101
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Yang F, Qian D, Liu X. Socioeconomic disparities in prevalence, awareness, treatment, and control of hypertension over the life course in China. Int J Equity Health 2017; 16:100. [PMID: 28610576 PMCID: PMC5470255 DOI: 10.1186/s12939-017-0597-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/06/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The socioeconomically disadvantaged populations are more likely to suffer from hypertension, and few have effectively treated and controlled their hypertension. Research on socioeconomic disparities in prevalence, awareness, treatment, and control of hypertension is warranted to inform the development of new strategies for reducing such health inequities. METHODS The China Health and Nutrition Survey (CHNS) followed up 20,174 individuals over a 20-year period. We added seven key socioeconomic indicators with age and age-squared into the mixed-effects models to explicitly assess the effect of socioeconomic determinants on hypertension throughout the adult life course. RESULTS Prevalence of hypertension was at a higher level in the younger birth cohorts than that in the older generations. Age-related increases in prevalence, awareness, treatment, and control of hypertension were observed over the adult life course. Males, insured and ethnic Han were more likely to suffer from hypertension than their counterparts [coefficient (95% confidence intervals): 0.07(0.04, 0.09), 0.02(0.01, 0.03) and 0.05(0.03, 0.07), respectively]. Hypertension was more prevalent among individuals with higher income who lived in urbanized communities, and less among those with higher education attainment [coefficient (95% confidence intervals): -0.07(-0.12, -0.016)] across adulthood. High-level urbanization and education increased the probabilities of awareness, treatment, and control of hypertension, while household income decreased them [coefficient (95% confidence intervals): 0.28(0.17, 0.39), 0.27(0.17, 0.37) and 0.14(0.08, 0.21), respectively] over the adult life course. CONCLUSIONS Community urbanicity brought the raise in awareness, treatment, and control of hypertension, but also led to an increase in prevalence of hypertension. People with fewer educational years or higher income may be the disadvantaged population of hypertension over the adult life course in China.
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Affiliation(s)
- Fan Yang
- School of Health Policy & Management, Nanjing Medical University, Hanzhong Road 140, Nanjing, 210029 Jiangsu Province People’s Republic of China
| | - Dongfu Qian
- School of Health Policy & Management, Nanjing Medical University, Hanzhong Road 140, Nanjing, 210029 Jiangsu Province People’s Republic of China
| | - Xueyi Liu
- School of Health Policy & Management, Nanjing Medical University, Hanzhong Road 140, Nanjing, 210029 Jiangsu Province People’s Republic of China
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102
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Daniali SS, Darani FM, Eslami AA, Mazaheri M. Relationship between Self-efficacy and Physical Activity, Medication Adherence in Chronic Disease Patients. Adv Biomed Res 2017; 6:63. [PMID: 28603704 PMCID: PMC5458405 DOI: 10.4103/2277-9175.190997] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The global epidemic of unhealthy lifestyle causes to increase chronic disease. It has been proven that psychological factors such as self-efficacy are responsible to success in the process of lifestyle change. Low self-efficacy is usually related to low level of physical activity and medication adherence. Objective of the study was to investigate the effects of self-efficacy, other physical symptoms on physical activity and medication adherence in patients with chronic illness in public health centers. MATERIALS AND METHODS A cross-sectional study was conducted on 483 patients with chronic diseases attended to governmental health care centers in Isfahan. Participants were chosen by systematic random sampling. Inclusion criteria were having a chronic illness at least 6-month ago while prescription of medication and willing to take part in the survey. The parts of Stanford Self-management Questionnaire were used. Data were analyzed by SPSS 18 software using the descriptive and analytic statistics. P < 0.05 was considered significant. RESULTS Mean age of participants was 54.8 (7.22) years. The half of participants had low self-efficacy and 87.2% had low physical activity. Nearly 80% of patients had a good medication adherence. There was a significant relationship between self-efficacy and physical activity (P = 0.336, β = 1.01, P < 0.001). CONCLUSION Although chronic disease patients had a good medication adherence, other self-care behaviors such as physical activity has been neglected. It is seemed that concentration on psychological factors such as self-efficacy should be considered as a proximal factor to improve self-care.
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Affiliation(s)
- Seyde Shahrbanoo Daniali
- Department of Health, Student Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firooze Mostafavi Darani
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Ali Eslami
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mazaheri
- Department of Traditional Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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103
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Feng XL, Martinez-Alvarez M, Zhong J, Xu J, Yuan B, Meng Q, Balabanova D. Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949-1980). Int J Equity Health 2017; 16:49. [PMID: 28532500 PMCID: PMC5441056 DOI: 10.1186/s12939-017-0541-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has made remarkable progress in scaling up essential services during the last six decades, making health care increasingly available in rural areas. This was partly achieved through the building of a three-tier health system in the 1950s, established as a linked network with health service facilities at county, township and village level, to extend services to the whole population. METHODS We developed a Theory of Change to chart the policy context, contents and mechanisms that may have facilitated the establishment of the three-tier health service delivery system in rural China. We systematically synthesized the best available evidence on how China achieved universal access to essential services in resource-scarce rural settings, with a particular emphasis on the experiences learned before the 1980s, when the country suffered a particularly acute lack of resources. RESULTS The search identified only three peered-reviewed articles that fit our criteria for scientific rigor. We therefore drew extensively on government policy documents, and triangulated them with other publications and key informant interviews. We found that China's three-tier health service delivery system was established in response to acute health challenges, including high fertility and mortality rates. Health system resources were extremely low in view of the needs and insufficient to extend access to even basic care. With strong political commitment to rural health and a "health-for-all" policy vision underlying implementation, a three-tier health service delivery model connecting villages, townships and counties was quickly established. We identified several factors that contributed to the success of the three-tier system in China: a realistic health human resource development strategy, use of mass campaigns as a vehicle to increase demand, an innovative financing mechanisms, public-private partnership models in the early stages of scale up, and an integrated approach to service delivery. An implementation process involving gradual adaptation and incorporation of the lessons learnt was also essential. CONCLUSIONS China's 60 year experience in establishing a de-professionalized, community-based, health service delivery model that is economically feasible, institutionally and culturally appropriate mechanism can be useful to other low- and middle-income countries (LMICs) seeking to extend essential services. Lessons can be drawn from both reform content and from its implementation pathway, identifying the political, institutional and contextual factors shaping the three-tier delivery model over time.
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Affiliation(s)
- Xing Lin Feng
- School of Public Health, Peking University, Xueyuan Road 38#, Beijing, 100191, China.
| | | | - Jun Zhong
- School of Public Health, Peking University, Xueyuan Road 38#, Beijing, 100191, China
| | - Jin Xu
- London School of Hygiene and Tropical Medicine, London, UK.,Peking University China Center for Health Development Studies (CCHDS), Beijing, China
| | - Beibei Yuan
- Peking University China Center for Health Development Studies (CCHDS), Beijing, China
| | - Qingyue Meng
- Peking University China Center for Health Development Studies (CCHDS), Beijing, China
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104
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YANG F, QIAN D, HU D. Life-course and Cohort Trajectories of Chronic Non-communicable Diseases Risk Factors in China. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:591-601. [PMID: 28560188 PMCID: PMC5442270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND NCDs are the leading disease burdens in China and the NCDs risk factors shifts have accelerated at an unprecedented scale over the past 30 years. The aim of this study was to analysis the natural trajectories of NCDs risk factors over the life course. METHODS The large-scale longitudinal data from the CHNS includes nine rounds of surveys between 1989 and 2011. Overall, 145913 observations (29719 individuals) at multiple exams have been followed up over a 23-year period. The mixed-effects models with random intercepts were used to the characterize shifts in the distribution of these risk factors across the whole life course. RESULTS During about 23 years observational period across all age bands, the mean AMC, UAC, TSF, BMI, WC, DBP, SD, DD, and PA trajectory all increased until a certain age. Then decreased in both gender, whereas SBP strictly increased across lifespan; and the secular trend in AMC and WC, SBP, DBP was greater in women than in men; younger generations had higher AMC, UAC, TSF, BMI, WC, WHR, WHtR, SBP, DBP levels across adulthood, whereas younger birth cohorts had lower SD, DD, and PA levels. CONCLUSION We observed in a large and comprehensive longitudinal dataset that provided strong evidence of population-wide secular shifts from childhood onwards, which suggests that promoting healthier lifestyles, body weight, blood pressure and enhancing the primary practitioner's capability should be required to reduce the burden of NCDs in China.
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105
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Li J, Feng XL. Health care-seeking behaviours and health expenditures in adults aged 45 years and older in China, 2011-2013. Trop Med Int Health 2017; 22:638-654. [PMID: 28278358 DOI: 10.1111/tmi.12865] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To provide an assessment of China's progress to universal health coverage (UHC) from the perspective of people-centred care. METHODS We obtained data on 28 103 participants from the China Health and Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic regressions and generalised linear models to analyse care-seeking behaviours and medical expenditures. RESULTS We found that 95.5% of the subjects were covered by social health insurance in 2013, and nearly 60% subjects in need of medical care were self-medicated. Health insurance was a strong predictor for the access to outpatient care. Use of pure and mixed self-medication increased by 15% and 32% respectively, while use of pure outpatient care fell by 10% between 2011 and 2013, after adjusting for predisposing, service needs and enabling factors. Such trends were particularly evident for the Urban Resident Basic Medical Insurance and the New Cooperative Medical Scheme, which covered more than 80%. The monthly out-of-pocket medical expenditures and the probability of encountering catastrophic health expenditures for outpatient care were four times larger than that for self-medication. Between 2011 and 2013, outpatient care medical costs rose by nearly 50%, whereas there was no such obvious trend for self-medication. People with insurance schemes offering lower cost sharing incurred consistently higher out-of-pocket outpatient payments. CONCLUSIONS The monitoring of global progress to UHC should incorporate self-medication. In China, it seems that the current reform and the huge government investment have not resulted in access to affordable quality care. To achieve UHC, not only universal insurance, but system-level efforts are needed.
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Affiliation(s)
- Jiasen Li
- School of Public Health, Peking University, Beijing, China
| | - Xing Lin Feng
- School of Public Health, Peking University, Beijing, China
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106
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Zhang Y, Tang W, Zhang Y, Liu L, Zhang L. Effects of integrated chronic care models on hypertension outcomes and spending: a multi-town clustered randomized trial in China. BMC Public Health 2017; 17:244. [PMID: 28284202 PMCID: PMC5346199 DOI: 10.1186/s12889-017-4141-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 02/23/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hypertension affects one billion people globally and is one of the leading risk factors for cardiovascular and renal diseases. However, hypertension management remains poor, especially in rural China. METHODS A clustered randomized controlled trial was conducted in six towns in China's Qianjiang county between 7/2012 and 6/2014, including 5462 hypertension patients above 35 years old. Six towns were randomly assigned to three groups: Group 1 had the integrated care model including a multidisciplinary team and continuous care coordination, Group 2 had both the integrated care model and provider-level financial incentives, and the control group had the usual care. Primary outcomes were systolic blood pressure and health-related quality of life measured by SF36; secondary outcomes included hypertension-related hospitalization rate and inpatient spending. Blood pressure was measured sixteen times bimonthly between 12/1/2011 and 6/30/2014, and quality of life was measured on 7/1/2012 and 6/30/2014. Inpatient data between 7/1/2010 and 8/31/2014 were used. This trial is registered at the World Health Organization's International Clinical Trials Registry, number ChiCTR-OOR-14005563. RESULTS We found that the integrated care model effectively lowered blood pressure by 1.93 mmHg (95% CI 0.063-3.8), improved self-assessed health-related quality of life, and reduced the rate of hypertension-related hospitalization by 0.17 percentage points (95% CI 0.094-0.24). We also found that the provider-level financial contract further lowered blood pressure by 1.76 mmHg (95% CI 0.73-2.79) and reduced rates of hospitalization and inpatient spending, but it also reduced patients' self-assessed health-related quality of life. CONCLUSIONS Integrated care and financial incentives are effective in lowering blood pressure and reducing hospitalization rate, but financial contracts may hurt patient quality of life. This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563) on November 23, 2014. It was a retrospective registration.
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Affiliation(s)
- Yuting Zhang
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Wenxi Tang
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian St, Jiangning District, Nanjing, 211198, China
| | - Yan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province, Wuhan, Hubei, 430030, China
| | - Lulu Liu
- Department of Economics, University of Pittsburgh, 230 S. Bouquet St, Pittsburgh, PA, 15260, USA
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei, 430030, China. .,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province, Wuhan, Hubei, 430030, China.
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107
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Watkins DA, Nugent RA. Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries. HEART ASIA 2017; 9:54-58. [PMID: 28321266 PMCID: PMC5337683 DOI: 10.1136/heartasia-2015-010690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/04/2022]
Abstract
Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low- and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC.
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Affiliation(s)
- David A Watkins
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rachel A Nugent
- Research Triangle Institute International, Research Triangle Park, North Carolina, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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108
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Feng XL. Undiagnosed and Uncontrolled Chronic Conditions in China: Could Social Health Insurance Consolidation Make a Change? Med Care Res Rev 2017; 75:479-515. [PMID: 29148342 DOI: 10.1177/1077558717690303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Policy makers in China are considering consolidating the country's fragmented health insurance programs. This system consists of three components. The Urban Employee Basic Medical Insurance (UEBMI) covers formal employees, the New Cooperative Medical Scheme (NCMS) covers rural residents, and the Urban Resident Basic Medical Insurance (URBMI) covers urban residents. Consolidation could, in theory, create a more efficient health system that is better able to address noncommunicable diseases. Using national survey data during 2011 to 2013, I found that 44% to 76% cases of hypertension, diabetes, and dyslipidemia went undiagnosed among Chinese adults aged 45 and older. I found that the UEBMI enrollees had a greater number of health checks and 10% higher rates of diagnosis. Assuming that this level of efficiency would be possible under an integrated system, I conducted microsimulation analyses to project future benefits. Such consolidation could result in 46.2 million new diagnoses, and 30.0 million of these cases would be controlled.
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Affiliation(s)
- Xing Lin Feng
- 1 School of Public Health, Peking University, Beijing, China
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109
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Qin T, Liu W, Yin M, Shu C, Yan M, Zhang J, Yin P. Body mass index moderates the relationship between C-reactive protein and depressive symptoms: evidence from the China Health and Retirement Longitudinal Study. Sci Rep 2017; 7:39940. [PMID: 28128231 PMCID: PMC5269588 DOI: 10.1038/srep39940] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/29/2016] [Indexed: 12/17/2022] Open
Abstract
The present study aimed to investigate the role of abnormal body mass index (BMI, kg/m2) in the depression-CRP (C-reactive protein) relationship in a healthy middle-aged and elderly Chinese population. Analytical samples were drawn from the China Health and Retirement Longitudinal Study (CHARLS), and participants were categorized by different BMI levels. Depressive subtypes were evaluated both at baseline and follow-up using the Center for Epidemiology Studies Depression scale. Hs-CRP and other variables were measured at baseline. Multiple linear regression analyses were used to evaluate the cross-sectional and longitudinal relationship between depression and baseline hs-CRP. Depression was significantly negatively associated with BMI (ρ = −0.077, p < 0.0001), with underweight associated with worse depressive symptoms than other BMI groups. Both cross-sectional and longitudinal associations between serum hs-CRP and depressive subtypes were significantly positive in the underweight group (p < 0.05). However, in the other BMI groups (from normal weight to obesity), the CRP-depression relationship was no longer significant (p > 0.05). The significant relationship between CRP and depression in the underweight group suggested that not only obesity but also a low BMI could explain a substantial portion of the inflammation-depression link.
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Affiliation(s)
- Tingting Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wenhua Liu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Minghui Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chang Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mingming Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jianyuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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110
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Daniali SS, Eslami AA, Maracy MR, Shahabi J, Mostafavi-Darani F. The impact of educational intervention on self-care behaviors in overweight hypertensive women: A randomized control trial. ARYA ATHEROSCLEROSIS 2017; 13:20-28. [PMID: 28761451 PMCID: PMC5515187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 11/04/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND The improper control of self-care in hypertension imposes a lot of financial burden on the health-care system. On the other hand, the importance of participatory care and high effectiveness of self-management programs have been confirmed. This study was aimed to examine the effect of an educational intervention on self-efficacy, self-care behaviors and blood pressure (BP) of hypertensive obese or overweight women in the primary health-care setting in Isfahan, Iran. METHODS This randomized controlled trial was an educational intervention program. It was performed among 146 hypertensive women of 30-65 age range who referred to 6 health care centers of Isfahan that randomly assigned to a control and intervention groups. The interventional group participated in the 6 weekly sessions including exercises, weight control, medication adherence, and home self-monitoring based on goal setting, and promotion of self-efficacy. The control group received routine care from health-care center and any special intervention has been done for the control group. Output variables were analyzed after intervention, and 6-month follow-up. RESULTS There are no significant differences between age, weight, body mass index and BP and biochemical variables except lipids as well as behavioral factors at the baseline. After 6 months intervention self-efficacy (< 0.001) and physical activity (< 0.001) improvement of in the intervention group was significantly different in comparison with the control group. After 6 months, there was a significant reduction in systolic (P < 0.001) and diastolic BP (P = 0.010) in the intervention group. CONCLUSION Participatory method of education could help us to convince patients to have better self-care to control disease. Furthermore, since adherence to the treatment of hypertensive patients in our society is low, organizing such courses can teach essential knowledge and skills to lifestyle change and prevention of complications. Performing these courses is recommended for other chronic disease patients in health-care centers to assess self-management programs on self-care behavior.
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Affiliation(s)
- Seyedeh Shahrbanoo Daniali
- PhD Candidate, Student Research Committee, Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Ali Eslami
- Associate Professor, Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Professor, Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Shahabi
- Assistant Professor, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi-Darani
- Associate Professor, Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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111
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Shen Y, Peng X, Wang M, Zheng X, Xu G, Lü L, Xu K, Burstrom B, Burstrom K, Wang J. Family member-based supervision of patients with hypertension: a cluster randomized trial in rural China. J Hum Hypertens 2017; 31:29-36. [PMID: 26911532 PMCID: PMC5144121 DOI: 10.1038/jhh.2016.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
Empirical evidence has suggested that social support from family can help patients take their medicines correctly. This study aims to evaluate the role of a family member-based supervision package in the management of hypertension using a cluster randomized trial in rural China. We recruited patients with hypertension from four villages in Yangzhong and randomly allocated them to the control group (n=288) and the intervention group (n=266). A family member-based supervision package was applied to the intervention group, while the usual service was applied to the controls. Patients were followed for 12 months and completed face-to-face interviews at the end of 6 and 12 months. The primary outcomes were patients' medication adherence and frequency of blood pressure measurement. Secondary outcomes included changes in blood pressure, altered risk behaviours and occurrence of hypertension-related complications. To control for the effects of cluster randomization, multilevel mixed-effects regression models were used to compare group changes. We observed that the intervention improved patients' blood pressure measurement frequency (OR: 9.00, 95% CI: 4.52-17.91) and adherence to antihypertensive treatment (OR: 1.74, 95% CI: 0.91-3.32). Its effect on the blood pressure control rate was significant at the mid-term investigation (OR: 0.67, 95% CI: 0.40-0.93), but the long-term effect was not significant (OR: 0.89, 95% CI: 0.64-1.26). After 6 months of intervention, either systolic or diastolic blood pressure was significantly decreased in the intervention group. However, this difference was not significant at the final investigation. Findings from this study revealed that the family member-based supervised therapy may have positive effects on patients' adherence to blood monitoring and hypertensive medications.
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Affiliation(s)
- Y Shen
- Department of Gastrointestinal Surgery, Aoyoung Hospital, Zhangjiagang, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Peng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - M Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Zheng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - G Xu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - L Lü
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - K Xu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - B Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - K Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - J Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- The Innovation Center for Social Risk Governance in Health, School of Public Health, Nanjing Medical University, Nanjing, China
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112
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Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, Damasceno A, Delles C, Gimenez-Roqueplo AP, Hering D, López-Jaramillo P, Martinez F, Perkovic V, Rietzschel ER, Schillaci G, Schutte AE, Scuteri A, Sharman JE, Wachtell K, Wang JG. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet 2016; 388:2665-2712. [PMID: 27671667 DOI: 10.1016/s0140-6736(16)31134-5] [Citation(s) in RCA: 579] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Michael H Olsen
- Department of Internal Medicine, Holbæk Hospital and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Sonia Y Angell
- Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Samira Asma
- Global NCD Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pierre Boutouyrie
- Department of Pharmacology and INSERM U 970, Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada
| | - Julio A Chirinos
- Department of Medicine at University Hospital of Pennsylvania and Veteran's Administration, PA, USA
| | | | - Christian Delles
- Christian Delles: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Anne-Paule Gimenez-Roqueplo
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015, Paris, France; Paris Descartes University, F-75006, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Genetics, F-75015, Paris, France
| | - Dagmara Hering
- The University of Western Australia-Royal Perth Hospital, Perth, WA, Australia
| | - Patricio López-Jaramillo
- Direccion de Investigaciones, FOSCAL and Instituto de Investigaciones MASIRA, Facultad de Medicina, Universidad de Santander, Bucaramanga, Colombia
| | - Fernando Martinez
- Hypertension Clinic, Internal Medicine, Hospital Clinico, University of Valencia, Valencia, Spain
| | - Vlado Perkovic
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Ernst R Rietzschel
- Department of Cardiology, Ghent University and Biobanking & Cardiovascular Epidemiology, Ghent University Hospital, Ghent, Belgium
| | - Giuseppe Schillaci
- Department of Internal Medicine, University of Perugia, Terni University Hospital, Terni, Italy
| | - Aletta E Schutte
- Medical Research Council Unit on Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Angelo Scuteri
- Hypertension Center, Hypertension and Nephrology Unit, Department of Medicien, Policlinico Tor Vergata, Rome, Italy
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kristian Wachtell
- Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases Oslo University Hospital, Oslo, Norway
| | - Ji Guang Wang
- The Shanghai Institute of Hypertension, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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113
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Yin M, Augustin B, Fu Z, Yan M, Fu A, Yin P. Geographic Distributions in Hypertension Diagnosis, Measurement, Prevalence, Awareness, Treatment and Control Rates among Middle-aged and Older Adults in China. Sci Rep 2016; 6:37020. [PMID: 27841326 PMCID: PMC5107929 DOI: 10.1038/srep37020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/24/2016] [Indexed: 12/22/2022] Open
Abstract
Hypertension is of public health importance in China, but information on geographic distribution on hypertension by map visualization is limited for middle-aged and older adults. Regional geographic variations remain unexplained. Our study is to present geographic distributions at the provincial level and identify provinces and municipalities with high hypertension diagnosis, measurement and prevalence rates and/or low awareness, treatment, control rates among aged 45+ adults in China. We used data collected from the China Health and Retirement Longitudinal Study (n = 13,583) of Chinese people aged 45 years or older. We used weighted rates for our analysis. The rates by provinces and municipalities were compared using map visualization, and explore the main factors of the disparity using ordinal logistic regression. Higher hypertension prevalence rates (56.3%) but lower hypertension awareness, treatment and control rates (37.3%, 21.1% and 14.9%, respectively) were observed in Guizhou. Shanghai and Beijing had the highest hypertension prevalence, awareness and treatment rates (65.0%, 87.8% and 80.0% for Shanghai, 57.5%, 88.6% and 77.5% for Beijing, respectively). Remarkable variations were observed among surveyed provinces and municipalities. Several Chinese regions show particularly higher prevalence rates and/or lack of hypertension awareness and poor control.
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Affiliation(s)
- Minghui Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Balekouzou Augustin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingming Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Adan Fu
- Department of Nursing, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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114
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Yin M, Augustin B, Shu C, Qin T, Yin P. Probit Models to Investigate Prevalence of Total Diagnosed and Undiagnosed Diabetes among Aged 45 Years or Older Adults in China. PLoS One 2016; 11:e0164481. [PMID: 27723833 PMCID: PMC5056726 DOI: 10.1371/journal.pone.0164481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/25/2016] [Indexed: 01/19/2023] Open
Abstract
The aims of this study are to identify the most important predictors of total diagnosed and undiagnosed diabetes and estimate the mean change in the predicted probability among aged 45+ adults in China. We used baseline data collected from 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS) (n = 9,513). First, we estimated the prevalence of diagnosed, measured, total diagnosed, and undiagnosed diabetes. Second, we used probit models to determine whether individual attributes, socioeconomic characteristics and behavioral health factors, including smoking, alcohol consumption, obesity, central obesity, are associated with total diagnosed and undiagnosed diabetes. We also consider other factors, including contact with medical system, hypertension and urban/rural settings. Third, we estimated average marginal effects of variables in probit models. Among Chinese people aged 45+, the prevalence of diagnosed, measured, total diagnosed and undiagnosed diabetes were 5.8% (95%CI, 5.3%-6.3%), 14.7% (95%CI, 14.0%-15.4%), 17.0% (95%CI, 16.3%-17.7%), 11.3% (95%CI, 10.6%-12.0%), respectively. The probability of total diagnosed diabetes is 3.3% (95% CI, 1.2%-5.3%) and 10.2% (95% CI, 7.0%-13.5%) higher for overweight and obesity than normal BMI, 5.0% (95% CI, 3.0%-7.1%) higher for central obesity than normal waist circumference, 5.4% (95% CI, 3.7%-7.0%) higher for hypertensive than normotensive and 1.8% (95% CI, 0.8%- 2.7%) higher in urban areas than in rural areas, respectively. The probability of undiagnosed diabetes is 2.7% (95% CI, 1.2%-4.2%) and 7.2% (95% CI, 4.7%-9.6%) higher for overweight and obesity than normal BMI, 2.6% (95% CI, 0.9%-4.4%) higher for central obesity than normal waist circumference and 2.6% (95% CI, 1.2%-4.0%) higher for hypertensive than normotensive, respectively, and -1.5% (95% CI, -2.5% to -0.5%) lower for individuals who were in contact with the medical system. Greater focus on prevention of diabetes is necessary for obesity, central obesity, hypertensive and in urban areas for middle-aged and older in China.
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Affiliation(s)
- Minghui Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Balekouzou Augustin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chang Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tingting Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail:
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115
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Huang K, Song YT, He YH, Feng XL. Health system strengthening and hypertension management in China. Glob Health Res Policy 2016; 1:13. [PMID: 29202062 PMCID: PMC5693514 DOI: 10.1186/s41256-016-0013-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/09/2016] [Indexed: 01/16/2023] Open
Abstract
Background Non-communicable diseases are the leading causes of global burden of diseases, and hypertension is one of the most important risk factors. Hypertension prevalence doubled in China in the past decade and affects more than 300 million Chinese people. In the review we systematically searched peer-reviewed publications that link health system level factors with hypertension management in China and provide the current knowledge on how to improve a country’s health system to manage the hypertension epidemic. Methods A framework was developed to guide the review. The database of PubMed, CNKI were systematically searched from inception to April 13, 2016. Two authors independently screened the searched results for inclusion, conducted data extraction and appraised the quality of studies. Key findings were described according to the framework. Findings Five hundred seventy-two publications were identified, where 11 articles were left according to the inclusion and exclusion criteria. The study periods range from 2010 to 2015. All about 11 researches linked health system factors to the outcome of hypertension management. And the outcomes were just focused on the awareness, treatment and control of hypertension but not hypertension incidence. One study is about the role of health system governance, investigating the performance of different organized community health care centers; three studies were about health financing comparing differences in insurance coverage; three studies were about health information practicing the hypertension guidelines of China or the WHO, and the rest three about mechanisms of health service delivery. No researches were identified about physical resources for health and human resources for health. Conclusions Hypertension prevalence has been rising rapidly in China and the management of hypertension in China is a detection problem rather than treatment problem. Limited evidence shows the positive effect of health system factors on hypertension management and joint efforts from health system and epidemiological researchers are warranted to extend knowledge in this area. Electronic supplementary material The online version of this article (doi:10.1186/s41256-016-0013-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kehui Huang
- School of Public Health, Peking University, Xueyuan road 38#, Beijing, 100191 People's Republic of China
| | - Yu Ting Song
- School of Public Health, Peking University, Xueyuan road 38#, Beijing, 100191 People's Republic of China
| | - Yong Huan He
- School of Public Health, Peking University, Xueyuan road 38#, Beijing, 100191 People's Republic of China
| | - Xing Lin Feng
- School of Public Health, Peking University, Xueyuan road 38#, Beijing, 100191 People's Republic of China
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116
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Zhang X, Zhang Y, Xiao X, Ma X, He J. The relation between health insurance and management of hypertension in Shanghai, China: a cross-sectional study. BMC Public Health 2016; 16:959. [PMID: 27613593 PMCID: PMC5018164 DOI: 10.1186/s12889-016-3627-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/02/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We aimed to investigate the management of hypertension in Shanghai, China and to examine whether there was any difference of hypertension management among people enrolled in different health insurances. METHODS In this cross-sectional study, a total of 31,531 residents were selected in Shanghai, using a randomized, stratified, multi-stage sampling method, and were asked to provide their status of hypertension, condition of hypertension management, health insurances and other demographic information. A weighted propensity score model was used to adjust confounders and to analyze the differences on hypertension management among hypertension patients enrolled in different health insurances. RESULTS In Shanghai, most hypertension patients achieved good management of hypertension. However, patients enrolled in the New Cooperative Medical Scheme or the Urban Resident Basic Medical Insurance scheme were more likely to achieve publicity of precautionary knowledge about hypertension (OR = 2.36 [95 % CI :1.96,2.85] and 1.28 [95 % CI:1.12,1.45], respectively) and had their blood pressure under control (OR = 1.33 [95 % CI :1.09,1.62] and 1.22 [95 % CI:1.05,1.42], respectively) than patients enrolled in the Urban Employee Basic Health Insurance scheme. CONCLUSION The study provided a comprehensive description of hypertension in Shanghai, China. To support the management of hypertension, publicity of hypertension prevention knowledge should be improved, especially to people enrolled in the Urban Employee Basic Health Insurance scheme.
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Affiliation(s)
- Xinji Zhang
- Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433 China
| | - Yuan Zhang
- Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433 China
| | - Xiang Xiao
- Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433 China
| | - Xiuqiang Ma
- Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433 China
| | - Jia He
- Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433 China
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117
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Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China. Int J Hypertens 2016; 2016:7404957. [PMID: 27630771 PMCID: PMC5005589 DOI: 10.1155/2016/7404957] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/05/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022] Open
Abstract
Hypertension is a major risk factor of cardiovascular disease in China, and yet little is known about health-related quality of life (HRQOL) and its associations with demographic and social-economic characteristics in middle-aged patients with hypertension. A cross-sectional survey was undertaken in Chongqing, China, using a multistage stratified random sampling methodology. Data was collected on 1,224 eligible adults, aged between 45 and 53 years, including the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hypertension was associated with poor state of physical functioning, role-physical, bodily pain, general health, vitality, and social function (p < 0.05 for all). In multivariable analyses, education level, job conditions, average monthly income, smoking status, sleep quality, perception of relationship with family, childhood breastfeeding history, and body mass index were associated with domains of SF36 among those with hypertension (p < 0.05 for all). Hypertensive respondents with high education, marital status, breastfeeding, higher incomes, good quality of sleep, positive relationship with family, and higher body mass index have better HRQOL in middle-aged people with hypertension. Those unemployed had a better state of general health and had a poorer state of social function. Nonsmokers had a poorer state of bodily pain than smokers. This study provides detailed information of the implications for health care providers to gain a more complete picture of their hypertension patients' health.
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118
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Care Utilization with China’s New Rural Cooperative Medical Scheme: Updated Evidence from the China Health and Retirement Longitudinal Study 2011–2012. Int J Behav Med 2016; 23:655-663. [DOI: 10.1007/s12529-016-9560-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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119
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The dynamics of hypertension prevalence, awareness, treatment, control and associated factors in Chinese adults: results from CHNS 1991-2011. J Hypertens 2016; 33:1688-96. [PMID: 26136071 DOI: 10.1097/hjh.0000000000000594] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To analyze the trends in blood pressure (BP), and the prevalence, awareness, treatment and control of hypertension and associated factors in Chinese adults from 1991 to 2011. METHODS On the basis of the longitudinal data of China Health and Nutrition Survey, 75 526 records of 24 410 adults were selected according to the eligibility criteria. The age-standardized levels of SBP, DBP, prevalence, awareness, treatment and control of hypertension were calculated by sex and age group within each year. Generalized estimating equation was employed to investigate the associations between demographic factors and status of hypertension, awareness, treatment and control. RESULTS From 1991 to 2011, the BP level elevated (SBP 120.0-124.5 mmHg, DBP 76.7-79.3 mmHg) and the prevalence of hypertension increased from 23.4 to 28.6%. The increasing levels of BP and hypertension prevalence were more apparent among men and older patients. The rates of hypertension awareness, treatment and control also increased while kept at low levels. Factors such as age, sex, smoking habit, drinking habit, household income, health insurance, BMI, residential region, marital status, educational level and nationality were significantly associated with the status of hypertension, awareness, treatment and control. CONCLUSION The BP level and hypertension prevalence have increased among Chinese adults in recent years. However, levels of hypertension awareness, treatment and control were quite low. To reduce the disease burden of the hypertension, improvements in health education programs, detection and treatment strategies are warranted.
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120
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Wang S, Chen R, Liu Q, Shu Z, Zhan S, Li L. Prevalence, awareness and treatment of chronic kidney disease among middle-aged and elderly: The China Health and Retirement Longitudinal Study. Nephrology (Carlton) 2016; 20:474-84. [PMID: 25773384 DOI: 10.1111/nep.12449] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/31/2022]
Abstract
AIM To provide reliable estimates of the prevalence, awareness, and treatment of chronic kidney disease (CKD), and their distribution and related influencing factors in middle-aged and elderly population in China. METHODS A cross-sessional survey called the China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2011-2012 in Chinese people aged 45 years or older. This was to evaluate the prevalence of CKD, disease awareness compared to other chronic diseases in the population, and whether they were being treated for their CKD. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. CKD was defined as eGFR less than 60 mL/min per 1.73 m(2) . Multivariable logistic regressions were used to estimate odds ratios (ORs) for the risk factors. RESULTS The overall prevalence of CKD was 11.5% (95%CI: 10.1% ∼ 12.8%). It was higher in urban than rural population (13.0% vs 10.0%, P < 0.05). Among all patients with CKD, only 8.7% were aware of the diagnosis. 4.9% of the patients were receiving treatment. The proportion of those aware of their condition and those who were treated decreased with age in both sexes. Of those aware (8.9%), 55.9% were treated. 31.4% of the treated patients took Chinese traditional medicine. CONCLUSIONS There is a surprising prevalence of CKD in the Chinese middle-aged and elderly population, with disproportionately low awareness and treatment. A comprehensive strategy toward prevention, screening, treatment and control of CKD is needed to slow the epidemic of CKD.
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Affiliation(s)
- Shengfeng Wang
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ru Chen
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Qing Liu
- School of Public Health, Department of Epidemiology, ScM, Brown University, Providence, Rhode Island, USA
| | - Zheng Shu
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Liming Li
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China
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121
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Hou Z, Meng Q, Zhang Y. Hypertension Prevalence, Awareness, Treatment, and Control Following China's Healthcare Reform. Am J Hypertens 2016; 29:428-31. [PMID: 26232034 PMCID: PMC4886484 DOI: 10.1093/ajh/hpv125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/20/2015] [Accepted: 07/06/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In 2009, China started an impressive national healthcare system reform. One of the key components is to promote equity in access to essential healthcare services including chronic disease management. We assessed the changes in hypertension management and its equity before and after China's healthcare reform in 2009. METHODS We used data from the 2008 and 2012 waves of the China Health and Retirement Longitudinal Study (CHARLS). The surveys were conducted in Zhejiang and Gansu provinces, containing 1,961 and 1,836 respondents aged 45 and older in 2008 and 2012 respectively. We measured the prevalence of hypertension, and proportions of respondents with hypertension aware of their conditions, receiving treatment and under effective control, separately for 2008 and 2012. We also reported these measures in provinces and rural/urban areas. RESULTS From 2008 to 2012, the age standardized prevalence of hypertension was steady at 46.2%, but hypertension management improved substantially. Among those with hypertension, the proportion of patients aware of their conditions increased from 57.8% to 69.9%, the proportion of patients receiving treatment increased from 38.1% to 56.1%, and the proportion of patients with hypertension under effective control increased from 21.7% to 36.4%. The highest improvement was found in rural areas of the underdeveloped province, which indicated that the inequity across regions declined over time. CONCLUSIONS Among Chinese population aged 45 and older in Zhejiang and Gansu provinces, hypertension management improved following healthcare reform. The rate of improvement was faster in rural and underdeveloped areas, possibly related to additional governmental subsidies to these areas.
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Affiliation(s)
- Zhiyuan Hou
- Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (Ministry of Health), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China;
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yuting Zhang
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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122
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Ning M, Zhang Q, Yang M. Comparison of self-reported and biomedical data on hypertension and diabetes: findings from the China Health and Retirement Longitudinal Study (CHARLS). BMJ Open 2016; 6:e009836. [PMID: 26729390 PMCID: PMC4716227 DOI: 10.1136/bmjopen-2015-009836] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES We examined the level of agreement between biomedical and self-reported measurements of hypertension and diabetes in a Chinese national community sample, and explored associations of the agreement and possible contextual effects among provinces and geographic regions in China. DESIGN Secondary analysis of a cohort sample. SETTING AND PARTICIPANTS Community samples were drawn from the national baseline survey of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2012) through multistage probability sampling, which included households with members 45 years of age or above with a total sample size of 17,708 individuals. OUTCOME MEASURES Sensitivity, specificity and κ were used as measurements of agreements or validity; variance of validity measures among provinces and communities was estimated using random-effects models. RESULTS Self-reports for hypertension and diabetes showed high specificity (96.3% and 98.3%, respectively) but low sensitivity (56.3% and 61.5%, respectively). Agreement between self-reported data and biomedical measurements was moderate for both hypertension (κ 0.57) and diabetes (κ 0.65), with respondents who were older, of higher socioeconomic status, better educated and who had hospital admissions in the past 12 months showing stronger agreements than their counterparts. Large and significant variations in the sensitivity among provinces for hypertension, and among communities for both hypertension and diabetes, could neither be attributed to the effects of respondents' characteristics nor to the contextual effects of city-village differences. CONCLUSIONS As a considerable number of people in the overall sample were unaware of their conditions, self-reports will lead to an underestimation of the prevalence of hypertension and diabetes. However, in more developed communities or provinces, self-reported data can be a reliable estimate of the prevalence of the two conditions. Further investigations of contextual effects at provincial and community levels could highlight public health strategies to improve awareness of the two conditions.
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Affiliation(s)
- Meng Ning
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Qiang Zhang
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, China
- School of Medicine, University of Nottingham, Nottingham, UK
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Safaeian L, Hajhashemi V, Haghjoo Javanmard S, Sanaye Naderi H. The Effect of Protocatechuic Acid on Blood Pressure and Oxidative Stress in Glucocorticoid-induced Hypertension in Rat. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2016; 15:83-91. [PMID: 28228807 PMCID: PMC5242355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Oxidative stress is one of the important mechanisms involved in Dexamethasone (Dex)-induced hypertension. Protocatechuic acid (PCA) is a natural compound with high antioxidant capacity. In this investigation, the effect of pretreatment with PCA was studied in Dex-induced hypertensive male Wistar rats. For induction of hypertension, Dex was injected subcutaneously for 14 days. PCA (50, 100 and 200 mg/kg) was started from 4 days before Dex administration and continued during the test period. Systolic blood pressure (SBP) was recorded using tail-cuff method. Measurement of thymus weight was done as a marker of glucocorticoid activity. The hydrogen peroxide (H2O2) concentration and ferric reducing antioxidant power (FRAP) were determined in plasma samples. Significant increase in SBP and plasma H2O2 concentration and decrease in FRAP value and in the body and thymus weights were observed in Dex-induced hypertensive rats. PCA dose-dependently prevented hypertension and body weight loss, and reduced plasma H2O2 concentration and increased FRAP values. These results suggest the antihypertensive and antioxidant effects of PCA against Dex-induced hypertension.
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Affiliation(s)
- Leila Safaeian
- Department of Pharmacology and Toxicology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran. ,E mail:
| | - Valiollah Hajhashemi
- Department of Pharmacology and Toxicology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | - Hamed Sanaye Naderi
- Department of Pharmacology and Toxicology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
SummaryThis study’s objectives were, first, to examine the association between social engagement and the odds of taking hypertensive medications and treatment among adults in China; and second, to explore the lifestyle and psychological mechanisms underlying this association. Data were from the WHO Study on Global AGEing and Adult Health (WHO-SAGE), a national survey of 11,046 participants aged 18 to 69 conducted in China in 2010. The key outcome was a dichotomous indicator of whether the respondent was taking hypertensive medication or other treatment. A series of logistic regression models were fitted to examine the research questions. Higher levels of social engagement were found to be associated with a lower odds of taking hypertensive medication or treatment, and the association was stronger for women than for men. Lifestyle factors (i.e. smoking and BMI) and perceived overall life satisfaction were significant covariates. Life satisfaction helped explain some of the social engagement benefit for both men and women and BMI only appeared to be a mediator for men. Being married was not significantly associated with lower odds of taking hypertensive medication or treatment in either men or women. Social engagement seems to be protective against hypertension for adult men and women in China, although causation could not be determined in this cross-sectional study. Psychosocial mechanisms are probably at work, but these vary by gender.
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125
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Sarki AM, Nduka CU, Stranges S, Kandala NB, Uthman OA. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1959. [PMID: 26683910 PMCID: PMC5058882 DOI: 10.1097/md.0000000000001959] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022] Open
Abstract
We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.
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Affiliation(s)
- Ahmed M Sarki
- From the Division of Health Sciences, University of Warwick Medical School, Coventry, UK (AMS, CUN); Family and Youth Health Initiative (FAYOHI), Nigeria (AMS); Department of Population Health, Luxembourg Institute of Health, Luxembourg (SS, N-BK); Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of health Sciences, University of Warwick Medical School, Coventry, UK (OAU); and Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK (OAU); Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK (N-BK)
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126
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Meng Q, Fang H, Liu X, Yuan B, Xu J. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet 2015; 386:1484-92. [PMID: 26466052 DOI: 10.1016/s0140-6736(15)00342-6] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.
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Affiliation(s)
- Qingyue Meng
- China Centre for Health Development Studies, Peking University, Beijing, China.
| | - Hai Fang
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Beibei Yuan
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Jin Xu
- China Centre for Health Development Studies, Peking University, Beijing, China
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127
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Li G, Cai AP, Mo YJ, Chen JY, Wei RB, Huang YQ, Tang ST, Zhou YL, Feng YQ. Effects of guideline-based hypertension management in rural areas of Guangdong Province. Chin Med J (Engl) 2015; 128:799-803. [PMID: 25758276 PMCID: PMC4833986 DOI: 10.4103/0366-6999.152644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Despite the improvement in the health care industry, the rates of undetected, untreated, and uncontrolled hypertension (HTN) are still very high, especially in rural areas of China. The aim of this study was to investigate the efficacy and efficiency of a guideline-based HTN management (novel therapy) in population of rural areas of Guangdong Province. Methods: Totally, 3113 patients with essential HTN in a rural area of Guangdong Province were enrolled and assigned to two groups, named traditional (n = 372) and novel therapeutic (n = 2741) groups, respectively. Patients in the traditional group were treated routinely, and patients in the novel group were treated in a novel model characterized by regular educational programs for hypertensive populations, close monitoring of blood pressure in combination with finely tuned antihypertensive medications, strict implementation of lifestyle modification and improving medical knowledge and skill of local medical staff efficiently. After 2 years of follow-up, primary endpoints including magnitude of systolic and diastolic blood pressures (SBP and DBP) decrease, treated and controlled rates, as well as secondary endpoints, were evaluated in both groups. Results: Initially, the treated rate was significantly higher in traditional group than that of novel group (71.15% vs. 64.99%, P < 0.05), while the controlled rates were comparable and insignificant difference between baseline BP in both groups (31.07% vs. 26.88%, P > 0.05). Four variables were significantly different, namely smoking rate, daily vegetable consumption (VC), and serum levels of low-density lipoprotein-cholesterol and fasting blood glucose between these two groups. After 2 years of follow-up, decreases in SBP and DBP were more prominent in the novel group (P < 0.001). Treated and controlled rates in both groups were both increased. Nevertheless, in comparison to the traditional group, controlled rate increased more significantly in the novel group (64.31% vs. 37.85%, P < 0.001). Variables indicating lifestyle modification such as high sodium consumption, percentages of alcohol abuse, daily VC were profoundly improved in the novel group. Conclusions: The guideline-based HTN management implemented in the current study was beneficial for HTN control in rural areas of Guangdong Province.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
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Tenkorang EY, Sedziafa P, Sano Y, Kuuire V, Banchani E. Validity of Self-Report Data in Hypertension Research: Findings From The Study on Global Ageing and Adult Health. J Clin Hypertens (Greenwich) 2015. [DOI: 10.1111/jch.12616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Pearl Sedziafa
- Department of Sociology; Memorial University; St. John's NF Canada
| | - Yuji Sano
- Department of Sociology; Memorial University; St. John's NF Canada
| | - Vincent Kuuire
- Department of Geography; The University of Western Ontario; London ON Canada
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Chor D, Pinho Ribeiro AL, Sá Carvalho M, Duncan BB, Andrade Lotufo P, Araújo Nobre A, de Aquino EMLL, Schmidt MI, Griep RH, Molina MDCB, Barreto SM, Passos VMDA, Benseñor IJM, Matos SMA, Mill JG. Prevalence, Awareness, Treatment and Influence of Socioeconomic Variables on Control of High Blood Pressure: Results of the ELSA-Brasil Study. PLoS One 2015; 10:e0127382. [PMID: 26102079 PMCID: PMC4478044 DOI: 10.1371/journal.pone.0127382] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 04/15/2015] [Indexed: 12/22/2022] Open
Abstract
High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103 (54% female) civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education (PR = 1.21; 95% CI: 1.14-1.28), and among Asian (PR = 1.21; 95% CI: 1.12-1.32) and 'Whites (PR = 1.19; 95% CI: 1.12-1.26) compared to Blacks. Socioeconomic and racial inequality-as measured by different indicators-are strongly associated with HBP control, beyond the expected influence of health services access.
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Affiliation(s)
- Dóra Chor
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | | | - Marilia Sá Carvalho
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Bruce Bartholow Duncan
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Aline Araújo Nobre
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Maria Inês Schmidt
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rosane Härter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Sandhi Maria Barreto
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, ES, Brazil
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Abstract
We examined the migration patterns of older adults in China and the determinants associated with migration. Using select data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), we conducted a spatial analysis to explore the geographical patterns of different types of older migrants. The relationships between personal, environmental attributes, and migration were examined using logistic-linear modeling techniques. Approximately 6.6% of the Chinese adults aged 60 and older migrated in the past 10 years. Elderly migration occurred primarily in metropolitan areas and frontier provinces in China. Personal attributes, family structure, and housing conditions were associated with migration. The spatial patterns were associated with personal culture background, social policy, and regional development. The implications of elderly migration, with respect to establishing proper social policy and paying attention to the living environment of both migrant and non-migrant elders were discussed.
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Affiliation(s)
- Xiaolu Dou
- 1 College of Urban and Environmental Science, Peking University, Beijing, China
| | - Yujun Liu
- 2 Department of Human Development, Virginia Tech, Blacksburg, VA, USA
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131
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Zou G, Zhang Z, Walley J, Gong W, Yu Y, Hu R, Yin J, Yu M, Wei X. Use of medications and lifestyles of hypertensive patients with high risk of cardiovascular disease in rural China. PLoS One 2015; 10:e0124484. [PMID: 25932640 PMCID: PMC4416726 DOI: 10.1371/journal.pone.0124484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/02/2015] [Indexed: 01/22/2023] Open
Abstract
Background Hypertension, with a global prevalence of 40%, is a risk factor for cardiovascular diseases (CVD). We conducted an exploratory study in Zhejiang China to understand the prevention of CVD among hypertensive patients with a 10 year CVD risk of 20% or higher. We assessed current practices in a rural ‘township hospital’ (a primary care facility), and compared them with international evidence-based practice. Methods A questionnaire survey was conducted to examine the use of modern drugs (antihypertensive drugs, statins and aspirin) and traditional drugs, compliance to medications and lifestyle among 274 hypertensive patients aged 40-74, with a CVD risk of 20% or higher (using the Asian Equation). Results The majority (72%) were diagnosed with hypertension at township hospitals. Only 15% of study participants used two anti-hypertensive drugs, 0.7% took statin and 2.9% aspirin. Only 2.9% combined two types of modern drugs, while 0.4% combined three types (antihypertensives, statins and aspirin). Herbal compounds, sometimes with internationally rarely recommended drugs such as Reserpine were taken by 44%. Analysis of drug adherence showed that 9.8% had discontinued their drug therapy by themselves. 16% had missed doses and these were on less anti-hypertensive drugs than those who did not (t=-5.217, P=0.003). Of all participants, 28% currently smoked, 39% drank regularly and only 21% exercised frequently. The average salt intake per day was 7.1 (±3.8) g, while the national recommended level is 6g. Conclusion The study revealed outdated and inadequate treatment and health education for hypertensive patients, especially for those who have high risk scores for CVD. There is a need to review the community-based guidelines for hypertension management. Health providers and patients should make a transition from solely treating hypertension, towards prevention of CVD. Health system issues need addressing including improving rural health insurance cover and primary care doctors’ capacity to manage chronic disease patients.
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Affiliation(s)
- Guanyang Zou
- COMDIS Health Services Delivery Research Program, China Program, University of Leeds, Shenzhen, China
| | - Zhitong Zhang
- COMDIS Health Services Delivery Research Program, China Program, University of Leeds, Shenzhen, China
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Weiwei Gong
- Zhejiang Centre for Disease Control and Prevention, Hangzhou, China
| | - Yunxian Yu
- Schoo of Public Health, Zhejiang University, Hangzhou, China
| | - Ruying Hu
- Zhejiang Centre for Disease Control and Prevention, Hangzhou, China
| | - Jia Yin
- School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Min Yu
- Zhejiang Centre for Disease Control and Prevention, Hangzhou, China
| | - Xiaolin Wei
- School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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132
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Li C, Xiong H, Wu W, Tian X, Wang Y, Wu D, Lin WH, Miao F, Zhang H, Huang W, Zhang YT. The relationship between heart-carotid pulse transit time and carotid intima-media thickness in hypertensive patients. J Hum Hypertens 2015; 29:663-8. [PMID: 25761666 DOI: 10.1038/jhh.2015.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 01/07/2015] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
Abstract
The study aimed to investigate the relationship between heart-carotid pulse transit time and carotid intima-media thickness (CIMT) in hypertensive patients, and whether including the pre-ejection period (PEP) in heart-carotid pulse transit time would affect this correlation. A total of 62 hypertensive patients were included in this study. They were divided into the normal CIMT group (n=33, CIMT⩽0.8 mm) and the thickened CIMT group (n=29, CIMT>0.8 mm). The noninvasive ultrasound method was used to measure CIMT, electrocardiogram R-wave-based heart-carotid pulse transit time (rcPTT) and PEP. Aortic valve-carotid artery pulse transit time (acPTT) was calculated by subtracting PEP from rcPTT. Simple linear analysis showed that CIMT was negatively associated with rcPTT and acPTT (r=-0.57, P<0.0001; r=-0.41, P=0.016) in the normal CIMT group as well as in the thickened CIMT group (r=-0.50, P=0.0053; r=-0.59, P=0.001). These relationships were eliminated in the normal CIMT group after adjusting for age, gender, smoking behaviour, systolic blood pressure, diastolic blood pressure and cholesterol levels. However, rcPTT and acPTT still showed significant correlations with CIMT in the thickened CIMT group. In conclusion, rcPTT and acPTT were associated with CIMT, independent of well-known clinical confounders in thickened CIMT hypertensive patients. Therefore, rcPTT and acPTT might be useful markers for atherosclerosis evaluation.
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Affiliation(s)
- C Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Key Laboratory for Health Informatics of the Chinese Academy of Sciences, Shenzhen, China
| | - H Xiong
- Departments of Ultrasound, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - W Wu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Key Laboratory for Health Informatics of the Chinese Academy of Sciences, Shenzhen, China
| | - X Tian
- Cardiac Electrocardiogram Room, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Y Wang
- Clinical Laboratory, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - D Wu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Key Laboratory for Health Informatics of the Chinese Academy of Sciences, Shenzhen, China
| | - W-H Lin
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Key Laboratory for Health Informatics of the Chinese Academy of Sciences, Shenzhen, China
| | - F Miao
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Key Laboratory for Health Informatics of the Chinese Academy of Sciences, Shenzhen, China
| | - H Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Key Laboratory for Health Informatics of the Chinese Academy of Sciences, Shenzhen, China
| | - W Huang
- Institute of Clinical Anatomy, Southern Medical University, Guangzhou, China
| | - Y-T Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Key Laboratory for Health Informatics of the Chinese Academy of Sciences, Shenzhen, China.,Department of Electronic Engineering, Joint Research Centre for Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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Li D, Lv J, Liu F, Liu P, Yang X, Feng Y, Chen G, Hao M. Hypertension burden and control in mainland China: Analysis of nationwide data 2003-2012. Int J Cardiol 2015; 184:637-644. [PMID: 25771229 DOI: 10.1016/j.ijcard.2015.03.045] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/03/2014] [Accepted: 03/03/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND No nationwide survey on hypertension was conducted in China since 2002. We assessed the prevalence, awareness, treatment, and control of hypertension in mainland China and in various regions using nationwide data from 2003 to 2012. METHODS AND RESULTS We identified studies that reported age- and gender-specific prevalence and/or age-specific awareness, treatment and control of hypertension in representative population samples from 31 provinces, using China National Knowledge Infrastructure, Wanfang and PubMed, supplemented by a manual search of references of retrieved articles. All data were extracted independently by two investigators using a standardized data-collection form. Overall, 265 million adults (145 million men and 120 million women) had hypertension for a prevalence of 26.7% (28.9% among men and 24.5% among women) in 2010. Among hypertensive patients, only 44.6% were aware of their condition, 35.2% were taking antihypertensive medication, and 11.2% achieved adequate blood pressure control. There were substantial geographic variations in the prevalence and control of hypertension. Hypertension prevalence was the highest in east region (32.6%) followed by northeast region (31.8%). Worse still, the control rate among hypertensive people was very poor in southwest (4.8%) and northeast (5.9%) regions. CONCLUSIONS Hypertension is highly prevalent in mainland China, with inadequate awareness, treatment, and control of hypertension. Effective strategies are urgently needed in China, especially in the regions with high prevalence and low control.
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Affiliation(s)
- Dianjiang Li
- Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China
| | - Jun Lv
- Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China
| | - Fangchao Liu
- Department of Evidence Based Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Liu
- Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China
| | - Xueli Yang
- Department of Evidence Based Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yating Feng
- Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China
| | - Gang Chen
- Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China
| | - Mo Hao
- Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China.
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134
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Maurer J, Ramos A. One-year routine opportunistic screening for hypertension in formal medical settings and potential improvements in hypertension awareness among older persons in developing countries: evidence from the Study on Global Ageing and Adult Health (SAGE). Am J Epidemiol 2015; 181:180-4. [PMID: 25550358 DOI: 10.1093/aje/kwu339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Hypertension is a leading risk factor in the global disease burden. Limited hypertension awareness is a major determinant of widespread gaps in hypertension treatment and control, especially in developing countries. We analyzed data on persons aged 50 years or older from 6 low- and middle-income countries participating in the first wave (2007-2010) of the World Health Organization's Survey of Global Ageing and Adult Health (SAGE). Our estimates suggest that just 1 year of routine opportunistic hypertension screening during formal visits to medical-care providers could yield significant increases in hypertension awareness among seniors in the developing world. We also show that eliminating missed opportunities for hypertension screening in medical settings would not necessarily exacerbate existing socioeconomic differences in hypertension awareness, despite requiring at least occasional contact with a formal health-care provider for obtaining a hypertension diagnosis. Thus, routine opportunistic screening for hypertension in formal medical settings may provide a simple but reliable way to increase hypertension awareness. Moreover, the proposed approach has the added advantage of leveraging existing resources and infrastructures, as well as facilitating a direct transition from the point of diagnosis to subsequent expert counseling and clinical care for newly identified hypertension patients.
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135
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Li H, Wei X, Wong MC, Yang N, Wong SY, Lao X, Griffiths SM. A comparison of the quality of hypertension management in primary care between Shanghai and Shenzhen: a cohort study of 3196 patients. Medicine (Baltimore) 2015; 94:e455. [PMID: 25654383 PMCID: PMC4602719 DOI: 10.1097/md.0000000000000455] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Strong primary care is in urgent need for the management and control of hypertension. This study aimed to compare the quality of hypertensive care delivered by community health centers (CHCs) in Shanghai and Shenzhen. Multistage random sampling method was used to select 4 CHCs in each city as study settings. A cohort of hypertensive patients under the hypertensive management program in the CHCs was selected from the electronic information system by using a systematic random sampling method. Binary logistic regression models were constructed for comparison between the 2 cities. A total of 3196 patients' records were assessed. The proportions of hypertensive patients who received advice on smoking cessation (33.8 vs 7.7%, P < 0.001), increasing physical activity (52.4 vs 16.8%, P < 0.001), low-sodium diet (72.0 vs 64.1%, P < 0.001), and regular follow-up (37.8 vs 8.6%, P < 0.001) were higher in Shenzhen than in Shanghai. However, the drug treatment rate in Shenzhen was lower than that in Shanghai (74.2 vs 95.2%, P < 0.001). The hypertension control rate in Shenzhen was lower than that in Shanghai (76.3 vs 83.2%, P < 0.001). Better performance in the process of hypertensive care in terms of increasing physical activity advice, low-sodium diet advice, regular follow-up, and drug prescription was associated with a higher rate of hypertension control. The study indicates that primary care is effective in managing hypertension irrespective of management and operation models of CHCs in urban China. Our study suggests that improvements in the process of hypertensive care may lead to better hypertension control.
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Affiliation(s)
- Haitao Li
- From the School of Medicine (HL), Shenzhen University, Shenzhen; and School of Public Health and Primary Care (XW, MCW, NY, SYW, XL, SMG), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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136
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Safaeian L, Ghasemi-Dehkordi N, Javanmard SH, Namvar H. Antihypertensive and antioxidant effects of a hydroalcoholic extract obtained from aerial parts of Otostegia persica (Burm.) Boiss. Res Pharm Sci 2015; 10:192-9. [PMID: 26600845 PMCID: PMC4621625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Otostegia persica (Burm.) Boiss. is used for the treatment of various diseases in traditional medicine. The aim of this study was to assess the effects of hydroalcoholic extract of the aerial parts of O. persica in dexamethasone (Dex) induced hypertension in male Wistar rats. For induction of hypertension, Dex at 30 μg/kg/day was administered subcutaneously for 14 days. In a prevention study, animals received O. persica extract orally at various doses of 100, 200 and 400 mg/kg 4 days before Dex administration and during the test period lasted for 18 days. In a reversal study, rats received O. persica extract from day 8 to 14. Systolic blood pressure (SBP) was measured using tail-cuff method. The weight of thymus gland was measured as a marker of glucocorticoid activity. The hydrogen peroxide (H2O2) concentration and ferric reducing antioxidant power (FRAP) were determined in plasma samples. Dex injection significantly increased SBP and plasma H2O2 levels while decreased the body and thymus weights and FRAP values. Oral administration of O. persica extract prevented and dose-dependently reversed a rise in SBP. Pre-treatment with O. persica extract also reduced the plasma H2O2 concentration, increased the plasma FRAP levels and prevented the body weight loss upon Dex administration. These results suggest antihypertensive and antioxidant effects of O. persica extract in Dex-induced hypertension. However, further investigations are needed to elucidate the detailed mechanism(s) of antihypertensive effect of this traditional herbal medicine.
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Affiliation(s)
- L. Safaeian
- Department of Pharmacology and Toxicology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran,Corresponding author: L. Safaeian Tel: 0098 31 37927067, Fax: 0098 31 36680011
| | - N. Ghasemi-Dehkordi
- Department of Pharmacognosy and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| | - Sh. Haghjoo Javanmard
- Applied Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| | - H. Namvar
- Department of Pharmacology and Toxicology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
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Alam DS, Chowdhury MAH, Siddiquee AT, Ahmed S, Niessen LW. Awareness and control of hypertension in Bangladesh: follow-up of a hypertensive cohort. BMJ Open 2014; 4:e004983. [PMID: 25537780 PMCID: PMC4275678 DOI: 10.1136/bmjopen-2014-004983] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the effect of awareness and advice to seek care on blood pressure (BP) control among patients with hypertension in Bangladesh. DESIGN Longitudinal study. SETTING The study was carried out in icddr,b surveillance sites at rural Matlab in Chandpur district and semi-urban Kamalapur in Dhaka, Bangladesh. PARTICIPANTS Randomly selected men and non-pregnant women aged 20 years or older without any acute illness or history of any vascular events such as stroke or acute myocardial infarction. MAIN OUTCOME MEASURE Hypertension was defined as systolic BP (SBP) ≥140 and/or diastolic BP (DBP) ≥90 mm Hg or as self-reported hypertension under medication. We advised patients to seek care from a qualified provider and to adopt a healthy lifestyle. We compared changes in BP from baseline to follow-up at around 6 months. RESULTS Overall, 17.1% (n=287) of participants had hypertension at baseline with significantly higher prevalence in the semi-urban than in the rural population (23.6% vs 10.8%; p<0.001); half were unaware of their condition. At follow-up, 83% (n=204) reported a visit to any healthcare provider. In the semi-urban area, a higher proportion of patients visited medically qualified practitioners than in the rural area (76.7% vs 36.6%, p<0.000). SBP (-3.3±20.7 mm Hg; p<0.01) and DBP (-2.0±13.0 mm Hg; p<0.02) were lower at follow-up. Those who visited medically qualified practitioners had significant SBP (-3.9±22.4 mm Hg; p<0.03) and DBP (-2.7±14.1 mm Hg; p<0.02) reduction. BP reduction did not reach statistical significance among those visiting a pharmacist or their village doctors. Overall, half of the patients with hypertension achieved the BP control goal (BP<140/90 mm Hg). CONCLUSIONS Awareness and simple health messages increase provider visit, reduce blood pressure and improve BP control in hypertensive Bangladeshis. Longer-term follow-up is required to verify the sustainability.
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Affiliation(s)
- Dewan Shamsul Alam
- Centre for Control of Chronic Diseases (CCCD), icddr,b, Dhaka, Bangladesh
| | | | | | - Shyfuddin Ahmed
- Centre for Control of Chronic Diseases (CCCD), icddr,b, Dhaka, Bangladesh
| | - Louis Wilhelmus Niessen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Liverpool School of Tropical Medicine, University of Warwick, Liverpool, UK
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Li C, Liu T, Sun W, Wu L, Zou ZY. Prevalence and risk factors of arthritis in a middle-aged and older Chinese population: the China health and retirement longitudinal study. Rheumatology (Oxford) 2014; 54:697-706. [PMID: 25288780 DOI: 10.1093/rheumatology/keu391] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The aims of this study were to estimate the prevalence of arthritis and to identify risk factors of arthritis in a middle-aged and older Chinese adult population. METHODS The China Health and Retirement Longitudinal Study (CHARLS) national survey data were used to estimate overall arthritis prevalence and prevalence by age and gender groups taking into account the complex survey design and response rate. The PROC SURVEYLOGISTIC procedure (SAS 9.3; SAS Institute, Cary, NC, USA) was applied to identify factors associated with arthritis using the CHARLS national survey data. Significant factors were further evaluated in the longitudinal CHARLS pilot study. RESULTS The overall prevalence of arthritis among middle-aged and older Chinese adults was 31.4% (95% CI 30.3, 32.4). Prevalence increased with age. Females had a higher prevalence of arthritis than males in each age group. In the cross-sectional analysis, age, gender, education, BMI, sleep duration, vigorous physical activity and self-reported doctor-diagnosed chronic lung disease, hypertension, chronic liver disease, cardiovascular disease, stroke, chronic kidney disease and chronic digestive disease were associated with arthritis. Age, gender, vigorous physical activity and cardiovascular disease were confirmed to be risk factors of arthritis in the longitudinal analysis. Participants with cardiovascular disease were 1.67 times (95% CI 1.02, 2.74) more likely to have self-reported arthritis in a 4-year period of follow-up in the CHARLS pilot study. CONCLUSION Middle-aged and older Chinese adults had a high prevalence of arthritis. Cardiovascular disease is a novel risk factor for arthritis in this population.
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Affiliation(s)
- Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Tingting Liu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Wenjie Sun
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Lang Wu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhi-Yong Zou
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, Department of Global Health and Environmental Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, MN, USA and Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
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139
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Jang DJ, Bae SK, Oh E. Coated dextrin microcapsules of amlodipine incorporable into orally disintegrating tablets for geriatric patients. Biomed Pharmacother 2014; 68:1117-24. [DOI: 10.1016/j.biopha.2014.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/16/2014] [Indexed: 11/27/2022] Open
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141
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Ni X, Zhang J, Zhang P, Wu F, Xia M, Ying G, Chen J. Effects of spironolactone on dialysis patients with refractory hypertension: a randomized controlled study. J Clin Hypertens (Greenwich) 2014; 16:658-63. [PMID: 25052724 PMCID: PMC8031582 DOI: 10.1111/jch.12374] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/09/2014] [Accepted: 06/11/2014] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to evaluate the effects of spironolactone on dialysis patients with refractory hypertension and possible adverse effects. This was a 12-week prospective, randomized, double-blind trial of 82 patients randomly assigned to 12-week treatment with 25 mg/d spironolactone or placebo as add-on therapy. Visits were scheduled at the start of treatment and after 12 weeks. Measurements of 24-hour ambulatory blood pressure (BP) monitoring and morning BP were performed. After 12 weeks, spironolactone significantly improved refractory hypertension. Average placebo-corrected morning BP was reduced by 16.7/7.6 mm Hg. Mean 24-hour ambulatory BP was reduced by 10.9/5.8 mm Hg. In contrast, serum aldosterone levels in the spironolactone group slightly increased and serum potassium levels insignificantly increased. This study has demonstrated that spironolactone (50 mg) safely and effectively reduces BP in patients with refractory hypertension undergoing dialysis.
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Affiliation(s)
- Xiaoying Ni
- Department of NephrologyPeople's Hospital of YinzhouCollege of MedicineNingbo UniversityNingboChina
| | - Jisheng Zhang
- Department of NephrologyBeilun Branch of the First Affiliated HospitalCollege of MedicineZhejiang UniversityNingboChina
| | - Ping Zhang
- Department of NephrologyThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouChina
| | - Fuquan Wu
- Department of NephrologyBeilun Branch of the First Affiliated HospitalCollege of MedicineZhejiang UniversityNingboChina
| | - Min Xia
- Department of NephrologyBeilun Branch of the First Affiliated HospitalCollege of MedicineZhejiang UniversityNingboChina
| | - Guanghui Ying
- Department of NephrologyBeilun Branch of the First Affiliated HospitalCollege of MedicineZhejiang UniversityNingboChina
| | - Jianghua Chen
- Department of NephrologyThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouChina
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Abstract
Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals.
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Affiliation(s)
- Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK.
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Dalton ARH. Universal health insurance – a prerequisite of a 21st century health system: the case for hypertension management. Future Cardiol 2014; 10:327-31. [DOI: 10.2217/fca.14.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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