Cardiovascular disease (CVD) is a major health problem in Japan. Among the risk factors for CVD, cigarette smoking is the strongest and smoking cessation reduces mortality, morbidity, hospital readmissions, restenosis after coronary revascularizations, and the need for coronary artery bypass surgery. A few of patients sustained smoking cessation after hospital discharge. The aim of this study of Japanese men who were hospitalized with CVD was to explore the demographic and clinical characteristics of smokers, their pattern of smoking, knowledge of smoking, and past attempts to quit. The data were collected individual interview based on a questionnaire. The questionnaire included modified Global Adult Tobacco Survey (GATS) core questionnaire (CDC, 2008; GTSS, 2010), Smoking and Health Problem Questionnaire (Ministry of Health and Welfare, 1999), Fagerstrom Test for Nicotine Dependence, Minnesota Withdrawal Scale, Patient Health Questionnaire-9, Enriched Social Support Instrument, and Confidence questionnaire.

A cross-sectional study of 104 men smokers who were hospitalized CVD was conducted in four Japanese hospitals that specialize in cardiovascular disease in Japan. Mean age was 60.6 (±13.5) years, most (55.7%) were 60 or over. Almost half of the men had high school or some college or diploma education, and one third had a bachelors or graduate degree and most (60%) were married. Half of the sample was admitted because of AP or MI (46.1%), 14.4% admitted because of CHF and 11.5% admitted because of arrhythmias. Most subjects (about 80%) were moderately to high nicotine dependent. Their knowledge of smoking and its effect on their health was limited. Two third of participant made at least one quit attempt in the past and most of them used self-help methods and less utilized pharmacological treatment. The nurses were less likely than physician to offer smoking cessation intervention.

Pearson correlation confident test were performed to examine relationship among selected variables. Withdrawal symptoms (MNWS) (r=-0.31, p=0.00) and social support (ESSI) (r=0.25, p=0.01) were statistically significantly correlated with confidence to resist the urge to smoke. The result of this study will be useful in developing effective and culturally unique smoking cessation intervention programs, for the Japanese population with CVD.

BACKGROUND. Death from all causes during tuberculosis (TB) treatment has remained about 10% in San Francisco County. Estimating risk factors for all-cause mortality was this study's aim.

METHODS. A retrospective cohort study design was used to examine 1,730 subjects with TB older than 24 years in San Francisco from 1995 to 2004. The observation period was from the first day of TB treatment to the last day of treatment or death from any cause. Mean follow-up was 35.8 (± 20) weeks. Host characteristics including age, gender, race, immigration, and language; social-environmental factors including residence, incarceration, and unemployment; TB disease characteristics including anatomic site, culture, chest radiograph, resistance, previous TB; comorbid conditions including HIV coinfection and substance use; health care delivery factors including directly observed (DOT) or self-administered therapy (SAT), and public or private TB medical provider were tested for their predictive value on all-cause mortality.

RESULTS. All-cause mortality was 10.6% (184/1730); 50% of deaths (92/184) occurred < 8 weeks of treatment. Statistically significant predictors of all-cause mortality were age 45-64 (OR 2.2, 95% CI: 1.3, 3.9), age ≥ 65 (OR 2.5, 95% CI: 1.3, 4.7); male gender (OR 1.6, 95% CI: 1.1, 2.4); homelessness (OR 2.1, 95% CI: 1.2, 3.5); not working (OR 5.9, 95% CI: 3.0, 11.5); HIV coinfection (OR 8.1, 95% CI: 3.8, 17.0); and private TB medical provider (OR 3.8, 95%CI: 2.6, 5.7). Previous TB was associated with protection from all-cause mortality (OR 0.6, 95% CI: 0.3, 0.9); concomitant extrapulmonary TB was not associated with all-cause mortality (OR 1.3, 95% CI 0.9, 1.8). Subset analysis of patients receiving public TB care showed that SAT (OR 0.5, 95% CI 0.2, 0.9) and a combination of DOT and SAT were associated with a protective effect when compared with DOT only (OR 0.3, 95% CI: 0.1, 0.8).

CONCLUSION. Middle and older age, male gender, homelessness, not working, positive TB culture, and HIV coinfection predict all-cause mortality. Private TB medical provider was predictive of mortality, and the combination of DOT and SAT is beneficial, suggesting that public-private, TB-care partnerships need to be strengthened and that supervision of therapy should be flexible.

Background. More women than men die of cardiovascular disease (CVD) in Korea. Of important concern to Korean women is the dramatically increasing mortality rate from coronary heart disease (CHD). Despite the significant burden of CHD in Korean women and its adverse impact on national public health, women have received little attention in cardiac research in Korea.

Purpose. The purposes of this study were to: (1) describe the prevalence of cardiovascular risk factors in Korean women, (2) estimate the 10-year risk for CHD, and (3) evaluate the proportion of women who need to be treated based on the American Heart Association (AHA) evidence-based guidelines for CVD prevention.

Methods. A cross-sectional design using the data set from the 2008 Korea National Health and Nutrition Examination Survey IV was used. The sample was 3,301 asymptomatic women aged 20 years or older. Ten-year risk for CHD was estimated with the Framingham Risk Score. Korean women were classified into three risk subgroups. The proportion of women who were in need of treatment for each subgroup was presented.

Results. About 35% of Korean women had two or more major modifiable risk factors for CHD. Among Korean women free of CVD, 97.4% had a 10-year risk for CHD of < 10%, 2.4% had a risk of 10 to 20%, and 0.2% had a risk of > 20%. About 75% of Korean women in the high risk group were in need of lipid lowering treatment, but only 10.9% of them were receiving treatment.

Conclusions. Modifiable cardiovascular risk factors were highly prevalent among asymptomatic Korean women of all ages, and the clustering of risk factors was common. Ten-year risk for developing CHD risk in Korean women was comparable to that of women in the U.S. However, the proportion of Korean women who were not at AHA guideline goals was substantial. Furthermore, there was a significant treatment gap in Korean women. The findings of this study suggest that Korean women free of CVD need to be treated more intensively. Aggressive risk reduction efforts are urgently needed to prevent CHD in Korean women.

Purpose: To examine the relationship between BP and BP awareness; eating habits and exercise self-confidence; lifestyle behaviors; social capital; chronic disease management self-confidence, social support; depression; and antihypertensive medication adherence in Black African American adults.

Significance: High blood pressure (HBP) is the leading cause of cardiovascular disease such as stroke, coronary heart disease, and end-stage renal disease; all are leading causes of death in the US. HBP has been attributed to higher rates of morbidity, comorbidities, and excess death rates in Black Americans of African descent. Little is known about the extent to which lifestyle behaviors and HBP are modified by the socioecological context of social capital (SC) (e.g. bonding, bridging, and linking).

Design: Cross-sectional descriptive study.

Methods(/bold>: A convenience sample (n=208) was recruited from community settings in California. Inclusion criteria were: self-identify as Black African American, 18 years and older, born/raised in US, reads and/or speaks English, resident of California, no major cardiovascular event or currently on dialysis, and non-pregnant women. The data collection instrument consisted of 161 questions. Subjects' BP and body weight were also measured.

Findings: Findings: Subjects diagnosed with HBP prior to the study had higher self-confidence in getting information from community resources and in managing chronic disease compared to subjects without a prior HBP diagnosis (p=0.01). Predictors of measured HBP included: education (OR=0.1; 95% CI 0.0, 0.8); income (OR=0.1, 95% CI 0.1, 0.9); age-income interaction (OR=5.9, 95% CI 1.3, 26.5); age-education interaction (OR=11.1, 95% CI 2.0, 60.7); and bonding SC (OR=2.3, 95% CI 1.1, 5.0) for subjects less than 60 years old. Predictors of measured HBP for subjects 60 years and older included: bonding SC (OR=0.3, 95% CI 1.1, 15.4); bridging SC (OR=0.5, 95% CI 0.3, 0.9); and linking SC (OR=0.3, 95% CI 0.1, 0.9).

Conclusions: Subjects with normal BP were less confident in their ability to obtain information and manage chronic illness compared to subjects with HBP who were taking antihypertensive medication prior to the study. Results were mixed with regard to SC and BP elevation; as bonding SC increased in subjects less than 60 years old their measured BP levels also increased. In subjects 60 years and older, the results were reversed; as bonding, bridging, and linking SC increased their BP levels decreased as expected. Multiple logistic regression analysis indicated bonding SC as the only predictor of HBP in subjects less than 60 years old.

Implications: This study shows a need for further development of the SC concept as a methodological framework in nursing research and the need for further empirical investigation of SC as a predictor of physiological outcome measures such as HBP.

Purpose: The purpose of this study was to critically examine the knowledge, attitudes, beliefs and behaviors about physical activity (PA), weight, nutrition, health, depression, social support, self efficacy, acculturation and fatalism to better understand excess weight in young, low-income Latina adults.

Significance: The health consequences due to overweight and obesity (excess weight) are extensive. Although obesity is a global epidemic, an increasing proportion of individuals in the United States (US) are obese, especially Latinos. Specifically in the US, Mexican American women have the second highest prevalence of obesity and Mexican Americans have the highest reported prevalence of leisure time physical inactivity.

Design: cross-sectional study

Methods: A convenience sample (n=132) who consented to an interview-administered questionnaire were recruited from two clinics. Inclusion criteria were: self-identified Latina women, 18 to 45 years of age, who spoke English or Spanish and lived in Northern California.

yFindings: Most were born in Mexico (41%) or Guatemala (37%), had < high school education (49%), were married (44%) or partnered (31%), had a household income< $20,000, an average household size of 4 (±1), and two children. Most had lived in the US an average of 10 years (±5.5) and almost all participants (97%) had a low level of acculturation. Two of 10 independent variables were statistically significantly associated with excess weight: current body silhouette size [OR=2.78, 95% CI: 1.28, 6.04] and receiving health information from newspapers [OR=7.31, 95% CI: 1.43, 37.35].

Conclusion: Of these Latina women, 20% had a healthy weight, 46% were overweight and 34% were obese, 83% reported meeting federal PA guidelines, and 59% indicated an insufficient PA duration necessary for weight maintenance. Most women of a healthy weight rated their health as "good", while those who had excess weight rated their health as "fair". Body silhouette size and getting health information from newspapers were statistically significantly associated with excess weight.

Implications: This study shows the need for further research on excess weight to increase awareness about healthy weight and the practices that influence healthy behaviors in young, low-income, immigrant Latinas.

Coronary Heart disease (CHD) is the leading cause of death in women. CHD claims more lives than the next six causes of death combined with more than one-half million women dying of CHD each year (AHA, 2006). The gap between women's perceived knowledge of CHD risk and their actual risk may contribute to these alarming statistics. The aims of this descriptive, cross-sectional study is to explore the perceived versus actual risk of CHD in women and to assess the relationship between knowledge of CHD in women and understanding of perceived risk. A sample of 106 subjects was evaluated with a self report questionnaire to determine knowledge and perception of CHD in women and their personal risk. All subjects underwent a lipid profile and blood pressure check to calculate their actual CHD 10 year risk using the Framingham Risk Score (FRS). The sample of women was on average 53 years old; 68% were Caucasian; were well educated (69% being college educated or more) and report an annual household income of $75,000 to $100,000. Important new findings of this study are the comparison between the women's perception of their CHD risk versus estimated 10 year risk of CHD. More than half of the women (55%) accurately perceived their risk; 7 % underestimated and 38% overestimated their risk. In addition, greater knowledge was significantly correlated with a more accurate perceived risk score (r=0.23; p≤ 0.05). This study is unique in that it describes women's perceived versus actual risk of CHD, after the national study by Mosca (2006 & 2004) identified the inadequate knowledge and awareness of women regarding heart disease risk. This study shows that knowledge, awareness and perception of CHD in women continue to progressively improve. This study also shows that opportunities for patient-health care provider discussions could be increased. Continued education and awareness for women about heart disease being the leading cause of death, risk factors for CHD and atypical heart attack symptoms is essential at the national level as well as in the clinical setting.

Introduction: Smoking is a leading cause of cardiac diseases and deaths worldwide, killing 6 million people annually. Depression has been found to be an important comorbidity in persons with heart disease, and may play a significant role in patients' relapse to smoking after quit attempts. Despite the health hazards and the public's awareness of the tragic consequences of smoking, tobacco use remains surprisingly highly prevalent.

Objectives: To examine the relationships between demographic, clinical and health factors, smoking history and patterns, nicotine dependence and withdrawal symptoms, smoking outcome expectancies, social support, depression, and willingness to quit smoking after hospital discharge in adult Jordanian men who were smokers and were admitted to the hospital with a CVD diagnosis.

Methods: This cross-sectional study recruited adult men smokers from three hospitals. Data were collected using medical record abstraction and structured interviews.

Results: The sample included 167 men, 71% were cigarette smokers and 29% were waterpipe smokers. Their mean age was 50.7 (±6.9) years; 62.8% were nicotine dependent. 40.4% were classified as depressed [scored 10 (or higher) on Patient Health Questioannaire-9]. Willingness to quit smoking was positively correlated with depression score (r = 0.16, p = 0.04), and social support (r = 0.33, p < 0.01). A multiple logistic regression analysis showed that smokers who have no health insurance, who have no one available to encourage them to quitting smoking "at least sometimes", who had tried quitting smoking in the past, and had no difficulty with depressive symptoms while at work, taking care of things at home, or getting along with other people were less likely to quit smoking after hospital discharge.

Discussion: The high nicotine dependence in these men indicates that there is an urgent need for smoking cessation treatment, including behavioral counseling and pharmacological therapies, to achieve successful smoking cessation. This study showed a high prevalence of depressive symptoms. The presence of depression is associated with more severe nicotine withdrawal symptoms and is inversely associated with smoking cessation. Thus, screening all patients for tobacco use and depression is needed and should be incorporated in the care of these patients.

ABSTRACT

Background: Tobacco use is the most preventable cause of death worldwide. Despite high rates of tobacco use and high prevalence of cardiovascular disease (CVD) in Jordan, little is known about smoking behaviors in patients who smoke and have CVD.

Objectives: To describe perceptions and patterns of smoking in patients hospitalized with CVD in Amman, Jordan.

Methods: This cross-sectional study recruited a convenience sample from two hospitals. Data were collected using medical record abstraction and structured interviews.

Results: This sample of consists of 112 men who were hospitalized with CVD; they were middle-aged (52.5 ± 9.7 years), most were married, educated (≥ high school), and had incomes above the national average. The mean number of years of cigarette smoking was [35.9 (±10.4)], and they smoked 24.5(±13.62) cigarettes per day. The majority (82.3%) had medium to high nicotine dependence. About 40% had attempted to quit smoking in the past 12 months using "their own way without help from others," and intend to quit in the future using the same unsuccessful methods. The men were unaware of hazards of smoking such as stroke and addiction to nicotine; nor of the long term health benefits of quitting smoking. A logistic regression analysis showed that men with higher income (OR: 7.7, 95% CI: 2.7, 22.3), with longer hospital stays (OR: 2.6, 95% CI:1.3, 5.3), in acute cardiac settings (OR:3.9, 95% CI:1.2, 12.7), and a diagnosis of an acute CVD event (OR:3.0, 95% CI:1.1, 8.3) were more confident in their ability to quit smoking.

Discussion: The key findings were that men with CVD were heavy smokers, unaware of the addictive nature of smoking and of the benefits of quitting. Some had previous unsuccessful quit attempts using their own methods, but planned to use these methods again in the future. These findings suggest that every patient admitted to the hospital must be screened for smoking status. Those who smoke need to be offered evidence based smoking cessation education and counseling.

Age Related Differences in Smoking Cessation Outcomes

For Women Hospitalized With Cardiovascular Disease

Daniel M. Doolan RN, MSN

ABSTRACT

Background: Smoking is the number one preventable cause of death and disease. Smoking cessation has immediate health benefits, even among those who have smoked for many years. Despite the known risks of smoking and the benefits of cessation, the efficacy of smoking cessation interventions among older adults and women has received limited research attention.

Objectives: To determine if there are age related clinical and demographic differences between older versus younger women with cardiovascular disease who smoke, and to determine if these two groups differ in their smoking cessation outcomes.

Method: An existing data set from The Women's Initiative for Nonsmoking (WINS) is used for this study. The original WINS study was an RCT that tested the efficacy of a smoking cessation intervention for Bay Area women hospitalized with cardiovascular disease. The current study compares WINS participants who were 62 and older with those younger than 62.

Results: The sample (n=277) contained 136 older smokers and 141 younger smokers. Older smokers were significantly more likely to be living alone, widowed, poorer, retired, have hypertension, and have multiple comorbidities. Older women were significantly less likely to be obese. Stanford Dependence Index scores showed older women had significantly lower levels of nicotine addiction. Older women were significantly less likely to have one or more housemates who smoke. At the 6 month follow-up, 52.1% of older smokers had quit smoking compared with 40.6% of younger smokers. At the 12 month follow-up, 52.0% of older smokers had quit smoking compared with 38.1% of younger smokers. The difference at 12 months was statistically significant. A Kaplan-Meier Survival Analysis found older women were significantly less likely to relapse over 12 months than younger women.

Discussion: Older women with cardiovascular disease demonstrated extremely high rates of smoking cessation, higher even than younger women with cardiovascular disease. Further research is needed to determine how to optimize smoking cessation rates for older smokers. Clinicians should be sure to also include older smokers in smoking assessments and smoking cessation interventions.

Abstract

Background: Oral clefts occur in approximately one out of 700 births worldwide

and can affect the lip, the palate, or both. In developing countries, lack of awareness

of cleft treatment options, scarcity of surgical services, and poverty create barriers

to corrective surgeries. To reduce global cleft care disparities, many

nongovernmental organizations have developed short-term missions that provide

surgical treatment. Few of these organizations have evaluated the impacts of their

programs for the children and their families.

Aim: To evaluate the activities of the surgical outreach organization Faces of Hope

(FOH) for the years 2005 through 2009.

Conceptual Framework: The Center for Disease Control Framework for Program

Development in Public Health was used to initiate the evaluation of FOH. Research

questions evaluated patient eligibility to receive services, and the outputs and

outcomes of the services provided.

Design: A cross sectional design utilizing five consecutive years of data collected for

clinical purposes.

Methods: Medical record review data provided the independent, dependent and

covariate variables.

Sample: A sample of 706 medical records documented the clinical encounters of

Guatemalan families seeking surgical services from the organization FOH for 2005

to 2009.

v

Results: There is no evidence that surgical repair of primary orofacial clefts

occurred sooner over the years of FOH activities. Surgical complications compared

by years suggest that a statistically significant difference exists between surgical

complications in 2006 and 2009. There were no complications in 2009 compared to

2006 in which there was an 11.3% complication rate. Anesthetic complications did

not have an association by year. Diagnosis, illness and wt/age- in- month Z scores

were statistically significant predictors of complications.

Eligibility (receiving surgical treatment) was predicted by previous surgery, illness

and diagnosis. Pre-operative vital signs and blood hemoglobin level did not predict

eligibility. Returning in subsequent years to seek additional services was predicted

by diagnosis, wt/age-in-month Z scores and documented futures needs.

Significance: Evaluation of short-term surgical missions is crucial as these

organizations continue to participate in the provision of surgical care for children

who may otherwise not receive treatment.