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Biomedical subjects

Izabella Rohlfs

Publications and source records attributed to Izabella Rohlfs.

13 recordsLinked to original sources
PubMed2005

Analysis of inequalities in secondary prevention of coronary heart disease in a universal coverage health care system.

OBJECTIVE: The purpose of this study was to analyse whether differences exist in social class or education level in coronary heart disease (CHD) secondary prevention and in cardiovascular risk factor control in a universal coverage health care system. DESIGN: Cross-sectional multi-centre study. PARTICIPANTS AND SETTING: 1022 CHD patients recruited from residents in the catchment areas covered by 23 primary health care facilities in Catalonia, Spain. MAIN OUTCOME MEASURES: Demographic data, cardiovascular co-morbidity, smoking, blood pressure, fasting blood glucose, triglycerides, total cholesterol, HDL and LDL cholesterol, body mass index (BMI), drug therapy used for secondary prevention, educational level, and social class based on occupation. RESULTS: Patients at the lowest educational level were more frequently women, older, and diabetic. Patients in the middle educational level were more frequently smokers than those in the highest or the lowest level (24.7, 8.7, and 12.0%, respectively; P = 0.008) and had better systolic blood pressure levels (125 mmHg (15), 135 mmHg (16), and 134 mmHg (17), respectively; P = 0.001). All educational levels and social classes had similar adjusted rates of risk factor control. Therapeutic management was also similar among all educational levels and social classes, after adjusting for confounders. CONCLUSIONS: CHD patients in the lower SES received similar treatment for secondary prevention and achieved similar control of risk factors. No social inequalities were found in secondary prevention in CHD patients using the National Health System in Spain.

Adult↗
PubMed2005

[Effect of reactions to symptoms onset on early mortality from myocardial infarction].

INTRODUCTION AND OBJECTIVES: A patient's social circumstances at the time when acute myocardial infarction (AMI) symptoms first appear might influence survival. Our objectives were to study the living conditions, the location where symptoms started, the type of symptoms, and the delay before action was taken in patients with AMI who survived more than one hour, and to analyze the relationship between these variables and mortality in different time periods. PATIENTS AND METHOD: Population-based observational cohort study carried out in 1997-1998. Main data source: Registre Gironí del Cor (REGICOR). Death certificates provided information on patients who died before they could be included in the register. The patients' demographic characteristics, lifestyle, clinical history, electrocardiographic abnormalities, cardiac enzyme levels, treatment, and diagnosis were recorded. Mortality before and during hospitalization, and overall mortality at 28 days were studied. RESULTS: Of the 1,097 patients included, 274 (24.97%) died before reaching hospital, 171 (15.58%) died in hospital, and 652 (59.4%) were alive at 28 days. Mortality was lower in patients who went directly to hospital (OR = 0.32, 95% CI, 0.17-0.59). Mortality at 28 days was higher in those with atypical symptoms (OR = 5.52, 95% CI, 2.90-10.50), and in those who lived in an institution (OR = 9.47, 95% CI, 1.05-84.9). CONCLUSIONS: In the absence of specially equipped ambulances, AMI patients who went directly to the hospital or who had typical symptoms had a better chance of survival both before hospitalization and at 28 days. In contrast, 28-day mortality was higher in institutionalized patients.

Adult↗
PubMed2004

Relationship of socioeconomic status with cardiovascular risk factors and lifestyle in a Mediterranean population.

BACKGROUND: Socioeconomic status greatly affects cardiovascular risk factors and lifestyle. Aim of the study To analyse the relationship between socioeconomic status and both cardiovascular risk factors and behavioural variables. AIM OF THE STUDY: To analyse the relationship between socioeconomic status and both cardiovascular risk factors and behavioural variables. METHODS: The present random sample of 838 men and 910 women of the 25 to 74 year old general population of Gerona according to the 1991 census, included cardiovascular risk factor measurements (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glycaemia, systolic blood pressure, diastolic blood pressure, body mass index, waist to hip ratio, and waist circumferences) and evaluation of dietary habits, alcohol consumption, smoking, and leisure-time physical activity with corresponding questionnaires. RESULTS: In this study, we used lifestyle factors (leisure-time physical activity, tobacco consumption, and alcohol drinking habits) in addition to dietary habits to determine whether changes in these factors correlate with the socioeconomic status, classified as degree of educational level, in a representative Spanish Mediterranean population. Multiple linear regression analysis adjusted for several confounders revealed a direct association of LDL-cholesterol (p = 0.03) and body mass index (p = 0.02) with low levels of educational status in men and women, respectively. A higher educational status was directly (p = 0.04) related to the smoking status in women. The two composite dietary scores, indicating overall dietary quality and cardiovascular protecting properties, were not associated with low socioeconomic status in our population. CONCLUSION: Dietary habits, alcohol drinking, and leisure-time physical activity seems not to be affected by educational status in either gender. This finding might partially explain the relationship between cardiovascular risk factors and socioeconomic status in our population. The importance of cultural values in the rural area of the Spanish province seems to be the stronger factor compared with education.

Adult↗
PubMed2004

Women, family demands and health: the importance of employment status and socio-economic position.

Although it is generally assumed that women engaged in paid work have better health than full-time homemakers, little is known about the situation in Southern European countries like Spain or about differences in the impact of family demands by employment status or the potential interaction with educational level. The objectives of this study are to analyse whether inequalities in health exist among housewives and employed women, and to assess whether the relationship between family demands and health differs by employment status. Additionally, for both objectives we examine the potential different patterns by educational level. The data have been taken from the 1994 Catalonian Health Survey (Spain). The sample was drawn from all women aged 25-64 years who were employed or full-time homemakers and married or cohabiting. Four health indicators (self-perceived health status, limiting long-standing illness, chronic conditions and mental health) and two health related behaviours (hours of sleeping and leisure-time physical activity) were analysed. Family demands were measured through household size, living with children under 15 and living with elderly. Overall, female workers had a better health status than housewives, although this pattern was more consistent for women of low educational level. Conversely, the health related behaviours analysed were less favourable for workers, mainly for those of low educational level. Among workers of low educational level, family demands showed a negative effect in most health indicators and health related behaviours, but had little or no negative association at all in workers of high educational level or in full-time homemakers. Moreover, among women of low educational level, both workers and housewives, living with elderly had showed a negative association with poor health status and health related behaviours. These results emphasise the need of considering the interaction between family demands, employment status and educational level in analysing the impact of family demands on women's health as well as in designing family policies and programmes of women's health promotion.

Adult↗
PubMed2004

[Gender and ischemic heart disease].

Physiological and pathological processes differ in men and women, depending on factors such as sex and sociological and anthropological characteristics. However, many diseases are still approached from a masculine point of view. In this respect, ischemic heart disease is one of the diseases that most clearly reflects biological differences and social inequalities. In women, the disease presents at a more advanced age, and presentation is frequently atypical with a higher prevalence of comorbidities and greater severity. Consequently, treatment and outcome differ from those in men. Additionally, women differ in their knowledge, and beliefs regarding ischemic heart disease, as well as in their attitudes at symptom onset. Therefore, clinical practice should place significant emphasis on all these aspects in order to avoid inequalities between men and women in the correct diagnosis, treatment, prevention, and rehabilitation of ischemic heart disease.

Female↗
PubMed2004

[Inequalities in health related to social class in women. What is the effect of the measure used?].

Classical theories of social stratification share the assumption that the family is the unit of stratification, using the man's occupation as a measure of social class. These theories were criticized by feminism, which claimed that women were not visible in class analysis. The present article aims firstly to review measurement of women's social class, secondly to review studies on the impact of different measures of social class on inequalities in health among women, and thirdly to illustrate the differences among alternative measures, using data from the Barcelona Health Interview Survey 2000 as an example. There are few studies analyzing inequalities in health among women that take into account several measures of social class; most studies have been performed in the United Kingdom, although some studies have been conducted in other countries. Typically, these studies compare several social class indicators: the conventional social class measure, which uses the husband's occupation or that of the head of household (a household measure); the individual social class measure, which uses women's occupation, and the dominant social class measure, which allocates an individual the highest social class within a household (also a household measure). The impact of the various measures on inequalities in health varies according to the study performed, but is usually greater with the conventional and dominant approaches. Data from the Health Interview Survey of Barcelona 2000 show the existence of inequalities in health using these three approaches, with varied impact according to the health indicators used and women's characteristics.The dominant social class measure has several advantages: it is gender-blind and is not sexist. When the dominant social class is a less privileged class (i.e. manual laborer) it means that both partners have an occupation equal to or lower than this measure. Finally, this indicator is easily obtained.

Female↗
PubMed2004

[Gender and health in the daily press].

To have a better understanding on the role of the press in the communication of gender and health issues, the content of the five most spread newspapers in Spain was studied (El País, ABC, El Mundo, La Vanguardia and El Periódico de Catalunya) for five years (1997-2001) and the electronic version of The New York Times of the period 1990-1999. An unequal distribution was observed in the responsibility as for the information related to three aspects: positions of responsibility in the newspapers (out of 71 main posts, 67 were men and 4 women); the authors of the articles on health issues (61.2% men and 38,8% women, among the articles that include the author) and the mentioned information sources (81.43% men and 17.77% women). Among the 120 health issues that were covered during the period of the study, only 20 explicitly mentioned a woman (16.67%). Those subjects that included more frequently explicit references were: ablation, iatrogenics, sterilization, sexual and reproductive health, incontinence, beauty and domestic violence. The analysis of the approach to these subjects helped to identify the stereotypes of gender inequality, in the language as well as in the approach.

Female↗
PubMed2004

[Prevalence of diabetes mellitus in the province of Girona, Spain: the REGICOR study].

Our aim was to determine the prevalence of diabetes mellitus in the 25-to-74-year-old population in the province of Gerona, Spain. History of known diabetes mellitus was recorded, and fasting glycemia was measured in venous blood. The 1997 diagnostic criteria of the American Diabetes Association were used. Crude prevalence of known diabetes mellitus was 10.0%, and age-standardized prevalence was 7.7% (95% confidence interval [CI], 7.3%-8.1%). Crude prevalence of impaired fasting glucose was 8.6%, and age-standardized prevalence was 7.6% (95% CI, 7.25%-8.1%). Crude prevalence of known diabetes mellitus combined with diabetes mellitus according to glycemia value (total prevalence of diabetes mellitus) was 13.0%, and age-standardized prevalence was 10.0% (95% CI, 9.6%-10.5%). A higher prevalence in men and an increase in prevalence with age were observed. The figures are different from those of other studies in Spain.

Adult↗
PubMed2003

[Comparison of population coronary heart disease risk estimated by the Framingham original and REGICOR calibrated functions].

BACKGROUND AND OBJECTIVE: The therapeutic consequences of using the Framingham function calibrated by the REGICOR and Framingham investigators (Framingham-REGICOR) in the Spanish population are unknown. The objective of this study was to determine the differences in the classification of the population coronary risk when using the classical Framingham function (Framingham-Wilson) and that calibrated, and its consequences on the theoretical indication of lipid-lowering treatment. PATIENTS AND METHOD: The classification into the < 2%, 2-4,9%, 5-9,9%, 10-19,9%, 20-39,9%, and >= 40% risk categories observed by the two functions was compared in 3.270 individuals aged 35 to 74 years with no history of ischaemic heart disease or lipid-lowering drug treatment, recruited in two population samples representative of Girona between 1994 and 2001. The number of lipid-lowering treatment candidates was estimated applying the most recent guidelines for clinical practice, according to the risk level obtained with both functions. RESULTS: The proportion of patients excluded owing to the fact that they already were on lipid-lowering treatment was 6.2%. The Framingham-REGICOR assigned 54.2% of women and 67.9% of men to a lower level of risk as compared to the Framingham-Wilson function. In 0.2% of women and 21.2% of men the decrease was two categories of risk. The figures in diabetic participants were 75.7 and 18.5%, respectively. When the European recommendations published in 2003 were applied, lipid-lowering treatment would have been indicated in 14.5% and in 4.4% of non-diabetic participants by the Framingham-Wilson and the Framingham-REGICOR, respectively. CONCLUSIONS: The calibrated Framingham-REGICOR function assigns a lower coronary risk category in more than 50% of women and almost 90% of men than the uncalibrated Framingham function. The calibrated function is more suitable for risk estimation in primary prevention than the original function in Spain.

Adult↗
PubMed2003

[Coronary risk estimation in Spain using a calibrated Framingham function].

INTRODUCTION AND OBJECTIVES: The Framingham coronary heart disease (CHD) functions overestimate the risk of CHD in countries with a low incidence. Consequently, these functions should be calibrated for the purpose of primary prevention. Calibrated Framingham function charts of overall CHD risk for the Spanish population are presented. Patients and methods. The Framingham functions were calibrated by substituting the prevalence of CHD risk factors and incidence found in Framingham with the same values for Spain. The Framingham function that included high-density lipoprotein (HDL) cholesterol was used. The 10-year probability of developing a CHD event was estimated for several combinations of risk factors and HDL levels ranging from 35 to 59 mg/dl. Color-coded charts were prepared that show the exact probability of CHD corresponding to each combination of risk factors, shown in separate cells on the chart. RESULTS: The event rate and prevalence of CHD risk factors differed considerably between Girona and Framingham. HDL < 35 mg/dL increased risk by approximately 50% and HDL > 60 mg/dL reduced it by 50%. The proportion of cells in which the 10-year probability of developing a CHD event was > 9% was 2.3 times higher and that of cells with a probability > 19% was 13 times lower in the chart calibrated for Spain than in the original Framingham charts. CONCLUSIONS: The calibrated Framingham function may help to more accurately estimate the overall risk of CHD in the Spanish population for primary prevention purposes. The calibrated function should be validated, and the development of functions for the Spanish population should be promoted.

Algorithms↗
PubMed2002

[Trends in the proportion of patients younger than 75 years with acute myocardial infarction and Killip class III and IV. variables associated with occurence and case-fatality: 1978-1997].

INTRODUCTION: Acute pulmonary edema (Killip III) or cardiogenic shock (Killip IV) is associated with a higher mortality in the acute phase of myocardial infarction (AMI). OBJECTIVES: To analyze trends in the proportion of patients who developed Killip III and IV in AMI over a 20-year period in order to identify the variables associated with occurrence and case-fatality. METHODS: Hospital registry of first AMI in patients under than 75 years, from 1978 to 1997. Sociodemographic variables, cardiovascular risk factors, clinical variables, treatments, procedures, and worst Killip class were recorded. RESULTS: The registry included 2,590 patients. Mean age was 60 years and 17% were women. Thirteen percent (13.5%) of the patients developed Killip III and IV, and no changes in this proportion were observed over the time period studied. Age, diabetes, previous angina, and anterior location of AMI were associated with a higher risk of Killip III and IV. Case-fatality at 28 days in this subgroup was 51.7%, with a decreasing linear trend over the years. Variables associated with a higher case-fatality were age and malignant ventricular arrhythmias, whereas the periods 1990-93 and 1994-97 were associated with a lower case-fatality. This protective effect disappeared after adjusting for treatment variables (antiplatelet agents and thrombolysis). CONCLUSIONS: The proportion of patients with AMI in which Killip class III and IV develops has remained stable in the last two decades. Although the 28-day case-fatality in these patients is high, a decrease has been observed in recent years in relation to the availability of new treatments (antiplatelet agents and thrombolysis).

Age Factors↗
PubMedDate not supplied

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36).

OBJECTIVE: The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). METHODS: A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbach's alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. RESULTS: Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbach's alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. CONCLUSIONS: The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode.

Adult↗