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1
Hanke, Samuel P. M. D. "Readmission within 30 Days of Pediatric Cardiac Surgery: Incidence, Risk Factors and Resource Utilization." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384869980.
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Jidéus, Lena. "Atrial Fibrillation after Coronary Artery Bypass Surgery : A Study of Causes and Risk Factors." Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-1488.
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The aim was to study pathophysiological mechanisms and risk factors for developing atrial fibrillation (AF) after coronary artery bypass grafting (CABG), and the effect of thoracic epidural anaesthesia (TEA).
The study comprised 141 patients undergoing CABG, including 45 patients randomised for TEA intra- and postoperatively. All patients underwent 24-hour Holter monitoring pre- and postoperatively for the analysis of arrhythmias and heart rate variability (HRV). Catecholamines and neuropeptides (reflecting sympathetic and parasympathetic activity), atrial peptides and echocardiographically assessed atrial arias were obtained pre- and postoperatively.
Logistic regression analysis identified body mass index (BMI), maximum supraventricular beats (SPB) per minute, and total amount of cardioplegia as independent predictors of postoperative AF. Patients developing AF showed limited diurnal variation of HRV preoperatively. All HRV parameters decreased significantly in all patients postoperatively. The significant postoperative increase in atrial areas and atrial peptides did not differ between patients developing AF and those who did not. TEA had no effect on the incidence of postoperative AF, but resulted in lower heart rate, less increase in adrenaline levels, and decreased neuropeptide levels (reflecting sympathetic and parasympathetic activity). AF was initiated by an SPB in 72.4% of non-TEA and 100% of TEA treated patients, whereas changes in heart rate only, before onset, were seen in 17.2% non-TEA patients.
The observed risk factors, SPB and cardioplegia, may both induce electrophysiological changes known to increase the susceptibility to AF. The observed postoperative atrial dilatation and autonomic imbalance, indicated by HRV and neuropeptide levels, may further favour the development of AF. The observation that a majority of postoperative AF was initiated by a premature atrial contraction supports our hypothesis that latent atrial foci may be a major trigger mechanism of postoperative AF.
3
Linden, Matthew D. "The haemostatic defect of cardiopulmonary bypass." University of Western Australia. School of Surgery and Pathology, 2003. http://theses.library.uwa.edu.au/adt-WU2006.0009.
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[Truncated abstract] Cardiac surgery involving cardiopulmonary bypass is a complex procedure that results in significant changes to blood coagulation, fibrinolytic biochemistry, platelet number and function, and the vasculature. These are due to pharmacological agents which are administered, haemodilution and contact of the blood with artificial surfaces. Consequently there are significant risks of thrombosis and haemorrhage associated with this procedure. The research presented in this thesis utilises in vitro, in vivo, and a novel ex vivo model to investigate the nature of the haemostatic defect induced by cardiopulmonary bypass. The components studied include the drugs heparin, protamine sulphate, and aprotinin, different types of bypass circuitry (including heparin bonded circuits) and procedures such as acute normovolaemic haemodilution. Patient variables, such as Factor V Leiden, are also studied. Each of these components is assessed for the effects on a number of laboratory measures of haemostasis including activated partial thromboplastin time, prothrombin time, activated protein C ratio, antithrombin concentration, heparin concentration, thrombin-antithrombin complex formation, prothrombin fragment 1+2 formation, markers of platelet surface activation and secretion, activated clotting time, haemoglobin concentration and coagulation factor assays.
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Salmon, Becky A. "Differences between men and women in compliance with risk factor reduction : pre and post coronary artery bypass surgery." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/865938.
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Coronary Artery Bypass Graft(CABG) Surgery increases blood flow to the endangered myocardium but does not slow the process of atherosclerosis. The only way to slow the process of coronary artery disease is to acknowledge the risk factors present and minimize or totally eliminate them from an individual's lifestyle. Men and women respond differently to stress and lifestyle modifications. The purpose of this study was to determine if there was a difference between genders in compliance to a heart healthy lifestyle pre and post CABG surgery.Thirty men and thirty women who had CABG surgery at least one year earlier were interviewed to assess coronary artery disease risk. The procedure for the protection of human subjects were followed. The instrument used was the RISKO Heart Hazard Appraisal Tool. This instrument was developed in 1985 by the American Heart Association and scored individuals on systolic blood pressure, weight, serum cholesterol level and cigarette smoking habits. Pre-operative records were also reviewed using the same tool to assess individuals preoperative risk. The research design used was 2 x 2 repeated measures. Data were analyzed using 2 x 2 repeated measures analysis of variance (ANOVA).Two findings were discovered. First there was a statistically significant difference between men and women (F=5.82 p=0.019) with men scoring lower RISKO scores than women, indicating lower risk and better compliance to a heart healthy lifestyle, both pre- and postoperatively. Second there was a significant difference between preand postoperative RISKO scores in the total population (F=8.77 p=0.004). Postoperative RISKO scores were lower indicating an improvement in heart healthy lifestyle. There was no statistically significant difference between genders in the difference of pre- and postoperative RISKO scores (F=2.56 p<.115). The significance of this study was that it looked specifically at gender differences and assessed disparities in cardiovascular risk factors and the impact of surgery on men and women.This study found that overall, men had lower RISKO scores than women. Both genders also had improved RISKO scores postoperatively from preoperatively. No statistically significant difference between genders of the RISKO scores from preoperatively to postoperatively was found. Education needs to continue to play a big part in the cardiac rehabilitation process for both genders and specifically women need to become the target of further research and education to improve compliance to a heart healthy lifestyle.School of Nursing
5
Stephens, Fiona Nancy. "Statistical modelling in health." Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/37058/1/37058_Stephens_2000.pdf.
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This thesis discusses the theory and application of a variety of statistical methods for addressing specific problems, which arise in medical research. The thesis
focuses on three data sets that are used as case studies. These data sets contain information on heart disease surgical outcomes and aortic valve allograft survival.
An overview of statistical methods for risk stratification and survival analysis is provided. A new method of outcome specific pruning of classification trees for risk stratification of rare events is discussed, applied and interpreted for one of the
case studies. Applications for survival analysis are illustrated with Kaplan-Meier and Cox regression analyses and interpreted for the remaining two case studies.
The outputs for this research include technology transfer of statistical skills and methods to a medical research community. Development of a new method for better stratifying rare events, statistical analysis and interpretation of data are directly applicable to cardiac surgery practices at The Prince Charles Hospital.
6
Andersson, Anna, and Anna Hardin. "Riskfaktorer för postoperativt delirium efter hjärtkirurgi : En systematisk litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-84913.
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Bakgrund: Att genomgå hjärtkirurgi kan rädda en patients liv men det kan även leda till en ökad risk att drabbas av en komplikation som postoperativt delirium. Delirium är inte ett sjukdomstillstånd utan ett tillstånd av mental förvirring som påverkar patientens uppmärksamhet, medvetenhet och kognitiva förmåga. Postoperativt delirium kan leda till många negativa konsekvenser vilket kan medföra lidande för patienten. Vården ska ha som mål att lindra patientens lidande genom att se till hela patienten i den vårdande relationen, det är det som är kärnan i vårdvetenskap. Forskning har visat att det är viktigt för patientens postoperativa återhämtning att tidigt kunna upptäcka och förebygga postoperativt delirium. Det har framkommit att intensivvårdssjuksköterskor behöver ha ökad förståelse och kunskap om ämnet för att kunna upptäcka och förebygga postoperativt delirium efter hjärtkirurgi. Syfte: Syftet med studien är att identifiera riskfaktorer som kan påverka utvecklingen av postoperativt delirium bland intensivvårdspatienter efter hjärtkirurgi. Metod: En systematisk litteraturstudie där kvantitativa artiklar har analyserats efter Bettany-Saltikov och McSherry (2016) analysmetod. Resultat: Analysen resulterade i fyra kategorier: Patientens bakgrund, Tiden i hjärt-lungmaskin, Längden av respiratorbehandling samt Komplikationer till följd av hjärtkirurgi som är riskfaktorer som visade sig påverka utvecklingen av postoperativt delirium. Slutsats: Den samlade kunskapen som föreliggande studie har givit kan ligga till grund för intensivvårdssjuksköterskor i vården av patienter med postoperativt delirium. Intensivvårdssjuksköterskor ska ha med sig i den vårdande relationen att patientens situation är komplex och att det de utsätts för kan bidra till ökat lidande för patienten. Mer forskning behövs kring riskfaktorer för postoperativt delirium och hur den mentala förvirringen påverkar patienten och dess anhöriga.Background: Heart surgery can save a patient's life but can also lead to an increased risk of suffering from a complication such as postoperative delirium. Delirium is not an illness but a state of mental confusion that affects the patient's attention, awareness and cognitive ability. Postoperative delirium can lead to many negative consequences which can cause patient suffering. Nursing care has aimed to alleviate a patient's suffering by seeing the entire patient in the caring relationship. This is the core in nursing science. Research has shown that it is important for the patient's postoperative recovery to be able to detect and prevent postoperative delirium in an early stage. It has appeared that intensive care nurses need more education and knowledge in this area in order to be able to detect and prevent postoperative delirium after heart surgery. Aim: The aim of the study is to identify risk factors that are associated with the development of postoperative delirium after heart surgery within patients in the intensive care unit. Method: A systematic literature review that analyzed quantitative articles according to a method of analysis by Bettany-Saltikov and McSherry (2016). Result: Four categories emerged from the analysis: Patients background, length of mechanical ventilation, Heart- and lung machine duration and Complications after heart surgery that were risk factors which affected the development of postoperative delirium. Conclusion: The overall knowledge that the study has provided can form a basis for intensive care nurses in the care of patients with postoperative delirium. Further research is needed on risk factors for postoperative delirium and how the mental confusion affects both the patient and relatives. More research is also needed about how postoperative delirium can be prevented.
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Bagés, Nuri. "Psychosocial risk factors and coronary heart disease." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2000. http://arno.unimaas.nl/show.cgi?fid=6899.
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Ramsey, Priscilla W., and L. Lee Glenn. "Risk Factors for Heart Disease in Rural Appalachia." Digital Commons @ East Tennessee State University, 1998. https://dc.etsu.edu/etsu-works/7539.
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The objectives of the study were to identify which risk factors for heart disease were most prevalent in a poor, underserved, rural Appalachian county. A random sample of medical records was selected (n = 292) of adult men and women who participated in a countywide health care project. Data were obtained from a health risk appraisal questionnaire and other physical and demographic information and were analyzed using univariate and bivariate statistical procedures. The findings indicated that these rural Appalachian subjects had a significant number of heart disease risk factors: excessive smoking, lack of exercise, high fat diets, and abnormal serum lipid levels.
9
Jaf, Andersson Victor. "Seroma formation following breast surgery - incidence and risk factors." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-52541.
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Alolayan, Albraa Badr A. "Risk factors of neurosensory disturbance following bimaxillary orthognathic surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B50639511.
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Objectives: To report the incidence of objective and subjective neurosensory disturbance (NSD) after orthognathic surgery in a major orthognathic centre in Hong Kong, and to investigate the risk factors that contributed to the incidence of NSD after orthognathic surgery.
Materials and Methods: A retrospective cross-sectional study on NSD after orthognathic surgery in a local major orthognathic centre. Patients who had bimaxillary orthognathic surgery reviewed at post-operative 6 months, 12 months or 24 months were recruited to undergo a neurosensory test with subjective and 3 objective assessments. Possible risk factors of NSD including subjects’ age and gender, surgical procedures and surgeons’ experience were analyzed.
Results: 238 patients with 476 sides each of maxillary and mandibular procedures were recruited. The incidences of subjective NSD after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively. Objective neurosensory tests showed general reduced sensitivity in subjects with subjective NSD. Increased age was found to be a significant risk factor of NSD after orthognathic surgery at short term (at 6 months and 12 months) but not at 24 months. SSO has a significantly higher risk of NSD when compared to VSSO. SSO in combination with anterior mandibular surgery has a higher risk of NSD when compared to VSSO in combination with anterior mandibular surgery or anterior mandibular surgery alone. Gender of patients a nd surgeons’ experience were not found to be risk factors of NSD after orthognathic surgery.
Conclusion: The incidence of NSD after maxillary and mandibular orthognathic procedures at post-operative 6 months, 12 months and 24 months was reported. Increased age was identified as a risk factor of short term post-operative NSD but not in long term (24 months or more). Specific mandibular procedures were related to higher incidence of NSD after orthognathic surgery.published_or_final_version
Dental Surgery
Master
Master of Dental Surgery
11
Bartone, Cheryl L. "Variables that increase heart failure patients' risk of early readmission: a retrospective analysis." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1377869498.
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Spriggs, David Arthur. "Risk factors for stroke : a case-controlled study." Thesis, University of Newcastle Upon Tyne, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308766.
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Brown, Katherine Louise. "The development and initial applications of a risk model to adjust for severity of case mix in paediatric cardiac surgery using the national audit database (UK Congenital Heart Audit)." Thesis, University of Cambridge, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708446.
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Hedberg, Magnus. "Stroke during cardiac surgery : risk factors, mechanisms and survival effects." Doctoral thesis, Umeå universitet, Kirurgi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-38079.
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Introduction: Neurological complications and stroke in association with cardiac surgery is a serious problem. The stroke event can occur during surgery (early stroke) or in the postoperative period with a symptom free interval (delayed stroke). Particle embolization due to aortic manipulation during surgery has been suspected as a mechanism for early stroke. The present thesis address mechanisms and survival effects of stroke both clinically (I-III) and experimentally (IV-V). Methods: Study I) Within a cohort of 2641 consecutive cases, a group of cardiac surgery patients with stroke and evaluated by computed tomography (CT) were studied (n=77). CT-findings were analyzed in relation to stroke symptoms. Study II) Data from 9122 patients undergoing coronary surgery were analyzed. Records of patients with any signs of neurological complications were reviewed to extract 149 subjects with stroke at extubation (early, 1.6%) versus 99 patients having a free interval (delayed, 1.1%). Early and delayed stroke were evaluated separately. Independent risk factors for stroke were analyzed by logistic regression and survival by Cox regression (9.3 years median follow-up). Study III) Patients with early (n=223) and delayed stroke (n=116) were identified among 10809 patients undergoing cardiac and aortic surgery, both groups exposed to cardiopulmonary bypass. Stroke patients were subdivided by the hemispheric location of lesions. Subgroups were compared and their associated pre- and peroperative variables and survival were analyzed. Study IV) Aortic cross-clamp manipulation was studied in a human cadaveric perfusion model. The pressurized aorta was repeatedly cross-clamped and washout samples were collected before and after clamp maneuvers. Particles in the washout samples were evaluated by microscopy and by digital image analysis. Study V) Pig aortas were pressurized and cannulated. Washout samples were collected before and after cannulation (n = 40). Particles were deposited onto a 10-μm filter to be evaluated by microscopy and digital image analysis. Results: Study I) In the group of patients exposed to routine cardiac surgery (i.e., clamping and cannulation) and with early stroke, right-hemispheric lesions were more frequent than of the contra-lateral side (P=0.005). Patients with aortic dissections had a strong dominance of bilateral findings, which was different from the unilateral pattern in the routine-surgery group (P<0.001). Study II) Early and delayed stroke did not share any risk factors. Both early and delayed stroke explained mortality in the early postoperative period (P<0.001, P<0.001 respectively) but also at long term follow-up (P=0.008, P<0.001 respectively). For patients surviving their first postoperative year, delayed but not early stroke influenced long-term mortality (P=0.001 and P=0.695, respectively). Study III) Stroke lesions in association to cardiac surgery were near exclusively ischemic. Early stroke had a preponderance for right-hemispheric lesions (P=0.009). In contrast, patients with early stroke that had undergone surgery of the aorta with circulatory arrest showed a pattern with more bilateral lesions compared to ‘cardiac-type’ operations (P<0.001). Patients with bilateral lesions had a dramatically impaired survival compared to those with unilateral lesions (P<0.001). Study IV) In the cadaveric perfusion model, cross-clamping produced a significant output of particles, which was seen for size intervals of 1 mm and smaller (P=0.002 to P=0.022). In all size intervals the particle output correlated with the degree of overall aortic calcification (P =0.002 to P=0.025). Study V) At cannulation of the pig aorta, more particles were noted after cannulation compared to before the maneuver (P<0.001). This increase included small (<0.1 mm, P<0.001) and intermediate-size particles (0.1-0.5 mm, P< 0.001). Particles above 0.5 mm were few and were not associated with cannulation. Conclusions: The influence of stroke on mortality was devastating, for both early and delayed stroke. These two stroke groups had obvious differences in both their risk factors and their hemispheric distribution. It is here emphasized that early and delayed stroke should be considered as two separate entities with suggested mechanistic differences. Ischemic lesions accounted for near all stroke events seen in association to cardiac surgery. For early stroke, these were mostly located within the right hemisphere. Results from the experimental studies underscore microembolic risks associated with aortic manipulation.
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Piccione, Joseph. "Bronchiectasis in Chronic Pulmonary Aspiration: Risk Factors,Time Course and Clinical Implications." University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1292360198.
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Lo, Ling-fun, and 盧玲芬. "Cardiac risk factors in Hong Kong adults." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25797463.
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Abstract
Many studies have been conducted in Caucasian populations on the optimal body mass index cut-off for obesity, as well as the relationship between body mass index and percentage body fat and their associations with cardiovascular risk factors. However, few studies of this kind have been conducted in the Hong Kong Chinese population, This research is deemed to be important due to ethnic differences between Asians and Caucasians, Therefore, this dissertation aims to determine any ethnic differences from a sample of the local Hong Kong Chinese population, in order to advance health care policies controlling known cardiovascular risk factors.
A total of 800 subjects were randomly selected from a pool of subjects participated in a Hong Kong Cardiovascular Risk Factor Prevalence study conducted in 1994-1996. These subjects were contacted and 453 disease-free subjects (210 males and 243 females) consented to participate in the current study, Data collected included serum and blood pressure measurements, body mass index, percentage body fat measured by bioelectrical impedance analysis, and a self-completed cardiovascular risk factor questionnaire,
The mean age of the 453 subjects was 51.64 years (SD=12.3). When obesity was defined as percentage body fat ~ 25 and 2: 30 in males and females respectively, 23 kg/m2 was found to be the optimum cut-off value, with 78% correct classification (95% CI = 69%-87%). The corresponding sensitivity and specificity were 88% (95% CI = 81 %-95%) and 67% (95% CI = 57%-77%) respectively. On the other hand, if obesity was defined as percentage body fat ~ 25 and 2: 35 in males and females respectively, then 25 kg/m2 was found to be the best cut-off value with 82% correct classification
(95% CI = 74%-90%). The corresponding sensitivity and specificity were 78% (95% CI = 69%-87%) and 85% (95% Cl = 78%-92%) respectively.
Moreover, body mass index was found to be quadratically body fat. The quadratic relationship did not appear two genders, except that the percentage body fat of of females by 9.97 (SE=0.33).
Finally, except for total cholesterol, high density lipoprotein cholesterol, and fasting glucose, body mass index did not provide any substantial information additional to percentage body fat on serum and blood pressure measurements. was the only measure on which percentage body fat did additional to body mass index. When waist-hip body mass index and percentage body fat,. except for
body mass index did not have additional information on measurements when percentage body fat or/and
[n conclusion, the optimal body mass index cut-off for obesity in Hong Kong Chinese was lower than the 30kg/m2 recommended by the World Health Organization, a clear reflection of ethnic difference between Asians and Caucasians. The quadratic relationship between percentage body fat and body mass index was similar in Hong Kong Chinese as in Caucasians and Blacks. Moreover, percentage body fat together with waist-hip-ratio were found to be better indicators of cardiovascular risk factors in Hong Kong. This was the first time such findings were found in the Hong Kong Chinese population.
IIabstract
toc
Medical Sciences
Master
Master of Medical Sciences
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Ashton, Emma Louise, and emma ashton@deakin edu au. "Effects of dietary constituents on coronary heart disease risk factors." Deakin University. School of Biological and Chemical Sciences, 2000. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20061207.153511.
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Coronary Heart Disease (CHD) is a major cause of death in Western countries. Mediterranean and Asian populations have a lower risk of death from CHD compared to Westernised population, as do vegetarian versus omnivorous populations. Dietary constituents of traditional diets consumed by these populations are thought to influence both the classical risk factors for CHD, and the more recently identified risk factors, such as oxidative modification of low density lipoprotein (LDL), LDL particle size, arterial compliance and haemostatic factors. The aim of this thesis was to examine the effects of several food components, particularly soybean and monounsaturated fat (MUFA), on CHD risk factors through 3 carefully controlled dietary interventions, and a cross-sectional study.
A randomised crossover dietary intervention study was conducted in 42 healthy males to investigate the effect on CHD risk factors of replacing lean meat with tofu, a soybean product regularly consumed by Asian populations, while controlling all other dietary factors. The tofu diet resulted in significantly lower total cholesterol and triacylglycerol levels compared to the lean meat diet, and LDL particles that were more resistant to in vitro oxidative modification. However, insulin, fibrinogen, factor VII, and lipoprotein (a) were not significantly different on the 2 diets.
A postprandial study was subsequently conducted to investigate any acute effects of a tofu test meal on the oxidative modification of LDL in 16 male subjects. There was no significant difference between the susceptibility of LDL to oxidative modification before and after the tofu meal.
Twenty eight healthy subjects completed a separate randomised crossover dietary intervention comparing a high MUFA fat diet, using an Australian high oleic sunflower oil, with a low fat, high carbohydrate diet on CHD risk factors. The high MUFA oil diet significantly increased high density lipoprotein cholesterol compared to the low fat diet as well as producing LDL that were more resistant to oxidative modification. Neither the size of the LDL particle nor arterial compliance were significantly different on the 2 diets.
Twelve matched pairs of vegetations and omnivores were also studies to compare the habitual diet of a low and higher risk population group, to compare their risk factors and identify dietary constituents that may explain the differences. The vegetarians consumed less saturated fat (SFA) and dietary cholesterol while consuming more polyunsaturated fat, dietary fibre and vitamin E compared to omnivores. The vegetarians had lower total cholesterol, LDL cholesterol and triacylglycerol levels compared to the omnivores and had LDL particles that were more resistant to in vitro oxidation.
These findings contribute to our knowledge about the dietary constituents that can alter some CHD risk factors in healthy subjects, and which could reduce the risk of developing CHD. Investigations in high risk groups might reveal even more benefits.
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Sarwar, Nadeem. "Emerging molecular and genetic risk factors for coronary heart disease." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611549.
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Sandridge, Amy Leona. "Risk factors for congenital heart defects in Saudi Arabian infants." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2007. http://researchonline.lshtm.ac.uk/1620411/.
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Two studies were undertaken. Firstly, congenital heart defect (CHD) data from the Saudi Arabian Congenital Heart Defects registry (CHD registry) were compared to data published by the Baltimore-Washington Infant Survey (BWIS) group and the European Surveillance of Congenital Anomalies registry (EUROCAT). Distributions of CHD diagnoses within the Saudi Arabian dataset (Riyadh region and Saudi Arabia as a whole) were similar to those from these more comprehensive efforts, providing evidence for the completeness and accuracy of the CHD registry, for Riyadh region in particular. Secondly, an unmatched case-control study of risk factors for all structural congenital heart defects in children resident in Riyadh, Saudi Arabia was undertaken. The primary exposure of interest was consanguinity up to and including third cousins. Incident cases were identified from the CHD Registry from June 1, 2002 to December 31, 2004. Controls were obtained from the Well Baby Clinic, Riyadh Anned Forces (Military) Hospital. Using a detailed and reverse translated questionnaire, a face to face interview was conducted with 235 case and 247 control mothers by research assistants fluent in the local dialect. Mothers were asked to consider their exposure to risk factors within the period of 3 months prior to and 3 months post conception. Consanguinity was collected by phylogram method. The majority of mothers were interviewed when the infant was less than one year of age. Analyses were conducted using four different case groups: all cases, isolated cardiac cases, and embryological earliest and latest cases. Twenty five percent of cases and controls were first cousins or closer. Sixteen percent of cases versus 13 percent of controls were first cousins once removed or equivalent and 12 percent of both cases and controls were second 01' third cousins. Consanguinity was not found to increase the risk of CHD in this population. The adjusted odds ratio for all cases was 1.0 (CI9S=O.7-1.7) and for isolated cardiac cases it was 1.2 (CI9S=O.7-2.0). Statistically significant associations were found for other exposures such as previous pregnancy losses, maternal age, multiplicity, maternal use of hair dyes and pesticides sprayed in the house, confirming findings from previous studies. It is unlikely that the findings for consanguinity can be explained by misclassification of exposure or, in the analysis of all cases, low statistical power.
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Tarassova, Inna. "Factors associated with recovery from cardiac surgery in female patients." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/254.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Nursing
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Thomson, Patricia. "Complex factors that influence patient and partner and dyad outcome 4 months after coronary artery bypass surgery." Thesis, University of Stirling, 2008. http://hdl.handle.net/1893/21183.
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Background: Coronary heart disease (CHD) remains a major cause of death and ill- health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner's is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest.
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Voors, Adriaan Alexander. "Risk factors, endothelial function, and clinical outcome after coronary bypass surgery." [S.l. : [Groningen] : s.n.] ; [University Library Groningen] [Host], 1997. http://irs.ub.rug.nl/ppn/157840069.
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Ingelsson, Erik. "Insulin Resistance and Inflammation as Risk Factors for Congestive Heart Failure." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5879.
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Tannenbaum, Rebecca L. "Risk Factors Associated with Prematurity in Patients Diagnosed with Hypospadias." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1368024479.
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Ashton, William David. "Coronary risk factors in women in the United Kingdom." Thesis, University of Salford, 1997. http://usir.salford.ac.uk/42977/.
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Coronary heart disease (CHD) has traditionally been regarded as a male disease and, because of this, the magnitude of the problem in women is often overlooked. Yet, cardiovascular disease (CVD) and CHD in particular, remains, next to cancer, the leading cause of morbidity and mortality in women. The longstanding emphasis on the problem of CHD in men, has resulted in a widespread tendency to minimise the incidence and severity of the disease in women. Moreover, most epidemiologic studies examining morbidity and mortality from CHD have focused largely on men, producing a significant gender gap in the research. The lack of information on CHD risk factors and prevention of heart disease in women in Britain is of particular concern, given that British women have one of the highest rates of coronary disease in the world. The Marks and Spencer Coronary Risk Factor Study (MSCRFS) is a cross-sectional and prospective study of CHD risk factors in female employees of the Marks and Spencer retail organisation. The present study is confined to an analysis of cross-sectional data from 14,077 women screened between June 1988 and July 1991. The prevalence and distribution of a variety of lipid, lipoprotein, biochemical, anthropometric and lifestyle-related CHD risk factors among women in the United Kingdom is described, together with their key interrelationships. In addition, the metabolic impact of exogenous hormones, specifically oral contraceptives and postmenopausal hormone replacement, is described. This study - the largest of its kind in the UK - provides reference ranges for a wide range of CHD risk factors in women in the UK, and gives a unique insight into the impact of a variety of lifestyle-related factors on CHD risk. There is an enormous potential for reducing the very high risk of CHD among women in the UK, which needs to be addressed. Based on these data, health strategies designed to reduce morbidity and mortality from CHD can be planned and implemented more effectively.
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Reilly, Jacqueline. "Surgical wound infection : addressing the risk factors within a change theory framework." Thesis, Glasgow Caledonian University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322215.
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Ramsay, Jean Marilyn Christina. "Psychosocial risk factors for coronary artery disease and symptom reporting." Thesis, University of East London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.361848.
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Woodhouse, Peter Robert. "Seasonal variation of cardiovascular disease risk factors in older adults." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295672.
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Haddad, Sleiman. "Surgical site infections in spinal surgery: from risk factors to surgical outcomes." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665823.
Full textAbstract:
Durante la última década ha aumentado significativamente el volumen de cirugías de columna, además de la complejidad tanto médica como quirúrgica de los pacientes tratados. Esto ha dado lugar a un aumento de complicaciones asociadas. Los profesionales de la salud son ahora más conscientes del impacto de ciertas complicaciones prevenibles, especialmente la infección de la herida quirúrgica (IHQ), cosa que ha provocado un aumento de los esfuerzos para reducir su incidencia. Se han descrito factores de riesgo generales para las IHQ. No obstante, el rol del estado neurológico y del traumatismo no se han analizado específicamente. Además, el impacto de las IHQ en los resultados clínicos tras la cirugía de deformidad espinal del adulto (DEA) aún no está claro.
El objetivo de esta tesis doctoral es revisar los factores de riesgo de la IHQ en la cirugía del raquis así como su impacto sobre el resultado final. Se centra principalmente en el diagnóstico (traumático vs. degenerativo) y el estado neurológico (Lesión medular LM o mielopatía MP) como predictores de la IHQ. También informa de las morbilidades y los costes asociados y evalúa los resultados quirúrgicos después de una IHQ.
La National Inpatient Survey (NIS) y la base de datos del Thomas Jefferson University Hospital (TJUH) se usaron para analizar la infección en la cirugía cervical primaria. Mediante un análisis multivariante, se analizaron los posibles factores de riesgo incluyendo el trauma y la lesión neurológica. Luego se procedió a un análisis de costes. La base de datos del European Spine Study Group (ESSG) sirvió para evaluar su impacto sobre los resultados funcionales y clínicos en pacientes con fusión posterior para la DEA mediante la comparación de cohortes emparejadas.
Un total de 1.247.281 (NIS) y 5.540 (TJUH) pacientes cumplieron los criterios de inclusión. La incidencia de la IHQ fue de 0.73% (NIS) y 1.75% (TJUH). Aumentó progresivamente desde 0,52% en pacientes sin MP hasta 1,97% en el grupo con LM traumática en la muestra del NIS y desde 0,88% a 5,54% en TJUH. Hubo diferencias significativas en las tasas de IHQ entre muestras. El estado neurológico (Odds Ratio [OR] 1,69, p<.0001) y el trauma (OR 1.30, p=.0003) fueron asociados a IHQ en la muestra del NIS. En la muestra del TJUH, solo el trauma (OR 2.11, p=.03) era significativo cuando se tuvieron en cuenta las otras comorbilidades. Los costes de la infección variaron entre los grupos diagnósticos y alcanzaron $184060 en el grupo LM traumática. Los pacientes con IHQ utilizaron con más frecuencia las instituciones especializadas al alta.
Se identificaron 444 pacientes con DEA tratados quirúrgicamente y con más de 2 años de seguimiento. 20 padecieron una IHQ aguda y fueron emparejados a 60 controles. No se observaron diferencias basales entre grupos tanto en variables radiológicas como calidad de vida. Los pacientes con IHQ tuvieron una estancia hospitalaria más prolongada y más complicaciones mecánicas. La infección se asoció a más complicaciones y revisiones no relacionadas. La corrección de la deformidad se mantuvo indiferentemente de la infección a lo largo del seguimiento. Hubo una muerte relacionada con IHQ. Los pacientes con IHQ presentaban peor calidad de vida al año y tenían menos probabilidades de experimentar mejoría. Sin embargo, no se registraron diferencias significativas a partir del año.
Como conclusión, tanto el diagnóstico primario (trauma vs. degenerativo) como el estado neurológico (MP o LM) son predictores de la IHQ en cirugía cervical. La infección afecta significativamente el primer año después de la cirugía de la DEA, se asocia con más complicaciones, revisiones no relacionadas y peor calidad de vida. Sin embargo, su impacto negativo parece diluirse en el segundo año.Over the last decade there has been a significant increase in volume of spinal surgeries performed as well as in medical and surgical complexity of patients. This was accompanied by an increased overall morbidity and volume of complications. At the same time, health care professionals have become more aware of the impact of specific preventable complications such as surgical site infections (SSI) and huge efforts have been directed to reduce SSI incidence. Although the general risk factors for SSI have been discussed, the relationship of neurologic status and trauma to SSI has not been explicitly explored. In addition, the direct and indirect impact of deep SSI on surgical outcomes especially after adult spinal deformity (ASD) surgery is still unclear. The aim of this doctoral thesis is to review the risk factors for developing a SSI after spine surgery, as well as how SSI affects clinical outcome. It mainly focuses on diagnosis (Traumatic vs. Degenerative) and neurological status (Spinal Cord Injury SCI or Myelopathy MP) as predictors for SSI. It also reports the associated morbidities and costs of SSI and evaluates the surgical outcomes after SSI. The National Inpatient Survey (NIS) and the Thomas Jefferson University Hospital (TJUH) databases were probed to analyse infection in patients with primary cervical surgery. Using a multivariate analysis, all interplaying comorbidities and risk factors have been. A subsequent resource utilization analysis has been done. The European Spine Study Group (ESSG) prospective database was used to study the functional and clinical outcomes of SSI in patients with posterior fusion for Adult Spinal Deformity (ASD) through the comparison of matched cohorts. Readmissions, reoperations, deformity correction and fusion rates were also studied. A total of 1,247,281 and 5,540 patients met inclusion criteria in the NIS and TJUH databases respectively. SSI incidence was 0.73% (NIS) versus 1.75% (TJUH). It increased steadily from 0.52% in patients without MP to 1.97% in the traumatic SCI group in the NIS data and from 0.88% to 5.54% in the TJUH. Differences between diagnostic groups and cohorts reached statistical significance. SSI was predicted significantly by neurological status (odds ratio [OR] 1.69, p<.0001) and trauma (OR 1.30, p=.0003) in the NIS data. Other significant predictors included: approach, number of levels fused, female gender, black race, medium size hospital, rural hospital, large hospital, western US hospital and Medicare coverage. In TJUH, only trauma (OR 2.11, p=.03) reached significance when accounting for comorbidities. Costs of infection varied among diagnostic groups and summed $184060 in the SCI group. Patients with SSI were also more likely to be discharged to specialized institutions. 444 surgical ASD patients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter. As a conclusion, both primary diagnosis (trauma vs. degenerative) and neurologic status (MP or SCI) were found to be strong and independent predictors of SSI in cervical spine surgery. Also, SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it's negative impact seems to be diluted by the second postoperative year.
30
Wilkins, Kathryn. "Socioeconomic status and risk factors for coronary heart disease, Canada, 1971-1985." Thesis, McGill University, 1987. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=64061.
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Lopes, Philippe. "The relationships between respiratory sinus arrhythmia and coronary heart disease risk factors." Thesis, University of Ulster, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287137.
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Dean, Chalkley Tracey Shelly. "The effects of soy isoflavones on risk factors for coronary heart disease." Thesis, King's College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269628.
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Yasmin. "Coronary heart disease : relationships between some metabolic risk factors and anthropometric variables." Thesis, University of Cambridge, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339727.
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Best, Kate Elizabeth. "Survival and risk factors for mortality among individuals with congenital heart disease." Thesis, University of Newcastle upon Tyne, 2016. http://hdl.handle.net/10443/3441.
Full textAbstract:
With advances in medical, surgical and intensive care interventions, more individuals with congenital heart disease (CHD) are surviving infancy. However, long-term survival is not well researched. Given that UK paediatric cardiovascular services are undergoing reforms to ensure there are adequate health-care provisions, further information is required on CHD prevalence and survival. An analysis of data from six British Isles Network of Congenital Anomaly Registers (BINOCARs), showed no overall trend in CHD prevalence between 1991 and 2010. However, there was an increasing trend in the prevalence of tetralogy of Fallot, equating to a yearly excess of 16 cases in England and Wales. There was an increased risk of CHD in twins, particularly monochorionic (MC) twins. The prevalence of CHD in MC twins increased over time, equating to a yearly excess of seven cases in England and Wales. Using a systematic review and meta-analysis, pooled five and 10-year survival was 85.4% and 81.4%, respectively. Year of delivery, preterm delivery, extra-cardiac anomalies (ECAs) and birth weight were associated with mortality. In an analysis of data from one BINOCAR linked to death registrations, one-year survival was 89.1%, decreasing to 85.2% at 20 years. Less recent year of delivery, lower gestational age, low birth weight, prenatal diagnosis and the presence of ECAs increased the risk of mortality. The predicted 20-year survival of individuals born with isolated CHD in 2015 was 98.7%. The predicted prevalence of CHD was 74.0 and 68.8 per 10,000 live births in 2015 and 2020, respectively. Using ONS data to extrapolate, this equates to approximately 296,000 cases of CHD being born between 2012-2017 in the UK. Given that infants with CHD require complex surgeries, the predicted prevalence and survival estimates described in this thesis are important for health service planning and for providing accurate information to parents when a CHD is diagnosed prenatally.
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Weinstein, Patricia. "Awareness of Increased Risk for Heart Disease and Cardiovascular Risk Factors in Women with Systemic Lupus Erythematosus." Doctoral diss., University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2652.
Full textAbstract:
Women with systemic lupus erythematosus (SLE) develop cardiovascular disease (CVD) earlier and at a more accelerated rate compared to women without SLE. Many women with SLE are unaware of their increased risk despite years spent in the health care system, thus giving the atherogenic process time to accrue damage. Research has not explained fully why women with SLE are unaware of their increased risk for CVD or why awareness does not correspond to risk-educing behaviors. Stage theories of behavior like the Precaution Adoption Process Model (PAPM) propose that health behavior change proceeds through qualitatively different stages, and people at one stage face similar barriers before they can progress to the next. The Common Sense Model (CSM), a self-regulatory model of health behavior, explains the emotional and cognitive processes involved in progression from one stage to the next and the formation of a personal risk/illness representation. Combining the PAPM and CSM helps understand the relationship between risk perception and adoption of risk reducing behaviors. The specific aims of this study were to assess in women with SLE: (1) general knowledge of heart disease compared to women without SLE; (2) awareness of increased CVD risk and CVD risk factors; and (3) personal and healthcare system factors that influence awareness of increased CVD risk and adoption of risk reducing behaviors. Sixty women with SLE, 18 years of age or older, were recruited to participate in this descriptive study. Data included demographic information, self-report questionnaires (perceived CVD risk, CVD risk factors, depression, physical activity), body measures (height, weight, waist circumference, blood pressure), and blood samples for physiologic markers of traditional and novel CVD risk factors (glucose, insulin, lipoprotein lipids, creatinine, C-reactive protein, homocysteine, antiphospholipid antibodies). The Beck Depression Inventory-Primary Care and the Physical Activity Disability Survey were used to determine depression and activity level respectively. General knowledge of heart disease was assessed using the American Heart Association (AHA) National Survey on women's awareness of heart disease. Logistic regression was used to categorize participants into subgroups according to perceived risk and identify important factors that influenced their PAPM stage categorization. Women with SLE in this study were more aware of women's leading cause of death than United States women who responded to the 2006 AHA survey (73% v 57%), but fewer than 25% perceived themselves at increased CVD risk. Age was a significant predictor (p=0.05) for awareness of increased risk; younger age correlated with increased awareness. Most women received information about heart disease from public media. On average, women had 4 CVD risk factors, but they perceived they had only 2. The number of perceived risk factors predicted adoption of risk reducing behaviors (p=0.03). Women in this study with SLE underestimated their CVD risk factors and did not personalize their increased CVD risk. Healthcare providers' identification and discussion of CVD risk factors in women with SLE may enhance their risk awareness and the adoption of risk reducing behaviors. This information may contribute to the development of stage-matched interventions, a potentially more effective and efficient approach than a generic program of risk-reduction, especially in individuals with SLE who face the additional burden of a chronic illness.Ph.D.
School of Nursing
Other
Nursing PhD
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Bottomley, Nicholas J. "Anteromedial osteoarthritis : a surgical perspective of incidence, progression and risk factors." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:34c87265-bbae-4018-b120-ef1d6bed73aa.
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Anteromedial osteoarthritis of the knee (AMOA) has been defined anatomically, histologically and radiologically and yet little is known about the epidemiology of the disease or the risk factors involved in the development of the disease. The broad aim of this thesis was to combine clinical insight with the utilisation of modern, large epidemiological datasets to provide information to inform better the clinical management of patients with AMOA. Specifically, the prevalence and incidence of AMOA, the time taken to progress from early disease to severe disease that may require surgical intervention, the radiological characterisation of disease and the assessment of mechanical risk factors implicit in the development of this pattern of disease are investigated. A cross-sectional study of the radiological prevalence of AMOA in a symptomatic cohort in a specialist secondary care knee clinic showed that AMOA was the commonest pattern of knee OA, present in more than 60% of symptomatic subjects. Less than 25% of subjects with AMOA presented with advanced or 'bone-on-bone' disease, emphasising the clinical importance of understanding the progression from earlier stages of disease to this advanced stage. A 20-year longitudinal radiographic study was performed on 1000 women to describe the prevalence, incidence and progression of AMOA. The prevalence of AMOA was 43% and the incidence over 20-years was 0.4. Life table analysis showed that the risk of developing advanced AMOA in a previously normal knee was 2.6%. Of those subjects with early radiological AMOA, 11% progressed to advanced 'bone-on-bone' disease within 10 years and 37% within 20 years. The role of mechanical risk factors in the development of AMOA showed that both anatomical limb and proximal tibial alignment were significantly more varus aligned in those that developed AMOA at 20-years. Assessment of the shape of the medial tibial plateau in a longitudinal MRI study showed that the angle of the upslope at the anterior aspect of the plateau was significantly increased in the group that subsequently developed AMOA. To enable AMOA to be studies in future MRI studies, the MRI description of the disease was defined. In summary, AMOA was shown to be the most common pattern of knee OA both in symptomatic surgical cohorts and in the community. The progression of the disease from an early stage to an advanced stage, which may require surgical intervention, was described for the first time. To enable better the recognition of AMOA in modern epidemiological studies, the MRI description of AMOA was defined and the clinical relevance of modern MRI was discussed. The anatomical alignment of the limb, the alignment of the proximal tibia and the morphology of the tibial plateau were all shown to have a role in the development of AMOA. Addressing these mechanical factors may provide a therapeutic surgical target for the management of patients with AMOA.
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Pikkujämsä, S. (Sirkku). "Heart rate variability and baroreflex sensitivity in subjects without heart disease:effects of age, sex and cardiovascular risk factors." Doctoral thesis, University of Oulu, 1999. http://urn.fi/urn:isbn:9514252276.
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Abstract
Healthy subjects show wide interindividual variation in their
heart rate behavior, but the factors affecting heart rate dynamics
are not well known. This research was undertaken to evaluate heart
rate variability (HRV) and baroreflex sensitivity (BRS) in a large
random sample of subjects without evidence of heart disease, and
to estimate the relation of heart rate behavior to age, sex and
cardiovascular risk factors.
Short-term HRV was analyzed from 15-minute periods of standardized
recording in supine and upright positions using time and frequency
domain measures, and BRS was calculated using the Valsalva maneuver
in an original randomly selected population of 600 hypertensive
and 600 control middle-aged subjects. In addition, HRV was analyzed
from the same segments using new measures based on fractals and
complexity (chaos theory) of R - R interval dynamics in
the same random population, and from 24-hour period in 114 healthy
subjects aged from 1 to 82 years.
Large interindividual variation was observed in the measures
of HRV and BRS in middle-aged subjects; coefficient of variation
(CV) of the standard deviation of R - R intervals (SDNN)
39% (54 ± 21 ms) and CV of BRS 49% (9.9 ± 4.9
ms/mmHg). In healthy middle-aged men, SDNN was weakly related
to age (r = -0.19, p < 0.01),
HDL cholesterol (0.19, p < 0.01), serum
insulin (-0.23, p < 0.001) and triglyceride
(-0.25, p < 0.001) levels.
In women, SDNN was only related to insulin levels (r = -0.23,
p < 0.001). BRS was related to systolic
blood pressure (r = -0.31 and -0.30,
in men and women respectively, p < 0.001
for both) and blood glucose (r = -0.25,
p < 0.01) and serum insulin levels (r = -0.34,
p < 0.001) in women. Lesser intersubject
variation was observed in the non-linear measures of HRV; CV 14% of
short-term scaling exponent (a1), a measure of fractal-like correlation
properties of HRV, (1.21 ± 0.17) and
CV 12% of approximate entropy, a measure of complexity,
(1.13 ± 0.14). Neither a1 or ApEn was
related to any risk factors. Women had lower overall short-term
HRV (p < 0.01) and BRS (p < 0.001),
but a higher spectral high-frequency component of HRV, higher ApEn
and lower a1 (p < 0.001 for all) compared
to men. The impairment in overall HRV was confined to the hypertensive
subjects with metabolic features of the insulin resistance syndrome
(IRS, n = 69), but the BRS and spectral
high-frequency component were also impaired in hypertensive subjects
without IRS compared to normotensive subjects. The 24-hour cardiac
interbeat interval dynamics changed markedly from childhood to
old age. Children showed similar complexity and fractal correlation
properties of R - R intervals as young adults. Healthy aging
resulted in R - R interval dynamics with higher regularity
and predictability and altered fractal scaling.
The traditional measures of HRV and BRS are weakly related
to many cardiovascular risk factors in subjects without heart disease,
but the interindividual variation of HRV and BRS is only partly
explained by these factors, suggesting a genetic background of
the intersubject variation in cardiovascular autonomic regulation.
The new dynamical measures of HRV show less interindividual variation
than the conventional measures of HRV in healthy subjects and are
not related to cardiovascular risk variables, suggesting that these
dynamical measures quantify the "intrinsic" capacity of a healthy
cardiovascular control system without the significant influence
of life-style, metabolic or demographic variables. However, there
are sex and age-related differences also in the fractal and complexity
measures of heart rate behavior.
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Smith, William Cairns Stewart. "An epidemiological study of coronary heart disease and its risk factors in Scotland : the Scottish Heart Health Study." Thesis, University of Dundee, 1989. https://discovery.dundee.ac.uk/en/studentTheses/63823b71-1377-4e78-bc4b-4c662c58a289.
Full textAbstract:
The Scottish Heart Health Study was conducted in response to a report by a Working Group of the Chief Scientist Organisation and followed an initial of the Cardiovascular Epidemiology Unit. The aims of the study were to establish the levels of coronary risk factors in Scotland, to determine the extent to which these risks factors explained the geographical variation in coronary heart disease, and their relative contribution to the prediction of coronary heart disease in a cohort of men and women.The Scottish Heart Health Study is a study of lifestyle and coronary heart disease risk factors in 10 359 men and women aged 40-59 years, in 22 districts of Scotland. The study was conducted in 1984-86, when Scotland had the highest national coronary mortality reported by the World Health Organisation. The study employed standardised methods emphasing quality e4 control based on a World Health Organisation protocol to allow comparisons in place and time, and therefore to provide a definitive baseline against which interventions can be assessed. The cross sectional aspect of the study has been analysed and addresses the first two study objectives. The third objective will only be achieved when sufficient prospective coronary events have occurred.Current cigarette smokers constitute 39% of men and 38% of women, higher levels than those reported in England but lower than previous Scottish reports. Considerable variation in smoking was noted across the study districts from 29% to 52% in men. Mean blood pressure levels were 134/84 mmHg for men and 131/81 mmHg in women, these levels are lower than previous studies in Britain and there was a narrow range of levels across the districts. Mean levels of blood cholesterol were 6.4 mmol/l in men and 6.6 mmol/l in women - as high as other British studies and high by international standards. There was little geographical variation in blood cholesterol noted.High levels of blood cholesterol and cigarette smoking provide a classical explanation for the excess coronary deaths in Scotland, justifying action, but other factors, such as dietary deficiencies, also merit further investigation. The geographical variation in coronary mortality can best be explained by a group of risk factors which all show a social gradient and these include cigarette smoking, physical activity, blood pressure, and the consumption of alcohol, fruit and green vegetables.
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Erdenebileg, Ariuntsatsral Ariunaa. "Is Maternal Headache a Risk Factor for Congenital Heart Disease?" Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/iph_theses/70.
Full textAbstract:
Congenital Heart Disease (CHD) is one of the most common birth defects. It is the single most modifiable cause of infant mortality under one year of age. Therefore, the causes of CHD have been extensively researched in the past but the etiology remains largely unknown. Environmental risks, particularly maternal risk factors for congenital cardiac malformation have been evaluated in the original BWIS previously. However, in this research we examined one of the additional risk factors. We sought to determine whether maternal headache during six months prior to conception and throughout gestation until birth is a risk factor for CHD in the BWIS dataset. Among 3274 singleton cases and 3519 controls, a maternal report of headache was found to be associated with a nearly 20% increase in the risk of a congenital heart defect (OR= 1.2 p=0.001). Moreover, any medications use for headache 1-6 months prior to conception increased the risk of abnormal cardiac development by 1.3 fold (OR = 1.3, p=0.0004). Aspirin or aspirin containing analgesics were found to increase the risk for CHD at the defined risk period. According to subgroup analysis, aspirin or aspirin containing analgesics and acetaminophen or acetaminophen containing analgesics were found to be the risk factor for CTD i.e. Conotruncal defects. Furthermore, aspirin or aspirin containing analgesics increased the risk for PVSD i.e. Peri-membranous Ventricular Defect in offspring when the mother uses these drugs 1-6 months prior to conception. Additionally, the risk for CVD i.e. critical valve disease were found to be increased when women were exposed to aspirin or aspirin containing analgesics during third trimester after pregnancy. In conclusion, maternal headache increased the risk for CHD by 20% and the use of headache medications specifically pain relievers during 1-6 months prior to conception modulated type of defect was observed.
40
Mariscalco, Giovanni. "Atrial fibrillation after cardiac surgery : an analysis of risk factors, mechanisms, and survival effects." Doctoral thesis, Umeå universitet, Kirurgi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1798.
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Background: Despite the recent improvements in surgical techniques and postoperative patient care, atrial fibrillation (AF) remains the most frequent complication after cardiac surgery. Although postoperative AF is often regarded as a benign clinical condition, this arrhythmia has significant adverse effects on patient recovery and postoperative survival. Its exact pathophysiology has not yet been elucidated. The present thesis aims to analyze AF risk factors and their interaction, pre-existing histological explanatory alterations of the atrium, the AF impact on postoperative survival and the compliance of a prophylactic drug regimen. Methods: During a 10-year period, consecutive cardiac surgery cases with complete data on AF occurrence and postoperative survival were extracted. All patients were operated on for coronary or valvular surgery, with cardiopulmonary bypass (CPB). Hospital and long-term survival data were obtained from Swedish population registry. Study I) Isolated coronary artery bypass grafting (CABG, n=7056), aortic valve replacement (n=690) and their combination (n=688) were considered. Independent AF risk factors and AF effects on early and 1 year mortality were investigated. Study II) Patients affected by postoperative AF among isolated CABG patients (n=7621), valvular surgeries (n=995) and their combination (n=879) were studied. Long-term survival was obtained and prognostic factors identified. Study III) Seventy patients were randomized to on-pump (n=35) or off-pump (n=35) CABG. Samples from the right atrial appendage were collected and histology was evaluated by means of light and electronic microscopy with reference to preexistent alterations related to postoperative AF. Study IV) Cardiac surgery patients with complete data on smoking status (n=3245) were reviewed. Effects of smoking on AF development and interaction among variables were explored. Study V) CABG patients without clinical contraindications to receive oral sotalol (80 mg twice daily) and magnesium were prospectively enrolled (n = 49) and compared with a matched contemporary control CABG group (n = 844). The clinical compliance to the AF prophylactic drug regimen was tested. Results: The overall AF incidence was around 26%, subdivided into 23%, 40% and 45% for isolated CABG, valve procedures and their combined surgeries, respectively. Age was the strongest predictor of postoperative AF. Coronary disease superimposed risk factors with reference to myocardial conditions at CPB weaning. Considering the preoperative smoking condition, smokers demonstrated a reduced AF incidence compared to non-smokers (20% versus 27%, p<0.001). An interaction between smoking status and inotropic support was observed: without this interaction smoking conferred a 46% risk reduction of AF (p=0.011). At the histological level, myocyte vacuolization and nuclear derangement represented anatomical independent AF predictors (p=0.002 and p=0.016, respectively). CPB exposure was not associated to postoperative AF nor histological changes. Although, postoperative AF increases the length of hospitalization in all patient groups, it did not affect the hospital survival. However, AF independently impaired the late survival, a phenomenon seen in the CABG group only. With reference to the tested sotalolmagnesium drug regimen, only 55% of CABG patients were compliant to the treatment, with marginal effects on AF occurrence. Conclusions: In addition to age, details at the CPB weaning period, pre-existing histopathological changes, the hyperadrenergic state and catecholamines are key mechanisms in the pathophysiology of postoperative AF. In particular, the CPB period hides valuable information for timely AF prophylactic stratifications. Further, compliance effects due to patient selection should also be considered in a prophylactic therapy model. Postoperative AF increases late mortality after isolated CABG surgery, but not after valvular procedures. Although the mechanisms are unclear, our results draw the attention to possible AF recurrence after hospital discharge, indicating a strict postoperative surveillance.
41
Evangelista, Kimberly. "Factors Associated with Depression in Adult Cardiac Surgery Patients." Honors in the Major Thesis, University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1163.
Full textAbstract:
This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
42
Shoair, Osama. "Risk Factors for Postoperative Cognitive Dysfunction in Older Adults Undergoing Major Noncardiac Surgery." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/503.
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Background: Postoperative cognitive dysfunction (POCD) is a deterioration in cognitive function that occurs after surgery as measured by neuropsychological tests. The purpose of this study was to determine the incidence and risk factors for POCD in older adults three months after major noncardiac surgery. Methods: This is a prospective study of patients aged 65 years and older who underwent major noncardiac surgery. Patients’ cognitive function was assessed before and three months after surgery using a computerized neurocognitive battery. Blood samples were withdrawn from patients before surgery to identify patients with high level of C-reactive protein (CRP), and patients who had the apolipoprotein-E4 (ApoE4) allele, as potential inflammatory and genetic biomarkers for POCD, respectively. A nonsurgical control group, that is similar to patients in age, education level, and computer familiarity, was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Patients were classified as having POCD if they had less than -1.96 in the individual Z-scores of two or more tests or in the composite Z-score. Results: A total of 69 patients and 54 controls completed the study. The mean age for patients was 71 ± 5.4 (65–88) years old and 66.7% of them were females. The majority of patients (78.3%) had above high school education. There was no difference between the surgical and nonsurgical groups in demographics except for age which was marginally higher in the nonsurgical group [73 ± 6.3 (65-92)]. The incidence of POCD was 15.9% three months after surgery. Multivariable logistic regression showed that carrying the ApoE4 allele (OR = 4.74, 95% CI = 1.09 – 22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35 – 30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49 – 34.66) were risk factors for POCD. Conclusion: The incidence of POCD in older adults is 15.9% three months after major noncardiac surgery. Risk factors for POCD were carrying the ApoE4 allele, using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery, and receiving sevoflurane for anesthesia.
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Nikolis, Andreas. "Assessment of risk factors in the development of thromboembolism in a trauma population." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=29577.
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The aim of this study was to: (a) identify risk factors for the development of venothromboembolism in a trauma population, (b) evaluate whether risk factors vary with increasing Injury Severity Score (ISS), and (c) assess the predictive ability of the Risk Assessment Profile for Thromboembolism (RAPT) in this trauma population. There were 7532 admissions for trauma between 1993 and 1998 to the Montreal General Hospital trauma center. A nested case-control design was used. Cases were defined as all patients with radiological evidence of either a deep venous thrombosis or pulmonary embolus during their admission. Controls were patients satisfying the same inclusion criteria who did not suffer a symptomatic deep venous thrombosis or pulmonary embolism while in hospital, did not have evidence of deep venous thrombosis prior to the traumatic event, and found to be free of any symptomatic thromboembolic events on consequent follow up. Patients were divided into three categories, ISS 1--24 (mild-moderate injuries), ISS 25--59 (moderate-severe injuries), and ISS 60--75 (severe-fatal injuries). (Abstract shortened by UMI.)
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Slunga, Lisbeth. "Serum lipoprotein(a) in relation to ischemic heart disease and associated risk factors." Doctoral thesis, Umeå universitet, Klinisk kemi, 1993. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-101298.
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Lipoprotein(a) (Lp(a)) consists of an LDL-like particle and the specific protein apo(a), which is very similar to plasminogen. Apo(a) contains repeated kringle structures and a serine protease domain, which cannot be activated by t-PA. Lp(a) is considered to be a predictor for atherosclerotic disease. It has been found incorporated in atherosclerotic plaques and inhibits in vitro fibrinolysis. Lp(a) was determined in 1527 randomly selected individuals participating in the Northern Sweden WHO-MONICA project. A weak but significant relation between Lp(a) and increasing age was found. Menopausal status was the strongest independent predictor of Lp(a) level in women. Fibrinogen was independently related to Lp(a) in both sexes. Only a minor fraction of Lp(a) variance could be explained for in a multiple regression model, which is in agreement with the contention that Lp(a) is highly genetically determined. Lp(a) was determined in 1571 patients investigated with coronary angiography because of suspected severe coronary artery disease (CAD). Patients with proven CAD at elective angiography had significantly higher Lp(a) than patients without significant CAD or healthy controls. Lp(a) was found to be an independent discriminator of CAD in both sexes. HLA-DR genotype 13 or 17 was found more frequently in 30 male patients with angiographic CAD at young age (< 50 years) than in 30 age matched controls. These genotypes were common in patients with high Lp(a) levels, which indicates that Lp(a) may be related to immunological processes. The reaction of Lp(a) was investigated in 32 patients with acute myocardial infarction (AMI). Lp(a) increased during the first week, but the response was comparatively weak. Individual Lp(a) responses were heterogeneous and no correlations to infarct size or changes in the acute phase proteins were found. In a randomized cross-over study on 36 hypercholesterolaemic patients treated with simvastatin/placebo during 12+12 weeks Lp(a) did not change significantly, but patients with high Lp(a) levels at baseline tended to develop further increased Lp(a). To conclude, Lp(a) was found to be an independent predictor of angiographic CAD in both men and women. Lp(a) levels are primarily genetically determined and only a small fraction of Lp(a) variance could be explained by other factors in this study. Lp(a) may be related to HLA DR types and immunological processes involved in atherosclerotic disease. Lp(a) increased slightly during the first week of AMI, but was not related to changes in the acute-phase proteins. The effective LDL-lowering agent simvastatin did not influence Lp(a) significantly.Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 5 uppsatser.
digitalisering@umu
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Marusic, Andrej. "Some relationships between standard and suggested psychosocial risk factors, and ishaemic heart disease." Thesis, King's College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266596.
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Zelt, Jason. "Risk Factors, Mechanisms and Therapeuthic for Right Heart Failure Associated with Pulmonary Hypertension." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40737.
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Right ventricular function (RV) is one of the most important predictors of prognosis in
many cardiovascular disease states. Despite the significance of RV function to survival, there are
no therapies that directly nor selectively improve RV function. As well, the basis for RV failure
is poorly understood. This is particularly relevant for patients with pulmonary arterial
hypertension (PAH), where RV failure in the setting of pressure overload is the leading cause of
death. PAH will be introduced in the 2nd chapter of this thesis by comparing and refining
contemporary mortality risk assessment strategies. I will then explore 1) RV neurohormonal
function and, 2) RV energetics, two molecular pathways thought to be involved in the
pathogenesis and progression of maladaptive RV failure. I employed small animal molecular
imaging using positron emission tomography (PET) to non-invasively investigate these
pathways. The PET imaging techniques employed in this thesis have the unique potential for
translation to human studies, to further explore disease mechanisms.
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Phoku, Nkosinathi Terrence. "Cardiovascular risk factors among 15-20 years old rural subjects residing in Dikgale Demographic Surveillance Site (DDSS), Limpopo Province." Thesis, University of Limpopo (Turfloop Campus), 2013. http://hdl.handle.net/10386/1048.
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Thesis (M.Sc. (Chemical Pathology) --University of Limpopo, 2013Cardiovascular diseases (CVDs) are among one of the well documented conditions and pose a significant health burden in the world as they areconsidered to be of adult onset. However, recent studies have shown that in developed countries CVD risk factors are becoming prevalent in young people which isof great concern. Therefore, the aim of this study was to determine if CVD risk factors are present in young subjects aged 15-20 years of age residing in a rural area of a developing country. Methods: Subjects aged between 15-20 years who participated in the “Gene - Environment interaction project” were included in this sub-study. Total cholesterol, triglycerides, HDL-cholesterol, LDLcholesterol, insulin, glucose, creatinine, Lp(a), apoB, apoA-1 and hs-CRPwere determined. Blood pressure, physical activity (number of steps/day), weight, height, waist circumference and hip circumference were obtained from the database. Subjects with CRP levels above 10mg/L and creatinine levels above 130 mmol/L were excluded. Results: The present study showed an overall high prevalence of some CVD risk factors. There was high prevalence of insulin resistance (23.0% in females and 34.7% in males), and high hs-CRP (18.4% in females, 12.9% in males). The prevalence of low HDL-C levels was high (55.2% in females and 16.8 % in males), however, the prevalence of abnormal levels of other lipids such as total cholesterol/HDL-cholesterol ratio was low in both males and females. The prevalence of an increased apoB/apoA ratio was significantly higher in females 26.4% compared to males 7.9%. The prevalence of overweight (12.6%) and obesity (9.2%) was higher in females than in males (overweight 1%, obesity 0 %). The prevalence of hypertension was comparable between the two genders (5.7% in females and 10.9 % in males). Conclusion: The results showed a relatively high prevalence of non-traditional risk factors for cardiovascular diseases in adolescents residing in a rural area, Limpopo Province, while the prevalence of traditional risk factors such as total cholesterol and triglycerides was low.
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Afif, Waqqas. "Risk factors for lymphoma in patients with inflammatory bowel disease: a case-control study." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=107621.
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Background: Subgroups of patients with inflammatory bowel disease (IBD) may have an increased risk of developing lymphoma. We sought to identify factors that were associated with lymphoma in IBD patients. Methods: Cases and controls were identified though a centralized diagnostic index. We identified 80 adult IBD patients who subsequently developed biopsy-proven lymphoma between 1980 and 2009. For each case, two controls were matched for subtype of IBD, geographic location, and length of IBD follow-up at our institution prior to lymphoma diagnosis. Medical records were abstracted for demographic and clinical information. Conditional logistical regression was used to assess associations between risk factors and the development of lymphoma. Results: Sixty cases were males (75%) vs. 77 controls (48%). Median age at index date was 59 years for cases and 42 years for controls. Twenty cases (25%) and 23 controls (14%) were receiving immunosuppressive medications at the index date. Four cases (5%) and six controls (4%) were receiving anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents at the index date. In multivariate analysis, age per decade (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.37-2.43), male gender (OR, 4.05; 95% CI, 1.82-9.02) and immunosuppressive exposure at the index date (OR, 4.20; 95% CI, 1.35-13.11) were significantly associated with increased odds of developing lymphoma. Disease severity and use of anti-TNF-alpha agents were not independently associated with developing lymphoma. Conclusions: In this case-control study, increasing age, male gender and use of immunosuppressive medications were associated with an increased risk of lymphoma in patients with IBD, whereas disease severity and anti-TNF-alpha use were not associated with increased odds.Cadre de l'étude: Certains sous-groupes de patients atteints de maladies inflammatoires de l'intestin (MII) peuvent courir un risque accru de développer un lymphome. Nous avons chercher à identifier les facteurs associés avec le lymphome chez les patients avec des MII. Méthodologie: Les cas et les témoins ont été identifiés à partir d'un répertoire de diagnostics centralisé. Nous avons identifié 80 patients adultes atteints de MII et qui ont dévelopé un lymphome confirmé par biopsie entre les années 1980-2009. Deux témoins étaient appariés pour chaque cas sur le sous-type de MII, la localisation géographique et la durée du suivi pour les MII dans notre centre jusqu'au diagnostic de lymphome. Les dossiers médicaux ont été consultés afin d'obtenir les données démographiques et cliniques. Un modèle de régression logistique conditionel a été utilisé pour évaluer les associations entre les facteurs de risque et le développement d'un lymphome. Résultats: Parmi les cas retenus, 60 étaient des hommes (75%) vs 77 dans le groupe de témoins (48%). L'âge médian à la date index était de 59 ans pour les cas et de 42 ans pour les témoins. Vingt cas (25%) et 23 témoins (14%) recevaient des médicaments immunosuppresseurs à la date index. Quatre cas (5%) et six témoins (4%) recevaient des anticorps antagonistes du TNF-alpha à la date index. Lors d'une analyse multivariée, l'age par décennie (rapport de cotes [RC]:1,83, intervalle de confiance à 95%[IC]: 1,37-2,43), le sexe masculin (RC:4,05, IC 95%:1,82-9,02) et l'exposition aux médicaments immunosuppresseurs à la date index (RC:4,20, IC 95%: 1,35-13,11) ont été associés, de façon significative, à un risque accru de developper un lymphome. La sévérité de la maladie et l'utilisation d'anticorps antagonistes du TNF-alpha n'ont pas été associés de manière indépendante au developpement d'un lymphome. Conclusion: Dans cette étude de cas-témoin, l'age avancé, le sexe masculin et l'tilisation de médicaments immunosuppresseurs ont été associés à un risque supérieur de lymphome chez les patients atteints de MII. Par contre, la sévérité de la maladie et l'utilisation des anticorps antagonistes du TNF-alpha n'ont pas été associés à un risque plus élevé.
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Guerra, Stefano. "Risk factors for incidence and persistence of asthma-like symptoms." Diss., The University of Arizona, 2003. http://hdl.handle.net/10150/280354.
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Asthma represents the most common chronic disease in childhood. Children with asthma are at increased risk for developing long-term irreversible airway obstruction in adult life, the fourth leading cause of death in USA. Our aims were to: (1) Determine whether reduced IFNgamma production and plasma soluble CD14 (sCD14) levels in early life are significant risk factors for the development of wheezing in the first year of life; (2) Estimate rates of persistence and remission of childhood wheezing after puberty; (3) Study risk factors affecting persistence of childhood wheezing after puberty. We used data from the two large ongoing birth cohorts of the Tucson Infant Immune Study (IIS) and the Tucson Children's Respiratory Study (CRS). Among 238 children from IIS, we found the odds of developing recurrent wheezing in the first year of life to be 4.5 times higher for children in the lowest quartile of IFNgamma production at 3 months (p = .0005) and 3.2 times higher for children in the lowest quartile of sCD14 levels at birth (p = .004) as compared with children in the other 3 combined quartiles of IFNgamma and sCD14, respectively. We studied persistence and remission of wheezing after puberty among 732 children from the CRS cohort. We found that 29% of children with infrequent wheezing during childhood experienced persistent wheezing after contrast, the proportion of persistent wheezing was much higher (60%) among children meeting the for asthma during childhood. Frequency of wheezing during childhood, obesity, an early onset of puberty, bronchial hyperresponsiveness, and skin test sensitization were significant predictors of persistent asthma after puberty. By looking at genetic factors, we also found that the homozygous status for Gly in codon 16 of the beta2 Adrenoceptor doubled the risk for persistent wheezing after puberty among boys (RR 2.01, p = .0008) but not girls. Our findings from two population-based longitudinal cohorts provide the first evidence that altered immunological markers precede the onset of wheezing early in life, challenge the commonly held view that most asthma cases remit during adolescence, and provide a profile of risk.
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Huang, Wen Li. "A comparative review study of risk factors and physical activities related to heart disease." Thesis, University of Macau, 2018. http://umaclib3.umac.mo/record=b3952606.
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