits, certification for using long-term care insurance, and Japan Science and Technology Agency Index of Competence [JST-IC]) were obtained through interview. Body composition, grip strength, 5 walking time (usual pace, maximum speed), timed-up and go test (TUG), single-leg standing time, cognitive function, and depression were evaluated to assess physical and psychological function. Frailty was defined by the KCL. For between-groups comparisons, the Student t-test and Mann-Whitney U-test were used. To determine factors related to heart disease with functional decline, we used a multiple logistic regression analysis with the group (the non-heart disease group [0] and the heart disease group [1]) as the dependent variable and the decline in physical and psychological function as the independent variable.Results Men in the heart disease group had less grip strength, worse balance, and lower JST-IC scores than did men in the non-heart disease group. Women in the heart disease group had greater 5 walking times (usual pace, maximum speed) than those in the non-heart disease group. Both men and women in the heart disease group overall used more drugs and statins, and medications for heart disease than did participants in the non-heart disease group. In the multiple logistic regression analysis, 5 walking time (maximum speed) was shown to be associated with heart disease.Conclusions The community-dwelling elderly with heart disease showed declined physical functions. Our results suggested that these functional declines may be induced via medication and/or declines in daily activity.

Occurrence of Congenital Heart Disease among Children with Down syndrome: What is the Influence of Maternal Age?

Abstract Background: The occurrence of Down syndrome is strongly dependent on maternal age and incidence varies at various maternal ages. This incidence may differ from one country to another according to the social and environmental factors predominant in such countries. The study aims to document the prevalence of congenital heart defects in patients with Down syndrome, identify the association between maternal age and occurrence of congenital heart disease among these subjects Methods: The study was prospective, cross-sectional and consecutive, involving subjects from two centers which were; a tertiary hospital, a private hospital which is a major cardiology center. Children with clinical features of Down syndrome had transthoracic echocardiography done by a cardiologist. Results: A total of 195 patients with Down syndrome were studied ages between1day to 12years. The mean age + SD were 241.03 + 529.71days and male to female ratio of 1.04:1. The mother’s age range was from 19 to 44years with a mean age + SD of 32.36 + 5.43 years. Up to 16.9% had structurally normal heart. The most common heart defect was atrioventricular septal defect 24.1%. There was no significant association between maternal age and occurrence of congenital heart defects in the subjects. Conclusion: The incidence of congenital heart disease is high among subjects with Down syndrome. Atrioventricular defects were the commonest cardiac defect among the subjects. The incidence of congenital heart defect in the subjects was decreasing from maternal age 36 years and above. Routine cardiac evaluation including echocardiography is recommended for all patients with Down syndrome.

Testing message framing to increase physical activity among British South Asians

ABSTRACTObjective: British South Asians (BSAs) experience a higher incidence of coronary heart disease (CHD) which is not declining in line with the UK national average. Low physical activity levels are likely to contribute to this elevated risk. This study investigated the effectiveness of message framing, cultural sensitivity and their interaction on promoting physical activity among BSAs.Design: One hundred and seventy-nine participants (70 males and 109 females) were randomly allocated to watch one of four films in a 2 (loss vs. gain) × 2 (culturally sensitive vs. non-culturally sensitive) design.Main outcome measures: Measures of self-reported physical activity and behavioural intention were completed at baseline and two-month follow-up.Results: The analysis revealed no main effects for message framing, cultural sensitivity or for the interaction between these factors for self-reported physical activity and behavioural intention.Conclusions: Healthy BSAs appear not to respond to health promotion messages which have been manipulated by message framing or cultural sensitivity. Possible explanations are that despite an increased risk of developing CHD, healthy BSAs may be unwilling to engage in immediate action for a potential future health problem and cultural sensitivity may be irrelevant to a ‘Westernised’ sample. Nevertheless, future research ought to investigate variations of the current intervention by using a larger sample size, targeting a more sedentary population, varying the length and exposure to the intervention in less assimilated groups, clinically symptomatic populations or those at high risk of CHD.

A Longitudinal Definition of the Value of Cancer Drugs

Background Cancer drugs now account for a greater fraction of the national health care expenditure than ever before. A new movement has been formed that argues for meaningful definition of the value of drugs as a pre-requisite for their approval as well as for clinical decision-making. Numerous frameworks have been designed to allow comparison of different pharmacological agents based on patient-related factors (efficacy, safety, cost). However, these formulas largely ignore chronic, long-term toxicities which are particularly important in the case of highly-curable cancers like Hodgkin Lymphoma and testicular cancer. We propose a drug value scheme that incorporates debilitating and life-threatening long-term toxicities along with traditional factors (efficacy and acute safety) when defining a drug's merit. Methods A longitudinal framework for assessing drug value is suggested. Pertinent drug-related characteristics - efficacy, acute adverse events, and long-term toxicities - are included. For each drug characteristic, patient-centred surrogate markers are chosen: efficacy is defined by the 10-year overall survival, acute safety by the rate of neutropenia and life-threatening infections, and long-term toxicity by the cumulative incidence of secondary cancers and heart disease at 5 and 10 years, respectively. Advanced Hodgkin Lymphoma is chosen for simulation. The most commonly used regimens are compared. Data from high-value prospective clinical trials (see references) are used to grade each regimen. Points are given for each percentile range in each category (higher score for greater efficacy and lower toxicity; see Appendix 1). Percentile intervals are chosen according to the presumed clinical impact. The net value of each regimen is assessed by adding the score for each individual care component and comparing it to a similar model that does not include long-term toxicity. Results Risk score calculation yielded results as shown in Table 1. ABVD And Stanford V gained the highest score (26; of 30) while COPP-EBV-CAD and BEACOPP obtained lower scores (24 and 22, respectively). Stanford V reached a better value score than COPP-EBV-CAD, and was equivalent to ABVD, in contrast to a drug value scheme that neglected long-term toxicities, in which it was inferior to both. The superiority of ABVD to COPP-EBV-CAD and BEACOPP persisted in the model, as was the overall advantage of COPP-EBV-CAD over BEACOPP. Conclusions As the treatment of cancer continues to improve, value should no longer be derived only from a drug's overall survival and acute injury profiles. A more comprehensive appreciation of a drug's benefit-to-risk ratio entails an understanding of its more distant health implications. Our model shows that such an easily-constructible framework results in a different value estimation of drugs compared with the traditional one. Appendix 1: Value Score: - Efficacy * Overall Survival: 7 if <74.9%, 8 if 75.0-80.9%, 9 if 81.0-85.9%, 10 if 86.0-88.9%, 11 if >89.0% - Acute toxicity * Incidence of severe infections: 3 if >10.0%, 4 if 5.0-9.9%, 5 if <4.9% * Incidence of grade 3 neutropenia: 1 if > 50.0%, 2 if 28.0-49.9%, 3 if <27.9% - Late toxicity * Incidence of heart disease at 5 years: 1 if >5.6%, 3 if 4.0-5.5%, 4 if 2.0-3.9%, 5 if <1.9% * Incidence of secondary cancers at 10 years: 6 if <3.9%, 4 if 4.0-9.0%, 3 if 9.1-13.0%, 1 if >13.1% *** Example: ABVD value score = 9 (for OS of 85%) + 5 (for severe infection incidence of 2%) + 3 (for grade 3 neutropenia incidence of 25%) + 3 (for 5-year heart disease incidence of 5.5%) + 6 (for 10-year secondary cancer incidence of 0.9%) = 26

TCT-628 Very Long-Term (Up To 23 Years) Follow-Up After Successful Mitral Balloon Valvuloplasty In A Large Series Of Patients With Rheumatic Mitral Stenosis

Introduction: Although there has been a steady decline in the incidence of rheumatic heart disease, rheumatic mitral stenosis still causes significant morbi-mortality worldwide. Percutaneous mitral balloon valvuloplasty (PMBV) remains as the preferred treatment option for patients with suitable anatomy and severe symptomatic rheumatic mitral stenosis. Hypothesis: We sought to assess the very long-term outcomes after successful PMBV. Methods: This is a single center analysis of all consecutive patients who underwent successful PBMV (post-procedural valve area ≥ 1.5 cm 2 and regurgitation moderate or less, without in-hospital major adverse cardiac and cerebrovascular events) between 1988 and 2011. The primary endpoint was to determine the incidence of major adverse cardiac events (MACE), including global death and need for mitral surgery or repeat PMBV up to 23 year after the procedure. Results: Among all 1577 patients, the success rate was achieved in 91.3% (1140 patients). The predictors of success were NYHA functional class III-IV (hazard ratio [HR]: 1.73, 95% CI: 1.15-2.60, p=0.008) and Wilkins-score Conclusions: Up to 23 years after successful PMBV, a sizeable proportion of patients still exhibit sustained results after PMBV.

Physical Activity and Incident Chronic Diseases: A Longitudinal Observational Study in 16 European Countries.

The minimum frequency of physical activity associated with reduced risk for onset of several chronic diseases is not well established. Therefore, this study examined, in a large sample of citizens from 16 European countries, the predictive value of physical activity frequency and intensity on the incidence of heart diseases, cerebrovascular diseases, diabetes, cancer of any subtype, breast cancer, and colon/rectum cancer. Using data from the longitudinal Survey of Health, Ageing, and Retirement in Europe, the long-term associations of physical activity with incident diseases in people aged ≥50 years were investigated. Cox proportional hazard models adjusted for potential confounders were performed for each disease. Data were collected between 2004 and 2013 and analyzed in 2015. Compared with people who never do physical activity, those doing vigorous physical activity once a week had a reduced risk of developing heart diseases (hazard ratio=0.80; 95% CI=0.70, 0.91), whereas those doing moderate physical activity once a week had a reduced risk of developing diabetes (hazard ratio=0.80; 95% CI=0.68, 0.95) and cerebrovascular diseases (hazard ratio=0.73; 95% CI 0.58, 0.91). The magnitude of the associations increased with higher frequencies for both moderate and vigorous physical activity. Consistent results were obtained in sensitivity analyses. Doing physical activity once a week, which is less than current recommendations in terms of frequency, is associated with reduced risk of developing cardiovascular diseases and diabetes among middle-aged and older adults.

How to prevent or delay heart disease in diabetics

A strong link between diabetes and heart disease is now well established. Studies showed a two- to threefold increase in the incidence of heart disease in patients with diabetes compared with those without diabetes who were being followed in the Framingham Heart Study. In fact, cardiovascular disease leading to heart attack or stroke is by far the leading cause of death in both men and women with diabetes. Unfortunately, in patients with diabetes, improvement in survival has been less than half as much as in the general population. Evidence shows that patients with diabetes have an increased level of low-grade inflammation of their arterial lining, a process that initiates the blood vessel changes leading to heart disease. Some of the new tests to assess this inflammation are being evaluated, including C-reactive protein and homocysteine. The good news is that there are steps to reduce your risk for heart disease: – control your weight; – get regular physical activity; – quit smoking; – maintain tight control over glucose; – lower your LDL cholesterol (the “bad” type); – control your blood pressure; – consider incorporating aspirin into your daily routine. “High blood glucose in adults with diabetes increase the risk of heart attack, stroke, angina, and coronary artery disease. 1. People with type 2 diabetes also have high rates of high blood pressure, lipid problems, and obesity, which contribute to their high-risk of CVD.” The best way to prevent or delay the development of cardiovascular disease is to prevent diabetes it self.

O descortinar de uma epigastralgia

Introduction: Epigastric pain is frequently associated with gastrointestinal disease. However, when faced with a patient complaining of epigastric pain it is important to obtain a careful history and perform a physical examination because this may also be associated with other diseases. Case Description: We present the story of a 41 year-old man with a history of smoking, dyslipidemia, hypertension and obesity. His father died at age 46 from an acute myocardial infarction. In July 2014 he came to a private clinic complaining of epigastric pain. Following a brief history and physical examination, he received analgesia and gastric mucosal protection with improvement in his symptoms. One month later, he experienced a similar episode of pain, without recourse to medical assistance. In September 2014, came to his family doctor and requested further examinations, including gastroscopy and colonoscopy. The patient also reported that during episodes of epigastric pain he had also experienced a sense of left upper limb numbness. The doctor ordered additional tests, including biochemical analyses, an abdominal ultrasound, an electrocardiogram (ECG), and a stress test. The patient was then referred for an urgent consultation with a cardiologist and coronary artery bypass surgery was performed for triple vessel disease. Discussion: The incidence of heart disease is increasing along with the prevalence of risk factors for cardiovascular disease. This patient had several risk factors that might suggest atypical ischemic pain as the cause of his epigastric pain. Physicians are aware of the most common causes of symptoms reported by the patient but must also consider atypical presentations of less common diagnoses.

Incidence of valvular heart disease after combination of dopamin agonists with statins

Incidence of valvular heart disease after combination of dopamin agonists with statins

The Relationship of Fertility, Lifestyle, and Longevity Among Women

Longevity in women has been found to be associated with several reproductive factors; the age of women when they give birth, their total number of children, and the age at which they experience menopause. In the context of expectations from the evolutionary theory of aging, the focus of this study examined relationships between lifetime reproduction, age at menopause and longevity, while accounting for various lifestyle factors. The purpose of this study was to assess fertility and age at onset of menopause in 197 women of the Georgia Centenarian Study. It was hypothesized that greater lifetime reproduction would predict earlier menopause and subsequently an earlier death. An independent t test was computed to assess ethnic differences between Caucasian and African American participants. Two block-wise multiple regression analyses were computed to evaluate the impact of low socioeconomic status in childhood, the age at the time of the first childbirth, the total number of children, smoking and alcohol use, incidence of heart disease and stroke, and the age at onset of menopause on longevity. Results from this study suggest a positive association between the total number of children to the age at onset of menopause and longevity. However, when considering the lifestyle factor of smoking, the association of the total number of children to longevity is diminished.

Heart disease during pregnancy in the KSA: A suggested plan

Abstract Objectives Congenital heart disease in pregnancy is a leading cause of maternal death in developed countries while rheumatic fever is the commonest cause of valvular disease in pregnancy in developing countries. Improvement in neonatal and paediatric cardiac surgery has increased the incidence of congenital heart disease in pregnancy worldwide. Published data regarding heart disease in pregnancy (HDP) in KSA are scant and relatively old. This study examines the current status of HDP in KSA and describes the rationale and design of the suggested plan for HDP in KSA, i.e., the Registry Of Saudi Heart Disease And Pregnancy (ROSHDAP). Methods A systematic search was conducted through the ProQuest MEDLINE® database using the keyword phrase “cardiovascular disease in pregnancy”. An extensive literature review about heart disease in pregnancywas performed. Results There are only 4 available Saudi studies of HDP. The ROSHDAP study is expected to establish a foundation for Saudi research in this field and will create an extensive database that will enrich knowledge about HDP. All Saudi women with HDP who wish to participate are eligible for enrolment in the registry. Five phases are planned for the registry, and data will be collected prospectively, confidentially, and electronically. The data will be transmitted from participating centres to a central coordinating office for data management and analysis. Conclusion The ROSHDAP study suggested in this article will provide contemporary data on HDP in KSA that will promote research and encourage evidence-based medical care of pregnant women with heart disease.

High-density lipoprotein: a potential target for therapeutic angiogenesis

Prior studies have shown that high-density lipoprotein (HDL) is an independent risk factor for cardiovascular disease and is inversely correlated with the incidence of ischemic heart disease as well as other atherosclerosis-related ischemic conditions. Therapeutic angiogenesis has proved to be promising in increasing myocardial perfusion for patients with ischemic heart disease. This review focuses on the effects of HDL on repairing endothelial injury and promoting angiogenesis, aiming to provide new insights on therapeutic angiogenesis for ischemic heart disease. Key words: Cholesterol, HDL; Endothelium, vascular; Myocardial ischemic

Pediatric cardiothoracic program in Malaysia: a study based on the outcome of the program.

Vulnerable communities in Malaysia have been facing issues of accessibility and availability for pediatric cardiac services for years due to long waiting times, high costs and a lack of pediatric cardiothoracic surgeons. To ease this situation, the government has allocated a certain amount of funds, introduced through the Pediatric Cardiothoracic Program (PCP), in which the patients are transported to the Narayana Health Institute of Cardiac Science (NH) in India to receive a heart operation following an eligibility check at MediAssist4U Sdn Bhd in Selangor, Malaysia, a facility appointed by the NH. This study aimed to determine the demographic incidence of congenital heart diseases of patients in this program and to evaluate the outcome of the program in association with post-operative mortality rate and the beneficial factors of the program. In this study, 241 patients who participated in this program from August 2008 to September 2012 were reviewed. Fisher's exact tests were applied to calculate p-values of categorical data. Out of 241, 11 patients were rejected because of their poor health condition for flight transportation to India, leaving 230 patients for analysis. The majority of patients were 1 to 4 years of age (57.8%), Malays (61.7%), from families of monthly household income less than RM 1,500 (86.5%) and with primary school-educated parents (86.5%). Patients could apply from any government hospital in Malaysia, but 34.8% of the patients were from the state of Johor. The region (Peninsular Malaysia and East Malaysia) of patients seeking pediatric cardiac services was significantly associated with race (p<0.001), low household income (p<0.001) and low education background of parents (p=0.004). The associations between the age group and diagnosis group (p=0.010) and between duration of hospitalization and outcome of medical management (p=0.013) were significant. Post-operative mortality rate was 1.7% (95% confidence interval, 0.5-4.4). In conclusion, the patients and the government were considered to have benefited from the PCP.

The Effects of Satureja hortensis L. Dried Leaves on Serum Sugar, Lipid Profiles, hs-CRP, and Blood Pressure in Metabolic Syndrome Patients: A Double-Blind Randomized Clinical Trial

Background: Metabolic syndrome, which includes multiple metabolic disorders in an individual, has a direct relationship with incidence of various heart diseases. Satureja hortensis L. has been considered to treat this syndrome because its active compounds have valuable therapeutic effects, including anti-inflammatory, antihyperglycemic, vasodilator, and antihyperlipidemic properties as well as being antioxidants and free radical scavengers. Objectives: This double-blind randomized clinical trial assessed the effects of dried leave of S. hortensis on the serum sugar levels, lipid profiles, high-sensitivity CRP (hs-CRP), and blood pressures of 60 metabolic syndrome patients referred to the healthy heart institute in Shiraz, Iran during 2013. Materials and Methods: First, components from the essential oil of the plant powder were identified using GC-MS instrumentation. Then, capsules of the plant were used in a double-blind randomized and controlled clinical trial involving 47 metabolic syndrome patients who were treated with either dried leaves from S. hortensis or a placebo capsule once daily for 10 weeks. Results: This study was registered at the Iranian Registry of Clinical Trials (No. IRCT2014012616372N1). At the end of the study, group changes (mean ± SD) in the group that received S. hortensis showed significant reductions in total cholesterol (239.4 ± 34.6 to 222.3 ± 38.0; P < 0.05), low-density lipoprotein cholesterol (LDL-C) (138.6 ± 25.2 to 117.6 ± 20.8; P < 0.001), triglycerides (TG) (220.0 ± 67.5 to 187.5 ± 65.9; P < 0.05), diastolic blood pressure (DBP) (83.1 ± 11.3 to 75.3 ± 9.5; P < 0.001), and hs-CRP (3.03 ± 1.84 to 1.51 ± 1.76; P < 0.05) as well as an elevation in high-density lipoprotein cholesterol (HDL-C) (43.8 ± 7.4 to 47.3 ± 9.6; P < 0.05). In the placebo group, a significant increase was only observed for hs-CRP (2.31 ± 1.18 to 3.32 ± 1.52; P < 0.05). Different outcomes between the groups (means (95% CIs)) revealed statistically significant diminutions in LDL-C when the dosage was 27.1 mg/dL ((-16.3, -37.9); P < 0.001), in TG with a dosage of 39.1 mg/dL ((-19.5, -64.4); P < 0.05), in DBP with a dosage of 7.6 mm/Hg ((-4.3, -11.2); P = 0.001), and in hs-CRP with a dosage of 2.5 ng/mL ((-1.4, -5.1); P < 0.05). Conclusions: When used as a supplement, S. hortensis could be helpful for prevention or improvement of metabolic syndrome symptoms and primary concomitant disorders.

Racial differences in the predictive role of high depressive symptoms on incident heart disease over 18 years: Results from the health and retirement study

Background: Studies have investigated racial differences in the relationship between depression and CVD mortality. Objectives: This study tested the hypothesis that race moderates the effect of baseline depressive symptoms on subsequent heart disease among a nationally representative sample of Black and White older Americans. Patients and Methods: Data came from ten waves of the health and retirement study (HRS), a nationally representative longitudi- nal study of US adults over age 50. The present study followed 7,444 Black and White individuals without a diagnosis of heart disease at baseline for up to 18 years for incident heart disease. Elevated depressive symptoms at baseline was the independent variable, time to incident heart disease was the dependent variable, while baseline sociodemographics, health risk behaviors, obesity, and chronic medical conditions were controls. We used Cox proportional hazards models in the pooled sample and stratified by race to test the effect of elevated depressive symptoms on the outcome net of other risk factors. Results: In the pooled sample, a significant positive interaction was found between the effect of elevated depressive symptoms and Black race (hazard ratio, 1.29; 95% CI = 1.01 -1.65), suggesting a stronger effect for Blacks compared to Whites. In fully adjusted race- stratified models, elevated depressive symptoms increased the risk of developing heart disease for Blacks (hazard ratio, 1.47; 95% CI = 1.04 - 2.07) but not Whites (hazard ratio, 1.13; 95% CI = 0.97 -1.32). Conclusions: Black and White older adults differ in the effect of depressive symptoms on subsequent heart disease over a long period of follow up. Elevated depressive symptoms are associated with a larger risk of incident heart disease among Black but not White older individuals.

Sex Variations in the Effects of Arthritis and Activity Limitation on First Heart Disease Event Occurrence in the Canadian General Population: Results From the Longitudinal National Population Health Survey.

To estimate sex-specific effects of arthritis and activity limitation on incident heart disease in a nationally representative, Canadian longitudinal population-based survey. Information on sociodemographic variables, self-reported physician-diagnosed chronic conditions (including arthritis and heart disease), activity limitations, and traditional risk factors was collected every 2 years from 1994-1995 through 2010-2011 as part of the longitudinal Canadian National Population Health Survey. Deaths due to ischemic heart disease (International Classification of Diseases, Tenth Revision [ICD-10] codes I20-I25) and heart failure (ICD-10 codes I50.0-I50.9) were confirmed against the Canadian Vital Statistics Database. Discrete-time survival analysis stratified by sex was used to estimate effects of arthritis and activity limitation on first heart disease event occurrence. The study included 12,591 participants with no prior history of heart disease and 1,783 incident heart disease events. After adjusting for common risk factors, arthritis was associated with a significant increased risk of incident heart disease in women (adjusted odds ratio [OR] 1.58, 95% confidence interval [95% CI] 1.23-2.02). Even higher risks were reported in women with arthritis and activity limitation (OR 2.19, 95% CI 1.61-2.97). Arthritis was not associated with incident heart disease in men, except for when also reported with activity limitation (OR 1.60, 95% CI 1.14-2.26). Women with arthritis, and men with arthritis and activity limitation, have significant excess risks for developing heart disease in the general population. These findings point to the need for improved access to arthritis care, cardiovascular prevention strategies, particularly in women with arthritis, and directed interventions toward prevention of activity limitation.

Incidence of congenital heart diseases in children born at Eastern Regional Referral Hospital, Monggar

Introduction: Congenital heart diseases are the commonest birth defects worldwide. While the true incidence of congenital heart diseases is known in many countries, it has not been studied in Bhutan.&#x0D; Methods: Neonates born at the Eastern Regional Referral Hospital, Monggar in the year 2010 were screened for congenital heart diseases at birth by echocardiography and clinical examination including pulse oximetry.&#x0D; Results: The majority of the study subjects were natives of eastern districts of Bhutan. The incidence of congenital heart diseases was found to be 68 per 1000 live births, with Atrial Septal Defect being the commonest lesion.&#x0D; Conclusions: The overall incidence of congenital heart disease is higher than what is reported in other countries although the incidence of serious lesions was similar to what is reported elsewhere.

Compliance to the smoke-free law in Guatemala 5-years after implementation.

BackgroundSmoke-free environments decrease smoking prevalence and consequently the incidence of heart disease and lung cancer. Due to issues related to poor enforcement, scant data is currently available from low/middle income countries on the long-term compliance to smoke-free laws. In 2006, high levels of secondhand smoke (SHS) were found in bars and restaurants in Guatemala City. Six months after a smoking ban was implemented in 2009, levels significantly decreased. However, in 2010, poor law compliance was observed. Therefore, we sought to assess long-term compliance to the ban using SHS measurements.MethodsIn 2014 we assessed SHS exposure using airborne nicotine monitors in bars (n = 9) and restaurants (n = 12) for 7 days using the same protocol as in 2006 and in 2009. Nicotine was measured using gas-chromatography (μg/m3) and compared to levels pre- (2006) and post-ban (2009). Employees responded to a survey about SHS exposure, perceived economic impact of the ban and customers’ electronic cigarette use. In addition, we estimated the fines that could have been collected for each law infringement.ResultsMost (71 %) venues still have a smoking section, violating the law. The percentage of samples with detectable nicotine concentrations was 100, 85 and 43 % in 2006, 2009 and 2014, respectively. In bars, median (25th and 75th percentiles) nicotine concentrations were 4.58 μg/m3 (1.71, 6.45) in 2006, 0.28 (0.17, 0.66) in 2009, and 0.59 (0.01, 1.45) in 2014. In restaurants, the corresponding medians were 0.58 μg/m3 (0.44, 0.71), 0.04 (0.01, 0.11), and 0.01 (0.01, 0.09). Support for the law continues to be high (88 %) among bar and restaurant employees. Most employees report no economic impact of the law and that a high proportion of customers (78 %) use e-cigarettes. A total of US$50,012 could have been collected in fines.ConclusionsLong-term compliance to the smoking ban in Guatemala is decreasing. Additional research that evaluates the determinants of non-compliance is needed and could also contribute to improve enforcement and implementation of the smoke-free law in Guatemala.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2960-x) contains supplementary material, which is available to authorized users.