Breast cancer risk factors among Mexican-American women

Introduction: The average age of onset of breast cancer among Hispanic women is 50 years, more than a decade earlier than non-Hispanic white women. Age at diagnosis is an important prognostic factor for breast cancer; younger age at onset is more likely to be associated with advanced disease, poorer prognosis, hormone receptor negative breast tumors, and a greater likelihood of hereditary breast cancer. Studies of breast cancer risk factors including reproductive risk factors, family history of breast cancer, and breast cancer subtype have been conducted predominately in non-Hispanic whites. Breast cancer is a heterogeneous disease with the presence of clinically, biologically, and epidemiologically distinct subtypes that also differ with respect to their risk factors. The associations between reproductive risk factors and family history of breast cancer have been well documented in the literature. However, only a few studies have assessed these associations with breast cancer subtype in Hispanic populations. Methods: To assess the associations between reproductive risk factors and family history of breast cancer we conducted three separate studies. First, we conducted a case-control study of 172 Mexican-American breast cancer cases and 344 age matched controls residing in Harris County, TX to assess reproductive and other risk factors. We conducted logistic regression analysis to assess differences in cases and controls adjusted for age at diagnosis and birthplace and then we conducted a multinomial logistic regression analysis to compare reproductive risk factors among the breast tumor subtypes. In a second study, we identified 139 breast cancer patients with a first- or second-degree family history of breast cancer and 298 without a family history from the ELLA Bi-National Breast Cancer Study. In this analysis, we also computed a multinomial logistic regression to evaluate associations between family history of breast cancer and breast cancer subtypes, and logistic regression to estimate associations between breast cancer screening practices with family history of breast cancer. In the final study, we employed a cross-sectional study design in 7279 Mexican-American women in the Mano a Mano Cohort Study. We evaluated associations with family history of breast cancer and breast cancer risk factors including body mass index (BMI), lifestyle factors, migration history, and adherence to American Cancer Society (ACS) guidelines. Results: In the results of our first analyses, reproductive risk factors differed in the magnitude and direction of associations when stratified by age and birthplace among cases and controls. In our second study, family history of breast cancer, and having at least one relative diagnosed at an early age (<50 years) was associated with triple negative breast cancer (TNBC). Mammography prior to receiving a breast cancer diagnosis was associated with family history of breast cancer. In our third study that assessed lifestyle factors, migration history and family history of breast cancer; we found that women with a first-degree family history of breast cancer were more overweight or obese compared with their counterparts without a family history. There was no indication that having a family history contributed to women practicing healthier lifestyle behaviors and/or adhering to the ACS guidelines for cancer prevention. Conclusions: We observed that among Mexican-American women, reproductive risk factors were associated with breast cancer where the woman was born (US or Mexico). Having a family history of breast cancer, especially having either a first- or second-degree relative diagnosed at a younger age, was strongly associated with TNBC subtype. These results are consistent with other published studies in this area. Further, our results indicate that women with strong family histories of breast cancer are more likely to undertake mammography but not to engage in healthier lifestyle behaviors.^

Impacto de un programa de promoción de actividad física para la salud en niños de edad escolar de la ciudad de La Plata

Introducción. El aumento de la obesidad y el sedentarismo en niños es un problema social grave. La adopción de hábitos activos contribuye a la prevención de estos trastornos. Objetivos. Medir el efecto de un programa escolar de promoción de actividad física (AF). Material y método. Estudio de intervención controlado no aleatorizado. Participaron 123 niños de ambos sexos, 32 en el grupo intervención (I) y 92 en el grupo control (C). El nivel de AF se obtuvo por cuestionario. Se ponderó el grado de asociación conceptual entre AF y salud mediante test relacional. El grupo I participó de talleres durante 8 semanas durante una hora semanal en horario escolar. Resultados. La práctica deportiva creció 10 en grupo I y 2,9 en C, la diferencia entre medias fue 7.1. (p menor a 0.05). El grupo I aumentó la cantidad de veces que usan la bicicleta por semana 2,88 a 3,56. En el grupo I el tiempo de pedaleo aumentó 30.57 min./sem y disminuyó las horas frente al TV en 1.40 min/día. El grupo I aumentó la importancia que los niños asignan a la AF relación a la salud en forma significativa. Conclusiones. Implementar estrategias de promoción de AF puede favorecer cambios de hábitos y conductas hacia un estilo de vida saludable cuando se trabaja sistemáticamente en talleres mediante la participación activa de niños y maestros.

Impacto de un programa de promoción de actividad física para la salud en niños de edad escolar de la ciudad de La Plata

Introducción. El aumento de la obesidad y el sedentarismo en niños es un problema social grave. La adopción de hábitos activos contribuye a la prevención de estos trastornos. Objetivos. Medir el efecto de un programa escolar de promoción de actividad física (AF). Material y método. Estudio de intervención controlado no aleatorizado. Participaron 123 niños de ambos sexos, 32 en el grupo intervención (I) y 92 en el grupo control (C). El nivel de AF se obtuvo por cuestionario. Se ponderó el grado de asociación conceptual entre AF y salud mediante test relacional. El grupo I participó de talleres durante 8 semanas durante una hora semanal en horario escolar. Resultados. La práctica deportiva creció 10 en grupo I y 2,9 en C, la diferencia entre medias fue 7.1. (p menor a 0.05). El grupo I aumentó la cantidad de veces que usan la bicicleta por semana 2,88 a 3,56. En el grupo I el tiempo de pedaleo aumentó 30.57 min./sem y disminuyó las horas frente al TV en 1.40 min/día. El grupo I aumentó la importancia que los niños asignan a la AF relación a la salud en forma significativa. Conclusiones. Implementar estrategias de promoción de AF puede favorecer cambios de hábitos y conductas hacia un estilo de vida saludable cuando se trabaja sistemáticamente en talleres mediante la participación activa de niños y maestros.

Impacto de un programa de promoción de actividad física para la salud en niños de edad escolar de la ciudad de La Plata

Introducción. El aumento de la obesidad y el sedentarismo en niños es un problema social grave. La adopción de hábitos activos contribuye a la prevención de estos trastornos. Objetivos. Medir el efecto de un programa escolar de promoción de actividad física (AF). Material y método. Estudio de intervención controlado no aleatorizado. Participaron 123 niños de ambos sexos, 32 en el grupo intervención (I) y 92 en el grupo control (C). El nivel de AF se obtuvo por cuestionario. Se ponderó el grado de asociación conceptual entre AF y salud mediante test relacional. El grupo I participó de talleres durante 8 semanas durante una hora semanal en horario escolar. Resultados. La práctica deportiva creció 10 en grupo I y 2,9 en C, la diferencia entre medias fue 7.1. (p menor a 0.05). El grupo I aumentó la cantidad de veces que usan la bicicleta por semana 2,88 a 3,56. En el grupo I el tiempo de pedaleo aumentó 30.57 min./sem y disminuyó las horas frente al TV en 1.40 min/día. El grupo I aumentó la importancia que los niños asignan a la AF relación a la salud en forma significativa. Conclusiones. Implementar estrategias de promoción de AF puede favorecer cambios de hábitos y conductas hacia un estilo de vida saludable cuando se trabaja sistemáticamente en talleres mediante la participación activa de niños y maestros.

Evolução da perceção parental da imagem corporal da criança : análise retrospetiva de dois estudos

Introdução: A obesidade é reconhecida pela OMS como um importante problema de saúde pública, que afeta adultos, crianças e adolescentes e que tem tomado proporções epidémicas em todo o mundo. Os estudos revelam que os pais, mas sobretudo as mães se mostram preocupadas e concordam com a adoção de hábitos alimentares saudáveis, no entanto a perceção que estas têm do estado nutricional dos filhos nem sempre é adequada e frequentemente a imagem corporal é distorcida, percebendo-se contudo que esta distorção tem vindo a diminuir. Foi neste âmbito que emergiu como objetivo geral deste estudo, explorar a evolução da perceção parental da imagem corporal da criança em dois estudos, estudo A (Graça Aparício) e estudo B (Graça Aparício, Madalena Cunha, João Duarte; Anabela Pereira, Jorge Bonito, Carlos Albuquerque), publicados respetivamente, em 2012 e 2013 e relacioná-la com o comportamento alimentar da criança do estudo B. Material e métodos: Este estudo de carácter retrospetivo e transversal, foi realizado com as crianças que participaram no estudo A e no estudo B, num total de 2216 crianças em idade pré-escolar, média idade= 4.51 anos (±0.97Dp), residentes as crianças do estudo A na região de Viseu e Dão e as do estudo B, nas regiões Viseu, Lamego, Vila Real, Évora e Leiria, tendo sido efetuada pelos autores originais, uma avaliação antropométrica e classificação nutricional das crianças com base no referencial NCHS (CDC, 2000). Para a recolha de dados os autores originais, utilizaram um Questionário de Caracterização Sociodemográfica das Crianças e dos Progenitores; o Questionário de Avaliação da Perceção Parental da Imagem Corporal da criança (Collins, 1991) e o Questionário de Caracterização do Comportamento Alimentar Infantil (CEBQ), traduzido e validado para a população portuguesa por Viana & Sinde (2008). Resultados: Comparativamente ao estudo A, no estudo B os pais revelaram-se significativamente mais preocupados com o estado nutricional dos seus filhos (p= 0,000). Ainda no estudo B uma maior percentagem de pais assinala as imagens representativas de pré-obesidade (27,5%) e obesidade (0,6%), comparativamente ao estudo A, onde se verifica o oposto; uma maior sinalização das crianças no grupo da normalidade e baixo-peso (56,3% e 20,4% respetivamente). Apurou-se uma diferença de médias significativa da perceção parental da imagem corporal da criança entre o estudo A e o estudo B, evidenciando a perceção dos pais, a uma maior aproximação com os valores mais elevados de IMC dos filhos, ou seja, os pais têm uma perceção menos distorcida da imagem corporal dos filhos, quando estes apresentam valores de IMC mais elevados. Relativamente ao comportamento alimentar, apesar dos comportamentos de “atração pela comida” se associarem a uma perceção parental de imagem corporal maior, e de alguns dos comportamentos de “evitamento da comida” se associarem a uma perceção parental de imagem corporal menor, a relação entre o comportamento alimentar e a perceção parental da imagem corporal criança não se revelou significativa. Conclusões: Os resultados indicam uma maior acurácia da perceção da imagem corporal dos pais ao real estado nutricional dos filhos, podendo este facto ser o primeiro passo para o seu reconhecimento do excesso de peso dos seus filhos e facilitar a adequação a um estilo de vida mais saudável entre as crianças em idade pré-escolar, e maior sensibilização da família para o controlo do excesso de peso na infância. Palavras-chave: Perceção parental, imagem corporal, Obesidade infantil.

Characteristics of older dietary supplement users: Review of the literature

Published literature reports rates of dietary supplement usage by individuals aged 60 years or more to be 16−60%. Prevalence figures are dependent on the population studied and the method of data collection. In general, older supplement users are female, Caucasian and well educated, with healthier lifestyle practices than non-supplement users, and they are less likely to be overweight or to smoke. Neither income nor self-rated health status are reliable predictors of supplement use in this group. In many cases older supplement users report higher intakes of several micronutrients from food than older non-supplement users. Current patterns of supplement use by the older person reveal that although they consume a range of products, they do not supplement with nutrients that are of particular benefit to them. The supplements most commonly consumed by individuals aged 60 years and over are multivitamins and minerals, vitamin C and vitamin E preparations. There is insufficient data to quantify the dosage, frequency and duration of supplement use by the older population. Obtaining this information and data about herbal medicine use is an important step towards minimising the risk of drug–nutrient–herbal interactions. Identifying the health professionals who monitor the appropriateness and safety of supplement use in older individuals, particularly given the already high use of medication in this population, also needs to be a focus of future utilisation investigations. This systematic review of the literature published between 1982 and 2003 aims to measure the patterns of dietary supplement use by community-living individuals aged 60 years and over and to profile the characteristics of older supplement users.

Creating demand for better health by using social marketing techniques

The most significant environmental change to support people who want to give up smoking is the legislation to ban smoking in public places. Following Scotland in March 2006, and Wales and Northern Ireland in April 2007, England moves one step closer to being smoke free on 1 July 2007, when it becomes illegal to smoke in almost every enclosed public place and workplace. Social marketing will be used to support this health promoting policy and will become more prominent in the design of health promotion campaigns of the future. Social marketing is not a new approach to promoting health but its adoption by the Government does represent a paradigm shift in the challenge to change public opinion and social norms. As a result some behaviours, like smoking or excessive alcohol consumption, will no longer be socially acceptable. The Department of Health has decided that social marketing should be used in England to guide all future health promotion efforts directed at achieving behavioural goals. This paradigm shift was announced in Chapter 2 of the “Choosing health” White Paper with its emphasis on the consumer, noting that a wide range of lifestyle choices are marketed to people, although health as a commodity itself has not been marketed. The DoH has an internal social marketing development unit to integrate social marketing principles into its work and ensure that providers deliver. The National Centre for Social Marketing has funding to provide ongoing support, to build capacity and capability in the workforce. This article describes the distinguishing features of the social marketing approach. It seeks to answer some questions. Is this really a new idea, a paradigm shift, or simply a change in terminology? What do the marketing principles offer that is new, or are they merely familiar ideas repackaged in marketing jargon? Will these principles be more effective than current health promotion practice and, if so, how does it work? Finally, what are the implications for community pharmacy?

Contextualising accounts of illness:Notions of responsibility and blame in white and South Asian respondents' accounts of diabetes causation

We undertook a secondary analysis of in-depth interviews with white (n = 32) and Pakistani and Indian (n = 32) respondents who had type 2 diabetes, which explored their perceptions and understandings of disease causation. We observed subtle, but important, differences in the ways in which these respondent groups attributed responsibility and blame for developing the disease. Whereas Pakistani and Indian respondents tended to externalise responsibility, highlighting their life circumstances in general and/or their experiences of migrating to Britain in accounting for their diabetes (or the behaviours they saw as giving rise to it), white respondents, by contrast, tended to emphasise the role of their own lifestyle 'choices' and 'personal failings'. In seeking to understand these differences, we argue for a conceptual and analytical approach which embraces both micro- (i.e. everyday) and macro- (i.e. cultural) contextual factors and experiences. In so doing, we provide a critique of social scientific studies of lay accounts/understandings of health and illness. We suggest that greater attention needs to be paid to the research encounter (that is, to who is looking at whom and in what circumstances) to understand the different kinds of contexts researchers have highlighted in presenting and interpreting their data. © 2007 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Women's experiential journey toward voluntary childlessness

Voluntary childlessness is a relatively novel yet growing phenomenon. This idiographic study explored three women's experiential journeys toward voluntary childlessness. Semi-structured interviews were carried out and analysed using Interpretative Phenomenological Analysis. Themes identified were: Owning the choice to be childless, social expectations, and models of mothering. Despite defining ‘voluntary childlessness’ as an unequivocal decision, the women's experiential accounts revealed an intrinsic fluidity in their journeys toward childlessness. Factors including beliefs in equality, independence and career aspirations competed with constructs of mothering/motherhood, partnership and choice to create a complex tapestry of contributory factors in these women's childlessness. The findings question the notion of choice and particularly women's ownership of that choice. The journeys toward childlessness these women shared reveal a synthesis of agentic decision-making, personal histories and challenging lifestyle choices bound up within an existential need to be a woman. More research is needed to determine the place of voluntary childlessness within society. Copyright © 2010 John Wiley & Sons, Ltd

Genetic risk factors and age-related macular degeneration (AMD)

Age related macular degeneration (AMD) is the leading cause of blindness in individuals older than 65 years of age. It is a multifactorial disorder and identification of risk factors enables individuals to make lifestyle choices that may reduce the risk of disease. Collaboration between geneticists, ophthalmologists, and optometrists suggests that genetic risk factors play a more significant role in AMD than previously thought. The most important genes are associated with immune system modulation and the complement system, e.g., complement factor H (CFH), factor B (CFB), factor C3, and serpin peptidase inhibitor (SERPING1). Genes associated with membrane transport, e.g., ATP-binding cassette protein (ABCR) and voltage-dependent calcium channel gamma 3 (CACNG3), the vascular system, e.g., fibroblast growth factor 2 (FGF2), fibulin-5, lysyl oxidase-like gene (LOXL1) and selectin-P (SELP), and with lipid metabolism, e.g., apolipoprotein E (APOE) and hepatic lipase (LIPC) have also been implicated. In addition, several other genes exhibit some statistical association with AMD, e.g., age-related maculopathy susceptibility protein 2 (ARMS2) and DNA excision repair protein gene (ERCC6) but more research is needed to establish their significance. Modifiable risk factors for AMD should be discussed with patients whose lifestyle and/or family history place them in an increased risk category. Furthermore, calculation of AMD risk using current models should be recommended as a tool for patient education. It is likely that AMD management in future will be increasingly influenced by assessment of genetic risk as such screening methods become more widely available. © 2013 Spanish General Council of Optometry.

Adiposity, Sex Hormones, and Repetitive Element DNA Methylation in Healthy Postmenopausal Women

INTRODUCTION: Low levels of methylation within repetitive DNA elements, such as long interspersed nuclear element-1 (LINE-1) and Alu repeats, are believed to epigenetically predispose an individual to cancer and other diseases. The extent to which lifestyle factors affect the degree of DNA methylation within these genomic regions has yet to be fully understood. Adiposity and sex hormones are established risk factors for certain types of cancer and other illnesses, particularly amongst postmenopausal women. The aim of the current investigation is to assess the impact of adiposity and sex hormones on LINE-1 and Alu methylation in healthy postmenopausal women. METHODS: A cross-sectional study was conducted using baseline data from an ancillary study of the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial. Current adiposity was measured using a dual-energy x-ray absorptiometry (DXA) scan, computed tomography (CT) scan, and balance beam scale. Historical weights were self-reported in a questionnaire. Current endogenous sex hormone concentrations were measured in fasting blood serum. Estimated lifetime number of menstrual cycles was used as a proxy for cumulative exposure to ovarian sex hormones. Repetitive element methylation was quantified in white blood cells using a pyrosequencing assay. Linear regression was used to model the relations of interest while adjusting for important confounders. RESULTS: Adiposity and serum estrogen concentrations were positively related to LINE-1 methylation but were not associated with Alu methylation. Cumulative ovarian sex hormone exposure had a “U-shaped” relation with LINE-1 regardless of folate intake and a negative relation with Alu methylation amongst low folate consumers. Androgens were not associated with repetitive element DNA methylation in this population. CONCLUSION: Adiposity and estrogens appear to play a role in maintaining high levels of repetitive element DNA methylation in healthy postmenopausal women. LINE-1 methylation may be a mechanism whereby estrogen exposure protects against cardiovascular and neurodegenerative illnesses. These results add to the growing body of literature showing how the epigenome is shaped by our lifestyle choices. Future prospective studies assessing the relation between levels of repetitive element DNA methylation in healthy individuals and subsequent disease risk are needed to better understand the clinical significance of these results.

The influence of socio-demographic, psychological and knowledge-related variables alongside perceived cooking and food skills abilities in the prediction of diet quality in adults: a nationally representative cross-sectional study

Background: Interventions to increase cooking skills (CS) and food skills (FS) as a route to improving overall diet are popular within public health. This study tested a comprehensive model of diet quality by assessing the influence of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. The correspondence of two measures of diet quality further validated the Eating Choices Index (ECI) for use in quantitative research.
Methods: A cross-sectional survey was conducted in a quota-controlled nationally representative sample of 1049 adults aged 20–60 years drawn from the Island of Ireland. Surveys were administered in participants’ homes via computer-assisted personal interviewing (CAPI) assessing a range of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. Regression models were used to model factors influencing diet quality. Correspondence between 2 measures of diet quality was assessed using chi-square and Pearson correlations.
Results: ECI score was significantly negatively correlated with DINE Fat intake (r = -0.24, p < 0.001), and ECI score was significantly positively correlated with DINE Fibre intake (r = 0.38, p < 0.001), demonstrating a high agreement. Findings indicated that males, younger respondents and those with no/few educational qualifications scored significantly lower on both CS and FS abilities. The relative influence of socio-demographic, knowledge, psychological variables and CS and FS abilities on dietary outcomes varied, with regression models explaining 10–20 % of diet quality variance. CS ability exerted the strongest relationship with saturated fat intake (β = -0.296, p < 0.001) and was a significant predictor of fibre intake (β = -0.113, p < 0.05), although not for healthy food choices (ECI) (β = 0.04, p > 0.05).
Conclusion: Greater CS and FS abilities may not lead directly to healthier dietary choices given the myriad of other factors implicated; however, CS appear to have differential influences on aspects of the diet, most notably in relation to lowering saturated fat intake. Findings suggest that CS and FS should not be singular targets of interventions designed to improve diet; but targeting specific sub-groups of the population e.g. males, younger adults, those with limited education might be more fruitful. A greater understanding of the interaction of factors influencing cooking and food practices within the home is needed.

Evaluation of the uptake of voluntary calorie posting on menus in Ireland

This report was commissioned by the Department of Health, Ireland. Obesity is a public health problem in Ireland which is largely responsible for the increasing prevalence of diet-related diseases and growing financial burden on our healthcare system. Although overweight and obesity rates may have reached a plateau in Irish adults and children, they remain at an extremely high level as 1 in 4 children areoverweight or obese and an estimated 61% of adults are overweight or obese. Urgent public health action is required to reduce the levels of obesity among our children and adults. A sustainable national intervention strategy that combines government and community-led interventions is required. These interventions need to incorporate both nutrition education and environmental modification strategies to reduce levels of obesity. International literature suggests that calorie posting has the potential to have a positive effect on the obesity crisis by encouraging people to make healthier food choices through informed consumer decisions. This evaluation focuses on the uptake of voluntary calorie posting from a national representative sample of food service businesses in Ireland and explores the attitudes of food service businesses that do and do not display calories. This evaluation will explore the most effective and efficient way of implementing mandatory calorie posting on menus in Ireland.

Inkludering av nya motionärer på motionsanläggningar : Motionärers föreställningar om människor som inte motionerar

Syfte Syftet var att undersöka vad aktiva-motionärer anser om vardags-motionärer avseende livsstil, karaktärsdrag och hälsostatus. Metod För att inkludera vardags-motionärer på motionsanläggningar där motionärer finns bör man lösa upp barriärer till motion. Det kan därför vara av nytta att ta reda på om och i så fall vad aktiva-motionärer anser om vardags-motionärer. Detta för att kunna veta om förändringen ska ske hos aktiva-motionärer eller vardags-motionärer för att möjliggöra inkludering av vardagsmotionärer på motionsanläggningar där aktiva-motionärer finns. Detta genomfördes med en kvalitativt inriktad undersökning genom en intervjustudie i form av semistrukturerade intervjuer. Resultat Respondenterna anger att hälsa är en upplevd balans såväl psykiskt som fysiskt. I motsats till detta innebär ohälsa obalans. Konsekvenserna av denna obalans nämnde respondenterna som trötthet, sämre koncentration, övervikt, lättare att drabbas av sjukdomar samt försämrad livskvalité. Det respondenterna nämnde om en vardags-motionär är att denna individ sällan gör mer än vad det behöver i vardagen, är ohälsosamma, innehar obalans och kan drabbas av konsekvenserna som nämns ovan. Slutsats Undersökningen visar att det finns åsikter hos aktiva-motionärer om vardags-motionärer. Dock uttalar sig aktiva-motionärer ogärna om hur vardags-motionärer är som personer, men beskriver enklare deras leverne. Det undersökningen därmed kan konstatera är att andras åsikter är en befogad barriär till varför motion inte bedrivs. Om denna barriär är något som syns utåt på anläggningarna är dock svårt att säga.

Self-management of coronary heart disease in angina patients after percutaneous coronary intervention: A mixed methods study.

After having elective percutaneous coronary intervention (PCI) patients are expected to self-manage their coronary heart disease (CHD) by modifying their risk factors, adhering to medication and effectively managing any recurring angina symptoms but that may be ineffective. Objective: Explore how patients self-manage their coronary heart disease (CHD) after elective PCI and identify any factors that may infl uence that. Design and method: This mixed methods study recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected using a survey and were subject to univariate, bivariate and multi-variate analysis. Qualitative data from participant interviews was analysed using thematic analysis. Findings: After PCI, 74% of participants managed their angina symptoms inappropriately. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. Few patients adopted a healthier lifestyle after PCI. Qualitative analysis revealed that intentional non-adherence to some medicines was an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management. Participants reported strong emotional responses to CHD and this had a detrimental effect on their self-management. Few patients accessed cardiac rehabilitation.