Background: Studies regarding number of pregnancies and coronary heart disease have shown inconsistent results. In the present study, we assessed the association between number of pregnancies and heart attack (HA) in women.Methods: Using data from NHANES III a cross sectional data analysis of 10634 women aged 17 and above was conducted. We considered socio-demographic factors and other potential risk factors including physical activity, smoking, alcohol, diabetes, hypertension, hypercholesterolemia, BMI, age, and family history of heart attack. We conducted Bivariate analysis to determine prevalence and crude odds ratios. Multivariate logistic regression analysis was used to adjust for confounding variables using SPSS. Results: The prevalence and 95% CI of HA was 3.4% (3.0% – 3.7%). The age adjusted odds ratios for 7+ pregnancies was 2.33 95% CI [1.42-3.81], but this became insignificant when a fully adjusted model was used (odds ratio, 1.68: 95% CI, 0.89 to 3.16). For those with 4 pregnancies the risk was lowest in both age adjusted and fully adjusted models confirming the well known "J" shaped non linear relationship between number of pregnancies and heart attack. Conclusion: We found an association that was not significant between number of pregnancies and heart attack. Further studies using physician-confirmed diagnosis is needed to appropriately asses the potential relationship of gravidity and heart attack.

Urban sprawl often has a negative connotation, used as a derogatory label for certain forms and consequences of land development that are seen as environmentally and socially unpleasant. Although sprawl may be seen as offensive, there may be other, far greater and more harmful consequences of sprawl. The literature indicates that rates of negative health outcomes, such as obesity, tend to be higher in more developed areas. However, aside from a few studies, little empirical research looks specifically at the influence of sprawl when it comes to individual health. This research project focuses on sprawl and examines the relationships it has with health behaviors and health outcomes. By analyzing data from the CDC’s 2003 Behavioral Risk Factor Surveillance System (BRFSS), an annual telephone survey of adults that include more than two-hundred self- reported and calculated variables, I investigate the associations between sprawl, physical activity, body weight, and health outcomes using Structural Equation Modeling (SEM). By employing SEM, my research differs from previous research in this field by adding not only additional layers to the evaluation of sprawl and health outcomes, but also allows for the evaluation of associations through various “paths” instead of looking at variables within simpler hierarchical regression models. In addition to direct effects, it also allows for the determination of indirect, or mediated, effects between variables within a path model. Even though no direct relationship between sprawl and health outcomes was revealed, sprawl did show to have a statistically significant indirect effect on health outcomes mediated by physical activity and body weight. Physical activity is also shown to mediate the relationship between sprawl and body weight. Additionally, physical activity reveals both a direct and indirect effect on health outcomes, with its indirect effect being mediated by body weight. Finally, physical activity and body weight are both shown to have statistically significant direct effects on health outcomes. In the concluding chapter I propose a new path model in light of the results of the analyses of data in order to represent the associations between sprawl, physical activity, body weight, and health outcomes more accurately.

Bakgrund: Hjärt- och kärlsjukdomar är den vanligaste dödsorsaken för både män och kvinnor i Sverige. Trots att lika många kvinnor som män insjuknar förekommer stora skillnader vid insjuknande och behandling. Syfte: Att ur ett genusperspektiv beskriva likheter och skillnader i samband med insjuknande och vårdförlopp hos personer som drabbats av en hjärtinfarkt. Metod: Studien genomfördes som en allmän litteraturstudie. Utifrån en litteratursökning valdes 12 artiklar, som svarade mot syftet. Artiklarna granskades enligt Röda Korsets Granskningsmall. Resultat: Flertalet artiklar påvisade att det fanns skillnader i symptom för män och kvinnor som drabbats av en hjärtinfarkt och att män sökte vård tidigare än kvinnor. Tre studier visade dock inga skillnader i symptom. Vår studie visar att män och kvinnor inte får samma bemötande eller behandling. Diskussion: Skillnad i symtom, okunskap hos både patient och sjukvårdspersonal om sjukdomsbilden samt synen på manligt och kvinnligt beteende var faktorer som bidrog till skillnader vid vård av hjärtinfarkt. Sjukvården i allmänhet och sjuksköterskan i synnerhet behöver bli medveten om och hur genus påverkar omvårdnaden. Alla patienter är unika och ska behandlas utifrån sina behov och villkor. Slutsats: Forskning behövs för att omvårdnad och behandling vid hjärtinfarkt ska kunna ske evidensbaserat till alla oavsett kön. / Background: Cardio-vascular diseases are the main cause of death for both men and women in Sweden. Although as many women as men are diagnosed there are large differences in onset and treatment. Aim: The aim was to describe similarities and differences in onset, treatment and care of myocardial infarction from a gender perspective. Method: The study was performed as a literature study. Twelve articles that matched the aim for this study were chosen. The articles were analyzed according to the Red Cross analysis model. Result: The majority of the articles pointed out differences in indications for men and women who suffered a myocardial infarction. Men sought medical assistance at an earlier stage. Three studies, however, indicated that there were no gender differences in indications. Our study shows that men and women do not receive the same treatment. Discussion: Differences in indications, ignorance concerning symptoms in both patients and in nursing staff, and also preconceived ideas about male and female behaviour were elements that contributed to differences in treatment. The nursing staff generally need enhanced awareness of how gender affects care. Conclusion: More studies will be needed to ensure that both genders receive evidence-based care.

The main aim of this study is to compare the prevalence of diabetes-related complications in white to the prevalence in other racial and ethnic groups in United States using 2009 Behavioral Risk Factor Surveillance System (BRFSS). By constructing the logistic regression model, odds ratios (OR) were calculated to compare the prevalence of diabetes complications in white and other groups. Compared to white, the prevalence of hypertension and stroke in African Americans were higher, while the prevalence of heart attack and coronary heart disease were lower. The Asian Americans or Pacific Islanders, African Americans and Hispanics were more likely to develop retinopathy compared to white. The prevalence of hypertension, hypercholesterolemia, heart attack, coronary heart disease, Stroke in Native Americans and “other” group were not significantly different from the prevalence in white. Asian or Pacific Islanders were less likely to experience stroke.

Abstrakt Hjärtinfarkt är ett av de största hälsoproblemen i Sverige idag. Kvinnor drabbas i stor utsträckning av hjärtinfarkt men de riskeras att missas då den mesta evidensen utgår från ett manligt perspektiv och normer. Syftet med denna integrerade litteraturöversikt var att sammanställa kunskap inom omvårdnadsforskning om kvinnors erfarenheter  efter att ha drabbats av en första hjärtinfarkt. En integrerad litteraturöversikt enligt Whittemore och Knafl metod utfördes och granskades enligt SBU:s riktlinjer. Kvalitativa, kvantitativa och mix studier sammanställdes. Sökningen utfördes i databasen CINAHL. Resultatet visade att kvinnors symtom vid en första hjärtinfarkt särskildes sig från mäns symtom och riskerades att missas av vården på grund av kunskapsbrist. Kvinnor avvaktade att uppsöka vård på grund av ovisshet kring symtomens allvar. Sjuksköterskan behöver uppmärksamma prodromala symtom samt lyfta frågor kring sexuellt samliv. Ny evidens behövs för att få kunskap om kvinnors upplevelser av att drabbas av en första hjärtinfarkt.

Bakgrund: Hjärt-kärlsjukdom är den dominerande dödsorsaken i Sverige. För personen som drabbas är det en otäck händelse som påverkar individens livsvärld. Levnadsvanor såsom ohälsosamma matvanor, brist på daglig fysisk aktivitet samt tobaksanvändning är alla riskfaktorer. För att förhindra ett återinsjuknande är det viktigt att patienten tar till sig av de egenvårdsråd som ges av sjukvården efter en hjärtinfarkt. Syfte: Syftet med studien är att belysa patienters upplevelser av att följa egenvårdsråd efter att ha insjuknat i hjärtinfarkt. Metod: Studien har genomförts som en litteraturöversikt där kvalitativa artiklar har använts. Resultat: Två domäner i form av främjande och hindrande faktorer med fem kategorier och ytterligare underkategorier togs fram och bildade resultatet. I resultatet framkom att individualiserat stöd från sjukvårdspersonal var av stor vikt, för att möjliggöra förändring och ta till sig av de egenvårdsråden givna av sjukvården. Ytterligare framkom att vägledning kring hur livsstilsförändringen kan se ut samt stöd från anhöriga och jämlika spelade en betydande roll för möjligheten att implementera nya levnadsvanor. Slutsats: Slutsatsen som kan antas är att tydligheten och strukturen kring arbetet med patienter under eftervården bör tydliggöras och utformas i ett samarbete med patienter och närstående. / Background: Cardiovascular disease is the dominant cause of death in Sweden. For the person affected it is a fearful event that affects the whole life. Living habits such as unhealthy eating, tobacco use and lack of daily physical activity are all risk factors. To prevent a recurrence, it is important that the patient follows the self-care advice given by the healthcare after a heart attack. Aim: The aim of the study is to shed light on patients' experiences of following self-care advice after having had a heart attack. Method: The study has been conducted as a literature review where qualitative articles have been used. Results: Two domains in the form of promoting and hindering factors with five categories and additional subcategories were developed and formed the result. The results showed that individualized support from healthcare professionals was of great importance, to enable change and absorb the self-care advice given by healthcare. It also emerged that guidance on what lifestyle change can look like as well as support from relatives and peers played a significant role in the possibility of implementing new lifestyles. Conclusion: The clarity and structure of the work with patients during aftercare should be clarified and designed in collaboration with patients and relatives.

The purpose of this study was to discern the effectiveness of Cardiac Rehabilitation/ Secondary Prevention Programs (CR/ SPP’s) by evaluating increased functional capacity in the form of MET (metabolic equivalent) scores post-myocardial infarction (MI) or heart attack. The Duke Activity Status Index (DASI) survey is administered as part of the Standard Operating Procedure (SOP) for participation in the Secondary Prevention Program. Criterion for the research included patients 65 and older, with a history of one myocardial infarction, and had completed all 36 sessions of CR. The scores from 11 SPP surveys were analyzed and compared in three time increments from sessions 1-18 (initial, or “pre”), sessions 19-36 (“pan”), and sessions 1-36 (“post”). A total of 11 (n=11) surveys were collected and analyzed at The Computing and Statistical Technology Laboratory in Education (CASTLE) in the Teaching Academy on UCF Main Campus. Results from the data showed mean MET scores of 6.21 at session 1, 7.59 at session 18, and 8.15 at session 36. The mean changes over time represented in METs were 1.38 (1), .56 (18), and 1.93 (36). Percent changes over time were 27% (1), 8% (18), and 36% (36). This study showed increased functional capacity over time and will improve program design in terms of frequency and duration.

Syftet med detta examensarbete var att undersöka vilka behov och upplevelser av stöd personer som drabbats av hjärtinfarkt och deras närstående har. En litteraturstudie har genomförts, vilket har inneburit granskning och sammanvägning av resultat från vetenskapliga publikationer. Resultatet visar att personer som drabbats av hjärtinfarkt och deras närstående har stort behov av information, psykosocialt stöd och tillgänglighet av hälso- och sjukvårdspersonal. Det behovs fortfarande forskning kring personer som drabbats av hjärtinfarkt och deras närståendes behov av stöd speciellt ur ett genusperspektiv. Framförallt finns kunskapsbrist om hjärtinfarktens inverkan på relationen då en man förväntas vårda sin hustru. Hälso- och sjukvårdspersonalens roll i detta sammanhang är att visa förståelse och anpassa sitt bemötande för varje individ och stödja personer efter deras individuella behov. / The purpose of this examination paper was to investigate the experiences and need for support to persons who have suffered a heart attack and their relatives/spouses have. A literature review has been performed for the purpose of this study, which has involved a review and synthesis of results fro scientific publications. The results show that patients and relatives need furthur information, psycosocial support and availibility to health care staff. Further research concerning persons who have suffered a heart attack and their spouses is warranted, specially from a gender perspektive. In particular, knowledge is lacking regarding husbands who care for their wives. The health care staffs' role in this situation is to be understanding and to adjust their support after each person's individual needs.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the degree of Master of Science in Medicine, 2014 / The earliest possible initiation of reperfusion therapy is necessary to reduce morbidity and mortality from acute STEMI. Therefore improving the time to thrombolysis where percutaneous coronary interventional facilities are limited or do not exist is critical. The most effective system would integrate three key components to deliver continuous patient care, including: 1) from time of call for help through to emergency response; 2) transportation to and admission to hospital; 3) assessment and initiation of thrombolytic therapy. The purpose of this prospective study is: to develop a chest pain awareness education programme appropriate for the South African context; to assess safe initiation of thrombolytic therapy by emergency care practitioners for STEMI; and to compare the performance of emergency care practitioner thrombolysis with historical control data.

Objective. Coronary heart disease has been on the rise in poorer countries and decreasing in developed countries over the last twenty years. However, the cardiac-related health-related quality of life (HRQOL) in poorer countries has not been studied. This study aimed to compare HRQOL following heart attack in a developing country in the East with that of a developed country in the West. Using the self-regulation of health and illness behaviour, the relationships between illness beliefs, coping cognitions and HRQOL are studied. Design. This study was a cross-sectional correlational survey and data were collected shortly before myocardial infarction patients were discharged from hospital. Methods. A sample of 243 individuals from the UK and Indonesia were recruited. Illness beliefs were assessed with the B-IPQ, along with coping cognitions (Brief-COPE) and health-related quality of life (MacNew questionnaire). Results. Illness beliefs and coping cognitions predicted HRQOL in the combined sample. Some aspects of socio-demographic and clinical variables were concurrently associated with HRQOL. Conclusion. The results demonstrate that people in the East have low illness beliefs and these are associated with worse HRQOL compared with those in the West. The findings suggest that there is an urgent need for smoking cessation campaigns in the East, while the West could benefit more from tailored-cardiac rehabilitation programme.