Missed Opportunities for Coronary Heart Disease Diagnoses: Primary Care Experience

Cilj Istražiti propuštene prilike da se u primarnoj zdravstvenoj zaštiti otkriju postojeće koronarne srčane bolesti koje prethodno nisu bile dijagnosticirane i rizične čimbenike koji su povezani s njima. Methods Istraživanje je obuhvatilo 850 osoba starijih od 30 godina, koji u povijesti bolesti nisu imali koronarnu srčanu bolest, a bili su pacijenti centra primarne zdravstvene zaštite u prigradskom dijelu grada Antalya u Turskoj. Prikupili smo podatke o njihovoj dobi, spolu, stupnju izobrazbe, zdravstvenom osiguranju, prihodima, pušenju i fizičkim aktivnostima. Pacijente s nedijagnosticiranom koronarnom srčanom bolešću otkrili smo s pomoću Roseova upitnika, fizikalnim pregledom i elektrokardiogramom. Mjerili smo im visinu, težinu, krvni tlak, serumsku koncentraciju glukoze i kolesterola, a indeks tjelesne težine i omjer opsega struka i bokova smo izračunali. Svakom je pacijentu dodijeljen broj bodova za rizične čimbenike koji su uključivali dob, spol, pušenje, sistolički krvani tlak i koncentraciju kolesterola. Za svakoga je pojedinca izračunat rizik da u sljedećem desetljeću razvije koronarnu srčanu bolest. Rezultati Bilo je 126 (14.8%) prethodno nedijagnosticiranih slučajeva nedijagnosticirane koronarne srčane bolesti. Ukupni srednji (±standardna devijacija) broj bodova za rizik dobivanja koronarne srčane bolesti u sljedećem desetljeću bio je 6.1±6.8. Bolesti koje potiču razvitak koronarne srčane bolesti – hipertenzije, šećerne bolesti i hiperkolesterolemije otkrivene su u 255 (30.4%), odnosno u 70 (8.2%) i u 364 (43.4%) ispitanika. Debljina je utvrđena u 315 (37.1%) ispitanika, a 222 (26.1%) su bili pušači. Za osobe koje se koriste primarnom zdravstvenom zaštitom procijenjeni postotni rizik za razvitak koronarne srčane bolesti u sljedećem desetljeću bio je 7 do 45% za muškarce i 2 do 45% za žene. Zaključak U primarnoj se zdravstvenoj zaštiti propušta prilika za bolje otkrivanje koronarne srčane bolesti kao i topoglednih rizičnih čimbenika. Potrebno je poduzeti mjere da se oni na vrijeme otkrivaju.Aim To investigate missed opportunities to reveal existing but not formerly diagnosed coronary heart disease cases and related risk factors in primary health care. Methods The study comprised 850 people aged over 30 years with no known history of coronary heart disease, receiving health services from a primary care center located in a suburban area of Antalya, Turkey. Data on their age, gender, education level, health insurance status, income, smoking behavior, and physical activities were collected. Undiagnosed coronary heart disease patients were determined by the Rose questionnaire, physical examination, and electrocardiogram. Height and weight, blood pressure, serum glucose and cholesterol levels were measured, and body-mass index and waist-hip ratio calculated. Each patient was given a risk score regarding age, smoking behavior, tolic blood pressure, and cholesterol levels. Estimated risk ratio of each person for developing coronary heart disease in the next decade was determined. Results The number of formerly undiagnosed coronary heart disease cases was 126 (14.8%). Overall mean (±standard deviation) risk score for developing coronary heart disease in the next decade in study group was 6.1 ± 6.8. Diseases facilitating development of coronary heart disease: hypertension, diabetes, and hypercholesterolemia were present in 255 (30.4%), 70 (8.2%), and 364 (43.4%) participants, respectively. Obesity was detected in 315 (37.1%) subjects and there were 222 (26.1%) current smokers. For patients who attended primary health care, the estimated percentage risk for developing coronary heart disease in the next ten years was 7 to 45% in men and 2 to 45% in women. Conclusion Opportunities to reveal coronary heart disease and its risk factors are being missed in primary care. Measures should be taken to ensure timely diagnosis of coronary heart disease and related risk factors

The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study

BACKGROUND: Medical education requires detailed investigation because it is a period during which the attitudes and behaviors of physicians develop. The purpose of this study was to calculate the yearly smoking prevalence and incidence rates of medical faculty students and to identify the risk factors for adopting smoking behaviour. METHODS: This is a cohort study in which every student was asked about their smoking habits at the time of first registration to the medical faculty, and was monitored every year. Smoking prevalence, yearly incidence of initiation of smoking and average years of smoking were calculated in analysis. RESULTS: At the time of registration, 21.8% of the students smoked. At the end of six years, males had smoked for an average of 2.6 ± 3.0 years and females for 1.0 ± 1.8 years (p < 0.05). Of the 93 medical students who were not smokers at the time of registration, 30 (32.3%) were smokers at the end of the 6 years of the course. CONCLUSION: The first 3 years of medical education are the most risky period for initiation of smoking. We found that factors such as being male, having a smoking friend in the same environment and having a high trait anxiety score were related to the initiation of smoking. Targeted smoking training should be mandatory for students in the Medical Faculty

The role of oxidative stress and inflammatory response in high-fat diet induced peripheral neuropathy

Objective: Earlier studies suggest that high-calorie diet is an important risk factor for neuronal damage resulting from oxidative stress of lipid metabolism. In our experimental study of rats under high-fat diet, oxidative stress markers and axonal degeneration parameters were used to observe the sciatic nerve neuropathy. The aim of this study is to evaluate the pathophysiology of neuropathy induced by high-fat diet