Takeheart Health Check      

(102) How low density lipids protect is still a mystery. Methods of measurement need to be standardised.

(103) "Serum concentration of total cholesterol is the most important single blood lipid risk factor for ischaemic heart disease in men. High density lipid cholesterol concentration is less important and triglyceride concentrations do not have predictive importance once other risk factors have been taken into account."

(104) The Heartbeat Award Scheme (THAS). Short description, criteria for catering establishments and summary of effect in Brighton and Crewe.

(105) Coronary heart disease causes about one third of all deaths in men and about a quarter of all deaths in women. More than 150,000 deaths a year, a quarter of them under the age of 65.

(107) "You don't need high and low density lipids - you can treat and monitor the problem satisfactorily on the basis of the cholesterol".

(109) Disquiet regarding mass screening for hyperlipidaemia.

(110) Plumps for selective testing for cholesterol. Analogy with blood pressure screening
Level not known without testing
3 readings needed to establish base line
Single reading not definitive
Do risk factors behave in a multiplicative or additive way? TP reckons multiplicative (says Shaper is additive).

(111) Analysis of 19 drug/diet trials (36,000 patients) Reduction in deaths from coronary heart disease balanced by a significant increase in non-cardiac mortality.

(112) "Reducing heart disease should not be regarded as a reason for using tamoxifen. All work on cholesterol lowering has involved men and you cannot extrapolate the evidence to women. I do not believe cholesterol levels are an important predictor of heart disease in women. Women appear to tolerate higher cholesterol levels for a longer period than men."

(115) 28 in experimental group; 20 in usual care group.
Experimental group:- Low fat vegetarian diet, stop smoking, stress management training and moderate exercise.
195 coronary artery lesions analysed with angiography before and after 1 year.
Average diameter of stenosis regressed from 40 to 37.8 in exp group and progressed from 42.7 to 46.1 in control group.
"Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only one year".

(117) Evidence of regression of coronary heart disease with a regime of stop smoking, low fat vegetarian diet, stress management and exercise.
36 men, 35 women. Lifestyle changes versus usual care.
Chol down by 24% in exp group but only slightly in other.
Angina down by 91-28% in exp, increased in control.
Angiography:- Stenosis reduced 40 to 37.8% in exp and increased from 42.7 to 46.1 in control.

(118) Carbon monoxide in the home. A description of a case with 14 associated family cases. Due to gas central heating boiler in the kitchen. Breath analysis not mentioned.

Report boiler issues immediately. Carbon monoxide is a killer. Get boiler systems checked by registered companies. londonheat.co.uk are a Corgi & Gas Safe registered company serving London for boiler installation within any industrial or residential heating system.

Common features of carbon monoxide poisoning:-

Tends to occur in bad weather

Recurrent episodes common

Several people simultaneously

Spontaneous recovery

Variety of non-specific symptoms.

Gamma Glutamyl Transpeptidase (GGT) raised in:- Alcohol poisoning, liver metastases, liver abscess, hepatic granuloma, obstructive biliary disease, pancreatitis, myocardial infarction, tricyclic drugs, some renal disorders.

(123) A controlled trial of self help materials (Audio tape of 55 mins and a 27 page book) for anxiety/depression. Statistically significant success. "Clinicians welcomed the package as a valuable addition to the therapies available for managing chronic anxiety problems".

(125) Flesch scores for understandability of patient reading material. A review article of the whole topic.

William Harvey is credited with discovering the circulation of the blood. Select this picture if you wish to learn more about him.

(126) The Leeds/Hamilton assessment scale.

(127) The Likert scale and the general health questionnaire

(128) Latent trait analysis. A small set of screening questions followed by a set of further probe questions. Thresholds and slopes.

(129) East Anglia expenditure on cigarettes £3.71 /household/week. Alcohol £7.3 ditto.
East Anglia 31% of people smoke.
East Anglia 11% males drink more than 3.5 pints 3 times/week.
Figures quoted from the Family Expenditure Survey 1986 and the G.H.S 1984.

(132) "Consider for example the fact that American employers spend more than $700m a year to replace 200,000 men who die or are incapacitated by heart disease; or that in Britain heart disease is responsible for more than 21% of working days lost, especially among the middle aged."

Chinese proverb.

The superior doctor prevents sickness;

The mediocre doctor attends to impending sickness;

The inferior doctor treats actual sickness.

(134) "Active screening for coronary heart disease risk factors will go a long way to reduce the large sums of money spent on coronary heart disease in the United Kingdom today"

(135) "You can't avoid death in old age, but you can avoid death in middle age". Quoted in context of coronary heart disease prevention.

*** "Investing in people really does pay off. It can lead to improved customer service and higher product quality, to the development of new markets or the introduction of new technology. It can help you prepare for the challenge of tomorrow." "Seriously it is worth investing in people - your business has everything to gain." "Training is a serious business... So you are nobody's fool if you turn to..."

(136) It is estimated that 8% of the population are heavy drinkers, 2% are problem drinkers and 0.4% are alcohol dependent.

(138) 156,000 deaths from ischaemic heart disease per annum. 115,000 hospital discharges with ischaemic heart disease per annum. Prevalence is 24.7% in men aged 40-59

(139) Prevalence of coronary heart disease is greater in social classes 4 and 5 than in 1.2 and 3.

(141) Successful use of letters of encouragement in stopping smoking.

(144) "Management of elevated blood lipids should be part of an integrated strategy for coronary heart disease risk factor management."

(146) Increased cardiovascular risk commenced in younger men even at relatively low levels of excess weight.

(148) Some guidelines for testing in pharmacies - nothing out of the ordinary.

(149) Chemcard and Quickread tests for cholesterol. "Neither system produces reliable results"

(150)

Smoking among student nurses. Royal Free Hospital. 350 replies to a questionnaire.

43% Smokers

19% Ex Smokers

37% Never smoked