Dissertations / Theses on the topic 'Cardiovascular screening'
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Ouyang, Victoria(Victoria S. ). "Scalable integrated screening tools for cardiovascular disease." Thesis, Massachusetts Institute of Technology, 2020. https://hdl.handle.net/1721.1/129918.
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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, February, 2020Cataloged from student-submitted PDF of thesis.
Includes bibliographical references (pages 114-117).
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for more than 17.9 million deaths per year. Atherosclerosis, characterized by stiffening of the arteries, is the precursor to heart attacks and strokes, which cover 85% of all CVD mortalities. Since the disease is largely asymptomatic, a major challenge remains in screening for at-risk individuals. Existing screening tools primarily rely on questionnaires which do not account for ethnicity and require blood pressure and cholesterol readings. Thus, there is a crucial need for low-cost, non-invasive screening tools, especially in low-resource areas where people do not have access to routine clinical exams and blood tests. To address these shortcomings, this thesis presents a scalable integrated CVD screening toolkit that is practical and can be deployed in a real-world setting.
We have developed Android mobile apps and hardware capable of performing pulse wave analysis (PWA) and measuring pulse wave velocity (PWV) using PPG techniques. The analysis algorithms are configured to run on a custom server that is able to handle large amounts of medical data. In this thesis, I describe the PWA and PWV algorithms, the mobile applications associated with these measurements, and their integration with a custom server. To validate these new algorithms, data was used from two separate clinical studies conducted by our group. For PWA, I analyzed PPG waveforms from young athletic people, young non-athletic people, old healthy people, and old CAD patients, which resulted in median PWA Scores of 3.51 (0.57), 3.19 (0.78), 1.98 (0.66), and 1.81 (0.5) respectively. From these results, the PWA tool demonstrated sufficient sensitivity to distinguish between the four different cardiovascular health classifications.
Based on a larger clinical study with 100 subjects at the Sengupta Hospital and Research Institute in Nagpur, India, I found that PWV in the central artery behaves differently from the PWV in peripheral muscular arteries. The study showed that central aortic PWV is a good indicator of atherosclerosis and coronary arterial disease. Using these results, I demonstrated that our machine learning algorithm is able to reliably distinguish healthy patients from non-healthy with an AUC of 0.83 (0.18).
by Victoria Ouyang.
M. Eng.
M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science
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Ma, Botong. "Developing a low-cost cardiovascular mobile screening kit." Thesis, Massachusetts Institute of Technology, 2019. https://hdl.handle.net/1721.1/121679.
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This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2019
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 148-159).
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and 80% of CVD deaths occur in lower and middle-income countries. While many CVD risk factors can be improved by behavioral change or low-cost medication, a major challenge remains in identifying at-risk patients since most people are asymptomatic. Thus, low-cost non-invasive diagnostic tools are crucial in low-resource areas without routine blood tests or regular clinical exams. This thesis presents a low-cost cardiovascular screening kit that focuses on signs of arterial stiffening, the root issue of many CVDs. Since pulse wave velocity (PWV) and pulse wave analysis (PWA) features were known to be correlated with arterial stiffening, we developed a Python API that would extract these features from the pulse waveforms collected using the devices in our screening kit. Using these features, we also trained a machine learning algorithm to accurately identify patients that are at-risk. We confirm the usefulness of PWV and PWA features for CVD screening, and anticipate that as the number of training data points increase, our machine learning model will enable individuals to live a healthier lifestyle.
by Botong Ma.
M. Eng.
M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science
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Ritchie, L. D. "Computer assisted cardiovascular risk factor screening in general practice." Thesis, University of Aberdeen, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.593353.
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Objective - To assess a computer assisted nurse centred model for the measurement and modification of cardiovascular risk factors in general practice. Design - An open prospective study analysed using descriptive and comparative statistics. Subjects - 80504 patients who attended 18 health centres throughout the UK for opportunistic cardiovascular risk factor intervention. Results - The screened population comprised 36751 males (mean age 41.6 years) and 43753 females (mean age 40.7 years). The mean cholestrol level was 5.7 mM in both males and females. 25% of men and 24% of women had cholesterol levels ≥6.5 mM. The mean systolic/diastolic blood pressures were 130/81 mm Hg for men and 124/77 mm Hg for women. The mean body mass index for males was 25.3 kg/m^2 and for females 24.7 kg/m^2. 9% of men and 12% of women were classified as obese (grades II or III). 36% of males smoked compared to 33% of females. 80% of men were current drinkers as were 59% of women. 20% of men were classified as heavy drinkers compared to 4% of women. A composite risk score was used to assess all of the relevant risk factors at screening. 22% of males and 24% of females gave a positive family history in a first degree relative under 55 years of age. 6% of all patients were taking antihypertensive medication compared to 0.1% on lipid lowering drugs. Patterns of recruitment were examined and primary care staff accounted for 56% of referrals, friends and relatives encouraged 23% to attend, and self referrals amounted to 14%. Conclusions - The study succeeded in identifying the prevalence and nature of cardiovascular risk factors in a general practice population. Evidence of worthwhile reductions in risk factors was obtained. Patterns of recruitment and default were elucidated. The model constitutes a useful application of computers in primary care beyond the boundary of the individual practice. Further information from randomised controlled trials of cardiovascular risk factor intervention is awaited.
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Petersson, Ulla. "Screening for Cardiovascular Risk and Diabetes in Primary Health Care : The Söderåkra Risk Factor Screening Study." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17692.
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Background: Cardiovascular disease (CVD) has been the predominant cause of morbidity and mortality for many decades in Sweden. Preventive work in primary health care through individual approach and community-based programmes has shown some success. Still, we need better risk assessment tools and health strategies to lessen the burden of CVD in our population. Methods: This thesis is based on four studies that explore the cardiovascular risk factor pattern and its development to CVD morbidity and mortality in the middle-aged (40-59 years) population in Söderåkra, southern Sweden, 1989-2006. At a single physician consultation in 1989-1990 the participants provided information about lifestyle in a self-administered questionnaire, underwent a physical examination and received medical advice after a laboratory investigation. The laboratory tests consisted mainly of blood glucose, serum lipids and thyroid function tests. Blood samples were also frozen for later analyses. A telephone interview on self-reported lifestyle changes was conducted ten years later. In 2006, primary health care medical records were studied for incident diabetes and also for impaired glucose tolerance (IGT). Finally, national registers were studied for incident fatal or nonfatal cardiovascular disease until 2006. Cardiovascular risk assessments using three separate risk algorithms were applied on the population. Results: The participation rate was high with 90% attendance. The conclusion of this cross-sectional baseline analysis was that it is meaningful to check for a secondary cause of hyperlipidemia, hypothyroidism, in women with a cholesterol value above 7.0 mmol/L. After 10 years follow-up women reported significantly more lifestyle changes than men, odds ratio (OR) 1.56 (95% CI: 1.11- 2.18; p= 0.010). Men with a history of smoking or CVD at baseline and women with treated hypertension at baseline made successful lifestyle changes, OR 4.77 (95% CI: 2.18-10.5; p<0.001 and OR 1.84 (95% CI: 1.12-3.02; p= 0.016), respectively, than those without these characteristics. Until 2006, 38 participants had developed diabetes and four subjects IGT out of 664 participants, excluding 10 with diabetes at baseline. A low level of IGFBP-1 at baseline was associated with the development of type 2 diabetes/IGT, hazard ratio (HR) 3.54 (95% CI: 1.18-10.6, p=0.024). This was independent of abdominal obesity or inflammation (CRP). After excluding 16 participants with prevalent CVD at baseline, 71 first fatal or nonfatal CVD events in 689 men and women were registered. Several known risk factors and risk markers were applied on this population. Those that turned out to be significantly associated with development of incident CVD in univariate Cox´s regression proportional hazard analyses where used in three different risk assessment models: the consultation model, SCORE and the extensive model. A non-laboratory-based risk assessment model, including variables easily obtained during one consultation visit to a general practitioner (GP), predicted cardiovascular events as accurately, HR 2.72; (CI 95% 2.18-3.39, p<0.001), as the established SCORE algorithm, HR 2.73; (CI 95% 2.10-3.55, p<0.001), which requires laboratory testing. Furthermore, adding laboratory measurements covering lipids, inflammation and endothelial dysfunction, did not confer any additional value to the prediction of CVD risk, HR 2.72; (CI 95% 2.19-3.37, p<0.001). The c-statistics for the consultation model (0.794; CI 95% 0.762-0.823) was not significantly different from SCORE (0.767; CI 95% 0.733-0.798, p=0.12) or the extended model (0.806; CI 95% 0.774-0.835, p=0.55). Conclusions: Our study showed that it is worth searching for hypothyroidism, in women with a cholesterol value above 7 mmol/L. The study identified female gender, previous CVD, hypertension and smoking as predictors of positive lifestyle change during follow-up. A low level of IGFBP-1 predicted future diabetes/IGT in this population as did increased waist and CRP. Finally, data on nonlaboratory risk factors obtained during one GP visit predicted future cardiovascular risk as accurately as SCORE or a laboratory-based risk algorithm.
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Pandya, Ankur. "Optimizing Cardiovascular Disease Screening and Projection Efforts in the United States." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10160.
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The objective of this dissertation is to develop and evaluate quantitative models that have the potential to improve cardiovascular disease (CVD) screening and projection efforts in the U.S. Paper 1 assesses the exchangeability of a non-laboratory-based CVD risk score (predictors do not include cholesterol) with more commonly-used laboratory-based scores, such as the Framingham risk equations. Under conventional thresholds for identifying high-risk individuals, 92-96% of adults in the National Health and Nutrition Examination Survey (NHANES III) were equivalently characterized as high- or low-risk using either type of score. The 10-year CVD death results also suggest that simple CVD risk assessment could be a useful proxy for more expensive laboratory-based screening strategies in the U.S. or other resource-limited settings. Paper 2 uses micro-simulation modeling techniques to evaluate the cost effectiveness of primary cardiovascular disease (CVD) screening using staged laboratory-based and/or non-laboratory-based total CVD risk assessment. The results imply that efficient screening guidelines should include non-laboratory-based risk assessment, either as a single stage or as part of multistage screening approach. Compared to current CVD screening guidelines, fewer cholesterol tests would be administered and more adults would receive low-cost statins under cost-effective screening policies. Paper 3 examines the trends of CVD risk factors, treatment, and total risk in the U.S. from 1973-2010, and offers projections of these variables for 2015-2030. Nine waves of cross-sectional NHANES data show that the divergent, observed trends in common CVD risk factors (such as smoking, BMI, total cholesterol, and blood pressure) are expected to continue in future years. Age-adjusted CVD risk has decreased over time (during the observed and projected periods), but total risk has increased when considering the impact of aging on CVD risk. Scenario analyses suggest that strategies targeting cholesterol and blood pressure treatment have the greatest potential to reduce future CVD burden in the U.S.
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Link-Malcolm, Jessica. "Health message framing : motivating cardiovascular risk factor screening in young adults." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9066/.
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As the leading cause of death in the United States, coronary heart disease (CHD) is a growing public health problem, despite the fact that many risk factors for the disease are preventable, especially if addressed early in life. The purpose of the current study was to examine the effects of loss-framed versus gain-framed versus information-only health messages on both intention to attend and actual attendance at an appointment to get screened for CHD risk factors (i.e., hypertension, diabetes, and dyslipidemia). It was hypothesized that a population of young adults would be more likely to view screening for CHD risk factors as a low-risk, health-affirming behavior as opposed to a risky, illness-detecting behavior and would thus be more strongly influenced by gain-framed messages than loss-framed messages. Additional goals included the exploration of the extensively researched individual health beliefs of perceived threat (as defined by the health belief model) and health locus of control as they relate to message frames. One hundred forty-three undergraduate students were randomly assigned to either the loss-framed, gain-framed, or information-only control conditions. Framing manipulation checks revealed that participants failed to discern differences in the tone and emphasis of the experimental pamphlets. As a result, no tests of framing effects could be conducted. Sixteen (11.2%) of the 143 participants who participated in Part 1 of the experiment participated in Part 2 (i.e., attended a risk factor screening appointment). Multiple regression analysis revealed risk index, age, and powerful others health locus of control as significant predictors of screening intention. Gender was the only demographic or health related variable that was significantly related to screening outcome, such that women were more likely to get screened than men. Limitations and recommendations are discussed.
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Link-Malcolm, Jessica Kelly Kimberly. "Health message framing motivating cardiovascular risk factor screening in young adults /." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9066.
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Vanhook, Patricia M. "Cardiovascular and Stroke Education and Risk Factor Screening in the Rural Setting." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/7440.
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Pignatelli, Niccoló Pasquale Luigi Maria. "Design of a mobile kit for cardiovascular disease screening in resource constrained environments." Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/111241.
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Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, Technology and Policy Program, 2017.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 161-176).
In the past few decades global health has improved significantly and many countries have started to move away from high mortality rates due to infectious diseases. This trend has however been accompanied by an increase in chronic disease incidence, in particular Cardiovascular Diseases (CVDs). In countries that are making this epidemiological transition, such as India, chronic diseases are also a hindrance to economic health as a large portion of deaths occur when people are still active in the work force. There are various policies that may be implemented to curb the burden of CVDs. These include population based approaches and high risk management strategies. In this thesis, the design of a mobile CVD Screening Kit to aid the screening of high risk subjects by low-skilled health workers is described. Focusing on India, a fertile ground where a mobile tool-kit may be implemented was identified at the intersection of: 1. Strong health worker schemes in primary care, 2. The diffusion of mobile phone technology and 3. Well developed CVD risk management strategies. The tools that constitute this CVD Screening Kit were tested at Sengupta Hospital and Research Institute, Nagpur, India. These tests showed that there is potential to develop the CVD Screening Kit further into a commercial product. The main advantage of the CVD Screening Kit developed is that, differently from standard CVD risk factor analysis, it measures the root issue of many CVDs, i.e. arterial stiffness. Therefore, the CVD Screening Kit brings complex clinical analysis capabilities, that are generally only available in equipped hospitals, to the hands of low-skilled health workers working in primary care centers. Although the CVD Screening Kit is still at an early stage of development, how it may be implemented in current public and private health programs that tackle CVDs, is also analysed in this thesis. Furthermore, it is discussed that introducing mobile phones to healthworkers, who are mostly female, may have a slow but strong impact on the independence and leadership of women.
by Niccoló Pasquale Luigi Maria Pignatelli.
S.M. in Technology and Policy
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Nasser, Zeina. "Outdoor air pollutants and cardiovascular diseases in Lebanon." Doctoral thesis, Universite Libre de Bruxelles, 2016. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/221755.
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Outdoor air pollution is increasingly considered as a serious risk factor for cardiovascular diseases (CVD). High levels of airborne particulate matter (PM) constitute the greatest international air pollution threat. The purpose of this thesis is to broaden our knowledge regarding the relationship between outdoor air pollution and cardiovascular diseases in the Middle Eastern countries, specifically in Lebanon. Moreover, we aimed to develop a scale as CVD screening tool among the Lebanese population. To achieve these goals, we conducted three studies. The first was a systematic review of the literature aiming to assess levels and sources of PM across the Middle East area and to search for an evidence of relationship between PM exposure and CVD (Paper I).The second manuscript was a multicenter case-control study investigating the association between outdoor pollutants and cardiovascular diseases among Lebanese adults (Paper II) while the third study was conducted to develop a score that can be used as a screening tool in clinical and epidemiological settings among the Lebanese adults (Paper III).The annual average values of PM pollutants in the Middle East region are considered to be much higher than the WHO 2006 tolerated levels (PM2.5 = 10 µg/m3, PM10 = 20 µg/m3). We uncovered evidence of an association between PM and CVD in 4 Middle East countries: Iran, Kingdom of Saudi Arabia, Qatar and the United Arab Emirates. Ambient PM pollution is considered a potential risk factor for platelet activation and atherosclerosis. Moreover, it was associated with CVD and found to be linked with an increased risk for mortality and hospital admissions (Paper I). Increased risk of CVD with an odds ratio OR of 5.04, 95% CI (4.44-12.85) for living near busy highway and 4.76, 95% CI (2.07-10.91) for living close to local diesel generator was noticed among population exposed to outdoor air pollution (Paper II). In addition, our results highlight the importance of scale generation, which includes air pollution as predictive factor, as screening tool for patients at risk of CVD. This scale can foresee the cardiovascular disease outcomes better than the established score which use the traditional CVD risk factors (Paper III).In conclusion this study brings new evidence regarding the effects of particulate matter on cardiac diseases, points out the harmful role of diesel exhaust on health and suggest a an important role of traffic exhaust particles in exacerbating heart diseases in the Middle East Region. The developed scale could detect persons at high risk for CVD in the clinical and epidemiological settings. In addition, it serves as an essential public health screening tool for the primary prevention of CVD.Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished
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Eborall, Helen Claire. "Lay attitudes towards cardiovascular risk in the context of screening, prevention, and trial participation." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/24550.
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This study expands the understanding of lay attitudes towards, and perceptions of cardiovascular risk by exploring beliefs in the context of a large trial of screening and prevention in a ‘healthy’ population. Participants were members of a healthy population (50-79 years) invited to attend screening for asymptomatic atherosclerosis, some of whom were subsequently invited to participate in a randomised control trial assessing the efficacy of aspirin in preventing cardiovascular events. Attitudes and beliefs varied both between and within groups of participants from different stages and situations from the screening and trial process. Prominent themes included: Screening attendance: Participants discussed their own attitudes often as distinct from those of ‘known’ or ‘general’ others. Salient explanations of barriers included fatalism, optimistic bias, denial and disinterest. Screening experience: An ‘at risk’ result often mismatched expectations, and provoked varying reactions: some participants maintained prior beliefs about personal health and risk, seeking alternative explanations; others reinterpreted their pre-screening beliefs. Preventive medicine: Attitudes and behaviour appeared to contradict: prevention was typically described as “better than cure”, and aspirin emerged as a favoured drug with assumptions of trust, safety, and low perceived risk. Trial Participation: Participants’ accounts revealed a wide range of influences on trial participation. When considering benefits and drawbacks of the trial, attitudes expressed ranged from feelings about personal gain or loss, to altruistic attitudes. The present study demonstrates the ubiquity of low cardiovascular risk perception in members of a general public population, and how this underlay attitudes towards screening and prevention, and participation in a preventive research trial. The asymptomatic nature of atherosclerosis, and lack of awareness of the screening measure emerged as particularly important contributors to low perceived risk, amidst the complex context of personal and situational factors in which people make decisions about their health. The findings have implications for, and can inform, the promotion of preventive health for asymptomatic conditions. Furthermore, the findings about attitudes towards, and understanding of, trial participation have implications for those conducting research trials particularly regarding informed consent.
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Simpson, Wendy M. "Psychological factors predicting health behaviour : the response to risk factor screening for cardiovascular disease." Thesis, University of St Andrews, 1996. http://hdl.handle.net/10023/13356.
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The two main aims of this thesis were first, to predict health behaviour and, second, to apply and test the existing psychological theories in this field. The health behaviours concerned were the responses to screening for risk factors for cardiovascular disease. Three empirical studies were carried out. The first response to screening is whether one attends or not. Results showed that uptake of screening in worksite settings (N=425) (Chapter 2) could be predicted by the health beliefs derived from social cognition models. Intention to attend was the best predictor of attendance. However, differences in predictive beliefs between worksites suggested communication factors were also an issue. Subsequently, communication factors were investigated in a study of uptake in general practice (N=210) (Chapter 4) finding that the method of offering screening affected uptake significantly. The second response to screening is the impact it has on the screenee. Results found that communication factors had little effect on screening impact in that there was little difference between three methods of offering screening in terms of their subsequent impact on patients' satisfaction, knowledge, intention or behaviour change (Chapter 4). Social cognitions, however, were found to predict impact in terms of behaviour change with a sample of attenders (N=59) at a screening clinic in general practice (Chapter 3). In the latter study, perceived threat was the best predictor of behaviour change. Four social cognition models were compared against each other in the classification of attenders and non-attenders in the Worksite study (Chapter 2). Apart from Social Learning Theory the other models performed adequately, but the Theory of Reasoned Action was the most successful. More recent theories were examined in the prediction of behaviour change following screening (Chapter 3). The data supported the stage model, the Precaution Adoption Process. The internal structure of the Health Action Process Approach was questioned, but the addition of an 'action phase' in tills model showed promise.
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Zühlke, Liesl. "Computer-assisted auscultation as a screening tool for cardiovascular disease : a cross-sectional study." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11714.
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Includes synopsis.Includes bibliographical references.
Cardiac auscultation is inherently qualitative, highly subjective and requires considerable skill and experience. Computer- assisted auscultation (CAA) is an objective referral-decision support tool that aims to minimise inappropriate referrals. This study evaluated the sensitivity and specificity of 2 CAA systems, Cardioscan® and Sensi®, in detecting echo-confirmed cardiac abnormalities in 79 consecutive patients referred for assessment to a tertiary cardiac clinic. CAA demonstrated suboptimal sensitivity and specificity in detecting cardiac abnormalities in children and adults. As both systems demonstrate 100% sensitivity in detecting acyanotic heart disease, and theoretically carry significant potential in resource-limited settings, further development of current technologies to improve sensitivity and specificity for clinical applications is still warranted.
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Morrison, Barbara Nicole. "Evaluation of pre-participation screening and cardiovascular risk assessment in Masters athletes in British Columbia." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/58726.
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Background: Middle-aged individuals (≥ 35 years) are exercising more and living longer. Vigorous exercise can transiently increase the risk of sudden cardiac death (SCD) in those with underlying cardiovascular disease (CVD). Pre-participation screening (PPS) can detect CVD. The optimal screening method in Masters athletes is unclear. Suggested methods include cardiovascular history questionnaire, physical examination, cardiovascular risk scores, resting electrocardiogram (ECG), exercise treadmill test (ETT), and imaging techniques.
Purpose: To evaluate the prevalence of CVD and risk factors and the effectiveness of different screening methods for detecting cardiovascular risk in Masters athletes to prevent SCD in sport. To determine the prevalence of atrial fibrillation (AF) in Masters athletes, and its association with volume of activity.
Methods: This is a prospective observational study that evaluated Masters athletes from a variety of sports. The initial screen consisted of a physical examination, a resting ECG, Framingham Risk Score (FRS), an American Heart Association (AHA) questionnaire, and a physical activity and lifestyle questionnaire. If the initial screen was abnormal, the participant went on for further evaluations according to criteria defined a priori. CVD was confirmed by follow-up examinations and a positive predictive value (PPV) determined the effectiveness of the screening tools.
Results: A total of 297 athletes (67% male, mean age 54 ± 8.8, range 35-81 years) were included. The prevalence of CVD was 12% and 9% had a high FRS. CAD was the most frequent diagnosis (9%). Three (1%) athletes were diagnosed with AF. A high cardiovascular risk score was the most effective tool in detecting CAD (56% PPV), and the AHA questionnaire produced the greatest number of false-positives (82%). There was a greater prevalence of AF and valvular heart disease in those with greater volumes of physical activity.
Conclusion: Physically fit, asymptomatic Masters athletes are not immune to cardiovascular risk factors and have significant CVD. Systematic screening amongst Masters athletes may be reasonable; however, more research is needed to refine the current PPS methods to better suit the Masters athlete population.Medicine, Faculty of
Graduate
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Crutchley, James E. B. "Automation and scale-up of human induced pluripotent stem cell models of cardiovascular disease for drug screening." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/32207/.
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The global cost of heart failure is USD$45 billion and set to double in the next 15 years. The only method of treatment is heart transplant but demand far exceeds supply and is projected to increase. Meanwhile, global pharmaceutical development has been hindered by poor drug development success rates. Of the drugs that make it to phase I clinical trials, only 8 % pass phase III and existing drug screens do not always accurately predict or detect adverse cardiac events. Cardiotoxicity is the underlying reason for 26 % of safety related drug withdrawals between 1990-2006. Therefore, a source of human cardiomyocytes (CMs) is required to fill the need for regenerative medicine and drug screening applications. Differentiation of human pluripotent stem cells (hPSCs) to CMs is a viable solution to this bottleneck but the number of cells required is staggering; up to 5 million novel compounds are registered annually by pharmaceutical and academic institutions, while cell replacement studies in primates suggest that 10 billion CMs will be required per patient to repair the damaged myocardium post infarction. The objective of this thesis was to evaluate whether automated high throughput manufacture of hPSCs and CMs was possible, and to demonstrate that hPSC-CMs could be used in automated high throughput drug screening by carrying out assays in 384-well plates. This thesis started by carrying out three manual differentiation methods; an embryoid body (EB) based method and two monolayer methods. Batch variability in mouse embryonic fibroblast conditioned medium (MEF-CM) led to erratic and variable differentiation outcomes (as high as 94+/-0.3 % to as low as 25.6+/-39.7 % beating EBs per 96 well plate). Two monolayer methods, using defined media (mTeSR and E8) increased cell yields by up to 12-fold and 65-fold respectively and simplified the process technically. When these methods were automated, EB differentiation failed to generate spontaneously beating EBs, whereas both monolayer methods succeeded in generating spontaneously beating cardiomyocytes of purities >90 %. Finally, cryopreserved stocks of hiPSC-CMs produced by automation were used to evaluate whether cardiotoxicity from the anticancer drug doxorubicin could be decreased by co-treating with dexrazoxane (an existing doxorubicin cardio-protectant), carvedilol (a β-blocker), sildenafil (a vasoactive agent) and isoprenaline (a β-adrenoreceptor agonist). This was carried out in a real-time, fully automated assay setup to monitor induction of apoptosis by the marker propidium iodide using the Operetta confocal plate reader. The concentration of doxorubicin that led to 50 % hiPSC-CM death (TD50) was significantly reduced by co-treatment with dexrazoxane, carvedilol and sildenafil. Carvedilol showed the highest level of cardioprotection by increasing TD50 of doxorubicin by 7.5-fold. In contrast, isoprenaline reduced TD50 of doxorubicin, suggesting that isoprenaline would be contraindicated in patients undergoing doxorubicin treatment. Thus, this thesis demonstrated that automated differentiation of cardiomyocytes was technically feasible with capability of generating high yields (up to 39 million cells per flask) and high purity (>90 %) cardiomyocytes. Furthermore, this system was compatible with high content assays in 384-well plates for evaluating drug toxicity.
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Glowny, Michelle G. "Engagement in Family Screening for Hypertrophic Cardiomyopathy." eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsn_diss/57.
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Background: Despite consensus guidelines, only about half of at-risk relatives in families with Hypertrophic Cardiomyopathy (HCM) undergo clinical screening and even fewer undergo predictive genetic testing, leaving those unscreened at risk for sudden cardiac death. The use of qualitative inquiry to examine family communication and complex factors influencing uptake of screening may inform interventions to increase uptake and prevent sudden cardiac death.
Purpose: The purpose of this study was to describe the engagement of at-risk relatives in family screening for HCM.
Specific Aims: The specific aims were to (1) Describe the experience of communication of genetic risk of HCM in families with a causative variant for HCM; (2) Use the Theory of Engagement to identify facilitators and barriers to family screening in families with a causative variant for HCM; and (3) Identify strategies to increase uptake of clinical screening and predictive genetic testing in families with a causative variant for HCM.
Framework: The Theory of Engagement, adapted from McAllister, was used as an initial framework for the study.
Methods: A qualitative descriptive design with purposive and snowball sampling was used and data were analyzed using qualitative content analysis.
Results: The overarching theme of Bringing Genetic Risk to the Foreground was comprised of three major themes: Cues to Action, Preferences for Knowledge and Gateways to Screening, reflecting factors that affect engagement with genetic risk and family screening throughout the lifespan.
Conclusions: Integrated longitudinal care and access to genetic specialists are needed for patients and families with a causative variant for HCM.
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Henriksson, Martin. "Cost-effectiveness and Value of Further Research of Treatment Strategies for Cardiovascular Disease." Doctoral thesis, Linköping : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-9788.
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Riding, Nathan. "The effect of ethnicity and body size on the athlete's heart and their impact on cardiovascular pre-participation screening." Thesis, Liverpool John Moores University, 2014. http://researchonline.ljmu.ac.uk/4586/.
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In response to the augmented haemodynamic load placed upon the heart by intense and prolonged exercise, various forms of physiological remodelling are elicited. The resultant cardiac structural, functional and electrical adaptations are coined the athlete’s heart. Due to the nature of the remodelling, in some cases these adaptations may however overlap with the diagnostic criteria for varying pathological conditions, often related to sudden cardiac death. Several variables are associated with the athlete’s heart including age, sex, sport, body size, and ethnicity. Ethnicity is of particular importance as athletes of an African/Afro-Caribbean ethnicity demonstrate a greater prevalence of abnormal changes suggestive of pathology. There is however paucity in the literature of the athlete’s heart among other ethnicities. For this reason Study 1 investigated the impact of Arabic ethnicity upon the structure, function and electrophysiology of the heart in male athletes. Study 1 identified that while Arabic athletes had larger hearts than Arabic controls, they had significantly smaller hearts than their Black and Caucasian athletic counterparts. While Black athletes had a significantly greater prevalence of training unrelated/abnormal ECG findings, Arabic and Caucasian both had similar levels of training unrelated/abnormal findings, suggesting the European Society of Cardiology guidelines for ECG interpretation in athletes are applicable for the ethnicity. Study 2 investigated another important facet of the athlete’s heart, which is body size. Study 2 identified that while there was a progressive relationship between body size and cardiac dimensions, the previously identified upper limits of cardiac structural remodelling were applicable even among those with a body surface area (BSA) over 2.3m2. Among the cohort of athletes with a BSA >2.3m2, Black athletes demonstrated significantly greater wall thickness’ than Caucasian and Arabic athletes. The second aspect to the thesis highlighted how the findings of Study 1 and 2 impact upon pre-participation screening. While debate still exists around the most effective methodology to screen for pathological cardiac conditions, several organisations mandate the use of the echocardiography alongside the resting 12-Lead ECG. Study 3 established that should echocardiography be limited to use as a follow up investigation, significant cost benefits could be elicited (47% reduction). The premise of this significant cost reduction was that no pathological case was identified by echocardiography in isolation. While still found to be useful in confirming pathology, significantly, in our study the investigation failed to identify two cases of hypertrophic cardiomyopathy. Study 4 investigated the implications of adopting modified ECG interpretation guidelines in light of the criticism that ECG screening should be avoided due to a high false positive rate. Utilising an ethnically diverse cohort, Study 4 demonstrated that using the ‘Refined’ criteria reduced the false positive rate from 22% when using the 2010 ESC guidelines to 5%. Importantly both criteria achieved 100% sensitivity, highlighting the importance of the ECG in cardiovascular screening.
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Kenney, Shelby R. "Development of a high throughput small molecule screen using Staphylococcus aureus invasion of cells." Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/404.
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Narazaki, Genta. "Directed and systematic differentiation of cardiovascular cells from mouse induced pluripotent stem cells and their application to chemical screening." Kyoto University, 2011. http://hdl.handle.net/2433/142050.
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Rowland, Janice. "The impact of a single brief intervention versus multiple contact lifestyle intervention on change in body weight and modifiable cardiovascular risk factors in adults who have undertaken cardiovascular risk screening." Thesis, University of Dundee, 2016. https://discovery.dundee.ac.uk/en/studentTheses/ef8c63c9-630b-4eb4-baa9-9bf2b40541f7.
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Obesity is an increasing cause of poor health in Scotland and contributes to many premature deaths. There are a range of preventable conditions for which causal links with obesity have been suggested including; type 2 diabetes, hypertension, hyperlipideamia (which is a major risk factor for ischemic heart disease), cardiovascular diseases (CVD) and certain cancers. CVD relates strongly to lifestyles, and risk factor modifications have been shown to reduce mortality and morbidity. It has become clear that the major contributors to poor cardiovascular health are related to adverse health behaviours namely excess body weight, diet, physical activity and smoking, and that risk assessment and primary prevention of CVD should remain a priority for the Public Health Agenda. Participants of the TASCFORCE study screening healthy adults over 40yrs for CVD risk were invited to participate in the HF2 randomised comparison study. All participants received the brief intervention at screening, baseline measurements of body mass index (BMI) and lipids. Participants with BMI ≥25kg/m² were eligible for HF2. Questionnaires were mailed after screening to assess general health, diet and activity. On return of the questionnaires participants were randomised to multiple-contact intervention or follow-up only. For 16-weeks the multiple-contact group received monthly information packs and telephone consultations with lifestyle counsellors to help achieve weight-loss goals. Participants were then re-assessed for changes in weight, cardiovascular risk, diet, activity and general health. The novel components in the HF2 investigation were; a cohort consisting of a middle aged population having undergone CVD risk screening, a fully powered randomised controlled trial of 16 weeks duration with the primary outcome of change in body weight and secondary outcomes to evaluate change in CVD risk factors, using the telephone as the primary mode of delivery. Per Protocol data indicated the multiple-contact group lost significantly more weight than the brief single contact group (between group difference 1.1kg, CI 0.1563 – 2.0585, p=0.023), however, when adjusted using imputed data, the ITT data showed weight loss was no longer significant (between group difference 0.9kg, CI-0.1420 – 1.9180, p=0.090). Although the HF2 intervention was not successful in achieving statistically significant weight loss, there were many positive outcomes. There were significant improvements in anthropometric modifiable risk factors shown in the intervention group notably a reduction in waist circumference, total cholesterol and low density lipoproteins. Both groups were successful in achieving weight loss and significantly improving a number of CVD risk factors, indicating that the HF2 intervention and the brief (usual care) advice were effective at initiating behaviour change. The study was shown to be acceptable with good participation satisfaction feedback for both intervention and control groups, with 94.5% in the intervention group rating the program as “worthwhile or excellent”. This study demonstrates it is feasible to use the screening setting as an opportunity to recruit participants for a lifestyle intervention.
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Visagie, Claude. "Screening for abnormal heart sounds and murmurs by implementing neural networks." Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/3119.
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Thesis (MScEng (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2007.This thesis is concerned with the testing of an “auscultation jacket” as a means of recording heart sounds and electrocardiography (ECG) data from patients. A classification system based on Neural Networks, that is able to discriminate between normal and abnormal heart sounds and murmurs, has also been developed . The classification system uses the recorded data as training and testing data. This classification system is proposed to serve as an aid to physicians in diagnosing patients with cardiac abnormalities. Seventeen normal participants and 14 participants that suffer from valve-related heart disease have been recorded with the jacket. The “auscultation jacket” shows great promise as a wearable health monitoring aid for application in rural areas and in the telemedicine industry. The Neural Network classification system is able to differentiate between normal and abnormal heart sounds with a sensitivity of 85.7% and a specificity of 94.1%.
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Åsenlund, Ewa. "Riskfaktorer och bukaorta aneurysm : en beskrivande och korrelerande studie av två årskullar 65-åriga män som genomgått screening av bukaorta." Thesis, Högskolan i Gävle, Akademin för hälsa och arbetsliv, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-9795.
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Syftet med denna studie var att undersöka samband mellan bukaorta aneurysm hos 65-åriga män och riskfaktorer såsom rökning, BMI>25, kosttillskott, hypertoni, hyperlipidemi, ett stillasittande yrke samt hereditet. Kvantitativ ansats med deskriptiv och korrelativ design användes, 3854 65-åriga män från två årskullar som screenats för AAA ingick och uppgifter hämtades från ett dataregister. Resultat: Antalet personer med bukaorta aneurysm var 2,4 %, 65 % var/hade varit rökare, 67 % hade övervikt, 49 % stillasittande arbete, 41 % hypertoni, 25 % hyperlipidemi, 17 % åt kosttillskott och 4 % hade hereditet. Rökning, hypertoni och hyperlipidemi visade signifikant samband med och ökade risken för att utveckla AAA. Störst riskfaktor var rökning. Övriga riskfaktorer visade inte signifikant betydelse. Riskfaktorerna tillsammans förklarade variationen i AAA med 5 %. Konklusion: Tidigare kända riskfaktorers betydelse bekräftades för uppkomst av AAA. För män med AAA ses ett behov av hälsoförebyggande insatser. Sjuksköterskan har ansvar för och kunskaper om preventiva åtgärder, kan och bör därför användas som stöd till män med nyupptäckt AAA.
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Asomaning, Margaret. "Impact of a Wellness Clinic Visit on Cardiovascular Risk Biomarkers in Employees of a VA Medical Center." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3713.
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Background: Worksite screening programs are increasingly being provided by employers as a means to reduce cardiovascular risk in employees. A screening program that consists of fasting serum analysis of glucose plus a lipid panel is offered yearly to employees at the VA medical center in Tampa. A retrospective study was conducted to determine if a wellness clinic exposure resulted in significant changes in employees' markers of cardiovascular risk.
Methods: Computerized records were used to follow serial outcomes for glucose, triglycerides, HDL cholesterol, and LDL cholesterol in employees whose screening results showed abnormal levels of one or more of these markers. An intervention group with 66 subjects received a wellness clinic visit including a health risk assessment and education for lifestyle change, and a reference group with 109 subjects received only serum analysis. Outcomes at repeat screening were compared for the two groups.
Results: Both groups showed improvement in cardiovascular risk. In the intervention group there was significant intra-subject improvement from baseline for all markers except glucose. For triglycerides and LDL cholesterol there was a significantly greater proportion of subjects who improved in the intervention group. In addition, the improvement for triglycerides was significantly better in the intervention group.
Conclusions: This investigation confirms the value of a worksite wellness program in reducing cardiovascular risk in the population studied. A differential impact of age and gender was seen for glucose and triglycerides and indicates that such modifiers should be considered through covariate analysis in assessing wellness program effectiveness. Increasing levels of employee wellness participation to targets identified in this study and adding a health risk assessment for everyone screened will help to identify the specific benefits of the face to face wellness counseling intervention.
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Pereira, Alexandre da Costa. "Estudo do polimorfismo genético C242T no gene da p22phox e a incidência de eventos cardiovasculares na doença arterial coronária." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-29012009-092655/.
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O desenvolvimento de uma abordagem de estratificação de risco para a doença arterial coronária é certamente uma ferramenta de grande utilidade para o cardiologista clínico ou clínico geral, assim como para o planejamento de saúde pública e organização de ações de saúde pública mais eficazes. No entanto, esse conhecimento deve ser discutido dentro de um cenário de custo-efetividade e de acordo com seu potencial como objeto de valor econômico. O presente estudo tem como objetivo a identificação de fatores de risco genético de eventos cardiovasculares na população brasileira e o desenvolvimento de um algoritmo preditor que utilize essas informações para o diagnóstico. Esse trabalho encontra-se expositivamente dividido em dois módulos. No primeiro, procuramos exemplificar através de um estudo de associação genética nossa capacidade atual de encontrar e caracterizar variantes genéticas com poder de estratificação populacional com relação ao risco cardiovascular. Utilizamos dados obtidos a partir de pacientes com doença coronária multiarterial, analisando a relevância do polimorfismo C242T do gene da p22phox, subunidade protéica da NADPH oxidase, na predição de mortalidade desta população. Nossos dados permitem não apenas associar esse marcador genético a um risco aumentado de mortalidade nessa população, mas também fornecem informações a respeito do provável mecanismo molecular através do qual esse marcador genético age. No segundo módulo, procuramos detalhar as limitações da abordagem previamente exemplificada, avaliando a informação gerada para o paciente individual. Aqui propomos uma nova abordagem de estratificação de risco desta população, capaz de fornecer de maneira individualizada uma estimativa de risco com maior sensibilidade, especificidade e, conseqüentemente, acurácia. Através de uma abordagem analítica de redução de dimensionalidade obtivemos um algoritmo preditor com acurácia maior do que aquela encontrada utilizando-se apenas os fatores de risco clássicos ou fatores de risco genéticos analisados individualmente. O entendimento das bases genéticas do desenvolvimento de doenças cardiovasculares facilitará não apenas o diagnóstico precoce, possibilitando o surgimento de abordagens terapêuticas mais específicas e desenhadas a atender suscetibilidades individuais, mas também poderá levar à identificação de novas vias eficazes de intervenção.The development of risk stratification approaches in coronary artery disease is certainly an important tool for the clinical cardiologist or internist. It also helps in the planning of public health policies and in the development of effective disease management algorithms. Nevertheless, these tools necessarily have to be developed in a cost-effective scenario and in close relationship with its intrinsic economic value. The present research project aims at the identification of genetic risk factors for cardiovascular events in the Brazilian population and the development of an algorithm with high predictive value for the diagnosis of these events. This thesis is, didactically, divided into 2 modules. Firstly, we have exemplified the used paradigm through the development of a genetic association study conducted in the Brazilian population. Here, we were able to describe and characterize genetic variants with the capacity of risk stratify populations into high and low risk groups. This section was possible with the use of data derived from patients with multi-vessel coronary artery disease and the analysis of the C242T gene variant of the p22phox gene, a subunit of the NADPH oxidase protein complex. Our data show not only a major signal of association between this genetic variant and overall mortality in this population, but also shed light on the potential molecular mechanism of this finding. Secondly, we have described the potential limitations of this approach analyzing information derived for the individual patient. Here, we propose a new risk stratification algorithm for this population with the capacity to provide individual risk with increased sensitivity and specificity. Through the use of a dimensionality reduction analytical approach we were able to find a predictive algorithm with higher accuracy than the one derived with the use of only classical cardiovascular risk factors and no genetic information. The understanding of the genetic basis for cardiovascular disease will improve not only the early diagnosis of these disorders, facilitating the rise of therapeutic approaches more specific and tailored to ones particular genetic susceptibility, but also lead to the identification of new pathways for effective intervention
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Fisher, Leslie Reginald. "Evaluation of high-throughput methodology for multi-gene screening in patients with Non-Alcoholic Fatty Liver Disease (NAFLD)." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17896.
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Thesis (MScMedSc)--Stellenbosch University, 2011.ENGLISH ABSTRACT: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most prevalent chronic liver disease in Western countries and is considered the hepatic manifestation of the Metabolic Syndrome (MetS). Its heterogeneous nature ranges from hepatic steatosis through steatohepatitis to advanced fibrosis and cirrhosis where the ingestion of significant amounts of alcohol has been excluded. The disease profile of NAFLD and its necro-inflammatory subset Nonalcoholic Steatohepatitis (NASH) were described in the parent study, which provided a clinically well-characterised patient cohort for the present investigation. South African patients with NASH had significantly higher mean serum cholesterol and triglyceride levels than those with fatty liver only. The objective of this study was to implement a high-throughput real-time polymerase chain reaction (PCR) method in our laboratory to enable the assessment of cardiovascular genetic risk factors in NAFLD patients. The specific aims were to determine the clinical utility and perform analytical validation of each mutation included in the multi-gene cardiovascular disease (CVD) screening assay. The Pathology Supported Genetic Testing (PSGT) concept developed at our department provides a practical approach to personalized medicine. The CVD multi-gene screen analyses key metabolic pathways relating to atherogenic dyslipidaemia, chronic inflammation, hypercoagulation and iron dysregulation implicated in insulin resistance, which is known to be a universal factor in the pathogenesis of NAFLD. Deleterious low-penetrance mutations in the APOE (APOE2 and E4 alleles), MTHFR (677C>T and 1298A>C), F2 (20210G>A), FV (1691G>A, Leiden) and HFE (C282Y and H63D) genes were included for analysis due to their important role as genetic contributors to these biological processes. A total of 178 patients diagnosed with NAFLD and 75 controls were studied using direct DNA sequencing and a RT-PCR system for mutation detection. In addition, two patients with high ferritin levels were included as case studies. A significant association was found between HFE mutations and elevated Alanine Transaminase (ALT) levels in the NAFLD population (p = 0.04). This discovery is interpreted as the identification of a subset of patients at greater risk of developing progressive liver damage who would benefit most from genetic testing to direct more aggressive therapy at an earlier stage. The necessity of an integrative, systems-based network approach was demonstrated to more accurately distinguish between Hereditary Haemochromatosis (HH) and Insulin Resistance-associated Hepatic Iron Overload (IR-HIO) syndrome in obese patients. The PSGT approach to personalized medicine facilitates diagnosis of CVD subtypes, prevention of cumulative risk and the formulation of gene-based intervention programs tailored to the needs of the patient. These findings support the clinical utility of the CVD multi-gene test to guide chronic disease risk management in patients with NAFLD. The HFE mutation detection component of this test is of particular relevance in directing an effective treatment strategy in patients with a medical history of CVD and/or high iron stores.
AFRIKAANSE OPSOMMING: Nie-Alkoholiese Vettige Lewer Siekte (NAFLD) is die mees algemene kroniese lewer siekte in Westerse lande en word bestempel as die hepatiese manifestasie van die Metaboliese Sindroom (MetS). Die heterogene natuur van NAFLD strek van hepatiese steatose deur steatohepatietis tot gevorderde fibrose en sirrose waar grootskaalse alkohol inname uitgesluit is. Die siekte-profiel van NAFLD en sy nekro-inflammatoriese subtipe Nie-Alkoholiese Steatohepatietis (NASH) is reeds beskryf in die ouer studie, wat ‗n klinies goed-gekarakteriseerde pasiënt groep vir die huidige ondersoek daar gestel het. Suid-Afrikaanse pasiënte met NASH het beduidend hoër gemiddelde serum cholesterol en trigliseried vlakke in vergelyking met slegs vettige lewer. Die doel van hierdie studie was om ‗n hoë deurvoer rieëltyd polimerase kettingreaksie (RT-PCR) metode in ons laboratorium te implimenteer om kardiovaskulêre genetiese risiko faktore in NAFLD pasiënte te ondersoek. Die spesifieke mikpunte was om die kliniese nut en analitiese geldigheid van elke mutasie wat ingesluit is in die multi-geen kardiovaskulêre siekte (KVS) siftings toets vas te stel. Die Patologie Ondersteunde Genetiese Toetsing (PSGT) konsep wat by ons departement ontwikkel is, verskaf ‗n praktiese benadering tot persoonlike medisyne. Die KVS multi-geen toets analiseer belangrike metaboliese weë verwant aan atherogene dyslipidemie, kroniese inflammasie, oormatige bloedstolling en yster disregulering wat betrokke is by insulien weerstand wat bekend is as ‗n universele factor in the patogenese van NAFLD. Nadelige lae-penetrasie mutasies in die APOE (APOE2 en E4 allele), MTHFR (677C>T en 1298A>C) F2 (20210G>A), FV (1691G>A, Leiden) en HFE (C282Y en H63D) gene was ingesluit vir analise as gevolg van hul belangrike rol as genetiese bydraers tot die bogenoemde biologiese prosesse. ‗n Totaal van 178 pasiënte gediagnoseer met NAFLD en 75 kontroles is bestudeer deur gebruik te maak van direkte DNA volgordebepaling en ‗n RT-PCR metode vir mutasie opsporing. Twee pasiënte met verhoogde ferritien vlakke is ook as gevalle studies ingesluit. ‗n Beduidende assosiasie is gevind tussen HFE mutasies en verhoogde Alanien Transaminase (ALT) vlakke in die NAFLD studiepopulasie (p = 0.04) wat aanduidend is van ‗n subgroup van pasiënte wat die meeste baat sal vind uit genetiese toetsing om meer aggressiewe behandeling te rig op' n vroeër stadium. Die noodsaaklikheid van 'n geïntegreerde, stelsels-gebaseerde netwerk benadering is gewys om meer akkuraat te onderskei tussen Oorerflike Hemochromatose (HH) en Insulien Weerstand-geassosieerde Hepatiese Yster Oorlading (IR-HIO) sindroom in vetsugtige pasiënte. Die PSGT benadering tot persoonlike medisyne formuleer geen-gebaseerde intervensie programme aangepas tot die behoeftes van die pasiënt ek maak diagnose van KVS-subtipes en voorkoming van kumulatiewe risiko moontlik. Hierdie bevindinge ondersteun die kliniese nut van die KVS multi-geen toets om riglyne vir die risikobestuur van kroniese siektes soos NAFLD daar te stel. Die HFE mutasie opsporings komponent van hierdie toets is van besondere belang om 'n effektiewe strategie vir die behandeling van pasiënte met 'n mediese geskiedenis van KVS en/of hoë yster vlakke daar te stel.
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Sensi, C. "LCAT MOLECULAR MODELING:APPLICATIONS TO STRUCTURE-FUNCTION RELATIONSHIPS AND TO INHIBITOR DISCOVERY." Doctoral thesis, Università degli Studi di Milano, 2013. http://hdl.handle.net/2434/216122.
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A series of large population studies have revealed the existence of a strong inverse correlation between plasma levels of high-density lipoprotein cholesterol (HDL-C) and cardiovascular risk. Accordingly, HDL has become a major target for the development of novel therapies for the treatment of atherosclerotic cardiovascular disease.
LCAT catalyzes cholesteryl ester synthesis and plays a central role in HDL structure and metabolism. Also, LCAT promotes the reverse cholesterol transport, and mediates its atheroprotective effects. Recent studies demonstrated that decreasing LCAT activity possibly has positive effects on HDL structure/function, and may represent a novel therapeutic strategy to reduce cardiovascular risk. To exploit LCAT therapeutic prospects, the availability of new potent and selective LCAT modulators is mandatory. With the present work, we identified molecules able to inhibit LCAT enzymatic activity implementing an in silico strategy.
The computational approach can be deployed in two different ways: i) the availability of large chemical databases, and the computational power of the new computers allow a very efficient in silico high-throughput screening starting from the target structure and independently of any pharmacophoric hypothesis; ii) the knowledge of the active site and of the catalytic mechanism of a target can be exploited for ab initio computer-aided drug design.
We have designed, through a de novo approach, an irreversible inhibitor, which is the first specific LCAT inhibitor known, and can be considered as a lead compound for the identification of new active molecules belonging to the same chemical family.
In parallel, the high-throughput screening carried out on LCAT identified some very potent reversible inhibitors, which can be of interest in further drug development steps.
Globally, this project produced innovative pharmacological entities to be further developed for a completely new therapeutic approach to the treatment of atherosclerotic cardiovascular diseases.
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Silva, Pãmela Rodrigues de Souza. "Programa de seguimento de coorte de pacientes com hipercolesterolemia familiar na região metropolitana de São Paulo." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-09052018-103651/.
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Introdução: A Hipercolesterolemia Familiar (HF) é uma doença genética caracterizada clinicamente por elevados níveis de lipoproteína de baixa densidade (LDL-C) na corrente sanguínea desde a infância. Indivíduos que apresentam HF podem desenvolver doença aterosclerótica ainda em idade jovem. Os principais preditores de risco no desenvolvimento da doença cardiovascular (DCV) nesses indivíduos após entrarem em um programa de rastreamento genético não são conhecidos na nossa população. Além disso, a HF é subdiagnosticada e subtratada mundialmente e o rastreamento genético em cascata dos familiares tem sido mundialmente avaliado como o método diagnóstico mais custo. Contudo, a efetividade do rastreamento genético em cascata é dependente dos critérios clínicos de entrada do primeiro indivíduo da família e não há um consenso de qual critério apresenta a melhor acurácia para detecção de uma mutação. Objetivos: Identificar os fatores determinantes para ocorrência de eventos cardiovasculares (CV) em todos os indivíduos da coorte e avaliar o critério clínico para detecção de uma variante genética patogênica para HF, no primeiro indivíduo da família, após serem inseridos em um programa de rastreamento genético em cascata.Métodos: Estudo de coorte prospectiva aberta dos pacientes que foram inseridos no programa de rastreamento genético em cascata para HF. A população do estudo é definida como caso índice (CI), o primeiro da família a ser identificado clinicamente e encaminhado para o teste genético, e os familiares, que são os parentes de 1º grau do CI em que foi encontrada uma alteração genética. Todos os indivíduos são inseridos na coorte no momento em que recebem o laudo genético (tempo zero, T0). Um ano depois do T0 é realizado o primeiro contato telefônico, ou seja, primeiro ano de seguimento (T1) Resultados: No T1, o total de 818 indivíduos foi incluído, sendo verificados 47 eventos CV, sendo 14 (29,7%) fatais. Para o CI, o único fator independente associado ao aumento do risco de eventos CV no T1 foi a presença de arco corneano (OR: 9,39; IC 95%: 2,46-35,82). Para os familiares com uma mutação positiva os fatores associados ao aumento do risco de eventos CV foram diabetes mellitus (OR: 7,97; IC 95%: 2,07-30,66) e consumo de tabaco (OR: 3,70; IC 95%: 1,09-12,50). Na análise do melhor critério clínico para detecção de uma mutação patogênica no CI os valores de LDL-C >= 230 mg/dL tiveram a melhor relação entre sensibilidade e especificidade. Na análise da curva ROC o escore Dutch Lipid Clinic Network (DLCN) apresentou melhor desempenho do que o LDL-C para identificar uma mutação, a área sob a curva ROC foi 0,744 (IC 95%: 0,704-0,784) e 0,730 (IC 95%: 0,687-0,774), respectivamente, p = 0, 014. Conclusão: Em um ano de seguimento essa coorte identificou uma alta incidência de eventos CV após a entrada em um programa de rastreamento genético em cascata e os preditores dos eventos CV diferem entre CI e familiares. Esses resultados podem contribuir para o desenvolvimento de ações preventivas nesse grupo altamente susceptível de indivíduos. Além disso, devido a importância da detecção da mutação para um diagnóstico definitivo de HF e a importância da cascata ser custo efetiva o estudo identificou que o critério único do LDL-C >= 230 mg/dl é viável para indicar o CI para o teste genéticoIntroduction: Familial Hypercholesterolemia (FH) is a genetic disease characterized clinically by high levels of low density lipoprotein (LDL-C) in the bloodstream since childhood. Individuals with FH can develop atherosclerotic disease at a young age. The main predictors of cardiovascular disease (CVD) risk in these individuals after entering a genetic screening program are not known in our population. In addition, FH is underdiagnosed and undertreated worldwide and cascaded genetic screening of family members has been evaluated globally as the most cost effective for the diagnosis of FH. However, the effectiveness of cascading genetic screening is dependent on the clinical entry criteria of the first individual in the family and there is no consensus as to which criterion shows the best accuracy for detecting a mutation. Objectives: To identify the determinant factors for cardiovascular (CV) events in all individuals in the cohort and to evaluate the clinical criteria for detecting a genetic variant pathogenic to FH in the first individual of the family after being inserted into a genetic screening program in cascade. Methods: Open prospective cohort study of patients who were enrolled in the cascade genetic screening program for FH. The study population is defined as index case (IC), the first of the family to be clinically identified and referred to the genetic test, and relatives, who are the first-degree relatives of the IC in which a genetic alteration was found. All individuals are inserted into the cohort at the moment they receive the genetic report (time zero, T0). The first follow-up telephone contact is made one year after T0 (first year of follow-up, T1). Results: In T1, a total of 818 subjects were included, and 47 CV events were verified, of which 14 (29.7%) were fatal. For IC, the only factor independently associated with the increased risk of CV events in T1 was the presence of a corneal arch (OR: 9.39; 95% CI: 2.46-35.82). For relatives with positive mutation, factors associated with increased risk of CV events were diabetes mellitus (OR: 7.97; 95% CI: 2.07-30.66) and tobacco consumption (OR: 3.70; 95% CI: 1.09-12.50). In the analysis of the best clinical criteria for the detection of a pathogenic mutation in the IC, the LDL-C values >= 230 mg/dL had the best relationship between sensitivity and specificity. In the ROC curve analysis, the Dutch Lipid Clinic Network (DLCN) score performed better than LDL-C to identify a mutation, the area under the ROC curve was 0.744 (95% CI: 0.704-0.784) and 0.730 (CI 95 %: 0.687-0.774), respectively, p = 0.014. Conclusion: At one year follow-up this cohort identified a high incidence of CV events following entry into a cascade genetic screening program and the predictors of CV events differ between IC and family members. These results may contribute to the development of preventive actions in this group highly susceptible to individuals. In addition, because of the importance of detecting the mutation for a definitive diagnosis of HF and the importance of the cascade being cost effective, the study identified that the single LDL-C criterion >= 230 mg / dl is feasible to indicate IC for the genetic test
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Böhm, Birgit Verfasser], Renate Maria [Akademischer Betreuer] Oberhoffer, and Arno [Akademischer Betreuer] [Schmidt-Trucksäss. "Risk screening and exercise interventions in pediatric prevention of atherosclerotic cardiovascular disease: Links between carotid intima-media thickness and physical fitness / Birgit Böhm. Gutachter: Renate Maria Oberhoffer ; Arno Schmidt-Trucksäss. Betreuer: Renate Maria Oberhoffer." München : Universitätsbibliothek der TU München, 2012. http://d-nb.info/1031076042/34.
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Romero-Albino, Zoila Olga, Rafael Omar Domínguez-Samamés, Maritza Ortiz-Arica, and María Sofía Cuba-Fuentes. "Need to review sanitary interventions promoted by the government for women in Peru." Instituto Nacional de Salud, 2020. http://hdl.handle.net/10757/655700.
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The main health interventions for health promotion and disease prevention that should be performed in women in the Peruvian health system are described. A review of normative technical documents and the recommendations of the main organizations for worldwide prevention was carried out. The prevention activities included physical activity, healthy eating, tobacco counseling, immunizations; In addition, the main screening for women, such as depression, violence, cardiovascular risk, cervical cytology, mammography, colon cancer, are detailed; and within the spectrum of quaternary prevention, interventions that have not shown evidence of benefit to women are detailed. The health interventions that are offered from the Peruvian health system for women, being merely focused on reproductive aspects, lose the conception of integrality that should prevail for the maintenance of health. In that sense, it is proposed to develop strategies that not only have evidence, but also know how to respond to the needs of women in the Peruvian context.Revisión por pares
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Palma, Cátia Cristina Silva Sousa Vergara. "Estudo de prevalência de disfunção tireoidiana em pacientes com diabetes mellitus acompanhados no ambulatório de diabetes do Hospital Universitário Pedro Ernesto." Universidade do Estado do Rio de Janeiro, 2013. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=6114.
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Fundação de Amparo à Pesquisa do Estado do Rio de JaneiroO diabetes mellitus(DM) e as disfunções tireoidianas(DT) são as duas desordens endocrinológicas mais comuns na prática clínica. A DT não reconhecida pode interferir no controle metabólico e adicionar mais risco a um cenário predisponente à doença cardiovascular. O objetivo deste estudo foi avaliar a prevalência da DT em pacientes com diabetes mellitus tipo 1 e tipo 2 (DM1 e DM2) e avaliar o risco cardiovascular em pacientes com DM2 com e sem DT utilizando parâmetros clínicos e laboratoriais. Trata-se de um estudo observacional de corte transversal. Foram avaliados 304 pacientes com DM2 e 82 pacientes com DM1. Os pacientes foram submetidos a um inquérito clínico-demográfico e avaliação laboratorial para determinação do perfil lipídico, glicídico e da função tireoidiana. Os pacientes com DM2 tiveram seus escores de risco cardiovascular em 10 anos determinados pelas equações de Framingham e do UKPDS risk engine. A frequência de disfunção tireoidiana entre os 386 pacientes foi de 14,7%, sendo de 13% nos que não possuíam disfunção prévia. A disfunção mais frequente encontrada foi de hipotireoidismo subclínico, com 13% no DM1 e de 12% no DM2. A prevalência de anticorpos anti-tireoperoxidase (TPO) positivos foi de 10,8%, sendo de14,6% em pacientes com DM1.Foram diagnosticados 44 (11,2%) novos casos de disfunção tireoidiana em pacientes que negavam ou desconheciam terem DT prévia.Destes novos casos, 12,8% em DM1 e 13,1% em DM2.Dos 49 pacientes com DT prévia, 50% dos DM1e 76% dos DM2 estavam compensados. Não foi observada diferença entre as médias do escore de risco de Framingham entre os pacientes DM2 com eutireoidismo e com hipotireoidismo subclínico. Observou-se uma associação entre o hipotireoidismo subclínico e risco cardiovascular nos pacientes com DM2 demonstrado pela diferença estatisticamente significativa entre as médias do escore UKPDS para doença coronariana não-fatal e fatal, acidente vascular cerebral fatal entre os dois grupos (p=0,007; 0,005;0,027 respectivamente). As demais funções tireodianas (hipotireoidismo clínico, hipertireoidismo clínico e subclínico) encontradas não foram analisadas devido ao pequeno número de pacientes em cada grupo.Concluímos que o rastreio da doença tireoidiana entre os pacientes com diabetes mellitus deve ser realizado rotineiramente considerando-se a prevalência de novos casos de DT diagnosticados e o fato de que os pacientes com DM2 e com hipotireoidismo subclínico avaliados possuírem um risco cardiovascular maior. Todavia, concluímos que estudos prospectivos e com maior número de pacientes são necessários para o esclarecimento do impacto da doença tireoidiana no risco cardiovascular do paciente com DM.
Diabetes mellitus and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice. The unrecognized TD may adversely affect the metabolic control and add more risk to an already predisposing scenario for cardiovascular diseases. The objective of this study was to evaluate the prevalence of TD in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM) and to evaluate the cardiovascular risk of patients with T2DM with and without thyroid dysfunction using clinical and laboratory parameters. This is an observational cross-sectional study. We evaluated 304 patients with T2DM and 82 patients with T1DM. The patients underwent a clinical-demographic survey and laboratory evaluation to determine the lipid and glycemic profile and thyroid function. Patients with T2DM had their 10 years cardiovascular risk scores determined by Framingham equations and the UKPDS risk engine. The frequency of TD among the 386 patients was 14.7% and 13% who denied previous TD. The most frequently TD was subclinical hypothyroidism, in 13% of patients with T1DM and in 12% of patients with T2DM.The prevalence of anti-TPO antibodies was 10.8%, being more frequently among patients with T1DM (14.6%). Forty-four (11.2%) new cases of TD were diagnosed during the study in patients who denied or were unaware of this clinical condition. Of the 49 patients with prior TD,50% of the T1DM and 76% of T2DM were compensated. No differencies were observed between the mean scores of the Framingham risk among patients with T2DM who had normal thyroid function compared to those with subclinical hypothyroidism. An association between subclinical hypothyroidism and cardiovascular risk in T2DM patients was found by statistically significant difference between the mean UKPDS scores for non-fatal and fatal CHD and fatal stroke between the two groups (p = 0,007;0,005;0027; respectively). The other TD (clinical hypothyroidism, clinical and subclinical hyperthyroidism) found were not analyzed due to the small number of patients in each group.We conclude that screening for thyroid disease among patients with diabetes mellitus should be routinely performed considering the prevalence of new cases diagnosed and the fact that patients with DM2 and subclinical hypothyroidism evaluated had a higher cardiovascular risk. However, prospective studies and with more patients are warranted to determine the impact of thyroid dysfunction in the cardiovascular risk of patients with diabetes.
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Smitherman, Emily A. "Improving Quality of Care for Childhood-onset Systemic Lupus Erythematosus: Cardiovascular and Bone Health Screenings." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1535381218464551.
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Saaristo, T. (Timo). "Assessment of risk and prevention of type 2 diabetes in primary health care." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514297113.
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Abstract Type 2 diabetes is one of the fastest increasing lifestyle diseases globally. Its cure is not yet possible, but there is firm evidence from scientific studies that it can effectively be prevented by lifestyle changes. There is limited evidence-based information on the prevention of diabetes in practice. This dissertation offers new desirable information on the issue. The aim of this dissertation study was to describe the prevalence of risk factors for type 2 diabetes and hidden glucose disorders predicting the development of diabetes in the Finnish adult population, and to analyse whether the risk for developing diabetes could be reduced by simple lifestyle counselling. Furthermore, the ability of the Finnish Diabetes Risk Score (FINDRISC) to detect glucose disorders leading to diabetes and undiagnosed diabetes was analysed. In the dissertation data from large Finnish population surveys (the FINRISK 2002 glucose tolerance survey and the FIN-D2D 2004−2005 survey) were analysed. In addition, a prospective design and large-scale intervention were included. We found that obesity and glucose disorders are very common in the Finnish middle-aged population. Prevalence of obesity was 24% for men and 28% for women, that of abnormal glucose metabolism 42% for men and 33% for women, and that of undiagnosed diabetes 9% for men and 7% for men. One quarter of individuals aged 45−64 years were at high risk for diabetes. Lifestyle interventions were offered to more than 10,000 high-risk individuals, 3,379 men and 6,770 women. Of the men, 43% were also at high risk for cardiovascular morbidity and 42% at high risk for cardiovascular mortality estimated through the FRAMINGHAM and SCORE risk engines, respectively. The FINDRISC, originally developed for predicting the risk of development of type 2 diabetes, also predicted the prevalence of diabetes in the population. The effect of lifestyle interventions on weight and its association with glucose tolerance was evaluated in individuals at high risk for diabetes in a one-year follow-up. In total 17.5% of them lost ≥ 5% weight. Their relative risk for diabetes decreased 69% compared with the group that maintained their weight. This study shows that FINDRISC predicts prevalent type 2 diabetes. A significant proportion of middle-aged Finnish population has a glucose disorder including undiagnosed type 2 diabetes. Lifestyle interventions in primary health care may promote weight loss, which decreases the risk of diabetesTiivistelmä Diabetes on yksi nopeimmin lisääntyvistä elintapasairauksista maailmassa. Sitä ei vielä voida parantaa, mutta tieteellisissä tutkimuksissa on kiistattomasti osoitettu, että sitä voidaan tehokkaasti ehkäistä elintapamuutoksilla. Diabeteksen ehkäisystä käytännössä on hyvin niukasti tutkimustietoa. Tämä väitöskirja tuo kaivattua lisätietoa aiheesta. Väitöstutkimuksen päätavoitteena oli selvittää diabeteksen riskitekijöiden ja piilevien diabetesta ennakoivien sokerihäiriöiden yleisyyttä suomalaisessa aikuisväestössä. Tämän ohella tavoitteena oli selvittää voidaanko yksinkertaisella elintapaneuvonnalla vähentää sellaisten henkilöiden sairastumisvaaraa, joilla oli suuri riski sairastua diabetekseen. Lisäksi arvioitiin diabetesriskitestin kykyä tunnistaa ennakoivat sokerihäiriöt ja aiemmin tunnistamaton diabetes. Tutkimuksessa käytettiin laajoja suomalaisia väestötutkimusaineistoja: FINRISKI-2002 -tutkimusta, sen alaotosta ja D2D-väestötutkimusta 2004–2005. Mukana oli myös pitkittäisasetelma ja laajamittainen interventio. Tutkimuksen perusteella huomasimme, että lihavuus ja sokerihäiriöt ovat hyvin yleisiä keski-ikäisillä suomalaisilla. Merkittävästi lihavia (BMI ≥ 30 kg/m2) oli 24 % miehistä ja 28 % naisista ja poikkeava sokeriaineenvaihdunta oli 42 %:lla miehistä ja 33 %:lla naisista. Tunnistamaton diabetes oli 9 %:lla miehistä ja 7 %:lla naisista. Suuressa diabetekseen sairastumisvaarassa oli neljäsosa 45−64-vuotiaista. Interventioon otettiin yli 10 000 suuressa diabeteksen sairastumisriskissä olevaa henkilöä, 3 379 miestä ja 6 770 naista. Miehistä 43 % oli suuressa sairastumisvaarassa myös sydän- ja verisuonisairauteen ja 42 % suuressa kuolemanvaarassa Framingham- ja SCORE-riskilaskureilla arvioituna. Tyypin 2 diabeteksen sairastumisriskin arviointiin kehitetty Riskitesti ennusti hyvin myös diabeteksen esiintymistä väestössä. Elintapainterventioiden vaikutusta painoon ja sokeriaineenvaihduntaan analysoitiin vuoden seurannassa sellaisilla henkilöillä, joilla oli suuri diabetesriski. Paino laski 5 % tai enemmän 17,5 %:lla, jolloin sairastumisriski diabetekseen väheni 69 % verrattuna ryhmään, jonka paino ei muuttunut. Tutkimuksen perusteella lihavuus, sokerihäiriöt ja tunnistamaton diabetes ovat yleisiä keski-ikäisessä väestössä. Riskitesti on hyvä työkalu myös diabeteksen seulonnassa. Perusterveydenhuollossa tarjottavalla elintapaneuvonnalla voidaan saada aikaan laihtuminen, joka vähentää sairastumisvaaraa diabetekseen
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Gianella-Borradori, Matteo Luca. "The identification & optimisation of endogenous signalling pathway modulators." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:4c87de5d-24a7-4998-8edb-917c3922aae1.
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Chapter 1 Provides an overview of drug discovery with particular emphasis on library selection and hit identification methods using virtual based approaches. Chapter 2 Gives an outline of the bone morphogenetic protein (BMP) signalling pathway and literature BMP pathway modulators. The association between the regulation of BMP pathway and cardiomyogenesis is also described. Chapter 3 Describes the use of ligand based virtual screening to discover small molecule activators of the BMP signalling pathway. A robust cell based BMP responsive gene activity reporter assay was developed to test the libraries of small molecules selected. Hit molecules from the screen were synthesised to validate activity. It was found that a group of known histone deacetylase (HDAC) inhibitors displayed most promising activity. These were evaluated in a secondary assay measuring the expression of two BMP pathway regulated genes, hepcidin and Id1, using reverse transcription polymerase chain reaction (RT-PCR). 188 was discovered to increase expression of both BMP-responsive genes. Chapter 4 Provides an overview of existing cannabinoid receptor (CBR) modulating molecules and their connection to progression of atherosclerosis. Chapter 5 Outlines the identification and optimisation of selective small molecule agonists acting at the cannabinoid 2 receptor (CB2R). Ligand based virtual screen was undertaken and promising hits were synthesised to allow structure activity relationship (SAR) to be developed around the hit molecule providing further information of the functional groups tolerated at the active site. Subsequent studies led to the investigation and optimisation of physicochemical properties around 236 leading to the development of a suitable compound for in vivo testing. Finally, a CB2R selective compound with favourable physicochemical properties was evaluated in vivo in a murine inflammation model and displayed reduced recruitment of monocytes to the site of inflammation.
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Tron, Laure. "Comportements de santé en lien avec le risque de comorbidités parmi les personnes vivant avec le VIH en France." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066507/document.
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A l'ère des multithérapies antirétrovirales, le poids des manifestations de l'infection VIH sur la morbi/mortalité s'est allégé alors que d'autres pathologies pèsent de plus en plus sur l'état de santé des personnes vivant avec le VIH (PvVIH). Le recours au dépistage des cancers et la prise en charge des facteurs de risque cardiovasculaire liés au mode de vie (tabac, alcool, inactivité physique, obésité) sont deux importantes composantes dans la prévention de ces comorbidités chez les PvVIH. A partir des données de l'enquête ANRS-Vespa2, nous avons montré que le recours au dépistage des cancers n'était pas moindre chez les PvVIH que dans la population générale. Cependant, le dépistage annuel du cancer du col de l'utérus n'était pas optimal, et le dépistage du cancer colorectal demeurait faible. Un faible niveau d'éducation et l'immunodépression étaient associés à un moindre recours au dépistage des cancers gynécologiques. D'autre part, plus de la moitié des PvVIH présentait au moins un facteur de risque cardiovasculaire. Les usagers de drogues et les hommes ayant des rapports sexuels avec des hommes étaient particulièrement sujets aux addictions, cumulant fréquemment ces facteurs, et les immigrées d'Afrique sub-Saharienne étaient surtout exposées à l'obésité et l'inactivité physique. Ces comportements étaient liés à la situation sociale et aux caractéristiques de la maladie VIH. Cette thèse permet de mieux appréhender la fréquence et les facteurs associés à ces comportements de santé au sein des groupes de la population séropositive, et de proposer des pistes pour améliorer la prévention des comorbidités afin de contribuer à en limiter le poids sur la santé des PvVIHIn the era of combined antiretroviral therapy, the burden of HIV-related morbidity/mortality has decreased while other health conditions are of growing concern among HIV-infected people. Cancer screening uptake and management of behavioral risk factors for cardiovascular disease (tobacco smoking, alcohol intake, lack of physical activity, obesity) are two major components in the prevention of those comorbidities among HIV-infected people. Analysis of data from the ANRS-Vespa2 survey showed that levels of cancer screening uptake were not lower among HIV-infected people compared to the general population. However, the level of cervical cancer screening uptake within the past year was suboptimal and the level of colorectal cancer screening uptake was low. Low educational attainment and immunodepression were correlated with a lower level of screening uptake for gynecological cancers. Furthermore, more than half of the HIV-infected population was exposed to at least one behavioral cardiovascular risk factor. Intravenous drug users and men who have sex with men were particularly prone to addictive behaviors (and lack of physical activity) and risk factors were often combined. Sub-Saharan African migrant women were mainly exposed to obesity and insufficient physical activity. Those behaviors were associated with social status and certain characteristics of the HIV-infection. This thesis allows to better understand the frequency and correlates of those health behaviors among the various sub-groups of people living with HIV and provides evidence to improve the prevention of comorbidities in order to reduce their burden on the health of those living with HIV
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"Development, validation and application of HO-1-u-1 cell line for sublingual drug absorption screening." Thesis, 2005. http://library.cuhk.edu.hk/record=b6075021.
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Finally, the pharmacodynamic effects of propranolol powder formulation with different buffering were carried out in two healthy male subjects. The maximal reduction in heart rate was found at the saliva pH of 7.6, which corresponded to the pHmax of propranolol. A buffered propranolol sublingual tablet was then prepared to achieve the saliva pH around 7.6. The preliminary investigation confirmed that the sublingually administrated buffered propranolol tablet produced a faster and more pronounced heart rate reduction than the non-buffered commercial propranolol tablet.Firstly, the use of the HO-1-u-1 cell culture for screening sublingual drug delivery was validated. The cells were seeded on cell culture inserts. The integrity of cell layers, inter-passage variation and directionality were assessed by measuring the resistance and the permeability of standard markers, beta-blockers and calcium channel blockers. The effect of pH, osmolarity and a permeation enhancer (GDC) were also studied. The results showed that HO-1-u-1 cells grown on inserts formed stratified and epithelial-like structure that preserved the typical histological feathers of the normal human sublingual epithelium. The maximal integrity was reached in 23 days. The Papp of beta-blockers and calcium channel blockers ranged from 2.89+/-0.17 x 10 -6 cm/s to 6.37+/-0.37 x 10-6 cm/s. The permeability of selected beta-blockers under different pH, osmolarity and GDC revealed that enhancing effects were significant for hydrophilic compounds but less for lipophilic compounds.
Secondly, fresh porcine sublingual mucosa was prepared and compared to the cell line model. Good correlations were obtained for both the Papp of beta-blockers and the enhancement ratios of pH and GDC between the two models.
The aims of the present study are (1) to develop and validate a human sublingual epithelial cell line model and (2) to demonstrate the application in sublingual development of cardiovascular drugs.
Thirdly, the steady-state flux (Jss) at various pH levels were measured. Results show that saturated propranolol solution at pH 7.0--7.6 resulted in a much higher Jss than the solution at other pHs. These data led to the development of theoretical equations for predicting the optimum pH (pHmax) for ionizable compounds. The calculation fitted well with the experimental data.
Wang Yanfeng.
Advisers: Moses S. S. Chow; Zhong Joan Zuo.
Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2005.
Includes bibliographical references (leaves 184-).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.
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Lin, Pei-Ching, and 林佩青. "Statistical Analysis of Age-onset for Cardiovascular Diseases based on Keelung Community-based Integrated Screening Study." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/2mgyd6.
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碩士國立交通大學
統計學研究所
103
Cardiovascular diseases are among the top 10 causes of death in Taiwan. In the thesis, we aim to study the age-onset for cardiovascular diseases (CVD) using the data collected by the Keelung community-based integrated screening study. All the subjects were free of CVD when they just entered the study and later were examined whether they developed CVD during the study period. Such a selection process, however, produces sampling bias. Therefore we analyze the data by statistical methods which account for the effects of left truncation and right censoring. We obtain nonparametric estimators of the age-onset distribution and then conduct regression analysis under the Cox proportional hazard model. Besides data analysis, we also perform simulations to examine the sensitivity issue when the truncation effect is ignored.
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Adelekan, Adeboye Mutiu. "Establishment of screening procedures for genetic disorders and risk factors in the South African Caucasian population." Diss., 2003. http://hdl.handle.net/2263/26738.
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Tu, Jui Chu, and 涂瑞珠. "Relationship between Cardiovascular Disease and Periodontal Disease and Tooth Loss -Based on a Community Health Screening in Taipei County." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/77148184870646644179.
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碩士高雄醫學大學
口腔衛生科學研究所碩士在職專班
94
Abstract Background: Periodontal disease (PD) is a very common oral disease among adults. Epidemiological studies have reported a strong association between PD and chronic systemic disease. However, studies relating PD to chronic systemic disease were limited. Study Objective: The purpose of this cross-sectional study was to evaluate the relationship of PD and CVD. Participants comprised 297 adults aged above 35 years from Taipei County in 2004. The statistical analyses were conducted by SAS JMP to determine the relationship between oral disease and chronic systemic disease. Results: The results showed the prevalence rate of PD among men and women was 69%. The community periodontal index of treatment needs (CPITN) increased with older age and (lower) education level. Serious periodontal attachment loss was related to increasing in age. Furthermore, decrease of the remaining number of teeth also correlated with lower education level and the elderly age group. For smokers and non-smokers, logistic regression analysis illustrated the relationship between CVD with PD, periodontal attachment loss and remaining teeth. Non-smoking subjects with higher education levels or with CVD had a 0.55-times and 2.24-times of risk for having PD respectively, than non-smoking subjects with lower education levels or without CVD. Non-smoking subjects aged 50-64 or with higher education levels had a 1.81-times and 0.36-times of risk for having periodontal attachment loss than non-smoking subjects aged 35-49 or with lower education levels. CPTIN and periodontal attachment loss in women with cardiovascular disease (CVD) were higher than women without CVD (p-value = 0.0013；p-value = 0.0126). CPTIN and periodontal attachment loss in areca quid, cigarette smoking and alcohol drinking user groups showed no significant difference with those groups who had never used areca quid, cigarette or alcohol. In comparison with women, the CPTIN and periodontal attachment loss were poor in men with CVD and having used areca quid. Conculsions: Oral health is a part of general health condition. It also reflects on good chewing function and balances nutrition in the human body. When CVD is a threat, the cost of treatment is very high. As the group of elderly is growing rapidly, oral health and periodontal disease prevention needs to be emphasized. Key Word: periodontal disease, cardiovascular disease, smoking
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Hung, Chung-Lieh, and 洪崇烈. "Comparison of the Diagnostic Accuracy and Cost-Effectiveness of Various Screening Tools on Projected Intermediate-to-High Cardiovascular Risk." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/22496162834615691047.
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碩士國立臺灣大學
健康政策與管理研究所
99
Abstract Background Owing to the high costs spent annually in cardiovascular diseases, there is an urgent need in identifying subjects at an early stage based on view point of preventive medicine. The development of a cost-effective screening tool with adequate diagnostic accuracy is thus crucial. Goals To investigate the diagnostic accuracy and cost-effectiveness of various cardiovascular screening tools in the estimation of intermediate-to-high risk Framingham risk score (FRS) subjects in asymptomatic population. Materials and Methods We consecutively studied 1200 asymptomatic subjects who underwent health evaluation from 2005-2009. FRS was calculated in all participants based on age, gender, blood pressure, body surface electrocardiography, medical histories, life styles and lipid profiles. We also assessed metabolic scores by additional anthropometric information. Data regarding high-sensitivity C reactive protein (Hs-CRP) serum level and carotid artery Doppler in assessing intima-media-thickness (IMT) and plaque existence were also obtained and correlated with FRS. Diagnostic accuracy and cost-effectiveness analysis were then conducted among these different tools aiming at a more efficient screen of intermediate-to-high Framingham risk population. Results Of all, totally 1101 participants (mean age: 50.6 ± 10.4, 38.6% women) were finally entered in our study. Higher Framingham risk score was associated with higher metabolic risk scores, higher prevalence of metabolic syndrome, elevated level of Hs-CRP, higher IMT thickness and higher prevalence of carotid artery plaque existence (all p<0.001 by linear regression or chi square test). In general, male had higher FRS than female gender, as well as higher metabolic risks scores, larger IMT (all p<0.001) though similar prevalence of carotid artery plaques (p=0.134). There was no gender-related difference in Hs-CRP level (p=0.15). By using metabolic score equal or larger than 1 as a cut-off, there seemed to be a very high sensitivity (94.43%, 95% CI: 92.05 - 96.27) in identifying a subject with intermediate-to-high Framingham risk score while the best specificity (98.27, 95% CI: 97.24 - 98.99) was achieved by utilizing carotid IMT equal or larger than 1mm as a cut-off. In addition, a metabolic score cut-off of 2, Hs-CRP of 0.101mg/dL and IMT of 0.65mm seemed to have the highest sum of both sensitivity and specificity. Compared to carotid artery study and metabolic score calculation, Hs-CRP with a cut-off value 0.1 seemed to have lowest cost (1519.3 NTD) in identifying an intermediate-to-high Framingham risk subject with highest screening cost occurred (62222.2 NTD) per positive case by simply using carotid echo-defined abnormal IMT (>=1mm). Conclusion Though diagnostic accuracy may differ to some degree by using different cut-off values in various studies, a low metabolic score has the best sensitivity with abnormal IMT had highest specificity in screening a subject at risk for future cardiovascular diseases. In addition, setting a low Hs-CRP serum level seemed to have the best cost-effectiveness in asymptomatic population.
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Marsay, Carina. "A retrospective review of state sector outpatients (Tara Hospital) prescribed olanzapine: adherence to metabolic and cardiovascular screening and monitoring guidelines." Thesis, 2011. http://hdl.handle.net/10539/8990.
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MMed, Psychiatry, University of the Witwatersrand, Faculty of Health SciencesIntroduction Antipsychotics are used for the treatment of psychotic disorders, most commonly schizophrenia, as well as mood disorders e.g. bipolar mood d isorder. The efficacy of the newer second generation (atypical) antipsychotics is equivalent to first generation antipsychotics. The apparent advantage of the second generation antipsychotics is related to their purported reduced side effect profile, thus making them more desirable due to improved compliance and relapse prevention. The limiting factor with this class of drugs, especially in the state sector in South Africa, has been the cost. However, reports of treatment-emergent adverse events such as diabetes mellitus, diabetic ketoacidosis, hyperglycaemia and dyslipidaemia in patients receiving second generation antipsychotics have increased in recent times. This has lead to growing concern about the link between metabolic complications and their use, with consequent reconsideration of the implications of prescribing. Aims The study aimed to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients who have been prescribed olanzapine, a second generation antipsychotic. Specifically the extent to which the American Diabetes Association Consensus Conference monitoring protocols were being implemented in a specialist psychiatric South African setting i.e.: at Tara: The H. Moross Centre’s outpatient department. Objectives The study objectives were to describe the demographic profile, clinical diagnosis and risk factors for metabolic complications in a sample of patients receiving olanzapine. Further, to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients prescribed olanzapine as well as to what extent the patients’s demographics, diagnosis and metabolic risk factors influenced the treating doctor’s adherence to screening guidelines. Method This study was undertaken at Tara: The H. Moross Centre (outpatient department). A convenience sample of patients prescribed olanzapine were selected as the study group. The study involved a review of case records. It was a retrospective descriptive study. Relevant data was entered on a data sheet, designed for the study in accordance with the objectives and adapted from the American Diabetes Association Consensus Development Conference on Antipsychotic Drugs, Obesity and Diabetes. The data sheet is based on an existing protocol for monitoring metabolic status. v Frequencies for the presence or absence of evidence of screening or monitoring for metabolic complications were established, as per American Diabetes Association monitoring protocol requirements. Although the study involved outpatients, not all patients were intiated on olanzapine as outpatients i.e. some of the prescribing was inpatient initiated. Results The sample comprised of 19 females and 20 males. 48.72% female and 51.28% male. The mean age of females in the sample was 52.38 years (SD=16.20) and the mean age of males was 41.28 (SD=17.05) years. The sample were predominantly single ( 61.54% n=24 ) with the majority being white (79.49% n=31 ); most had either tertiarty (43% n=17 ) or secondary (53.85% n =21 ) level of education. Only 2.56% (n=1) had only primary level education. With regards to the diagnoses of patients in the sample, 17,95% (n=7) were diagnosed with bipolar 1 disorder, 7.69% (n=3) with major depressive disorder with psychosis, 20,51% (n=8) schizoaffective disorder and 53,84% (n=21) with schizophrenia. The percentage of screening for all the parameters was generally less than 20% and it continued to decline to less than 20% until 4 months. The exception was weight, where frequency increased slightly over time. Comparing inpatient vesus outpatient initiated treatment there were apparent differences in the extent of screening i.e. greater for inpatient initiated treatment, specifically with respect to weight and blood pressure. Conclusion The current study was conducted in a very specific setting, but the findings demonstrated an area requiring attention i.e. adherence to acceptable clinical guidelines. Whilst one can only speculate on the basis for non-adherence, having established the status quo, there is a requirement for an appropriate strategy to address the deficit, given the implications of inadequate monitoring.
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Abrahams-Gessel, Shafika. "An examination of the ability of community health workers to effectively conduct community-based screening for cardiovascular disease in South Africa, Guatemala, and Mexico." Thesis, 2016. https://hdl.handle.net/2144/19526.
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BACKGROUND: This study explored training effectiveness for community health workers (CHWs) in a successful intervention in which they conducted primary screening for cardiovascular disease (CVD) in low resource settings. Implementation challenges related to scaling were explored with key informants.
METHODS: A multiple methods assessment was conducted to: (1) quantitatively assess training effectiveness; (2) qualitatively capture the CHWs’ experience of training; (3) gather feedback from key stakeholders about factors anticipated to impact scaling the intervention to the population level. Change in knowledge levels at three different time points was determined through comparison of group means (ANOVA). The Consolidated Framework for Implementation Research (CFIR) guided the qualitative data collection and analyses, using nVIVO® and Atlas.ti® software, combined with manual coding.
RESULTS: Training was effective at increasing content knowledge of CVD and the effect persisted for 3-6 months after completion of field work. CHWs felt empowered by the training and the acquisition of new skills but some expressed their reservations about written tests being used to accurately capture their capabilities. Some supervisors (nurses) perceived CHW training as a threat to their own professional standing while also acknowledging the value CHWs added to health services through their expert community knowledge and connections. CHWs remained frustrated by inadequate and irregular compensation, disrespect from formally trained health professionals, lack of career development pathways, and failure to account for the influence environmental factors – safety, extreme weather, and infrastructure – in workload planning. Key informants raised additional concerns about the negative impact of ineffective government communication regarding CHW programs and policies to communities and key actors in the health care system, including failure to consult key stakeholders, lack of clear role definitions, setting standards for training and performance evaluation, and lack of supervisory mechanisms. The issue of financing for CHW programs was not raised by key informants.
CONCLUSIONS: Scaling strategies for successful interventions using CHWs need to be guided by well-designed implementation plans that include proactive, multi-level engagement with communities and health systems, and appropriate evaluation measures tied to health outcomes. Training effectiveness should be evaluated and linked to well-defined outcome measures in CHW’s programs that involve task-shifting.
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"Self-reported anthropometric tools for screening children with overweight/obesity status and a clustering of cardiometabolic risk factors." Thesis, 2011. http://library.cuhk.edu.hk/record=b6075410.
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Chan, Po Tai.Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 128-150).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese; some appendixes in Chinese.
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Rodrigues, Ana Catarina Lopes de Castro. "Morte Súbita e o Desporto." Master's thesis, 2018. http://hdl.handle.net/10400.6/8376.
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A prática desportiva, para além dos benefícios indiscutíveis para a saúde, pode, em determinadas circunstâncias aumentar o risco de eventos cardíacos agudos.
O coração, como qualquer outro musculo do corpo, é um órgão que se adapta ao esforço através de hipertrofia e maximização de função. Assim, um atleta pode apresentar alterações cardíacas a nível funcional, estrutural e eletrocardiográfico, geralmente denominadas “coração do atleta”, que não representam mais que uma adaptação fisiológica ao exercício. Por vezes, no entanto, essas adaptações podem evoluir para alterações patológicas que aumentam o risco de eventos cardíacos agudos aquando da prática desportiva, eventos esses que podem, por fim, culminar em morte súbita. A morte súbita é definida como uma morte natural que ocorre dentro de uma hora após manifestação inicial aguda, pode ocorrer ou não na presença de doença cardíaca subjacente, no entanto o momento e modo de apresentação não são expectáveis. Entre os principais fatores de risco para morte súbita destacam-se a idade, o sexo masculino e a raça negra. As principais causas de morte súbita nos atletas são variadas e dependem da região estudada e da idade dos atletas. Destacam-se a Miocardiopatia Hipertrófica nos EUA, a Displasia Arritmogénica do Ventrículo Direito em Itália e a Doença Coronária em atletas com idade superior a 35 anos. A avaliação pré-competitiva dos atletas inclui história clínica e exame físico. O recurso à eletrocardiografia como primeira linha no screening cardiovascular de atletas é ainda muito discutido, sendo o elevado número de falsos positivos a principal objeção à sua utilização. A definição de critérios específicos para a avaliação de parâmetros eletrocardiográficos em atletas veio dar resposta a este problema, diminuindo significativamente os erros de interpretação. Em 2006 foram criados os “Critérios de Seattle” que permitem distinguir as alterações fisiológicas típicas do “coração do atleta” de alterações patológicas que acarretam risco de morte súbita. É essencial a formação dos profissionais de saúde nesta área e a adaptação das instalações desportivas para que possa ser dada uma assistência imediata em caso de um evento agudo potencialmente fatal. É também imprescindível que cada país realize um estudo acerca das principais etiologias de morte súbita dos seus atletas para que possa aplicar as estratégias preventivas mais adequadas à sua realidade.In addition to the unquestionable benefits of sports practice on our health, in some cases, strenuous exercise may increase the risk of acute cardiac events. The Heart, as any other muscle in the body, is an organ that adapts to effort through hypertrophy and maximizing function. Therefore, an athlete may have functional, structural and electrocardiographic cardiac alterations, commonly known as “Athlete’s Heart”, which represent nothing more than a physiological adaptation to exercise. However, sometimes, these adaptations may evolve to pathological changes that increase the risk of acute cardiac events during sports that may ultimately culminate in sudden death. Sudden death is defined as a natural death occurring within one hour after acute onset, whether or not it occurs in the presence of underlying heart disease, however presentation may be timid and not necessarily expected. The main risk factors for sudden cardiac death are: age, males and blacks. The main causes of sudden death in athletes are varied and depend on the demographic region and the age of the athlete. Being hypertrophic cardiomyopathy the most common cause in the USA, Arrhythmogenic Dysplasia of the Right Ventricle in Italy and Coronary Disease in athletes over 35 years of age. The pre-competitive evaluation of athletes includes clinical history and physical examination. The use of the electrocardiogram as a first line test for the cardiovascular screening of these athletes is still much discussed, and the high number of false positives is the main objection to its use. The definition of specific criteria for the evaluation of the athletes' electrocardiograms came as an answer to this problem, significantly reducing errors of interpretation. In 2006, the "Seattle Criteria" were created to distinguish typical physiological changes in the athlete's heart from pathological changes with increased risk of sudden death. It is essential to train health professionals in this area and to adapt sports facilities so that immediate assistance can be given in case of an acute fatal event. It is also imperative that each country carry out a study about the main etiologies of sudden death of its athletes so that the most appropriate preventive strategies may be applied.
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Крищишин, Василь Володимирович, and Vasyl Kryshchyshyn. "Розробка мобільного застосунку для діагностування серцевих захворювань." Bachelor's thesis, 2021. http://elartu.tntu.edu.ua/handle/lib/35789.
Full textAbstract:
Кваліфікаційна робота присвячена розробці мобільного застосунку для діагностування серцевих захворювань.
Метою даної кваліфікаційної роботи освітнього рівня «Бакалавр» є підвищення рівня поінформованості громадян та медичного персоналу щодо стану їхнього серця за рахунок реалізації функціональних можливостей автоматизованого розпізнавання серцевих захворювань.
В першому розділі кваліфікаційної роботи освітнього рівня «Бакалавр» проведено аналіз предметної області. Виконано постановку завдання розроблення мобільного застосунку для діагностування серцевих захворювань. Описано використовувані в процесі розроблення мобільного застосунку для діагностування серцевих захворювань методи та інструменти і набір даних.
В другому розділі кваліфікаційної роботи освітнього рівня «Бакалавр» розроблено алгоритм роботи мобільного застосунку. Запропоновано опис процедури навчання та спостереження з розробленням відповідних діаграм.Qualification work is devoted to the development of a mobile application for diagnosing heart disease. The purpose of this qualification work of the educational level "Bachelor" is to increase the level of awareness of citizens and medical staff about the condition of their heart through the implementation of functional capabilities of automated recognition of heart disease. In the first section of the qualification work of the educational level "Bachelor" the analysis of the subject area is carried out. The task of developing a mobile application for diagnosing heart disease has been completed. The methods and tools and data set used in the process of developing a mobile application for diagnosing heart disease are described. In the second section of the qualification work of the educational level "Bachelor" the algorithm of work of the mobile application is developed. A description of the training and observation procedure with the development of appropriate diagrams is offered.
ВСТУП 7 1 ПРЕДМЕТНА ОБЛАСТЬ, МЕТОДИ, ІНСТРУМЕНТИ ТА НАБІР ДАНИХ 8 1.1 Аналіз предметної області 8 1.2 Постановка завдання 11 1.3 Методи та інструменти 14 1.4 Набір даних 17 1.5 Висновок до першого розділу 18 2 РОЗРОБКА ТА ТЕСТУВАННЯ МОБІЛЬНОГО ЗАСТОСУНКУ ДЛЯ ДІАГНОСТУВАННЯ СЕРЦЕВИХ ЗАХВОРЮВАНЬ 19 2.1 Алгоритм роботи мобільного застосунку 19 2.2 Опис процедури навчання та спостереження 22 2.3 Результати роботи мобільного застосунку для діагностування серцевих захворювань 29 2.4 Тестування юзабіліті мобільного застосунку для діагностування серцевих захворювань 31 2.5 Аналіз результатів проведеної розробки мобільного застосунку для діагностування серцевих захворювань 32 2.6 Висновок до другого розділу 33 3 БЕЗПЕКА ЖИТТЄДІЯЛЬНОСТІ, ОСНОВИ ХОРОНИ ПРАЦІ 34 3.1 Природне середовище і його забруднення 34 3.2 Вимоги пожежної безпеки при гасінні електроустановок 36 3.3 Висновок до третього розділу 37 ВИСНОВКИ 38 ПЕРЕЛІК ДЖЕРЕЛ 39
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Viveiros, Catarina Cordeiro. "Rastreios Cardiovasculares - Perspetiva do Doente." Master's thesis, 2019. http://hdl.handle.net/10316/89524.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: A prevenção secundária tem mantido um crescente impacto na população e éimportante perceber de que forma é que esta altera as atitudes de cada indivíduo em relaçãoà sua saúde, uma vez que este tipo de prevenção pode ter grande influência na população,quando submetida a intervenções diagnósticas e sobretudo terapêuticas desnecessárias.Objetivo: Perceber como é que os resultados dos rastreios cardiovasculares afetam ocomportamento da população, qual a importância que lhes é atribuída em contraponto àspráticas que contribuem para um estilo de vida saudável.Métodos: Estudo observacional transversal através da aplicação de um questionário com 11perguntas elaborado com base na bibliografia consultada sobre o tema. Foi estudada umaamostra de conveniência de 190 pessoas que frequentavam Unidades de Saúde e outroslocais públicos da região de S. Miguel, Açores. Foram utilizadas estatísticas descritiva einferencial, segundo o tipo e a normalidade de dados, para estudo da amostra no softwareSPSS, versão 25 da IBM, com p<0,05 como nível de significância.Resultados: Para 95,6 % dos inquiridos há aceitação em realizar rastreio cardiovascularsempre que lhes é proposto verificando-se uma elevada percentagem de confiança nosresultados (99,4%) e nos conselhos dados após se submeterem aos rastreios (98,9%). Amaioria (73,1%) afirmou que é mais importante ter uma boa alimentação e atividade física doque fazer análises. As gerações mais velhas dão mais importância aos exames médicos doque as gerações mais novas que demonstram uma clara preferência por um estilo de vidasaudável. A frequência de consultas no Centro de Saúde no último ano mostrou-se maiselevada nas Classes sócio-económicas mais baixas.Conclusão: Foi possível verificar que existem insuficiências por colmatar na área daPromoção da Saúde da Prevenção da Doença, contudo, continua a ser atribuída importânciaà prática de estilos de vida saudáveis, principalmente pelos mais jovens. O papel do médicona vertente de educação para a saúde é essencial e pode vir a contribuir para uma melhoriana perspetiva do doente em relação à influência dos hábitos saudáveis na atenuação dosfatores de risco.
Introduction: The secondary prevention has a crescent impact in the population so beingimportant to notice in what way this alters each individual's attitudes regarding its relation tohis/her health, since pervention can have an great influence in the population, allthoughsometimes submitting it to unnecessary diagnostic interventions and therapeutics.Objective: To notice how the results of proposed cardiovascular screenings affect thebehavior of the population and the perceived importance in detriment of practices thatcontribute to a healthy lifestyle.Methods: Observational study through the application of a 11 questions questionnaire basedin the revised bibliography. A convenience sample of 190 people that frequent Health Unitsand other public places in S. Miguel, Azores was studied. Adapted descriptive and inferencialstatistics were performed with a p<0,05 as level of significance.Results: Of those inquired 95,6% accept the submission to a cardiovascular screeningwhenever it is proposed. We verified na elevated percentage of trust in the screening results(99,4%) and in the advice given after they’ve been submited to the screenings (98,9%). For(73,1%) it is more important to have a good nutrition and physical activity then to do bloodtests. The oldest generations pay more importance to the medical examinations than theyongest generations that showed an evident preference for a healthy lifestyle. The frequencyof consultations with the general practitioner doctor in the last year was higher among lowersocio-economic classes.Conclusion: There are flaws to be filled in the area of Health Promotion and DiseasePrevention. However, importance continues to to be attributed to the practice of healthylifestyles, mainly by the youngest generations. The doctor's role in health education is essentialand it can contribute to the its improvement in the patient’s perspective because of its influencein healthy stiles for risk factors reduction.