Cardiovascular disease (CVD) is a major contributor to chronic diseases. High blood pressure and other modifiable cardiovascular risk factors are on the increase in Nigeria. The purposes of this study were to (a) explore associations among high blood pressure, social economic status, and health status awareness and (b) measure the incidence and prevalence of cardiovascular diseases in 3 states of Nigeria: Lagos, Ekiti, and Ondo. Participants (N = 368) were selected through stratification and randomization. Data were collected in person with the aid of validated questionnaire, which measured socioeconomic status as well as other variables in Lagos, Ado Ekiti, Ijesa-Isu, and Akure. Logistic regression and correlation analyses showed no significant difference in the regional incidence and prevalence of cardiovascular disease (F (4, 362) = 1.23, p = 0.30); and there was no significant relationship between the health status variable and the standard of living variable. Due to the fact that only 3 out of 36 states were sampled, this study is not generalizable and some other cardiovascular diseases modifiable risks factors that were not measured could have reacted differently in analysis. This study's results set precedence by promoting cardiovascular health. When disseminated, the results of this study will help advocate for a change process that curtails cost and decreases the general burden of CVDs in other, similar areas. Recommendations include measuring this incidence and prevalence of CVDs in all 36 states of Nigeria and exploring the interactions between culture, religion, health, and beliefs.

Introduction : Les pays arabes du Moyen-Orient qui ont une prédominance de population jeune ont connu des changements socio-économiques rapides, une instabilité et une transition épidémiologique. Dans ces pays, la mortalité due aux maladies cardiovasculaires (MCV) représente 45% des décès, en Palestine, elle est estimée à 30,3% en 2018. De plus, le fardeau des facteurs de risque est inquiétant : un quart de la population Arabe adulte est hypertendue, le tabagisme dépasse 30 % chez les hommes, l'obésité est particulièrement alarmante chez les femmes et 9,2 % des adultes sont atteints du diabète. Très peu d'études en population général sur les MCV ont été menées dans ces pays. Méthodes : En 2017, une étude transversale utilisant un échantillon de grappes stratifiées a été menée conformément à l'approche STEP de l'OMS. Un échantillon de 2240 participants âgés de ≥25 ans ont participé à l'étude. Résultats : La prévalence de la maladie coronarienne est de 8,3 %, AVC est de 3,0 %, l'hypertension artérielle est retrouvée avec une prévalence de 28,4 %, le diabète 19,1 % et l'obésité 47,8 % (60% chez les femmes). L’artériopathie oblitérante des membres inférieurs (AOMI) est observé avec une prévalence de 13,7 %. La prévalence augmente avec l'âge. Elle est plus élevée chez les femmes que chez les hommes (15,6% vs 11,6% respectivement). L'hypertension artérielle et le diabète sont les facteurs associés les plus importants. Le syndrome métabolique est présent avec une prévalence de 41 % plus élevé chez les femmes que chez les hommes (50 % vs 39 %) et associé de façon significative à toutes les maladies cardiovasculaires. Conclusion : Selon ces données, la situation dans la bande de Gaza est alarmante, les efforts et la recherche de stratégies visant à réduire le risque cardiovasculaire sont souhaitables. / Introduction: Arab Middle East Countries which have a predominance of young population have undergone rapid socioeconomic changes, instability and epidemiologic transition. In these countries cardiovascular disease (CVD) mortality accounts for 45% of deaths, in Palestine it was estimated up to 30.3% in 2018. Also, the burden of risk factors is worrying; one quarter of adult population was hypertensives, tobacco smoking exceeds 30% in males, obesity is alarming mainly in females, and 9.2% of adults are living with diabetes. Very few community-based on CVD studies were conducted in these countries. Methods: In 2017 a cross-sectional study using stratified cluster sample, was conducted in accordance with WHO’s STEP wise. A sample of 2240 participants aged ≥25 years participated in the study. Results: The prevalence of CAD is 8.3%, stroke 3.0%, hypertension is found with a prevalence of 28.4%, diabetes19.1% and obesity 47.8% with higher rate in females (60%). Lower extremity artery disease (LEAD) is found with a prevalence of 13.7%. The prevalence increased with age and is higher in females than in males (respectively15.6% vs 11.6%). Hypertension and diabetes are the most significant associated factors with LEAD. Metabolic syndrome is present with a prevalence of 41% higher in females than males (50% vs 39%) and it is significantly associated with all cardiovascular conditions. Conclusion: According to these data the situation in Gaza strip is alarming, effort and research to monitor and improve strategies and policies for reducing cardiovascular risk are mandatory

A number of chronic disease and behavioural factors are recognised to increase the risk of cardiovascular and cerebrovascular diseases. These putative ???vascular??? risk factors have increasingly been recognised to increase the risk of cognitive impairment in the absence of clinically manifest ischemic events. Their relationship to structural brain changes has received limited attention. In this dissertation, I used high resolution magnetic resonance image (MRI) to examine two structural features of the brain, regional gray matter (GM) volumes and silent lacunar infarcts, and determined their association with vascular risk factors. I related these to cognitive function in both cross-sectional and longitudinal studies. The work was based on the data of three waves in two healthy cohorts drawn from the PATH Through Life Study, which is a population-based longitudinal study of ageing comprising 3 cohorts aged 20-24, 40-44, and 60-64 years, with about 2500 participants in each cohort. Random subsamples of Wave 1 of the cohort aged 60-64 years (N = 478) and Wave 2 of the 40+ cohort (aged 44-48 years) (N = 411) were examined cross-sectionally for the MRI sub-study. The MRI cohort aged 60-64 years was re-examined 4 years later in Wave 2. These studies showed that vascular risk factors are associated with lower regional GM volumes and this association varies at different ages. In adults aged 44-48 years, individual risk factors did not show a significant relationship with GM volumes, but the Framingham risk score was associated with less GM volumes in a number of brain regions, suggesting an additive effect of the risk factors. In the 60+ cohort, hypertension was independently associated with less regional GM volumes in bilateral medial frontal, right superior frontal, left superior temporal and precentral gyri. The same cohort, when examined in Wave 2, showed the negative association of hypertension with gray matter volumes to be more widespread. These associations were observed in men but not in women in either wave. Sex dimorphism was observed in the younger cohort as well, with greater GM volumes in temporal and occipital cortices, midbrain and cerebellum in men, while less GM volumes in cingulate and parietal cortices in comparison with women. Lacunar infarcts were present in 7.8 % of the 60+ cohort, and asymptomatic new lacunar lesions developed in 0.4 % per year in this group. The prevalence of lacunar infarcts was correlated with hypertension and a steeper decline in mental speed. These series of studies indicate the relationship of vascular risk factors with changes in brain structure and cognitive function in healthy middle-aged adults. It is suggested that modifying these vascular risk factors may protect the brain from silent lesions and cognitive impairment, and that intervention should begin early in life to have a major impact.

<p>Idag behandlas flera patienter med läkemedelsbehandling vid hjärt- och kärlsjukdomar. Av alla ordinerade läkemedel, är hjärt- och kärlmediciner de allra vanligaste. Sjuksköterskan och läkaren har en central roll för att följsamheten ska bli god. Att finna vad det är som besvärar patienten vid läkemedelsbehandling är därför en förutsättning för att sjuksköterskan ska kunna påverka följsamheten. Litteraturstudiens syfte var att beskriva vad som påverkade patientens följsamhet vid läkemedelsbehandling av hjärt- och kärlsjukdomar. Metoden var en litteraturstudie bestående av 17 artiklar samt en avhandling. Forskningen visade att patientens uppfattningar om läkemedel, sin sjukdom, och deras möte med vården påverkade följsamheten. Patienten var ofta medveten om nödvändigheten av läkemedelsbehandlingen, men var rädda och oroliga för de biverkningar som kunde uppkomma. Att ha kunskap om sin sjukdom och behandling resulterade i att patientens uppfattningar förändrades. Mötet med vården var en del i patientens behandling, då ett bra möte ledde till en ökad följsamhet och förståelse för behandlingen och sjukdomen. Patientens möte med vården blev bättre om patienten upplevde en delaktighet tillsammans med sjuksköterska och läkare. Framtida forskning bör fokusera på hur patienterna upplever sin situation i relation till följsamhet vid läkemedelsbehandling.</p> / <p>Today, several patients are treated with medication for cardiovascular diseases. Of all prescribed medicines the cardiovascular medicines are the most commonly. The nurse and the doctor had a central role if adherence should work out fine. To find what’s bother the patients in the medication treatment, it is therefore a prerequisite for the nurse to be able to affect adherence. The purpose of this literature study was to describe what influence patients adherence to medication treatment of cardiovascular diseases. The method was a literature study comprising 17 articles and a dissertation. Research showed that patient’s perceptions of medicines, their illness and their meeting with health care affected the adherence. The patients was often aware of the necessity of medicine treatment but were afraid and worried about the side effects that may occur. The knowledge of their illness and treatment resulted in that the patient’s perceptions changed. The meeting with healthcare was a part of the patient’s treatment, a good meeting led to increased adherence and understanding of the treatment of the illness. Patients encounter with healthcare would improve if the patients were experiencing an involvement with the nurse and doctor. Future research should focus on how patients experience their situation in relation to adherence in medicine treatment.</p>

<p><strong>Background:</strong> Coronary heart disease kills more than 7 million people worldwide each year. High levels of blood fat, cholesterol, contributes significantly to coronary heart disease. Lifestyle changes combined with lipid-lowering drugs, statins, is an effective treatment. But adherence to statins is low, not even a myocardial infarction always contributes to adherence. Adherence requires patient education and good communication between patient and physician. There is no deeper knowledge of why coronary heart patients stops with statin treatment. <strong>Objective:</strong> To describe how coronary heart patients experience the disease and the statin treatment, and furthermore, opportunities and difficulties to adhere with statin therapy. <strong>Design:</strong> An exploratory qualitative study. <strong>Method:</strong> 10 male coronary heart patients, 55-78 years were strategically selected from a cardiology clinic in a larger Swedish hospital. Patients were interviewed individually in a semi-structured form, 2009/2010. Data processing was done according to content analysis and yielded four themes: <em>empowerment, effects, decision basis, </em>and<em> trust.</em> <strong>Results:</strong> The patients did not mentioned heredity among the factors they could not affect in association with the disease. Several patients saw the medication as a limitation, doubted its efficacy, but mostly took it anyway, at least for a limited time. Medication and illness were associated with each other. Information requirements were in most patients. Many patients wanted to discontinue the statin therapy. <strong>Conclusion:</strong> Retention of power over the own body, good reference base for decision about adherence, and trust in health care. These are crucial components of patients’ adherence to statin therapy, in connection with coronary heart disease.</p> / <p><strong>Bakgrund:</strong><strong> Kranskärlssjukdom dödar drygt 7 miljoner människor i världen per år.</strong></p><p><strong>För höga halter av blodfettet kolesterol i blodet bidrar kraftigt till kranskärlssjukdom.</strong> <strong>Livsstilsförändringar kombinerat med blodfettssänkande läkemedel, statiner, är en effektiv behandling. Följsamheten till statiner är dock låg, inte ens genomgången hjärtinfarkt ökar följsamhet. Följsamhet kräver patientutbildning och god kommunikation mellan patient och läkare. Det saknas djupare kunskap om varför kranskärlspatienter slutar med statiner. Syfte: </strong><strong>att </strong><strong>beskriva hur kranskärlspatienter upplever sjukdomen och statinbehandlingen, samt möjligheter och svårigheter att följa statinbehandlingen. Design: </strong><strong>explorativ kvalitativ studie. Metod: </strong><strong>10 manliga kranskärlspatienter, 55-78 år valdes strategiskt via en kardiologklinik på ett större svenskt sjukhus. Patienterna intervjuades personligen i semistrukturerad form, 2009/2010. Databearbetning skedde enligt innehållsanalys och gav fyra teman:</strong><em> egenmakt, effekter</em><strong>, </strong><em>beslutsgrund, tilltro. </em><strong>Resultat:</strong><strong> Patienterna nämnde inte ärftlighet bland faktorer som ansågs opåverkbara i samband med kranskärlssjukdomen.</strong> Flera patienter såg medicinen som en begränsning och tvivlade på effekten, men tog den oftast ändå, åtminstone under en begränsad tid. Likhetstecken sattes mellan medicinering och sjukdom. Informationsbehov fanns hos flertalet patienter. Många patienter ville sluta med statinbehandlingen. <strong>Slutsats: </strong>Bibehållen makt över sin egen kropp, god referensgrund för beslut om följsamhet samt förtroende för sjukvården, är avgörande förutsättningar för kranskärlspatienters följsamhet till statinbehandling.<strong></strong></p>

Background: Coronary heart disease kills more than 7 million people worldwide each year. High levels of blood fat, cholesterol, contributes significantly to coronary heart disease. Lifestyle changes combined with lipid-lowering drugs, statins, is an effective treatment. But adherence to statins is low, not even a myocardial infarction always contributes to adherence. Adherence requires patient education and good communication between patient and physician. There is no deeper knowledge of why coronary heart patients stops with statin treatment. Objective: To describe how coronary heart patients experience the disease and the statin treatment, and furthermore, opportunities and difficulties to adhere with statin therapy. Design: An exploratory qualitative study. Method: 10 male coronary heart patients, 55-78 years were strategically selected from a cardiology clinic in a larger Swedish hospital. Patients were interviewed individually in a semi-structured form, 2009/2010. Data processing was done according to content analysis and yielded four themes: empowerment, effects, decision basis, and trust. Results: The patients did not mentioned heredity among the factors they could not affect in association with the disease. Several patients saw the medication as a limitation, doubted its efficacy, but mostly took it anyway, at least for a limited time. Medication and illness were associated with each other. Information requirements were in most patients. Many patients wanted to discontinue the statin therapy. Conclusion: Retention of power over the own body, good reference base for decision about adherence, and trust in health care. These are crucial components of patients’ adherence to statin therapy, in connection with coronary heart disease. / Bakgrund: Kranskärlssjukdom dödar drygt 7 miljoner människor i världen per år. För höga halter av blodfettet kolesterol i blodet bidrar kraftigt till kranskärlssjukdom. Livsstilsförändringar kombinerat med blodfettssänkande läkemedel, statiner, är en effektiv behandling. Följsamheten till statiner är dock låg, inte ens genomgången hjärtinfarkt ökar följsamhet. Följsamhet kräver patientutbildning och god kommunikation mellan patient och läkare. Det saknas djupare kunskap om varför kranskärlspatienter slutar med statiner. Syfte: att beskriva hur kranskärlspatienter upplever sjukdomen och statinbehandlingen, samt möjligheter och svårigheter att följa statinbehandlingen. Design: explorativ kvalitativ studie. Metod: 10 manliga kranskärlspatienter, 55-78 år valdes strategiskt via en kardiologklinik på ett större svenskt sjukhus. Patienterna intervjuades personligen i semistrukturerad form, 2009/2010. Databearbetning skedde enligt innehållsanalys och gav fyra teman: egenmakt, effekter, beslutsgrund, tilltro. Resultat: Patienterna nämnde inte ärftlighet bland faktorer som ansågs opåverkbara i samband med kranskärlssjukdomen. Flera patienter såg medicinen som en begränsning och tvivlade på effekten, men tog den oftast ändå, åtminstone under en begränsad tid. Likhetstecken sattes mellan medicinering och sjukdom. Informationsbehov fanns hos flertalet patienter. Många patienter ville sluta med statinbehandlingen. Slutsats: Bibehållen makt över sin egen kropp, god referensgrund för beslut om följsamhet samt förtroende för sjukvården, är avgörande förutsättningar för kranskärlspatienters följsamhet till statinbehandling.

<p>Hypertension is one of the most common non-communicable diseases, and it is the leading cause of cardiovascular diseases, death and disability worldwide, especially in developing countries. Physical activity has been regarded as a commonly accepted modality for preventing and treating hypertension. However, despite its known benefits, this modality of treatment and prevention of&nbsp / hypertension continues to be underused. The present study aimed to determine the demographic, social and health-related factors that are associated with levels of physical activity participation among adults with hypertension in Kigali, Rwanda. This cross-sectional study was conducted with 252 adults with hypertension and 87 healthcare professionals through the Godin Leisure-Time&nbsp / Exercise Questionnaire (GLTEQ) and Physical Activity Exit Interview (PAEI). Two thirds of the participants (69.44%) were classified as sedentary. The following factors were found to be significantly&nbsp / (P&lt / 0.05) associated with the levels of physical activity: age, marital status, and level of education, residence, tobacco / past and current users, alcohol / current user, diabetes mellitus, BMI, perceived health status, self-efficacy, and blood pressure. None of the healthcare professionals were considered good physical activity counsellor. The findings of the present study highlight the need for the implementation of health promotion strategies aimed at promoting physical activity lifestyle among individuals with hypertension in Rwanda. Efforts should be made in educating people with hypertension on the benefits of integrating regular physical&nbsp / activity in their daily lives. Furthermore, healthcare professionals should be educated concerning how to promote physical&nbsp / activity to all patients especially those with hypertension.</p>

Los pacientes con Diabetes tipo 1 (DM1) e hipoglucemias graves de repetición presentan de manera generalizada una alteración en la percepción y la respuesta sintomática ante las mismas. La utilización de sistemas de infusión subcutánea contínua de insulina mejora ambas alteraciones y estas mejoras se producen sin objetivarse un deterioro en el control glucémico evaluado por hemoglobina glucosilada (HbA1c) junto con una mejoría en los parámetros de variabilidad glucémica. Asimismo, su uso se asocia a una mejoría en la calidad de vida de estos pacientes. Inclusive en un grupo de pacientes jóvenes con DM1, la presencia de un mayor grado de aterosclerosis preclínica se asocia fundamentalmente a la edad y a la duración de la enfermedad. Las alteraciones pueden observarse en diferentes territorios vasculares y se asocian a defectos en la función endotelial. Aquellos pacientes con un mayor grado de aterosclerosis preclínica tienden a presentar peores perfiles de control metabólico y de parámetros de inflamación crónica. Los episodios repetidos de hipoglucemia confieren además de lo ya mencionado, un peor pronóstico cardiovascular a estos pacientes. / Title: “Continuous subcutaneous insulin infusion and continuous glucose monitoring systems in Type 1 Diabetes. Cardiovascular risk profile in patients with labile glycemic control due to repeated severe hypoglycemia” Short running title: “Hypoglycemia and atherosclerosis in Type 1 Diabetes” Abstract: Type 1 diabetic (T1D) patients with repeated severe hypoglycemic episodes usually show a reduced ability to recognize hypoglycemic signs and symptoms. The use of continuous subcutaneous insulin infusion not only improves both alterations but also is associated with a non deletereous effect in metabolic control evaluated in terms of glycated hemoglobin (HbA1c) and with an improvement in glycemic variability. Moreover, the use of these systems is associated with an improvement in self-reported quality-of-life. Even in a group of young adult patients with T1D, the presence of atherosclerosis is mostly related to age and disease duration. Both endothelial dysfunction and structural damage in different territories might be present in these subjects. Patients with higher degrees of atherosclerosis present worse glycemic control and alterations in different inflammation parameters. Repeated episodes of hypoglycemia are also associated with a worse cardiovascular prognosis in these subjects.

Idag behandlas flera patienter med läkemedelsbehandling vid hjärt- och kärlsjukdomar. Av alla ordinerade läkemedel, är hjärt- och kärlmediciner de allra vanligaste. Sjuksköterskan och läkaren har en central roll för att följsamheten ska bli god. Att finna vad det är som besvärar patienten vid läkemedelsbehandling är därför en förutsättning för att sjuksköterskan ska kunna påverka följsamheten. Litteraturstudiens syfte var att beskriva vad som påverkade patientens följsamhet vid läkemedelsbehandling av hjärt- och kärlsjukdomar. Metoden var en litteraturstudie bestående av 17 artiklar samt en avhandling. Forskningen visade att patientens uppfattningar om läkemedel, sin sjukdom, och deras möte med vården påverkade följsamheten. Patienten var ofta medveten om nödvändigheten av läkemedelsbehandlingen, men var rädda och oroliga för de biverkningar som kunde uppkomma. Att ha kunskap om sin sjukdom och behandling resulterade i att patientens uppfattningar förändrades. Mötet med vården var en del i patientens behandling, då ett bra möte ledde till en ökad följsamhet och förståelse för behandlingen och sjukdomen. Patientens möte med vården blev bättre om patienten upplevde en delaktighet tillsammans med sjuksköterska och läkare. Framtida forskning bör fokusera på hur patienterna upplever sin situation i relation till följsamhet vid läkemedelsbehandling. / Today, several patients are treated with medication for cardiovascular diseases. Of all prescribed medicines the cardiovascular medicines are the most commonly. The nurse and the doctor had a central role if adherence should work out fine. To find what’s bother the patients in the medication treatment, it is therefore a prerequisite for the nurse to be able to affect adherence. The purpose of this literature study was to describe what influence patients adherence to medication treatment of cardiovascular diseases. The method was a literature study comprising 17 articles and a dissertation. Research showed that patient’s perceptions of medicines, their illness and their meeting with health care affected the adherence. The patients was often aware of the necessity of medicine treatment but were afraid and worried about the side effects that may occur. The knowledge of their illness and treatment resulted in that the patient’s perceptions changed. The meeting with healthcare was a part of the patient’s treatment, a good meeting led to increased adherence and understanding of the treatment of the illness. Patients encounter with healthcare would improve if the patients were experiencing an involvement with the nurse and doctor. Future research should focus on how patients experience their situation in relation to adherence in medicine treatment.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 117-132).