Направления реализации образовательно-профилактической программы "Здоровую улыбку - детям" и их эффективность

СТОМАТОГНАТИЧЕСКИЕ БОЛЕЗНИ /профЗУБНЫХ БОЛЕЗНЕЙ ПРОФИЛАКТИКАДЕТИПРОФИЛАКТИЧЕСКАЯ СТОМАТОЛОГИ

Risk-factor control in treated hypertensive patients - epidemiological, gender-related, and quality-control aspects

The overall aim was to investigate the risk-factor profile in patients with hypertension, and patients on combined lipid-lowering (LLD) and antihypertensive treatment (AHT) in primary health care, in order to evaluate cardiovascular risk factors in relation to age, gender, lifestyle (smoking), and gender of the physician. Objectives To compare cardiovascular risk factors in smokers with non-smokers in a national sample of treated hypertensives (tHT) (Study I); to evaluate any gender differences in the control of blood pressure (BP) and lipid levels as well as other cardiovascular (CV) risk factors for cardiovascular disease in tHT patients in primary health care (PHC) (Study II); to investigate the relationship of physician's gender to control of blood pressure and lipid levels and CV risk factors in tHT men and women (Study III); to investigate any gender differences in CV risk factors, lipid- and BP control in patients on combined lipid-lowering (LLD) and antihypertensive treatment (AHT), stratified for gender of their physician (Study IV). Methods and materials These cross-sectional clinical studies, of tHTs (Studies I-III) and patients on both AHT and LLD (Study IV) were carried out in 2002-2003 (Study I), 2002-2005 (Studies II and III), and 2002-2006 (Study IV). They were run by 182 (Study I), 264 (Studies II, III) and 356 (Study IV) primary care physicians (PCPs) at primary health care centres (PHCs) in Sweden. The number of patients included were, in Study I, 4,424 tHTs (48% men); in Studies II and III: 6,537 tHTs (48% men) and in Study IV 4,319 patients on both AHT and LLD (53% men). The mean age was 66 years in all four studies. Patients were included retrospectively and consecutively and their data were registered on a web-form. BP and lipid control were defined as SBP/DBP <140/90 mmHg and total cholesterol (TC) <5.0 mmol/l in patients without diabetes mellitus (DM), and SBP/DBP <130/80 mmHg and TC <4.5 mmol/l in patients with DM. Results Study I: tHTs who reported daily smoking had a poorer CV risk factor profile than non-smokers, with higher DBP levels and a higher prevalence of microalbuminuria. Male smokers had left ventricular hypertrophy (LVH) and microalbuminuria more often than non-smokers did. Females smokers had higher mean levels of DBP and TC than non-smokers. Study II: only 28% of the tHTs achieved the BP treatment goal. The main clinical problem was the persistence of high SBP despite treatment. In addition, men had higher DBP and higher prevalence of DM and target organ damage (LVH and microalbuminuria) than women did. In contrast, women had higher SBP, pulse pressure (PP), and TC and higher prevalence rates of uncontrolled BP and TC than in men. Study III: female tHTs reached the BP treatment goal more often when treated by female PCPs than when treated by male PCPs. However, the majority of the patients did not reach the BP treatment goal, regardless of gender of physician. Both male and female tHTs more often achieved the TC and LDL-C treatment goals when treated by female PCPs than when treated by male PCPs. Study IV: male diabetic patients on both AHT and LLD more often had well-controlled SBP and TC when treated by female PCPs than when treatment was given by male PCPs. When the female diabetic patients were treated by female PCPs they more often achieved the BP treatment goals than when they were treated by male PCPs. In those patients with well- and intermediate-controlled SBP and TC, both men and women were more often treated by PCPs of their own gender. A low proportion of patients on both AHT and LLD achieved both BP and TC goals (16 % of the men and 10 % of the women). Conclusion There is still a need for intensifying treatment of elevated blood pressure and other risk factors for cardiovascular disease in patients on antihypertensive treatment, especially women. Female patients appeared to achieve the target blood pressure more often when treated by a female physician than when treated by a male physician. Both male and female hypertensives achieved cholesterol treatment goals more often when treated by female physicians than when treated by male physicians. Hypertensive men and women at the same cardiovascular risk level should be treated equally well and regardless of the gender of their physician

Risk factor control in treated hypertensives from Estonia and Sweden. Why the difference?

Background. It is of importance to study the risk factor control in treated hypertensives (tHT), both longitudinally within one country and between neighbouring countries, as hypertensive patients still run an increased cardiovascular risk in spite of treatment. Methods. In sample of 1135 tHT from Estonia and a similar number of age- and sex- matched Swedish tHT, the control of blood pressure and other cardiovascular risk factors were assessed as part of national surveys in primary health care. Data were retrieved form consecutive patients visiting primary health care centres all over each country. Results. The mean age of male patients (n=421) was 50 years and for female patients (n=714) it was 52 years. tHT from Sweden were more likely to be in better control of blood pressure and risk factor levels than corresponding Estonian patients, matched for age and gender. However, there was a significantly (p=0.0003) higher rate of smoking in Swedish female patients (22.4%) than in corresponding Estonian patients (16.0%). More Swedish women than men were prescribed thiazide diuretics, but fewer were prescribed angiotensin- converting enzyme (ACE) inhibitors. No similar Estonian data were available. Conclusion. Most cardiovascular risk factors were better controlled in the Swedish hypertensives, except for a higher smoking prevalence in Swedish female patients. This could be related not only to differences in clinical practice, but also influenced by social and lifestyle factors

Predicted impact of lipid lowering therapy on cardiovascular and economic outcomes of Swedish atherosclerotic cardiovascular disease guideline

Background: The effects on cardiovascular disease (CVD) by treatment recommendations on prevention of atherosclerotic CVD remain to be evaluated. The objectives were to assess treatment gap for low density lipoprotein cholesterol (LDL-C) according to guidelines, potential impact on CVD outcomes, and possible avoided economic costs, in post myocardial infarction (MI) patients, if target LDL-C levels of &lt;= 1.8 mmol/L would be achieved. Methods: All patients registered in the Swedish Secondary Prevention after Heart Intensive care Admission register, with one-year post-MI follow-up during 2013 were selected. The REACH risk prediction and a calibrated model for recurrent cardiovascular events and death were used to estimate unadjusted risk prediction based on the REACH equation henceforth called base case, and calibrated CVD outcomes based on gender-specific risk factors. The predicted impact of the LDL-C reduction on the risk of CVD was based on the Cholesterol Treatment Trialists' Collaboration findings. Results: A sample of n = 5904 patients (74% men) with a mean age of 64 years were included. Around 70% did not reach LDL-C target = 1.8 mmol/L. Over a 10-year period, 820-2262 events were predicted to occur in those who did not reach target corresponding to 20%-55% risk of CVD events. To achieve LDL-C target, the mean LDL-C had to be reduced by 0.73 mmol/L (29%). If this LDL-C reduction was achieved, 195-544 life years, 132-343 CVD events, and 7.9-20.9 million Swedish crowns (MSEK) of direct costs, and 19.3-51.0 MSEK of total costs would be avoided. Conclusion: Lowering of LDL cholesterol to achieve target levels according to guidelines for post-MI patients may lead to fewer cardiovascular events and avoidance of event costs

Sex differences in risk factor control of treated hypertensives: a national primary healthcare-based study in Sweden.

BACKGROUND: To evaluate potential sex differences, this study aimed to investigate blood pressure and lipid control and other risk factors for cardiovascular disease in treated hypertensive (tHT) patients from primary healthcare. DESIGN AND METHODS: This cross-sectional survey of tHT patients was carried out between 2002 and 2005 by 264 primary care physicians from Sweden who consecutively recruited 6537 tHT patients (48% men and 52% women) from medical records. RESULTS: tHT men more often reached the treatment goal for systolic/diastolic blood pressure, less than 140/90 mmHg, than tHT women (30 vs. 26%, P/=5.0 mmol/l than corresponding men (75 vs. 64% P<0.001). Men more often had diabetes (25 vs. 20% P<0.001), left ventricular hypertrophy (20 vs. 16% P<0.001), and microalbuminuria (24 vs. 16% P<0.001). Women were more often treated with diuretics (64 vs. 48%) and beta-receptor blockers (54 vs. 51%), and men more often treated with angiotensin-converting enzyme inhibitors (27 vs. 18%), calcium channel blockers (34 vs. 26%), and lipid-lowering drugs (34 vs. 29%). CONCLUSION: A need still exists for more intensified treatment of elevated blood pressure and hypercholesterolemia, especially in women. In hypertensives of both sexes, smoking and other risk factors also need to be addressed to reduce the risk of cardiovascular disease

Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare.

OBJECTIVE: To study the association of physician's sex with blood pressure, lipid control, and cardiovascular risk factors in treated hypertensive men and women, stratified for the sex of their physician. METHODS: In a cross-sectional survey of hypertensive patients, 264 primary care physicians (PCPs), 187 men and 77 women from across Sweden, recruited 6537 treated hypertensive patients (48% men) during 2002-2005, consecutively collected from medical records and registered on a web-based form connected to a central database. Patients were included consecutively in the same order as they visited the healthcare centre. RESULTS: Hypertensive women more often reached target systolic/diastolic blood pressure levels (<140/90 mmHg) when treated by female PCPs than when they were treated by male PCPs (32 vs. 24%, P < 0.001). This difference remained when comparing female and male physicians' nondiabetic female patients. Both male and female patients had better control of total cholesterol and low-density lipoprotein cholesterol levels when treated by female PCPs than when treated by male PCPs (total cholesterol <5 mmol/l: women 30 vs. 24%, P < 0.001; men 42 vs. 34%, P < 0.001; low-density lipoprotein cholesterol <3 mmol/l: women 39 vs. 33%, P < 0.01; men 41 vs. 35%, P < 0.05). Female PCPs had a higher proportion of treated hypertensive patients with diabetes than did male PCPs but male PCPs had a higher prevalence of treated hypertensive men with microalbuminuria compared with female PCPs. CONCLUSION: Female physicians appeared more often to reach the treatment goal for blood pressure in female patients and cholesterol levels in all patients than did male physicians

Physicians' gender is associated with risk factor control in patients on antihypertensive and lipid lowering treatment

The objective was to study gender differences in cardiovascular risk factors, lipid and blood pressure control in patients on combined lipid-lowering and antihypertensive treatment, in relation to gender of their physician. This was a cross-sectional study of 4319 patients (53% men) on lipid-lowering and antihypertensive treatment from two national surveys. Male physicians included 1643 men and 1311 women, and female physicians 605 men and 648 women. All data were collected consecutively from medical records. Women were older, had a higher systolic blood pressure (SBP), pulse pressure (PP), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), SBP >= 140 mmHg, and more often isolated systolic hypertension (ISH) compared with men. Men compared with women had more often diabetes, higher cardiovascular risk (SCORE) and achieved treatment goals more often for blood pressure in non-diabetics and TC in both non-diabetics and diabetics. Both men and women in well controlled and intermediate controlled groups were more often treated by physicians of their own gender. The female diabetes patients treated by female primary healthcare physicians more often achieved treatment goals for blood pressure [SBP/diastolic blood pressure (DBP) <130/80 mmHg]. Female physicians' male patients with diabetes more often belonged to the well controlled group. Physicians' gender may influence the control of risk factors for cardiovascular disease in both men and women on combined antihypertensive and lipid-lowering therapy

Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes

Background: The purpose of this study was to evaluate the impact of symptomatic hypoglycemia on medication adherence, satisfaction with treatment, and glycemic control in patients with type 2 diabetes based on the treatment goals stated in the Swedish national guidelines. Methods: This cross-sectional, multicenter study was carried out between January and August 2009 in 430 consecutive primary health care patients on stable doses of metformin and sulfonylureas for at least 6 months. The patients completed questionnaires covering their experiences of low blood glucose and adherence, as well as barriers to and satisfaction with drug treatment (using the Treatment Satisfaction Questionnaire for Medication). Physicians collected the data from medical records. Results: Patients who experienced moderate or worse symptoms of hypoglycemia reported poorer adherence to medication (46% versus 67%; P less than 0.01) and were more likely to perceive barriers such as "bothered by medication side effects" (36% versus 14%; P less than 0.001) compared with patients with no or mild symptoms. Patients with moderate or worse symptoms of hypoglycemia were less satisfied with their treatment than those with no or mild symptoms as determined by the Treatment Satisfaction Questionnaire for Medication-Global satisfaction (67.0 versus 71.2; P less than 0.05). Overall, achievement of target glycated hemoglobin (HbA(1c)) based on the treatment goals stated in the Swedish national guidelines was 40%. Despite poorer adherence, patients who experienced moderate or worse symptoms of hypoglycemia had lower mean HbA(1c) values than patients with no or mild symptoms (7.0% versus 7.3% [Diabetes Control and Complications Trial standard]; P less than 0.05). Conclusion: Symptomatic hypoglycemia in patients with type 2 diabetes on metformin and sulfonylureas was associated with nonadherence and decreased treatment satisfaction despite lower mean HbA(1c) values. A broader understanding of patient preferences and self-reported outcomes could improve the management of patients with type 2 diabetes