51
|
Fitzpatrick AL, van Pelt M, Heang H, Steinman L, Ide N, Chhea C, LoGerfo JP. Using Targeted mHealth Messages to Address Hypertension and Diabetes Self-Management in Cambodia: Protocol for a Clustered Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11614. [PMID: 30888330 PMCID: PMC6447150 DOI: 10.2196/11614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Hypertension and diabetes represent the first and third highest contributors to global disability. While mobile health (mHealth) messaging programs have rapidly increased in low- and middle-income countries (LMIC), adaptations for specific patient health needs is a new approach to manage chronic conditions. Objective The primary aim of this study is to develop and test an mHealth communication intervention using electronic data capture (by tablet) and voice messaging to improve hypertension and diabetes self-management in Cambodia. The secondary aim is to share results with the Cambodian Ministry of Health and development partners to inform health policy and develop strategies for hypertension and diabetes control. Methods The study design is a cluster randomized controlled clinical trial randomizing each of 75 Community peer educators (PEs), trained and coordinated by MoPoTsyo Patient Information Center in Phnom Penh, into one of 3 groups of 25 (approximately 60 patients each) to receive either tablet+messages, tablet only, or no intervention (control). The total sample within each group includes 25 clusters and approximately 1500 patients located in 7 Operational Districts in rural regions or urban slums in Cambodia. The interventions (groups 1 and 2) were compared with usual PE monitoring without the tablet or mHealth messaging interventions. Focus groups and informant interviews were conducted to develop messages according to specific themes—medications adherence, laboratory testing, physician visits, obesity, smoking, and general lifestyle issues. Using the data received at monthly PE monitoring meetings, patients will receive specific messages based on their individual health challenges. Following the intervention completion, clinical and process outcomes will be compared with baseline metrics between groups. Results PEs were randomized in July 2017, and the intervention was implemented in September 2017 through June 2018. Analyses are underway. Conclusions This project is unique in its combination of electronic data transfer, which can be accessed immediately, with voice messages most relevant to individual patients’ needs. Positive results will indicate the value of using targeted messaging in patient-specific, self-management issues to improve hypertension and diabetes control. International Registered Report Identifier (IRRID) DERR1-10.2196/11614
Collapse
Affiliation(s)
- Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Hen Heang
- MoPoTsyo Patient Information Center, Phnom Penh, Cambodia
| | - Lesley Steinman
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Nicole Ide
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | | | - James P LoGerfo
- Department of Global Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
52
|
Gafarov VV, Gromova EA, Panov DO, Gagulin IV, Gafarova AV. Effect of stress at work on the risk of cardiovascular diseases among the population of 25-64 years in Russia/Siberia (WHO program "MONICA-psychosocial"). TERAPEVT ARKH 2019; 91:13-18. [PMID: 31090365 DOI: 10.26442/00403660.2019.01.000022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM The aim of the study was to determine the impact of stress on work on the risk of cardiovascular disease over a 16-year period in an open population of 25-64 years in Russia/Siberia. MATERIALS AND METHODS A random representative sample of the population of both sexes of 25-64 years old in Novosibirsk in 1994 (men: n=657, 44.3±0.4 years, response - 82.1%, women: n=689, 45.4±0.4 years, response - 72.5%). The screening survey program included: registration of socio-demographic data, determination of stress at work (Karazek scale). The period of prospective follow-up of participants was 16 years. The study identified the following "end points": the first cases of myocardial infarction (MI), stroke. RESULTS A high level of stress at work was in 29.5% of men and 31.6% of women, the average level in 48.9% of men and 50.7% of women (χ2=2.574, υ=2, p=0.276). The risk of developing MI for a 16-year period, among people experiencing stressful situations at work, was: in men, HR=3.592, and women HR=3.218 (95% CI 1.146-9.042); stroke risk - among men, HR=2.603 (95% CI 1.06-4.153) in women HR=1.956 (95% CI 1.008-3.795). In multivariate analysis, in men with stress at work, the risk of MI among men was HR=1.15 (95% CI 0.6-2.2), among women - HR=2.543 (95% CI 1.88-7.351); risk of stroke, was in men, HR=3.8 (95% CI 1.6-8.8), in women - HR=1.95 (95% CI 0.984-3.887). The risk of stroke was higher among single, divorced and widowed men, HR=4.2 (95% CI 1.5-13.2), and in women with secondary or primary education, HR=3 (95% CI 0.852-11.039). CONCLUSION It was established that a high level of stress at work is not gender-specific; the risk of developing MI over a 16-year period is higher in women than in men, stroke in men; the risk of myocardial infarction and stroke in both sexes is affected by the social gradient.
Collapse
Affiliation(s)
- V V Gafarov
- Interdepartmental Laboratory for Epidemiology of Cardiovascular Diseases, Novosibirsk, Russia
| | - E A Gromova
- Interdepartmental Laboratory for Epidemiology of Cardiovascular Diseases, Novosibirsk, Russia
| | - D O Panov
- Interdepartmental Laboratory for Epidemiology of Cardiovascular Diseases, Novosibirsk, Russia
| | - I V Gagulin
- Interdepartmental Laboratory for Epidemiology of Cardiovascular Diseases, Novosibirsk, Russia
| | - A V Gafarova
- Interdepartmental Laboratory for Epidemiology of Cardiovascular Diseases, Novosibirsk, Russia
| |
Collapse
|
53
|
Acute Effects of Hibiscus Sabdariffa Calyces on Postprandial Blood Pressure, Vascular Function, Blood Lipids, Biomarkers of Insulin Resistance and Inflammation in Humans. Nutrients 2019; 11:nu11020341. [PMID: 30764582 PMCID: PMC6412462 DOI: 10.3390/nu11020341] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Objectives: The acute impact of Hibiscus sabdariffa calyces (HSC) extract on postprandial vascular function and other cardiometabolic risk factors have not been studied previously. This study investigated the acute impact of HSC extract consumption on blood pressure (BP), vascular function and other cardiometabolic risk markers. Subjects/Methods: Twenty-five men with 1% to 10% cardiovascular disease (CVD) risk (determined by QRISK®2) were randomised to consume either 250 mL of the aqueous extract of HSC or water with breakfast in a randomised, controlled, single-blinded, 2-meal cross-over study (ClinicalTrials.gov, NTC02165553) with a two weeks washout period between study days. BP was measured at baseline and hourly for 4 h. Flow mediated dilatation (FMD) of the branchial artery was measured at baseline, 2 and 4 h post intervention drink consumption. Results: Acute consumption of aqueous extract of HSC caused a significant increase in % FMD (p < 0.001), a non-significant decrease in systolic BP (SBP) and diastolic BP (DBP); non-significant increase in urinary and plasma nitric oxide (NOx) and reduced response of serum glucose, plasma insulin, serum triacylglycerol and C-reactive protein (CRP) levels; significant (p = 0.026) improvement in the area under systemic antioxidant response curve (0 to 2 h); no significant changes in arterial stiffness following the acute consumption of the extract of HSC. Gallic acid, 4-O-methylgallic acid, 3-O-methylgallic acid and hippuric acid reached a maximum plasma concentration at 1 to 2 h post consumption of the extract of HSC. Conclusion: The extract of HSC improved postprandial vascular function and may be a useful dietary strategy to reduce endothelial dysfunction and CVD risk, although this requires confirmation.
Collapse
|
54
|
Koritala BSC, Çakmaklı S. The human circadian clock from health to economics. Psych J 2018; 7:176-196. [DOI: 10.1002/pchj.252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Bala S. C. Koritala
- Department of Biology; Rutgers, The State University of New Jersey; Camden New Jersey USA
- Center for Computational and Integrative Biology; Rutgers, The State University of New Jersey; Camden New Jersey USA
| | - Selim Çakmaklı
- Department of Economics; Rutgers, The State University of New Jersey; Camden New Jersey USA
| |
Collapse
|
55
|
Zaid M, Hasnain S. Plasma lipid abnormalities in Pakistani population: trends, associated factors, and clinical implications. ACTA ACUST UNITED AC 2018; 51:e7239. [PMID: 30043855 PMCID: PMC6065832 DOI: 10.1590/1414-431x20187239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/29/2018] [Indexed: 12/21/2022]
Abstract
Previous studies have reported increased prevalence of coronary heart disease (CHD) in Indians and South Asian settlers in North America. This increased burden of CHD among South Asians is mainly caused by dyslipidemia. To the best of our knowledge, none of the previous works has studied the patterns and prevalence of dyslipidemia in the Pakistani population. The present work aimed to study the plasma lipid trends and abnormalities in a population-based sample of urban and rural Pakistanis. The study included 238 participants (108 males,130 females). Plasma lipid profiles of the participants were determined using standard protocols. We observed that 63% of the study population displayed irregularities in at least one major lipid-fraction including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides (TG). The most common form of isolated-dyslipidemia was low HDL-C (17.3%) followed by high TG (11.2%). Several overlaps between high TC, LDL-C, TG and low HDL-C were also noted. Gender, urbanization, and occupational class were all observed to have an impact on lipid profiles. Briefly, male, urban, and blue-collar participants displayed higher prevalence of dyslipidemia compared to female, rural, and white-collar participants, respectively. In comparison to normal subjects, dyslipidemic subjects displayed significantly higher values for different anthropometric variables including body mass index (BMI), body fat percentage, and waist circumference. The present work provides a comprehensive estimation of the prevalence of dyslipidemia and CHD risk in the Pakistani population. This information will be helpful for better healthcare planning and resource allocation in Pakistan.
Collapse
Affiliation(s)
- M Zaid
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan.,Department of Life Sciences, University of Management and Technology, Lahore, Pakistan
| | - S Hasnain
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| |
Collapse
|
56
|
Cavalcante DDFB, Brizon VSC, Probst LF, Meneghim MDC, Pereira AC, Ambrosano GMB. Did the Family Health Strategy have an impact on indicators of hospitalizations for stroke and heart failure? Longitudinal study in Brazil: 1998-2013. PLoS One 2018; 13:e0198428. [PMID: 29944665 PMCID: PMC6019246 DOI: 10.1371/journal.pone.0198428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/20/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The objective was to analyze whether socioeconomic factors related to the context and those related to the model of care-specifically the coverage of primary care by the Family Health Strategy (ESF)-had an impact on hospitalizations due to heart failure (HF) and stroke, in the State of São Paulo/Brazil between 1998 and 2013. METHODS A longitudinal ecological study involving 645 municipalities was conducted in the state of São Paulo/Brazil from 1998 to 2013, using the Hospital Information System (SIH-DataSUS database). The hospitalizations for primary care sensitive conditions: Stroke and heart failure (HF) that correspond to the International Classification of Diseases (ICD 10): I50, I63 to I67; I69, G45 to G46 were analyzed longitudinally during the period indicated regarding the percentage of people covered by the Family Health Program (PSF) adjusted for confounders (population size, gross domestic product -GDP and human development index- HDI). RESULTS There was a significant decrease in the number of hospitalizations for heart failure and stroke per 10000 (inhabitants) in the period (p <0.0001), with a significant relationship with increased proportion of ESF (p <0.0001), and this remained significant even when possible confounders (population size, GDP and HDI) were included in the model (p <0.0001). CONCLUSIONS GDP per capita was close to or higher than that if many European countries, which shows the relevance of the study. The health care model based on the Family Health Strategy positively impacted hospitalization indicators for heart failure and stroke, indicating that this model is effective in the prevention of primary care sensitive conditions.
Collapse
Affiliation(s)
| | - Valéria Silva Cândido Brizon
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Livia Fernandes Probst
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Marcelo de Castro Meneghim
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Antonio Carlos Pereira
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Gláucia Maria Bovi Ambrosano
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| |
Collapse
|
57
|
Han Y, Chen J, Qiu M, Li Y, Li J, Feng Y, Qiu J, Meng L, Sun Y, Tao G, Wu Z, Yang C, Guo J, Pu K, Chen S, Wang X. Predicting long-term ischemic events using routine clinical parameters in patients with coronary artery disease: The OPT-CAD risk score. Cardiovasc Ther 2018; 36:e12441. [PMID: 29869835 DOI: 10.1111/1755-5922.12441] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prognosis of patients with coronary artery disease (CAD) at hospital discharge was constantly varying, and postdischarge risk of ischemic events remain a concern. However, risk prediction tools to identify risk of ischemia for these patients has not yet been reported. AIMS We sought to develop a scoring system for predicting long-term ischemic events in CAD patients receiving antiplatelet therapy that would be beneficial in appropriate personalized decision-making for these patients. METHODS In this prospective Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD, NCT01735305) registry, a total of 14 032 patients with CAD receiving at least one kind of antiplatelet agent were enrolled from 107 centers across China, from January 2012 to March 2014. The risk scoring system was developed in a derivation cohort (enrolled initially 10 000 patients in the database) using a logistic regression model and was subsequently tested in a validation cohort (the last 4032 patients). Points in risk score were assigned based on the multivariable odds ratio of each factor. Ischemic events were defined as the composite of cardiac death, myocardial infarction or stroke. RESULTS Ischemic events occurred in 342 (3.4%) patients in the derivation cohort and 160 (4.0%) patients in the validation cohort during 1-year follow-up. The OPT-CAD score, ranging from 0-257 points, consist of 10 independent risk factors, including age (0-71 points), heart rates (0-36 points), hypertension (0-20 points), prior myocardial infarction (16 points), prior stroke (16 points), renal insufficient (21 points), anemia (19 points), low ejection fraction (22 points), positive cardiac troponin (23 points) and ST-segment deviation (13 points). In predicting 1-year ischemic events, the area under receiver operating characteristics curve were 0.73 and 0.72 in derivation and validation cohort, respectively. The incidences of ischemic events in low- (0-90 points), medium- (91-150 points) and high-risk (≥151 points) patients were 1.6%, 5.5%, and 15.0%, respectively. Compared to GRACE score, OPT-CAD score had a better discrimination in predicting ischemic events and all-cause mortality (ischemic events: 0.72 vs 0.65, all-cause mortality: 0.79 vs 0.72, both P < .001). CONCLUSIONS Among CAD patients, a risk score based on 10 baseline clinical variables performed better than the GRACE risk score in predicting long-term ischemic events. However, further research is needed to assess the value of the OPT-CAD score in guiding the management of antiplatelet therapy for patients with CAD.
Collapse
Affiliation(s)
- Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Jiyan Chen
- Guangdong General Hospital, Guangzhou, China
| | - Miaohan Qiu
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Yi Li
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Jing Li
- General Hospital of Shenyang Military Region, Shenyang, China
| | | | - Jian Qiu
- General Hospital of Guangzhou Military Region, Guangzhou, China
| | - Liang Meng
- The Central Hospital Affiliated to Shenyang Medical College, Shenyang, China
| | - Yihong Sun
- China-Japan Friendship Hospital, Beijing, China
| | - Guizhou Tao
- The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Zhaohui Wu
- The Guangdong General Hospital of Armed Police, Guangzhou, China
| | - Chunyu Yang
- The Central Hospital of Tonghua, Tonghua, China
| | - Jincheng Guo
- The Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Kui Pu
- The 254th Hospital of People's Liberation Army, Tianjin, China
| | | | - Xiaozeng Wang
- General Hospital of Shenyang Military Region, Shenyang, China
| |
Collapse
|
58
|
Jaffe MG, Frieden TR, Campbell NRC, Matsushita K, Appel LJ, Lackland DT, Zhang XH, Muruganathan A, Whelton PK. Recommended treatment protocols to improve management of hypertension globally: A statement by Resolve to Save Lives and the World Hypertension League (WHL). J Clin Hypertens (Greenwich) 2018; 20:829-836. [DOI: 10.1111/jch.13280] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/16/2018] [Accepted: 03/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Marc G. Jaffe
- Resolve to Save Lives; Vital Strategies; New York NY USA
- Kaiser Permanente South San Francisco Medical Center; South San Francisco CA USA
| | | | - Norman R. C. Campbell
- O'Brien Institute for Public Health; Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary AB USA
| | - Kunihiro Matsushita
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Daniel T. Lackland
- Medical University of South Carolina; Charleston SC USA
- World Hypertension League; Corvallis MT USA
| | - Xin Hua Zhang
- World Hypertension League; Corvallis MT USA
- WHO Country Office for China; Beijing China
| | - Arumugam Muruganathan
- The Tamil Nadu Dr. MGR Medical University; Chennai India
- American College of Physicians India Chapter; New Delhi India
| | - Paul K. Whelton
- Tulane University School of Public Health and Tropical Medicine; New Orleans; LA USA
| |
Collapse
|
59
|
Despond EA, Dawson JF. Classifying Cardiac Actin Mutations Associated With Hypertrophic Cardiomyopathy. Front Physiol 2018; 9:405. [PMID: 29719515 PMCID: PMC5913282 DOI: 10.3389/fphys.2018.00405] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/04/2018] [Indexed: 11/13/2022] Open
Abstract
Mutations in the cardiac actin gene (ACTC1) are associated with the development of hypertrophic cardiomyopathy (HCM). To date, 12 different ACTC1 mutations have been discovered in patients with HCM. Given the high degree of sequence conservation of actin proteins and the range of protein–protein interactions actin participates in, mutations in cardiac actin leading to HCM are particularly interesting. Here, we suggest the classification of ACTC1 mutations based on the location of the resulting amino acid change in actin into three main groups: (1) those affecting only the binding site of the myosin molecular motor, termed M-class mutations, (2) those affecting only the binding site of the tropomyosin (Tm) regulatory protein, designated T-class mutations, and (3) those affecting both the myosin- and Tm-binding sites, called MT-class mutations. To understand the precise pathogenesis of cardiac actin mutations and develop treatments specific to the molecular cause of disease, we need to integrate rapidly growing structural information with studies of regulated actomyosin systems.
Collapse
Affiliation(s)
- Evan A Despond
- Department of Molecular and Cellular Biology, Centre for Cardiovascular Investigations, University of Guelph, Guelph, ON, Canada
| | - John F Dawson
- Department of Molecular and Cellular Biology, Centre for Cardiovascular Investigations, University of Guelph, Guelph, ON, Canada
| |
Collapse
|
60
|
Ahsan SM, Thomas M, Reddy KK, Sooraparaju SG, Asthana A, Bhatnagar I. Chitosan as biomaterial in drug delivery and tissue engineering. Int J Biol Macromol 2018; 110:97-109. [DOI: 10.1016/j.ijbiomac.2017.08.140] [Citation(s) in RCA: 302] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 12/30/2022]
|
61
|
Ferreira RM, Salis LHA, de Souza E Silva NA. Socioeconomic Development and Cardiovascular Disease. Glob Heart 2018. [PMID: 29525286 DOI: 10.1016/j.gheart.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
62
|
Zhao Q, Wei H, Liu D, Shi B, Li L, Yan M, Zhang X, Wang F, Ouyang Y. PHACTR1 and SLC22A3 gene polymorphisms are associated with reduced coronary artery disease risk in the male Chinese Han population. Oncotarget 2018; 8:658-663. [PMID: 27893421 PMCID: PMC5352186 DOI: 10.18632/oncotarget.13506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/12/2016] [Indexed: 12/22/2022] Open
Abstract
Previous studies showed that PHACTR1 and SLC22A3 are involved in coronary vascular development and are key determinants of cardiovascular disease risk. We conducted a case-control study to examine the effect of SLC22A3 and PHACTR1 single nucleotide polymorphisms (SNPs) on CAD risk among 376 male CAD patients and 388 male healthy controls from China. Eleven SLC22A3 and PHACTR1 SNPs were selected and genotyped using Sequenom Mass-ARRAY technology. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression adjusting for age. The rs9381439 minor allele “A” (OR = 0.72; 95% CI = 0.54–0.96; p = 0.024) in an allelic model was associated with reduced CAD risk, as were the rs2048327 “C/C” (OR = 0.60; 95% CI: 0.37–0.97; p = 0.036) and rs1810126 “T/T” (OR = 0.58; 95% CI: 0.36–0.93; p = 0.024) genotypes. Likewise, the rs9349379 “A/G” genotype in a dominant model (p = 0.041), the rs1810126 “T/C” genotype in additive (p = 0.041) and recessive (p = 0.012) models, and the rs2048327 “C/T” genotype in a recessive model were associated with decreased CAD risk (p = 0.016). These results suggest several PHACTR1 and SLC22A3 polymorphisms are associated with decreased CAD risk in the male Chinese Han population.
Collapse
Affiliation(s)
- Qingbin Zhao
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Huiyi Wei
- Department of Geratology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Dandan Liu
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Baolan Shi
- Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010050, China
| | - Lei Li
- Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010050, China
| | - Mengdan Yan
- School of Life Science, Northwest University, Xi'an, Shaanxi, 710069, China
| | - Xiyang Zhang
- Xi'an Tiangen Precision Medical Institute, Xi'an, Shaanxi 710075, China
| | - Fengjiao Wang
- Xi'an Tiangen Precision Medical Institute, Xi'an, Shaanxi 710075, China
| | - Yongri Ouyang
- School of Life Science, Northwest University, Xi'an, Shaanxi, 710069, China
| |
Collapse
|
63
|
Lisy K, Aromataris E, Moola S, Tufanaru C, Lockwood C. Magnitude and scope of non-communicable disease-related disability: a systematic review protocol. ACTA ACUST UNITED AC 2018; 14:112-133. [PMID: 27846122 DOI: 10.11124/jbisrir-2016-002948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of the review will be to identify, assess and synthesize the evidence that examines the magnitude and scope of disability including impairments, activity limitations and participation restrictions associated with four main non-communicable diseases (NCDs): cardiovascular diseases (CVDs), cancers, diabetes and chronic respiratory diseases.To systematically examine the magnitude of disability associated with CVDs, cancers, diabetes and chronic lung diseases, the questions that this review will specifically address are:To systematically examine the scope of disability associated with CVDs, cancers, diabetes and chronic respiratory diseases, the questions that this review will address are.
Collapse
Affiliation(s)
- Karolina Lisy
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | | | | | | | | |
Collapse
|
64
|
Frieden TR, Jaffe MG. Saving 100 million lives by improving global treatment of hypertension and reducing cardiovascular disease risk factors. J Clin Hypertens (Greenwich) 2018; 20:208-211. [PMID: 29370471 DOI: 10.1111/jch.13195] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Marc G Jaffe
- Resolve to Save Lives, New York, NY, USA.,Kaiser Permanente South, San Francisco Medical Center South, San Francisco, CA, USA
| |
Collapse
|
65
|
Tran BX, Vu GT, Nguyen THT, Nguyen LH, Pham DD, Truong VQ, Thai TPT, Vu TMT, Nguyen TQ, Nguyen V, Nguyen THT, Latkin CA, Ho CS, Ho RC. Demand and willingness to pay for different treatment and care services among patients with heart diseases in Hanoi, Vietnam. Patient Prefer Adherence 2018; 12:2253-2261. [PMID: 30464415 PMCID: PMC6214407 DOI: 10.2147/ppa.s176262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In Vietnam, cardiovascular diseases (CVDs) are serious health issues, especially in the context of overload central heart hospitals, insufficient primary healthcare, and lack of customer-oriented care and treatment. Attempts to measure demand and willingness-to-pay (WTP) for different CVD treatments and care services have been limited. This study explored the preferences and WTP of patients with heart diseases for different home- and hospital-based services in Hanoi, Vietnam. METHODS A cross-sectional survey was performed at the Hanoi Heart Hospital from July to December 2017. A contingent valuation was adopted to determine the preferences of patients and measure their WTP. Interval regressions were employed to determine the potential predictors of patients' WTP. RESULTS Hospital-based services were most preferred by patients, with demand ranging from 45.6% to 82.3% of total participants, followed by home-based (45.4%-45.8%) and administrative services (28.9%-34%). WTP for hospital-based services were in the range of US$ 9.8 (US$ 8.4-11.2)-US$ 21.9 (US$ 20.3-23.4), while figures for home-based and administrative services were US$ 9.8 (US$ 8.4-11.2)-US$ 22 (US$ 18.7-25.3) and 1.9 (US$ 1.6-2.2)-US$ 7.5 (US$ 6.3-8.6), respectively. Patients who lived in urban areas, were employed, were having higher level of education, and were not covered by health insurance were willing to pay more for services, especially home-based ones. CONCLUSION Demand and WTP for home-based services among heart disease patients were moderately low compared with hospital-based ones. There is a need for more policies supporting home-based services, better communication of services' benefits to general public and patients, and introduction of services packages based on patients' preferences.
Collapse
Affiliation(s)
- Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | | | - Thao Phuong Thi Thai
- Department of General Planning and Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | | | | | - Vu Nguyen
- Department of Neurosurgery Spine-Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
| | - Cyrus Sh Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger Cm Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
66
|
Feinstein MJ, Bogorodskaya M, Bloomfield GS, Vedanthan R, Siedner MJ, Kwan GF, Longenecker CT. Cardiovascular Complications of HIV in Endemic Countries. Curr Cardiol Rep 2017; 18:113. [PMID: 27730474 DOI: 10.1007/s11886-016-0794-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Effective combination antiretroviral therapy (ART) has enabled human immunodeficiency virus (HIV) infection to evolve from a generally fatal condition to a manageable chronic disease. This transition began two decades ago in high-income countries and has more recently begun in lower income, HIV endemic countries (HIV-ECs). With this transition, there has been a concurrent shift in clinical and public health burden from AIDS-related complications and opportunistic infections to those associated with well-controlled HIV disease, including cardiovascular disease (CVD). In the current treatment era, traditional CVD risk factors and HIV-related factors both contribute to an elevated risk of myocardial infarction, stroke, heart failure, and arrhythmias. In HIV-ECs, the high prevalence of persons living with HIV and growing prevalence of CVD risk factors will contribute to a growing epidemic of HIV-associated CVD. In this review, we discuss the epidemiology and pathophysiology of cardiovascular complications of HIV and the resultant implications for public health efforts in HIV-ECs.
Collapse
Affiliation(s)
- Matthew J Feinstein
- Division of Cardiovascular Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, USA.
| | - Milana Bogorodskaya
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gerald S Bloomfield
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark J Siedner
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Gene F Kwan
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christopher T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| |
Collapse
|
67
|
Dainelli L, Xu T, Li M, Zimmermann D, Fang H, Wu Y, Detzel P. Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model. BMJ Open 2017; 7:e017136. [PMID: 28951410 PMCID: PMC5623478 DOI: 10.1136/bmjopen-2017-017136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To model the long-term cost-effectiveness of consuming milk powder fortified with potassium to decrease systolic blood pressure (SBP) and prevent cardiovascular events. DESIGN A best case scenario analysis using a Markov model was conducted. PARTICIPANTS 8.67% of 50-79 year olds who regularly consume milk in China, including individuals with and without a prior diagnosis of hypertension. INTERVENTION The model simulated the potential impact of a daily intake of two servings of milk powder fortified with potassium (+700 mg/day) vs the consumption of a milk powder without potassium fortification, assuming a market price equal to 0.99 international dollars (intl$; the consumption of a milk powder without potassium fortification, assuming a market price equal to intl$0.99 for the latter and to intl$1.12 for the first (+13.13%). Both deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results. MAIN OUTCOME MEASURES Estimates of the incidence of cardiovascular events and subsequent mortality in China were derived from the literature as well as the effect of increasing potassium intake on blood pressure. The incremental cost-effectiveness ratio (ICER) was used to determine the cost-effectiveness of a milk powder fortified with potassium taking into consideration the direct medical costs associated with the cardiovascular events, loss of working days and health utilities impact. RESULTS With an ICER equal to int$4711.56 per QALY (quality-adjusted life year) in the best case scenario and assuming 100% compliance, the daily consumption of a milk powder fortified with potassium shown to be a cost-effective approach to decrease SBP and reduce cardiovascular events in China. Healthcare savings due to prevention would amount to intl$8.41 billion. Sensitivity analyses showed the robustness of the results. CONCLUSION Together with other preventive interventions, the consumption of a milk powder fortified with potassium could represent a cost-effective strategy to attenuate the rapid rise in cardiovascular burden among the 50-79 year olds who regularly consume milk in China.
Collapse
Affiliation(s)
| | - Tingting Xu
- China Center for Health Development Studies, Peking University, Beijing, China
- Department of Health Policy and Administration, Peking University School of Public Health, Beijing, China
| | - Min Li
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yangfeng Wu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
- The George Institute for Global Health, Peking University Health Science Centre, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
| | | |
Collapse
|
68
|
AbuMweis S, Jew S, Tayyem R, Agraib L. Eicosapentaenoic acid and docosahexaenoic acid containing supplements modulate risk factors for cardiovascular disease: a meta-analysis of randomised placebo-control human clinical trials. J Hum Nutr Diet 2017; 31:67-84. [PMID: 28675488 DOI: 10.1111/jhn.12493] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Over 200 clinical trials have examined the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplements on risk factors associated with cardiovascular disease. However, an updated analysis of the evidence is lacking. The aim of the present meta-analysis was to quantify the effect of supplements containing EPA and DHA on risk factors for cardiovascular disease. METHODS An analysis was carried on 171 clinical trials with acceptable quality (Jadad score ≥3) that were identified from a comprehensive electronic search strategy of two databases (Pubmed and Cochrane Library). A random effect model was used to obtain an overall estimate on outcomes of interest. Heterogeneity between trial results was tested for using a standard chi-squared test. RESULTS Compared with control, EPA and DHA supplements produced significant reductions of triglycerides of 0.368 mmol L-1 [95% confidence interval (CI) = -0.427 to -0.309], systolic blood pressure of 2.195 mmHg (95% CI = -3.172 to -1.217), diastolic blood pressure of 1.08 mmHg (95% CI = -1.716 to -0.444), heart rate of 1.37 bpm (95% CI = -2.41 to -0.325) and C-reactive protein of 0.343 mg L-1 (95% CI = -0.454 to -0.232). This analysis indicates an increase in both low-density lipoprotein cholesterol (mean difference = 0.150 mmol L-1 ; 95% CI = 0.058-0.243) and high-density lipoprotein cholesterol (mean difference = 0.039 mmol L-1 ; 95% CI = 0.024-0.054). The triglyceride-lowering effect was dose-dependent. CONCLUSIONS The lipid-lowering, hypotensive, anti-arrhythmic and anti-inflammatory actions of EPA and DHA supplements were confirmed in this analysis of randomised placebo-control blinded clinical trials.
Collapse
Affiliation(s)
- S AbuMweis
- Department of Clinical Nutrition and Dietetics, The Hashemite University, Zarqa, Jordan
| | - S Jew
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB, Canada
| | - R Tayyem
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
| | - L Agraib
- Department of Clinical Nutrition and Dietetics, The Hashemite University, Zarqa, Jordan
| |
Collapse
|
69
|
Association of TERT polymorphisms and risk of coronary heart disease in a Chinese Han population. Oncotarget 2017; 8:67519-67525. [PMID: 28978050 PMCID: PMC5620190 DOI: 10.18632/oncotarget.18727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022] Open
Abstract
Genome-wide association studies have identified that TERT gene was associated with telomere length and age-related diseases. However, little study directly focused on the association between TERT gene polymorphisms and risk of coronary heart disease (CHD). We conducted a case-control study to examine the effect of TERT polymorphisms on CHD risk among 596 CHD patients and 603 healthy controls from China. Five significant single nucleotide polymorphisms (SNP) in TERT were selected and genotyped using Sequenom Mass-ARRAY technology. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression adjusting for age and gender. Allelic model analysis revealed that for TERT rs10069690, allele frequency distributions differed between cases and controls (OR= 1.267, 95%CI = 1.018-1.576; p = 0.034). Genotypic model analysis revealed that genotype frequency distributions of rs10069690 differed between cases and controls after adjusted by age and sex (TC vs. CC: adjusted OR = 1.352, 95% CI = 1.007-1.815; p = 0.045). Genetic model analysis revealed that rs10069690 was associated with an increased risk of CHD under co-dominant, dominant, over-dominant and log-additive models. After adjustments, it remained significant under over-dominant model (adjusted OR = 1.35, 95% CI = 1.01-1.81; p = 0.044). Our results shed new light on the association between telomere-related gene TERT polymorphisms and CHD susceptibility in a Chinese Han population.
Collapse
|
70
|
Ejike CECC. Prevalence of Hypertension in Nigerian Children and Adolescents: A Systematic Review and Trend Analysis of Data from the Past Four Decades. J Trop Pediatr 2017; 63:229-241. [PMID: 28082664 DOI: 10.1093/tropej/fmw087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite four decades of research, there is no systematic review and trend analysis on paediatric (pre)hypertension in Nigeria. This article reviewed data from cross-sectional studies on the subject. From the initial 9334 articles identified, 30 studies that met the inclusion criteria were systematically reviewed. Data from studies that defined hypertension as blood pressure (BP) greater than the 95th percentile for age, height and sex gave a prevalence of 8.2% [95% confidence interval (CI): 3.6-28.2%] for prehypertension and 5.1% (95% CI: 2.9-8.6%) for hypertension. For studies that defined hypertension as BP greater than 2 SD points from the mean of the population, the prevalence of hypertension was found to be 4.0% (95% CI: 2.8-5.7%). A significant negative trend (Z = -0.89; α < 0.01) with small magnitude (Q = -0.019; 95% CI: -0.070 to 0.028) was found for hypertension in the reviewed population. The prevalence of (pre)hypertension in Nigerian children and adolescents is moderate but has slightly declined over time.
Collapse
Affiliation(s)
- Chukwunonso E C C Ejike
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, Federal University Ndufu-Alike, Ikwo, PMB 1010 Abakaliki, Ebonyi State, Nigeria
| |
Collapse
|
71
|
Odunaiya NA, Louw QA, Grimmer K. Cross-cultural adaptation, content validation, and reliability of the Nigerian Composite Lifestyle CVD Risk Factors Questionnaire for adolescents among Yoruba rural adolescents in Nigeria. Malawi Med J 2017; 29:103-107. [PMID: 28955415 PMCID: PMC5610278 DOI: 10.4314/mmj.v29i2.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Assessment of lifestyle risk factors must be culturally- and contextually relevant and available in local languages. This paper reports on a study which aimed to cross culturally adapt a composite lifestyle cardiovascular disease (CVD) risk factors questionnaire into an African language (Yoruba) and testing some of its psychometric properties such as content validity and test retest reliability in comparison to the original English version. METHODS This study utilized a cross sectional design. Translation of the English version of the questionnaire into Yoruba was undertaken using the guideline by Beaton et al. The translated instrument was presented to 21 rural adolescents to assess comprehensibility and clarity using a sample of convenience. A test retest reliability was conducted among 150 rural adolescents using a purposive sampling. Data was analyzed using intraclass correlation (ICC ) model 3, Cohen kappa statistics and prevalence rates. RESULTS ICC ranged between 0.4-0.8. The Yoruba version was completed 15-20 minutes and was reported to be culturally appropriate and acceptable for rural Nigerian adolescents. CONCLUSIONS The Yoruba translation of the Nigerian composite lifestyle risk factors questionnaire performs at least as well as the original English version in terms of content validity and reliability. It took a shorter time to complete therefore may be more relevant to rural adolescents.
Collapse
Affiliation(s)
- Nse A Odunaiya
- Department of Physiotherpy, University of Ibadan, Ibadan, Nigeria
- Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa
| | - Quinette A Louw
- Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa
| | - Karen Grimmer
- Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa
- International Center for Allied Health Evidence, University of South Australia, Adelaide, Australia
| |
Collapse
|
72
|
Modeling the Burden of Cardiovascular Diseases in Iran from 2005 to 2025: The Impact of Demographic Changes. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:506-516. [PMID: 28540267 PMCID: PMC5439040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Estimating the burden of non-communicable diseases particularly cardiovascular disease (CVD) is essential for health management and policymaking. In this paper, we used a regression model to estimate the future impact of demographic changes on the burden of CVD in Iran during the next two decades. METHODS Disability-adjusted life years (DALY) were used to estimate the future burden of CVD in Iran. A regression model was used to estimate DALY caused by CVD in the Iranian population aged 30-100 yr, stratified by age group and sex. The predicted population of Iranians aged ≥ 30 yr was entered into the model and DALY were calculated over 2005-2025. To assess the areas of uncertainty in the model, we did sensitivity analysis and Monte Carlo Simulation. RESULTS In the year 2005, there were 847309 DALYs caused by CVD in Iranian adults aged ≥ 30 yr. This figure will nearly be 1728836 DALYs in 2025. In other words, just because of the aging, DALY related to CVD will increase more than two-fold in 2025 compared with 2005. The burden of CVD was higher in men (443235) than in women (404235) in 2005; but in 2025, the difference will be less (867639 vs. 861319). CONCLUSION The burden of CVD will increase steeply in Iran over 2005-2025, mainly because of the aging population. Therefore, more attention is needed to deal with the impact of CVD in the following decades in Iran.
Collapse
|
73
|
Gaziano T, Abrahams-Gessel S, Surka S, Sy S, Pandya A, Denman CA, Mendoza C, Puoane T, Levitt NS. Cardiovascular Disease Screening By Community Health Workers Can Be Cost-Effective In Low-Resource Countries. Health Aff (Millwood) 2017; 34:1538-45. [PMID: 26355056 DOI: 10.1377/hlthaff.2015.0349] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In low-resource settings, a physician is not always available. We recently demonstrated that community health workers-instead of physicians or nurses-can efficiently screen adults for cardiovascular disease in South Africa, Mexico, and Guatemala. In this analysis we sought to determine the health and economic impacts of shifting this screening to community health workers equipped with either a paper-based or a mobile phone-based screening tool. We found that screening by community health workers was very cost-effective or even cost-saving in all three countries, compared to the usual clinic-based screening. The mobile application emerged as the most cost-effective strategy because it could save more lives than the paper tool at minimal extra cost. Our modeling indicated that screening by community health workers, combined with improved treatment rates, would increase the number of deaths averted from 15,000 to 110,000, compared to standard care. Policy makers should promote greater acceptance of community health workers by both national populations and health professionals and should increase their commitment to treating cardiovascular disease and making medications available.
Collapse
Affiliation(s)
- Thomas Gaziano
- Thomas Gaziano is an assistant professor in the Cardiovascular Division of Brigham and Women's Hospital, in Boston, Massachusetts
| | - Shafika Abrahams-Gessel
- Shafika Abrahams-Gessel is a research manager at the Center for Health Decision Science in the Harvard T. H. Chan School of Public Health, in Boston
| | - Sam Surka
- Sam Surka is a researcher in the Chronic Diseases Initiative for Africa at Old Groote Schuur Hospital, in Cape Town, South Africa
| | - Stephen Sy
- Stephen Sy is a programmer at the Center for Health Decision Science in the Harvard T. H. Chan School of Public Health
| | - Ankur Pandya
- Ankur Pandya is an assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health
| | - Catalina A Denman
- Catalina A. Denman is a professor in the Centro de Estudios en Salud y Sociedad at El Colegio de Sonora, in Hermosillo, Mexico
| | - Carlos Mendoza
- Carlos Mendoza is a coinvestigator at the Instituto de Nutricion de Centro America y Panama, in Guatemala City, Guatemala
| | - Thandi Puoane
- Thandi Puoane is a professor in the School of Public Health at the University of the Western Cape, in Bellville, South Africa
| | - Naomi S Levitt
- Naomi S. Levitt is director of the Division of Diabetes and the Chronic Diseases Initiative for Africa, both at Old Groote Schuur Hospital
| |
Collapse
|
74
|
Elhneiti M, Al-Hussami M. Predicting Risk Factors of Heart Disease among Jordanian Patients. Health (London) 2017. [DOI: 10.4236/health.2017.92016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
75
|
Abstract
Countries in the Middle East and North Africa (MENA) region share important sociocultural features but also differ significantly on a number of dimensions, including methods and approaches to addressing the health of their national populations. This article is a systematic analysis of the health systems of the region, including a review of health patterns and services to address them. A number of health systems dimensions are discussed, including the organization of biomedical and traditional medical services, access to health services, financing and resourcing mechanisms, and leadership and governance issues. Current and future challenges that need to be addressed by countries to ensure more efficient and responsive systems are also reviewed.
Collapse
|
76
|
Vaughan Dickson V, Lee CS, Yehle KS, Mola A, Faulkner KM, Riegel B. Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI). Res Nurs Health 2016; 40:15-22. [PMID: 27686630 DOI: 10.1002/nur.21755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 12/11/2022]
Abstract
Although coronary heart disease (CHD) requires a significant amount of self-care, there are no instruments available to measure self-care in this population. The purpose of this study was to test the psychometric properties of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI). Using the Self-Care of Chronic Illness theory, we developed a 22-item measure of maintenance, management, and confidence appropriate for persons with stable CHD and tested it in a convenience sample of 392 adults (62% male, mean age 61.4 ± 9.6 years). Factorial validity was tested with confirmatory factor analysis. Convergent validity was tested with the Medical Outcomes Study MOS-SAS Specific Adherence Scale and the Decision Making Competency Inventory (DMCI). Cronbach alpha and factor determinacy scores (FDS) were calculated to assess reliability. Two multidimensional self-care scales were confirmed: self-care maintenance included "consultative behaviors" (e.g., taking medicines as prescribed) and "autonomous behaviors" (e.g., exercising 30 minute/day; FDS = .87). The multidimensional self-care management scale included "early recognition and response" (e.g., recognizing symptoms) and "delayed response" (e.g., taking an aspirin; FDS = .76). A unidimensional confidence factor captured confidence in each self-care process (α = .84). All the self-care dimensions were associated with treatment adherence as measured by the MOS-SAS. Only self-care maintenance and confidence were associated with decision-making (DCMI). These findings support the conceptual basis of self-care in patients with CHD as a process of maintenance that includes both consultative and autonomous behaviors, and management with symptom awareness and response. The SC-CHDI confidence scale is promising as a measure of self-efficacy, an important factor influencing self-care. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Victoria Vaughan Dickson
- Associate Professor, Rory Meyers College of Nursing, New York University, 433 First Ave, #742, New York, NY, 10010
| | - Christopher S Lee
- Carol A. Lindeman Distinguished Professor, Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR
| | - Karen S Yehle
- Associate Professor, School of Nursing, Center on Aging and the Life Course, Purdue University, West Lafayette, IN
| | - Ana Mola
- Director of Care Transitions and Population Health, NYU Langone Medical Center, New York, NY
| | - Kenneth M Faulkner
- Doctoral Student, Rory Meyers College of Nursing, New York University, New York, NY
| | - Barbara Riegel
- Edith Clemmer Steinbright Professor of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
77
|
Women in Saudi Arabia and the Prevalence of Cardiovascular Risk Factors: A Systematic Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2016; 2016:7479357. [PMID: 27777590 PMCID: PMC5061969 DOI: 10.1155/2016/7479357] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/09/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Abstract
Background. Cardiovascular disease (CVD) is one of the leading causes of death in Saudi Arabia. Saudi women in particular are more susceptible as there are sociocultural restrictions on female physical activities that may lead to high prevalence of CVD risks, especially obesity, and physical inactivity. This study aims to systematically review the published articles related to the prevalence of CVD risk among women in Saudi Arabia. The search strategy covers all published articles that assess the risk factor of CVD in Saudi Arabia from January 2000 to December 2015, using the following sources: Medline, Embase, and PsycINFO. A total of 61 studies were included. Results. Prevalence among Saudi women of smoking ranged from 1.1% to 9.1%, hypertension was 21.8%, diabetes ranged from 9.6% to 27.6%, overweight was 27%, and obesity was 40.23%, and physical inactivity ranged from 53.2% to 98.1%. Hypercholesterolemia prevalence on Saudi women on average was 24.5%, while metabolic syndrome ranged from 13.6% to 40.3%. Conclusion. The prevalence of CVD risk factors is high among women in Saudi Arabia especially in obesity and physical inactivity. Public health authorities must implement solutions from a gender specific aspect to reverse the trend and decrease the prevalence of CVDs among Saudi women.
Collapse
|
78
|
Babu AS, Lopez-Jimenez F, Thomas RJ, Isaranuwatchai W, Herdy AH, Hoch JS, Grace SL. Advocacy for outpatient cardiac rehabilitation globally. BMC Health Serv Res 2016; 16:471. [PMID: 27600379 PMCID: PMC5013580 DOI: 10.1186/s12913-016-1658-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 08/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are the leading cause of death globally. Cardiac rehabilitation (CR) is an evidence-based intervention recommended for patients with CVD, to prevent recurrent events and to improve quality of life. However, despite the proven benefits, only a small percentage of those would benefit from CR actually receive it worldwide. This paper by the International Council of Cardiovascular Prevention and Rehabilitation forwards the groundwork for successful CR advocacy to achieve broader reimbursement, and hence implementation. METHODS First, the results of the International Council's survey on national CR reimbursement policies by government and insurance companies are summarized. Second, a multi-faceted approach to CR advocacy is forwarded. Finally, as per the advocacy recommendations, the economic impact of CVD and the corresponding benefits of CR and its cost-effectiveness are summarized. This provides the case for CR reimbursement advocacy. RESULTS Thirty-one responses were received, from 25 different countries: 18 (58.1 %) were from high-income countries, 10 (32.4 %) from upper middle-income, and 3 (9.9 %) from lower middle-income countries. When asked who reimburses at least some portion of CR services in their country, 19 (61.3 %) reported the government, 17 (54.8 %) reported patients pay out-of-pocket, 16 (51.6 %) reported insurance companies, 12 (38.7 %) reported that it is shared between the patient and another source, and 7 (22.6 %) reported another source. CONCLUSIONS Many patients pay out-of-pocket for CR. CR reimbursement around the world is inconsistent and insufficient. Advocacy campaigns forwarding the CR cause, supported by the relevant literature, enlisting sources of support in a unified manner with an organized plan, are needed, and must be pursued persistently.
Collapse
Affiliation(s)
- Abraham Samuel Babu
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, 576104 Karnataka India
| | - Francisco Lopez-Jimenez
- Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Randal J. Thomas
- Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1 W8 ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7 ON Canada
| | - Artur Haddad Herdy
- Institute of Cardiology of Santa Catarina, Universidade e do Sul de Santa Catarina, Palhoça, Brazil
| | - Jeffrey S. Hoch
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1 W8 ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7 ON Canada
| | - Sherry L. Grace
- School of Kinesiology and Health Science, York University, Bethune 368, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
- Toronto Western Hospital, GoodLife Fitness Cardiovascular Rehabilitation Unit, University Health Network, Toronto, ON Canada
| | - in conjunction with the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR)
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, 576104 Karnataka India
- Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1 W8 ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7 ON Canada
- Institute of Cardiology of Santa Catarina, Universidade e do Sul de Santa Catarina, Palhoça, Brazil
- School of Kinesiology and Health Science, York University, Bethune 368, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
- Toronto Western Hospital, GoodLife Fitness Cardiovascular Rehabilitation Unit, University Health Network, Toronto, ON Canada
| |
Collapse
|
79
|
Coronary Bypass Occlusion and Predisposing Factors. Res Cardiovasc Med 2016. [DOI: 10.5812/cardiovascmed.34797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
80
|
Equity impact analysis of medical approaches to cardiovascular diseases prevention in Tanzania. Soc Sci Med 2016; 170:208-217. [PMID: 27590271 DOI: 10.1016/j.socscimed.2016.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 01/07/2023]
Abstract
Primary medical prevention of cardiovascular disease (CVD) has received low priority in Tanzania, despite evidence of the rising prevalence of CVD risk factors. Different guidelines have been proposed for medical CVD prevention, including the European Society of Cardiology (ESC) and the World Health Organization (WHO) guidelines, which recommend medical prevention for all individuals based on the consideration of single CVD risk thresholds. A third alternative is differentiated risk thresholds according to age. This paper compares the WHO and the differentiated risk threshold by age approaches against a baseline of no medical CVD prevention and a best scenario identical to the ESC approach in Tanzania. Assuming fixed budgets, we evaluate the guidelines according to three outcome measures, namely: efficiency, inequality and the combination of efficiency and inequality. We ran a Markov analysis for an estimated Tanzanian population at risk of CVD employing a 40 years time horizon to estimate the total expected costs and CVD deaths associated with provision of the different guidelines. The results were then used to calculate three outcomes: life expectancy at age 40 as a proxy for efficiency, the Gini coefficient (a measure of inequality), and the achievement index (which combines concerns of efficiency and inequality). Our results suggest that higher life expectancy (28.3 vs. 26.6 years) and more equally distributed health (Gini coefficient of 0.22 vs. 0.24) could be attained if medical CVD prevention was based on the differentiated risk threshold approach compared to the WHO single risk threshold, when the total cost of these approaches is the same. Preventing CVD based on differentiating risk thresholds by age seems to be the better alternative when concerns of both efficiency and inequality are considered important. However, further research on the country-specific distribution of CVD risk levels and budget impact analysis are important to assess the feasibility of its implementation.
Collapse
|
81
|
Abstract
OBJECTIVES The objectives of this review are to discuss the global epidemiology of cardiovascular disease, emphasizing congenital heart disease; to discuss the concept of epidemiologic transition and its role in studying the evolving epidemiology of disease; and to assess and address the global burden of congenital heart disease including its prevention and treatment. DATA SOURCE MEDLINE and PubMed. CONCLUSIONS Despite impressive reductions in mortality from congenital and acquired cardiovascular disease in high-income countries, these reductions have not been observed on a global scale. It will be necessary to continue our attempts to extend rational programs of care to middle- and low-income countries based on community empowerment, economics, and population health. The specialist in pediatric cardiac critical care can be a central driver of these programs.
Collapse
|
82
|
Ngalesoni FN, Ruhago GM, Mori AT, Robberstad B, Norheim OF. Cost-effectiveness of medical primary prevention strategies to reduce absolute risk of cardiovascular disease in Tanzania: a Markov modelling study. BMC Health Serv Res 2016; 16:185. [PMID: 27184802 PMCID: PMC4869389 DOI: 10.1186/s12913-016-1409-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a growing cause of mortality and morbidity in Tanzania, but contextualized evidence on cost-effective medical strategies to prevent it is scarce. We aim to perform a cost-effectiveness analysis of medical interventions for primary prevention of CVD using the World Health Organization’s (WHO) absolute risk approach for four risk levels. Methods The cost-effectiveness analysis was performed from a societal perspective using two Markov decision models: CVD risk without diabetes and CVD risk with diabetes. Primary provider and patient costs were estimated using the ingredients approach and step-down methodologies. Epidemiological data and efficacy inputs were derived from systematic reviews and meta-analyses. We used disability- adjusted life years (DALYs) averted as the outcome measure. Sensitivity analyses were conducted to evaluate the robustness of the model results. Results For CVD low-risk patients without diabetes, medical management is not cost-effective unless willingness to pay (WTP) is higher than US$1327 per DALY averted. For moderate-risk patients, WTP must exceed US$164 per DALY before a combination of angiotensin converting enzyme inhibitor (ACEI) and diuretic (Diu) becomes cost-effective, while for high-risk and very high-risk patients the thresholds are US$349 (ACEI, calcium channel blocker (CCB) and Diu) and US$498 per DALY (ACEI, CCB, Diu and Aspirin (ASA)) respectively. For patients with CVD risk with diabetes, a combination of sulfonylureas (Sulf), ACEI and CCB for low and moderate risk (incremental cost-effectiveness ratio (ICER) US$608 and US$115 per DALY respectively), is the most cost-effective, while adding biguanide (Big) to this combination yielded the most favourable ICERs of US$309 and US$350 per DALY for high and very high risk respectively. For the latter, ASA is also part of the combination. Conclusions Medical preventive cardiology is very cost-effective for all risk levels except low CVD risk. Budget impact analyses and distributional concerns should be considered further to assess governments’ ability and to whom these benefits will accrue.
Collapse
Affiliation(s)
- Frida N Ngalesoni
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania. .,Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway.
| | - George M Ruhago
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway
| | - Amani T Mori
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Centre of International Health, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Centre of International Health, University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway
| |
Collapse
|
83
|
Odunaiya NA, Louw QA, Grimmer KA. Are lifestyle cardiovascular disease risk factors associated with pre-hypertension in 15-18 years rural Nigerian youth? A cross sectional study. BMC Cardiovasc Disord 2015; 15:144. [PMID: 26537355 PMCID: PMC4632346 DOI: 10.1186/s12872-015-0134-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/25/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a public health concern worldwide. Hypertensive heart disease is predominant in Nigeria. To effectively reduce CVD in Nigeria, the prevalence of, and factors associated with, pre-hypertension in Nigerian youth first need to be established. METHODS A locally-validated CVD risk factor survey was completed by 15-18 year olds in a rural setting in south-west Nigeria. Body Mass Index (BMI), waist-hip ratio and systolic and diastolic blood pressure was measured. Putative risk factors were tested in gender-specific hypothesized causal pathways for overweight/obesity, and for pre-hypertension. RESULTS Of 1079 participants, prevalence of systolic pre-hypertension was 33.2 %, diastolic pre-hypertension prevalence approximated 5 %, and hypertension occurred in less than 10 % sample. There were no gender differences in prevalence of pre- hypertension, and significant predictors of systolic pre-hypertension (high BMI and older age) were identified. Considering high BMI, older age was a risk for both genders, whilst fried food preference was female-only risk, and low breakfast cereal intake was a male-only risk. CONCLUSION Rural Nigerian adolescents are at-risk of future CVD because of lifestyle factors, and high prevalence of systolic pre-hypertension. Relevant interventions can now be proposed to reduce BMI and thus ameliorate future rural adult Nigerian CVD.
Collapse
Affiliation(s)
- N A Odunaiya
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
- Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria.
| | - Q A Louw
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
| | - K A Grimmer
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
- International Center for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| |
Collapse
|
84
|
Yan LD, Chi BH, Sindano N, Bosomprah S, Stringer JS, Chilengi R. Prevalence of hypertension and its treatment among adults presenting to primary health clinics in rural Zambia: analysis of an observational database. BMC Public Health 2015; 15:933. [PMID: 26391985 PMCID: PMC4578849 DOI: 10.1186/s12889-015-2258-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background Hypertension constitutes a growing burden of illness in developing countries like Zambia. Adequately screening and treating hypertension could greatly reduce the complications of stroke and coronary disease. Our objective was to determine the prevalence of hypertension and identify current treatment practices among adult patients presenting for routine care to rural health facilities in the Better Health Outcomes through Mentoring and Assessments (BHOMA) project. Methods We conducted a retrospective analysis of routinely collected clinical data from 46 rural government clinics in Zambia. Our analysis cohort comprised patients ≥ 25 years with recorded blood pressure measurements, who sought care at primary health centers. Consistent with prior research, in our primary analysis, we only included data from first visits. Hypertension was defined as a systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or reported use of antihypertensive medication. A sensitivity analysis was performed using median blood pressure for individuals with multiple visits. Results and Discussion From January 2011 to December 2014, 116,130 first visits by adult patients met eligibility criteria. The crude prevalence of hypertension by onsite measurement or reported use of antihypertensive medication was 23.1 % [95 % CI: 22.8-23.3] (23.6 % in females, 22.3 % in males). The age standardized prevalence of hypertension across participating sites was 28.0 % [95 % CI: 27.7-28.3] (29.7 % in females, 25.8 % in males). Sensitivity analysis revealed a similar prevalence using data from all visits. Only 5.6 % of patients had a diagnosis of hypertension documented in their medical record. Among patients with hypertension, only 18.0 % had any antihypertensive drug prescribed, with nifedipine (8.9 %), furosemide (8.3 %), and propranolol (2.4 %) as the most common. Conclusions Age standardized prevalence of hypertension in rural primary health clinics in Zambia was high compared to other studies in rural Africa; however, we diagnosed hypertension with only one measurement and this may have biased our findings. Future efforts to improve hypertension control should focus on population preventive care and primary healthcare provider education on individual management. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2258-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lily D Yan
- Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. .,Stanford University School of Medicine, Stanford, California, USA.
| | - Benjamin H Chi
- Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. .,Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | - Ntazana Sindano
- Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia.
| | - Samuel Bosomprah
- Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. .,Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
| | - Jeffrey Sa Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | - Roma Chilengi
- Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. .,Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| |
Collapse
|
85
|
Nse O, Quinette L, Okechukwu O. A systematic review and appraisal of methods of developing and validating lifestyle cardiovascular disease risk factors questionnaires. Afr Health Sci 2015; 15:931-40. [PMID: 26957984 PMCID: PMC4765453 DOI: 10.4314/ahs.v15i3.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Well developed and validated lifestyle cardiovascular disease (CVD) risk factors questionnaires is the key to obtaining accurate information to enable planning of CVD prevention program which is a necessity in developing countries. We conducted this review to assess methods and processes used for development and content validation of lifestyle CVD risk factors questionnaires and possibly develop an evidence based guideline for development and content validation of lifestyle CVD risk factors questionnaires. MATERIALS/METHODS Relevant databases at the Stellenbosch University library were searched for studies conducted between 2008 and 2012, in English language and among humans. Using the following databases; pubmed, cinahl, psyc info and proquest. Search terms used were CVD risk factors, questionnaires, smoking, alcohol, physical activity and diet. RESULTS Methods identified for development of lifestyle CVD risk factors were; review of literature either systematic or traditional, involvement of expert and /or target population using focus group discussion/interview, clinical experience of authors and deductive reasoning of authors. For validation, methods used were; the involvement of expert panel, the use of target population and factor analysis. CONCLUSION Combination of methods produces questionnaires with good content validity and other psychometric properties which we consider good.
Collapse
Affiliation(s)
- Odunaiya Nse
- Division of Physiotherapy, Stellenbosch University, RSA
- Department of Physiotherapy, University of Ibadan, Nigeria
| | - Louw Quinette
- Division of Physiotherapy, Stellenbosch University, RSA
| | - Ogah Okechukwu
- Department of Internal medicine, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
86
|
Wensink GE, Schoffelen AF, Tempelman HA, Rookmaaker MB, Hoepelman AIM, Barth RE. Albuminuria Is Associated with Traditional Cardiovascular Risk Factors and Viral Load in HIV-Infected Patients in Rural South Africa. PLoS One 2015; 10:e0136529. [PMID: 26309226 PMCID: PMC4550462 DOI: 10.1371/journal.pone.0136529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/04/2015] [Indexed: 01/13/2023] Open
Abstract
Context As life expectancy improves among Human Immunodeficiency Virus (HIV) patients, renal and cardiovascular diseases are increasingly prevalent in this population. Renal and cardiovascular disease are mutual risk factors and are characterized by albuminuria. Understanding the interactions between HIV, cardiovascular risk factors and renal disease is the first step in tackling this new therapeutic frontier in HIV. Methods In a rural primary health care centre, 903 HIV-infected adult patients were randomly selected and data on HIV-infection and cardiovascular risk factors were collected. Glomerular filtration rate (eGFR) was estimated. Albuminuria was defined as an Albumin-Creatinine-Ratio above 30 mg/g. Multivariate logistic regression analysis was used to analyse albuminuria and demographic, clinical and HIV-associated variables. Results The study population consisted of 903 HIV-infected patients, with a median age of 40 years (Inter-Quartile Range (IQR) 34–48 years), and included 625 (69%) women. The median duration since HIV diagnosis was 26 months (IQR 12–58 months) and 787 (87%) received antiretroviral therapy. Thirty-six (4%) of the subjects were shown to have diabetes and 205 (23%) hypertension. In the cohort, 21% had albuminuria and 2% an eGFR <60 mL/min/1.73m2. Albuminuria was associated with hypertension (adjusted odds ratio (aOR) 1.59; 95% confidence interval (CI) 1.05–2.41; p<0.05), total cholesterol (aOR 1.31; 95% CI 1.11–1.54; p<0.05), eGFR (aOR 0.98; 95% CI 0.97–0.99; p<0.001) and detectable viral load (aOR 2.74; 95% CI 1.56–4.79; p<0.001). Hypertension was undertreated: 78% were not receiving treatment, while another 11% were inadequately treated. No patients were receiving lipid-lowering medication. Conclusion Glomerular filtration rate was well conserved, while albuminuria was common amongst HIV-infected patients in rural South Africa. Both cardiovascular and HIV-specific variables were associated with albuminuria. Improved cardiovascular risk prevention as well as adequate virus suppression might be the key to escape the vicious circle of renal failure and cardiovascular disease and improve the long-term prognosis of HIV-infected patients.
Collapse
Affiliation(s)
- G. Emerens Wensink
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Annelot F. Schoffelen
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
| | | | - Maarten B. Rookmaaker
- Department of Nephrology & Hypertension at the University Medical Centre in Utrecht, Utrecht, The Netherlands
| | - Andy I. M. Hoepelman
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
| | - Roos E. Barth
- Department of Internal Medicine & Infectious Diseases at the University Medical Centre in Utrecht, Utrecht, The Netherlands
| |
Collapse
|
87
|
Computational design, functional analysis and antigenic epitope estimation of a novel hybrid of 12 peptides of hirudin and reteplase. J Mol Model 2015; 21:229. [PMID: 26267298 DOI: 10.1007/s00894-015-2774-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
Cardiovascular and cerebrovascular diseases are leading causes of morbidity and mortality for human beings, and thrombosis is the major risk factor. Thrombolytic therapy has been testified to be the most effective approach to cure thrombosis-related diseases. In clinical treatment, we often adopt a combination therapeutic regimen of both thrombolytic and anticoagulant agents to prevent the recurrence of thrombosis. Thus, a novel hybrid (HV12p-rPA) comprised of the C-terminal 12 residues of hirudin-PA (HV12p) and reteplase (rPA) was designed. The three-dimensional structure of this hybrid was mimicked based on homology modeling and refined with dynamics simulation by utilizing Amber12.0 software. The function of the hybrid was analyzed by structure comparison and the root mean square deviation (RMSD) of Cα atoms between the hybrid and native rPA was calculated. The results showed that HV12p, which was located in the N-terminus of the hybrid, was far from the rPA segment of the hybrid and had no influence on the conformational stability of the rPA domain. The RMSD of Cα atoms of these superimposed proteins was about 40Å, implying that the hybrid had a similar spatial conformation to that of native rPA. Additionally, the antigenic epitopes of the hybrid were predicted by estimations of Hopp-Wood hydrophilicity, Janin accessibility, Zimmermane-Simha polarity, Bhaskaran-Ponnuswamy flexibility, as well as secondary structure analysis and Kolaskar-Tongaonkar antigenicity prediction. The results showed that the most likely antigenic determinants were located at or near regions 148-152, 257-262 and 321-330.
Collapse
|
88
|
Odunaiya NA, Grimmer K, Louw QA. High prevalence and clustering of modifiable CVD risk factors among rural adolescents in southwest Nigeria: implication for grass root prevention. BMC Public Health 2015; 15:661. [PMID: 26169588 PMCID: PMC4501296 DOI: 10.1186/s12889-015-2028-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 07/06/2015] [Indexed: 12/03/2022] Open
Abstract
Background Cardiovascular disease (CVD) is an immense global problem with serious economic and social consequences. Modifiable risk factors for CVD have been identified internationally in adolescents where early intervention programs have the potential to reduce CVD risk on individual and population levels. In developing countries such as Nigeria, little is known about the prevalence of modifiable CVD risk factors among adolescents especially in the rural areas. Methods This paper reports on a cross-sectional survey of modifiable CVD risk factors among rural adolescents in South-West Nigeria. All 15–18 years old adolescents in all the schools at Ibarapa central local government were approached and all those who assented and consented to participate in the study were involved. A total of 1500 adolescents participated in the study. Measurements of CVD risks factors taken were; smoking, physical activity, alcohol, dietary pattern using a questionnaire developed by authors. Other CVD risk factors such as waist hip ratio and BMI were taken using standardized instruments. Data were analyzed using STATA version 12. Results Data from 1079 adolescents (56.5 % males and 53.5 % females) were analyzed. Mean age of males was 16.4 ± 1.14 years and mean age for females was 16.29 ± 1.13 years. Adolescents showed clustering of CVD risk factors with about 72 % having between two and four risk factors. A total of 102 clustering patterns were reported. The most common clustering pattern (19.6 %) included high animal lipid and salt diet. Conclusion There is high level and clustering of CVD risk factors among rural adolescents in Southwest Nigeria. The most common clustering pattern was biased towards dietary factors. The high prevalence of CVD risk factors among rural adolescents in Southwest Nigeria suggests that urgent primary prevention programs are required to prevent the next generation of Nigerians from suffering of CVD. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2028-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- N A Odunaiya
- Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa. .,Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria.
| | - K Grimmer
- Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa. .,International Center for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| | - Q A Louw
- Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| |
Collapse
|
89
|
Hypocholesterolemic Effect and In Vitro Pancreatic Lipase Inhibitory Activity of an Opuntia ficus-indica Extract. BIOMED RESEARCH INTERNATIONAL 2015; 2015:837452. [PMID: 26078966 PMCID: PMC4442264 DOI: 10.1155/2015/837452] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/20/2015] [Indexed: 11/17/2022]
Abstract
Cholesterol control is fundamental for prevention of cardiovascular disorders. In this work, the hypocholesterolemic activity of an aqueous Opuntia ficus-indica extract (AOE) was tested in triton-induced mice. The inhibitory activity on pancreatic lipase enzyme was evaluated in vitro by the same extract. Furthermore, polyphenol content of the extract was evaluated. Hypercholesterolemia was induced in three groups of mice by intraperitoneal administration of Triton WR-1339. After induction of hypercholesterolemia, the groups were treated with an AOE (500 mg/kg) and saline solution and the positive control group with orlistat, respectively. Cholesterol levels were measured 24 h later in peripheral blood. The levels of blood cholesterol after administration of AOE significantly decreased compared to negative control. The inhibitory activity of AOE on pancreatic lipase enzyme was evaluated at concentrations from 60 to 1000 μg/mL. The AOE inhibited the pancreatic lipase with an IC50 = 588.5 μg/mL. The AOE had a high content of polyphenolic compounds. These results show that AOE is able to prevent hypercholesterolemia by pancreatic lipase inhibition, in part due to its polyphenolic compounds.
Collapse
|
90
|
Turk-Adawi KI, Grace SL. Narrative review comparing the benefits of and participation in cardiac rehabilitation in high-, middle- and low-income countries. Heart Lung Circ 2015; 24:510-20. [PMID: 25534902 PMCID: PMC4527841 DOI: 10.1016/j.hlc.2014.11.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/08/2014] [Accepted: 11/18/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cardiovascular disease is a leading cause of morbidity worldwide. Cardiac rehabilitation (CR) is a comprehensive secondary prevention approach, with established benefits in reducing morbidity in high-income countries (HICs). The objectives of this review were to summarise what is known about the benefits of CR, including consideration of cost-effectiveness, in addition to rates of CR participation and adherence in high-, as well as low- and middle-income countries (LMICs). METHODS A literature search of Medline, Excerpta Medica Database (EMBASE), and Google Scholar was conducted for published articles from database inception to October 2013. The search was first directed to identify meta-analyses and reviews reporting on the benefits of CR. Then, the search was focussed to identify articles reporting CR participation and dropout rates. Full-text versions of relevant abstracts were summarised qualitatively. RESULTS Based on meta-analysis, CR significantly reduced all-cause mortality by 13%-26%, cardiac mortality by 20%-36%, myocardial re-infarction by 25%-47%, and risk factors. CR is cost-effective in HICs. In LMICs, CR is demonstrated to reduce risk factors, with no studies on mortality or cost-effectiveness. Based on available data, CR participation rates are <50% in the majority of countries, with documented dropout rates up to 56% and 82% in high- and middle-income countries, respectively. CONCLUSIONS CR is a beneficial intervention for heart patients in high and LMICs, but is underutilised with low participation and adherence rates worldwide. While more research is needed in LMICs, strategies shown to increase participation and program adherence should be implemented.
Collapse
Affiliation(s)
- Karam I Turk-Adawi
- School of Health Policy and Management, York University, Toronto, Ontario, Canada; College of Health Professions, Al-Quds University, Jerusalem, Palestinian Authority.
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Cardiovascular Rehabilitation & Prevention, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
91
|
Deng XU, Xia KE, Chen PO, Ali Sheikh MS, Yang DAF, Li SM, Yang TL. Reversion of left ventricle remodeling in spontaneously hypertensive rats by valsartan is associated with the inhibition of caspase-3, -8 and -9 activities. Biomed Rep 2015; 3:533-536. [PMID: 26171161 DOI: 10.3892/br.2015.458] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/08/2015] [Indexed: 11/05/2022] Open
Abstract
The development of hypertension is closely associated with cardiac hypertrophy and apoptosis, and caspase-3, -8 and -9 are key enzymes of apoptosis. The aim of the present study was to evaluate the effects of valsartan on left ventricle hypertrophy and myocardial apoptosis in spontaneously hypertensive rats (SHRs) and to explore the mechanisms for valsartan against apoptosis. A total of 15 SHRs (16 weeks old) were randomly divided into two groups. The SHRs in the valsartan (n=8) and SHR groups (n=7) were fed with valsartan and distilled water for 8 weeks, respectively. Wistar-Kyoto rats (n=8) were the control group. At the end of the experiments, blood pressure, parameters regarding hypertrophy, apoptosis and activities of caspase-3, -8 and -9 were measured. The results showed that valsartan significantly reduced systolic blood pressure and left ventricular hypertrophy, improved left ventricular remodeling, attenuated the myocardial damage and apoptosis, and decreased the activities of caspase-3, -8 and -9 in SHRs. In conclusion, valsartan is able to reverse hypertension-induced left ventricle remodeling, which is associated with, at least in part, its inhibitory effect on myocardial apoptosis in the death receptor-mediated extrinsic, as well as the mitochondrial-mediated intrinsic pathways.
Collapse
Affiliation(s)
- X U Deng
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - K E Xia
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - P O Chen
- Hunan Provincial Tumor Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Md Sayed Ali Sheikh
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - DA-Feng Yang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Si-Min Li
- Xiangya Stomatological Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Tian-Lun Yang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| |
Collapse
|
92
|
Dahari M, Dawson JF. Do cardiac actin mutations lead to altered actomyosin interactions? Biochem Cell Biol 2015; 93:330-4. [PMID: 26194323 DOI: 10.1139/bcb-2014-0156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is currently hypothesized that increased heart muscle contractility leads to hypertrophic cardiomyopathy (HCM), and reduced contractility leads to dilated cardiomyopathy (DCM). To determine if changes in the core interaction between actin and myosin occur due to mutations in the cardiac actin gene (ACTC), we measured the interactions between myosin and 8 ACTC mutant proteins found in patients with HCM or DCM. R312H showed a decreased actin-activated myosin S1 ATPase rate (13.1 ± 0.63 μmol/L/min) compared to WT (15.3 ± 1.6 μmol/L/min), whereas the rate with E99K was significantly higher (20.1 ± 1.5 μmol/L/min). In vitro motility assays with varying ATP concentrations showed that the KM for E99K remains unchanged with a significantly decreased Vmax (1.90 ± 0.37 μm/sec) compared to WT (3.33 ± 0.46 μm/sec). Based on a 5 nm myosin step size, we calculated a duty ratio of approximately 0.04 for WT and the majority of mutant actins; however, the duty ratio for E99K was twice as high. Based on our analysis of 8 ACTC mutants, we infer that mutations in ACTC lead to disease through various molecular mechanisms. While changes in actomyosin interactions with the E99K mutation might cause increased ATP usage and tension leading to HCM, measurable changes in the basic interaction between actin and myosin do not appear to be involved in the mechanisms of disease development for the other ACTC mutants tested.
Collapse
Affiliation(s)
- Marissa Dahari
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada.,Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - John F Dawson
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada.,Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| |
Collapse
|
93
|
Mitchell-Fearon K, Willie-Tyndale D, Waldron N, Holder-Nevins D, James K, Laws H, Eldemire-Shearer D. Cardio-Vascular Disease and Cancer: A Dichotomy in Utilization of Clinical Preventive Services by Older Adults in a Developing Country. Gerontol Geriatr Med 2015; 1:2333721415611821. [PMID: 28138475 PMCID: PMC5119902 DOI: 10.1177/2333721415611821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 09/16/2015] [Indexed: 11/15/2022] Open
Abstract
Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services.
Collapse
Affiliation(s)
| | | | - N. Waldron
- The University of the West Indies, Kingston, Jamaica
| | | | - K. James
- The University of the West Indies, Kingston, Jamaica
| | - H. Laws
- The University of the West Indies, Kingston, Jamaica
| | | |
Collapse
|
94
|
Xu S, Huang Y, Xiao J, Zhu W, Wang L, Tang H, Hu Y, Liu T. The association between job strain and coronary heart disease: a meta-analysis of prospective cohort studies. Ann Med 2015; 47:512-8. [PMID: 26416502 DOI: 10.3109/07853890.2015.1075658] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies about work stress and the risk of coronary heart disease (CHD) have yielded inconsistent results. This meta-analysis aimed to investigate the association between job strain and the risk of CHD. METHODS We searched PubMed and Embase databases for studies reporting data on job strain and the risk of CHD. Studies were included if they reported multiple-adjusted relative risk (RR) with 95% confidence interval (CI) with respect to CHD from job strain. RESULTS Fourteen prospective cohort studies comprising 232,767 participants were included. The risk of CHD was increased in high-strain (RR 1.26; 95% CI 1.12-1.41) and passive jobs (RR 1.14; 95% CI 1.02-1.29) but not in active jobs (RR 1.09; 95% CI 0.97-1.22), when compared with low-strain group. The increased risk of CHD in high-strain and passive jobs was mainly driven by studies with a follow-up duration of ≥ 10 years. Neither the low-control (RR 1.06; 95% CI 0.93-1.19) nor high-demand (RR 1.13; 95% CI 0.97-1.32) dimension was independently associated with the risk of CHD. CONCLUSIONS Individuals with high-strain and passive jobs were more likely to experience a CHD event. Intervention programs incorporating individual and organizational levels are crucial for reducing job strain and the risk of CHD.
Collapse
Affiliation(s)
- Shuxian Xu
- a Shenzhen Psychiatric College, Anhui Medical University , Shenzhen, Guangdong , PR China.,b Department of Psychiatry , Shenzhen Key Laboratory of Psychological Health Center , Shenzhen, Guangdong , PR China
| | - Yuli Huang
- c Department of Cardiology , the First People's Hospital of Shunde (the Affiliated Hospital at Shunde, Southern Medical University) , Foshan, Guangdong , China
| | - Jiping Xiao
- d Department of Medical Psychology , Anhui Medical University , Hefei, Anhui , PR China
| | - Wenjing Zhu
- d Department of Medical Psychology , Anhui Medical University , Hefei, Anhui , PR China
| | - Lulu Wang
- e School of Nursing, Anhui Medical University , Hefei, Anhui , PR China
| | - Hongfeng Tang
- c Department of Cardiology , the First People's Hospital of Shunde (the Affiliated Hospital at Shunde, Southern Medical University) , Foshan, Guangdong , China
| | - Yunzhao Hu
- c Department of Cardiology , the First People's Hospital of Shunde (the Affiliated Hospital at Shunde, Southern Medical University) , Foshan, Guangdong , China
| | - Tiebang Liu
- b Department of Psychiatry , Shenzhen Key Laboratory of Psychological Health Center , Shenzhen, Guangdong , PR China
| |
Collapse
|
95
|
Mugure G, Karama M, Kyobutungi C, Karanja S. Correlates for cardiovascular diseases among diabetic/hypertensive patients attending outreach clinics in two Nairobi slums, Kenya. Pan Afr Med J 2014; 19:261. [PMID: 25852804 PMCID: PMC4382055 DOI: 10.11604/pamj.2014.19.261.5261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/27/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are the leading cause of death in the world. Over 80% of CVD related deaths occur in low- and middle-income countries (LMICs). Diabetes and hypertension, whose prevalence in Kenya is on the rise, are major risk factors for CVD. Despite this, studies indicate that awareness on the management of risk factors for CVD among diabetic/hypertensive patients in African populations is generally low. The aim of the study was to determine the risk factors for CVD among diabetic and/or hypertensive patients attending diabetes and hypertension management clinics in Korogocho and Viwandani slums of Nairobi. METHODS Data were collected using questionnaires administered to 206 diabetic/hypertensive patients attending the clinics between July 2010 and February 2011. A review of these patients' medical records was done to determine the history of CVD outcomes such as hypertensive heart diseases, stroke and peripheral arterial diseases. RESULTS Majority (66.5%) of the study participants were females mainly in the 51-65 age category. The study findings revealed that 73 (33.4%) respondents had CVD outcomes. In addition, 41.8% of the respondents were not aware of the causes of diabetes/hypertension. Age category 51-65 years had the highest (43.8%) number of respondents with CVD. Sex of the respondents and awareness of the link between hypertension and CVD were significantly associated with CVD outcomes (p<0.05) among the respondents. CONCLUSION Measures to improve awareness levels among patients at high risk of CVD outcomes are needed to complement other measures to reduce CVD risk among such patients.
Collapse
Affiliation(s)
- Gladys Mugure
- Jomo Kenyatta University of Agriculture and Technology-College of Health Sciences, Nairobi, Kenya
| | - Mohamed Karama
- Kenya Medical Research Institute, Mbagathi Way, Nairobi City, Kenya
| | | | - Simon Karanja
- Jomo Kenyatta University of Agriculture and Technology-College of Health Sciences, Nairobi, Kenya
| |
Collapse
|
96
|
Contractor A, Sarkar BK, Arora M, Saluja K. Addressing Cardiovascular Disease Burden in low and Middle Income Countries (LMICs). CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0405-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
97
|
|
98
|
Ding F, Deng H, Du Y, Shi X, Wang Q. Emerging chitin and chitosan nanofibrous materials for biomedical applications. NANOSCALE 2014; 6:9477-93. [PMID: 25000536 DOI: 10.1039/c4nr02814g] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Over the past several decades, we have witnessed significant progress in chitosan and chitin based nanostructured materials. The nanofibers from chitin and chitosan with appealing physical and biological features have attracted intense attention due to their excellent biological properties related to biodegradability, biocompatibility, antibacterial activity, low immunogenicity and wound healing capacity. Various methods, such as electrospinning, self-assembly, phase separation, mechanical treatment, printing, ultrasonication and chemical treatment were employed to prepare chitin and chitosan nanofibers. These nanofibrous materials have tremendous potential to be used as drug delivery systems, tissue engineering scaffolds, wound dressing materials, antimicrobial agents, and biosensors. This review article discusses the most recent progress in the preparation and application of chitin and chitosan based nanofibrous materials in biomedical fields.
Collapse
Affiliation(s)
- Fuyuan Ding
- School of Resource and Environmental Science and Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, 430079, China.
| | | | | | | | | |
Collapse
|
99
|
Ngalesoni F, Ruhago G, Norheim OF, Robberstad B. Economic cost of primary prevention of cardiovascular diseases in Tanzania. Health Policy Plan 2014; 30:875-84. [PMID: 25113027 PMCID: PMC4524339 DOI: 10.1093/heapol/czu088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important.
Collapse
Affiliation(s)
- Frida Ngalesoni
- Ministry of Health and Social Welfare, PO Box 9083 Dar es Salaam, Tanzania, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway,
| | - George Ruhago
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway, School of Public Health and Social Sciences, Muhimbili University, PO Box 65015 Dar es Salaam, Tanzania and
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway
| | - Bjarne Robberstad
- Center of International Health, University of Bergen, PO Box 7804, N-5020, Bergen, Norway
| |
Collapse
|
100
|
Rasella D, Harhay MO, Pamponet ML, Aquino R, Barreto ML. Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data. BMJ 2014; 349:g4014. [PMID: 24994807 PMCID: PMC4080829 DOI: 10.1136/bmj.g4014] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the impact of Brazil's recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil from 2000 to 2009. DESIGN Ecological longitudinal design, evaluating the impact of FHP using negative binomial regression models for panel data with fixed effects specifications. SETTING Nationwide analysis of data from Brazilian municipalities covering the period from 2000 to 2009. DATA SOURCES 1622 Brazilian municipalities with vital statistics of adequate quality. MAIN OUTCOME MEASURES The annual FHP coverage and the average FHP coverage in previous years were used as main independent variables and classified as none (0%), incipient (<30%), intermediate (30-69%), or consolidated (≥ 70%). Age standardised mortality rates from causes in the group of cerebrovascular (ICD-10 codes I60-69), ischaemic (ICD-10 I20-25), and other forms of heart diseases (ICD-10 I30-52), which were included in the national list of ambulatory care-sensitive conditions, were calculated for each municipality for each year. They accounted for 40% of all deaths from these groups during the study period. RESULTS FHP coverage was negatively associated with mortality rates from cerebrovascular and heart diseases (ambulatory care-sensitive conditions) in both unadjusted and adjusted models for demographic, social, and economic confounders. The FHP had no effect on the mortality rate for accidents, used as a control. The rate ratio for the effect of consolidated annual FHP coverage on cerebrovascular disease mortality and on heart disease mortality was 0.82 (95% confidence interval 0.79 to 0.86) and 0.79 (0.75 to 0.80) respectively, reaching the value of 0.69 (0.66 to 0.73) and 0.64 (0.59 to 0.68) when the coverage was consolidated during all the previous eight years. Moreover, FHP coverage increased the number of health education activities, domiciliary visits, and medical consultations and reduced hospitalisation rates for cerebrovascular and heart disease. Several complementary analyses showed quantitatively similar results. CONCLUSIONS Comprehensive and community based primary health care programmes, such as the FHP in Brazil, acting through cardiovascular disease prevention, care, and follow-up can contribute to decreased cardiovascular disease morbidity and mortality in a developing country such as Brazil.
Collapse
Affiliation(s)
- Davide Rasella
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil
| | - Michael O Harhay
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Marina L Pamponet
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil
| | - Rosana Aquino
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil Ciência, Tecnologia e Inovação em Saúde, INCT-CITECS, Salvador, Bahia, Brazil
| | - Mauricio L Barreto
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil Ciência, Tecnologia e Inovação em Saúde, INCT-CITECS, Salvador, Bahia, Brazil
| |
Collapse
|