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Socioeconomic differences in fat intake in a middle-aged population:: report from the Malmo Diet and Cancer Study

INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 2000年第3期29卷 438-448页

作者： Lindström, M Hanson, BS Brunner, E Wirfält, E Elmståhl, S Mattisson, I Östergren, PO Univ Lund Hosp Univ Hosp MAS Dept Community Med S-20502 Malmo Sweden UCL Int Ctr Hlth & Soc Dept Epidemiol & Publ Hlth London WC1E 6BT England Lund Univ Univ Hosp MAS Dept Med Surg & Ortoped S-20502 Malmo Sweden

Background The objective was to investigate whether socioeconomic differences in fat intake may explain socioeconomic differences in cardiovascular diseases. Methods The Malmo Diet and Cancer Study is a prospective cohort study. The baseline examinations used in the present cross-sectional study were undertaken in 1992-1994. Dietary habits were assessed using a modified diet history method consisting of a 7-day menu book and a 168-item questionnaire. A subpopulation of 11 837 individuals born 1926-1945 was investigated. This study examined high fat intake, defined as >35.9% among men and >34.8% among women (25% quartile limit) of the proportion of the non-alcohol energy intake contributed by fat. The subfractions saturated, mono-unsaturated and polyunsaturated fatty acids and the P:S ratio (polyunsaturated/saturated fatty acids) were analysed in the same way. The uppermost quartile (75%) of total and subgroup fat intake was also studied. Socioeconomic differences before and after adjustment for low energy reporting (LER), defined as energy intake below 1.2 x Basal Metabolic Rate, were examined. Results No socioeconomic differences in fat intake were seen between the SES groups, except for self-employed men, and male and female pensioners. Approximately 20% in most SES groups were LER. The LER and body mass index were strongly related. The SES pattern of fat intake remained unchanged after adjustment for age, country of origin and LER in a logistic regression model. The results for the subfractions of fat and the P:S ratio did not principally differ from the total fat results. Conclusions This study provides no evidence that fat intake contributes to the inverse socioeconomic differences in cardiovascular diseases.

关键词：人体质量指数心血管疾病/经济学心血管疾病/病因学膳食脂肪类/投药和剂量就业前瞻性研究危险性评估性别因素社会阶级女(雌)性人类男(雄)性中年人

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Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期86卷 17-23页

作者： Carlson, JJ Johnson, JA Franklin, BA VanderLaan, RL Stanford Univ Sch Med Stanford Ctr Res Dis Prevent Palo Alto CA 94304 USA Spectrum Hlth E Dept Prevent Cardiol & Rehabil Grand Rapids MI USA William Beaumont Hosp Div Cardiol Cardiac Rehabil Royal Oak MI 48072 USA

Common concerns with the traditional protocol (TP) for cardiac rehabilitation include suboptimal program participation, poor facilitation of independent exercise, the use of costly continuous electrocardiographic (ECG) monitoring, and lack of insurance reimbursement. To address these concerns, a reduced cost-modified protocol (MP) was developed to promote independent exercise. Eighty low- to moderate-risk cardiac patients were randomized to a TP (n = 42) or a MP (n = 38) and were compared over 6 months on program participation, exercise adherence, cardiovascular outcomes, and program costs. During month 1, patients followed identical regimens, including 3 ECG-monitored exercise sessions/ week, with encouragement to achieve greater than or equal to 5 thirty-minute sessions/week. In week 5, the TP continued with a facility-based regimen including 3 exercise sessions/week for 6 months and used ECG monitoring the initial 3 months, The MP discontinued ECG monitoring in week 5 and were gradually weaned to an off-site exercise regimen that was complemented with educational support meetings and telephone follow-up. Compared with TP patients, MP patients had higher rates of off-site exercise over 6 months (p = 0.05), and total exercise (on site + off site) during the final 3 months (p = 0.03). Also, MP patients were less likely to drop out (p = 0.05). Both protocols promoted comparable improvements in maximal oxygen uptake (p <0.05), blood lipids (0 <0.001), and hemodynamic measurements (p <0.002). The MP cost $738 less/patient than the TP and required 30% less staff (full-time equivalents). These results suggest that a reduced cost MP was as effective as an established TP in improving physiologic outcomes while demonstrating higher rates of exercise adherence and program participation. Thus, the MP or a similar protocol has applicability to hospitals with large capitated or managed care populations to provide cost-effective cardiovascular risk reduction to patients. (C) 200

关键词：心血管疾病/经济学心血管疾病/病理生理学心血管疾病/康复临床方案费用效益分析心电描记术/经济学运动疗法/经济学运动疗法/方法卫生保健费用保险健康补偿病人参与/经济学病人参与/方法治疗结果成年人老年人女(雌)性人类男(雄)性中年人

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PROGRESS IN INTERVENTIONAL CARDIOLOGY

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1994年第1期7卷 77-81页

作者： TALLEY, JD 1 Professor of Internal Medicine Associate Director Division of Cardiology University of Arkansas for Medical Sciences Chief Cardiology Section John L. McClellan Memorial Veterans&rsquo Hospital Little Rock Arkansas2 Assistant Professor of Medicine St. Louis University School of Medicine St. Louis Missouri

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The costs of not treating hypertension

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BLOOD PRESSURE 1999年第4期8卷 198-199页

作者： Swales, JD Univ Leicester Inst Cardiovasc Res Fac Med & Biol Sci Leicester Royal Infirm Leicester LE2 7LX Leics England

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关键词：心血管疾病/经济学心血管疾病/预防和控制脑血管障碍/经济学脑血管障碍/预防和控制成本及成本分析高血压/并发症高血压/经济学高血压/治疗危险因素人类

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President's page: Predicting the future

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第5期35卷 1361-1362页

作者： Beller, GA Univ Virginia Hlth Sci Ctr Dept Internal Med Div CardiovascHlth Syst Charlottesville VA 22908 USA

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The challenge of health care delivery to the elderly patient with cardiovascular disease: Demographic, epidemiologic, fiscal, and health policy implications

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Cardiology Clinics 1999年第1期17.0卷 1-15页

作者： Batchelor, W.B. Jollis, J.G. Friesinger, G.C. Box 31178 Duke University Medical Center Duke Hospital North Durham NC 27710 Erwin Road United States

Old age as our society is experiencing it is a new phenomenon. Never before in history have societies of developed countries enjoyed such longevity of life. In the next several decades the United States will face an unparalleled increase in the absolute number of elderly persons in our population. How will health care professionals, policy-makers, and society in general face the mammoth task of providing quality cardiovascular care for the elderly in an environment of limited financial resources? This article discusses the demographic, fiscal, and health policy implications of our aging society with particular emphasis on existing and anticipated impediments to the delivery of cardiovascular care to this rapidly expanding segment of our population.

关键词：心血管疾病/经济学心血管疾病/流行病学心血管疾病/治疗费用控制卫生保健提供/经济学卫生保健费用卫生政策老年人保健服务/经济学预期寿命/发展趋势 Medicare/经济学美国/流行病学老年人老年人 80以上女(雌)性人类男(雄)性

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Costs and outcomes of switching from amlodipine to felodipine

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2000年第24期57卷 2287-2288页

作者： Williams, CD Purdue Univ Wishard Mem Hosp Sch Pharm Indianapolis IN 46202 USA

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Cost-effectiveness of stress-echocardiography

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Cardiology Clinics 1999年第3期17卷 583-595页

作者： Marine, J.E. Freedberg, K.A. Davidoff, R. Section of Cardiology Boston Medical Center Boston MA 02118-2393 88 East Newton Street United States

Because of constraints on the costs of providing medical care, cardiologists in the future will find themselves challenged to provide care for their patients in the most cost-effective manner possible. Although stress-echocardiography has been shown to compare favorably with other tests in diagnostic accuracy, data on cost-effectiveness are scarce. In this article, general concepts of cost-effectiveness as they relate to stress- echocardiography are reviewed and the available literature is summarized. Although definitive data are lacking, there is evidence to suggest that stress-echocardiography may prove to be cost-effective in several clinical situations.

关键词：心血管疾病/经济学心血管疾病/超声检查费用效益分析超声心动描记术/经济学超声心动描记术/方法超声心动描记术/发展趋势运动试验/经济学心肌梗死/经济学心肌梗死/超声检查心肌血管重建术外科手术选择性美国人类

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