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Sharma AK, Baig VN, Ahuja J, Sharma S, Panwar RB, Katoch VM, Gupta R. Efficacy of IVRS-based mHealth intervention in reducing cardiovascular risk in metabolic syndrome: A cluster randomized trial. Diabetes Metab Syndr 2021; 15:102182. [PMID: 34330073 DOI: 10.1016/j.dsx.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
AIMS Efficacy of mobile-phone based intervention for reducing cardiovascular risk in metabolic syndrome (MetSyn). METHODS We screened adults 20-60 years in 10 villages in India for MetSyn using stratified cluster sampling. Lifestyle and biochemical risk factors were assessed. International Harmonized Criteria were used for diagnosis. Villages were randomized with 5 each in control and intervention groups. Interactive voice response system (IVRS) in Hindi was developed. In intervention clusters two messages for promotion of healthy lifestyle and medical treatment were broadcast daily over 12-months and risk factors reassessed. RESULTS 1012/1200(84%) persons were screened and MetSyn diagnosed in 286(28.3%). Villages were divided into 5 control(n = 136) and 5 intervention(n = 147) clusters. Baseline characteristics in both clusters were similar. Acceptability of intervention was >60% in 80% participants. At 12 months, significantly greater participants in intervention vs control clusters had healthier lifestyle (healthy diet 28.8vs14.7%, physical activity 25.9vs13.1%, tobacco 13.7vs32.5%), anthropometry (waist circumference 85.7 ± 6.3vs88.6 ± 14.0 cm, body mass index 21.9 ± 2.8vs23.1 ± 2.9 kg/m2), systolic BP 123.6 ± 7.7vs128.6 ± 14.1 mmHg, fasting glucose 95.6 ± 19.4vs109.4 ± 43.7 mg/dl, cholesterol 175.5 ± 36.5vs186.4 ± 43.3 mg/dl, and triglycerides 147.6 ± 48.3vs159.5 ± 60.7 mg/dl (p < 0.01). Prevalence of metabolic syndrome declined in intervention group by 22.3%vs3.9%, p < 0.001). CONCLUSION An interactive voice response system based technology significantly reduced multiple cardiovascular risk factors and prevalence of metabolic syndrome.
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Affiliation(s)
- Arvind K Sharma
- Departments of Community Medicine, RUHS College of Medical Sciences, Jaipur, 302033, India.
| | - Vaseem Naheed Baig
- Departments of Community Medicine, RUHS College of Medical Sciences, Jaipur, 302033, India
| | - Jitendra Ahuja
- Departments of Biochemistry, RUHS College of Medical Sciences, Jaipur, 302033, India
| | - Sonali Sharma
- Departments of Biochemistry, RUHS College of Medical Sciences, Jaipur, 302033, India
| | - Raja Babu Panwar
- Academic Research Development Unit, Rajasthan University of Health Sciences, 302033, Jaipur, India
| | - Vishwa Mohan Katoch
- Academic Research Development Unit, Rajasthan University of Health Sciences, 302033, Jaipur, India
| | - Rajeev Gupta
- Academic Research Development Unit, Rajasthan University of Health Sciences, 302033, Jaipur, India
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Natarajan V, Sekar T, Chockalingam P. Prevalence of cardiovascular health risk behaviors in college-going women in a major metropolis in India. Indian Heart J 2020; 72:451-453. [PMID: 33189212 PMCID: PMC7442570 DOI: 10.1016/j.ihj.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/18/2020] [Accepted: 08/17/2020] [Indexed: 11/15/2022] Open
Abstract
There is an increasing incidence of cardiovascular disease (CVD) in Indian men and women of younger ages but research related to CVD risk behaviors in college-going women in India is limited. A cross-sectional questionnaire-based survey conducted among 554 students from two women's colleges in Chennai showed that there was an alarmingly high prevalence of unhealthy diet and inadequate exercise, a moderately high prevalence of psychosocial risk and a low prevalence of tobacco use and alcohol consumption. It is imperative to increase awareness and provide targeted interventions to help our young women adopt a heart-healthy lifestyle.
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Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza-Albarrán AA, Ramaiya KL. Diabetes in developing countries. J Diabetes 2019; 11:522-539. [PMID: 30864190 DOI: 10.1111/1753-0407.12913] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022] Open
Abstract
There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.
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Affiliation(s)
- Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Hema Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
| | | | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Mario Soares
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alfredo A Reza-Albarrán
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Abstract
PURPOSE OF REVIEW Obesity has increased in South Asian countries that are still grappling with undernutrition. In this review, we highlight the characteristics of obesity, its relation to morbidities, and its management in South Asians. A literature search was conducted using relevant search engines and based on key words focusing on obesity in South Asians. RECENT FINDINGS The increasing trend in obesity prevalence is caused by imbalanced diets and physical inactivity. South Asians, in general, have higher body fat and lower skeletal muscle mass at the same or lower BMIs compared to white people ("high body fat-normal BMI-low muscle mass" phenotype). In addition, excess abdominal adiposity, typically seen in South Asians, and increased hepatic fat (non-alcoholic fatty liver disease) are associated with an increased risk for type 2 diabetes and cardiovascular disease. Challenges in treatment include lack of awareness regarding correct diets and non-compliance to diet and exercise regimens. Social and cultural issues limit physical activity in South Asian women. Finally, there is a lack of expert health professionals to deal with increased cases of obesity. Aggressive management of obesity is required in South Asians, with more intensive and earlier diet and exercise interventions (i.e., at lower BMI levels than internationally accepted). At a population level, there is no clear policy for tackling obesity in any South Asian country. Prevention strategies focusing on obesity in childhood and the creation of food and activity environments that encourage healthy lifestyles should be firmly applied. Obesity in South Asians should be evaluated with ethnic-specific guidelines and prevention and management strategies should be applied early and aggressively.
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Affiliation(s)
- Anoop Misra
- Metabolic Diseases and Allied Specialties, Fortis-C-DOC Hospital for Diabetes, B-16, Chirag Enclave, New Delhi, India.
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India.
- Diabetes Foundation (India), New Delhi, India.
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Shajith Anoop
- Metabolic Diseases and Allied Specialties, Fortis-C-DOC Hospital for Diabetes, B-16, Chirag Enclave, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
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Gupta R, Khedar RS, Gaur K, Xavier D. Low quality cardiovascular care is important coronary risk factor in India. Indian Heart J 2018; 70 Suppl 3:S419-S430. [PMID: 30595301 PMCID: PMC6309144 DOI: 10.1016/j.ihj.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023] Open
Abstract
Global Burden of Disease study has reported that cardiovascular and ischemic heart disease (IHD) mortality has increased by 34% in last 25 years in India. It has also been reported that despite having lower coronary risk factors compared to developed countries, incident cardiovascular mortality, cardiovascular events and case-fatality are greater in India. Reasons for the increasing trends and high mortality have not been studied. There is evidence that social determinants of IHD risk factors are widely prevalent and increasing. Epidemiological studies have reported low control rates of hypertension, hypercholesterolemia, diabetes and smoking/tobacco. Registries have reported greater mortality of acute coronary syndrome in India compared to developed countries. Secondary prevention therapies have significant gaps. Low quality cardiovascular care is an important risk factor in India. Package of interventions focusing on fiscal, intersectoral and public health measures, improvement of health services at community, primary and secondary healthcare levels and appropriate referral systems to specialized hospitals is urgently required.
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Affiliation(s)
- Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Raghubir S Khedar
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Kiran Gaur
- Department of Statistics, SKN Agricultural University, Jobner, Jaipur, India
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore, India
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Gopalan HS, Misra A, Jayawardena R. Nutrition and diabetes in South Asia. Eur J Clin Nutr 2018; 72:1267-1273. [PMID: 30185841 DOI: 10.1038/s41430-018-0219-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Hema S Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India
| | - Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, 110016, India. .,Diabetes Foundation (India), New Delhi, 110016, India. .,Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B 16, Chirag Enclave, New Delhi, India.
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Gupta R, Xavier D. Hypertension: The most important non communicable disease risk factor in India. Indian Heart J 2018; 70:565-572. [PMID: 30170654 PMCID: PMC6116711 DOI: 10.1016/j.ihj.2018.02.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/31/2017] [Accepted: 02/10/2018] [Indexed: 12/26/2022] Open
Abstract
Non-communicable diseases are important causes of mortality and morbidity in India. Data from the Registrar General of India, World Health Organization and Global Burden of Disease (GBD) Study have reported that cardiovascular diseases (CVD) are the most important causes of death and disability. Age-adjusted mortality from these conditions has increased by 31% in last 25 years. Case-control studies have reported that hypertension is most important risk factor for CVD in India. GBD Study has estimated that hypertension led to 1.6 million deaths and 33.9 million disability-adjusted life years in 2015 and is most important cause of disease burden in India. Intensive public health effort is required to increase its awareness, treatment and control. UN Sustainable Development Goals highlight the importance of high rates of hypertension control for achieving target of 1/3 reduction in non-communicable disease mortality by 2030. It is estimated that better hypertension control can prevent 400-500,000 premature deaths in India.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology and Internal Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur 302017 India.
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Sarjapur Road, Bengaluru 560034 India
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Nagarkar AM, Kulkarni SS. Obesity and its Effects on Health in Middle-Aged Women from Slums of Pune. J Midlife Health 2018; 9:79-84. [PMID: 29962806 PMCID: PMC6006801 DOI: 10.4103/jmh.jmh_8_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The study aims to find out the prevalence of obesity and its consequences on the health of middle-aged (45–59 years) women in slum areas. Methodology: The present study includes 559 women between 45 and 59 years of age from slums of Pune city, Maharashtra. Data were collected using a structured questionnaire, anthropometric measurements, physical activity using International Physical Activity Questionnaire long version, information on dietary habits, chronic illnesses, etc., Univariate analysis and further multiple logistic regressions were used to determine associations and risk estimates using Statistical Package for the Social Science version 16. Results: About 60% had body mass index (BMI) above normal, 39% were overweight, and 21.3% obese. The percentage of obesity increased with increasing age. Obesity was significantly associated with working status (P = 0.042), hypertension (P = 0.013), knee pain (P = 0.029), squatting (P = 0.001), walking (P = 0.001), climbing stairs (P = 0.004), and rising from chair (P = 0.040). Functional decline was reported by 62.8% women. Odds of having high blood pressure 1.8 (95% confidence interval [CI]: 1.1–3.0), difficulty in squatting, walking was 1.5 (95% CI: 1.0–2.4) and 1.9 (95% CI: 1.0–3.6) respectively more in overweight. Higher odds of having blood pressure 1.8 (95% CI: 1.0–3.3) and difficulty in walking 2.4 (95% CI: 1.2–4.6) was observed in obese women as compared to women in normal BMI category. Conclusion: The study shows that the prevalence of obesity is higher among women even in the low-income areas. This indicates a need for specific interventions targeted to women in urban slum. The inclusion of multicomponent intervention will prove to be beneficial at the community level.
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Affiliation(s)
- Arati Makarand Nagarkar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Snehal Sameer Kulkarni
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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Abstract
BACKGROUND Member states of the WHO, including India, have adopted a target 30% reduction in mean population salt consumption by 2025 to prevent noncommunicable diseases. Our aim was to support this initiative by summarizing existing data that describe mean salt consumption in India. METHOD Electronic databases - MEDLINE via Ovid, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews - were searched up to November 2015 for studies that reported mean or median dietary salt intake in Indian adults aged 19 years and older. Random effects meta-analysis was used to obtain summary estimates of salt intake. RESULTS Of 1201 abstracts identified, 90 were reviewed in full text and 21 were included: 18 cross-sectional surveys (n = 225 024), two randomized trials (n = 255) and one case-control study (n = 270). Data were collected between 1986 and 2014, and reported mean salt consumption levels were between 5.22 and 42.30 g/day. With an extreme outlier excluded, overall mean weighted salt intake was 10.98 g/day (95% confidence interval 8.57-13.40). There was significant heterogeneity between the estimates for contributing studies (I = 99.97%) (P homogeneity ≤0.001), which was likely attributable to the different measurement methods used and the different populations studied. There was no evidence of a change in intake over time (P trend = 0.08). CONCLUSION The available data leave some uncertainty about exact mean salt consumption in India but there is little doubt that population salt consumption far exceeds the WHO-recommended maximum of 5 g per person per day.
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Johnson C, Mohan S, Rogers K, Shivashankar R, Thout SR, Gupta P, He FJ, MacGregor GA, Webster J, Krishnan A, Maulik PK, Reddy KS, Prabhakaran D, Neal B. The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India. Nutrients 2017; 9:E144. [PMID: 28212309 PMCID: PMC5331575 DOI: 10.3390/nu9020144] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/16/2022] Open
Abstract
Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants' physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87-9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake-less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55-9.87 g/day) versus less-educated (9.34, 8.57-10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.
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Affiliation(s)
- Claire Johnson
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi 110070, India.
| | - Kris Rogers
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
| | - Roopa Shivashankar
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | | | - Priti Gupta
- Public Health Foundation of India, New Delhi 110070, India.
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Jacqui Webster
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad 500034, India.
- George Institute for Global Health, University of Oxford, Oxford OX1 3PA, UK.
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | - Bruce Neal
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
- Charles Perkins Centre, University of Sydney, Sydney 2050, Australia.
- School of Public Health, Imperial College, London SW7 2AZ, UK.
- Royal Prince Alfred Hospital, Sydney 2050, Australia.
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Ganassin GS, Silva EMD, Pimenta AM, Marcon SS. Efetividade da intervenção educativa no conhecimento de homens relacionado às doenças cardiovasculares. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Comparar o conhecimento sobre fatores de risco para doenças cardiovasculares antes e após intervenção educativa realizada com homens metalúrgicos. Métodos Estudo de intervenção, realizado com 135 metalúrgicos, com idades entre 18 e 70 anos. O conhecimento sobre doenças cardiovasculares foi determinado pelo questionário Heart Disease Fact Questionnaire (HDFQ-2). Foram utilizados testes t de Student para amostras independentes e de Mann-Whitney, na comparação entre grupos, e testes t de Student para amostras dependentes e de Wilcoxon, na avaliação pareada. Resultados Tanto no grupo intervenção quanto no controle houve aumento estatisticamente significativo de 1,4 pontos na média do conhecimento entre o momento de base e o de seguimento. Conclusão A intervenção educativa, realizada em grupo, no local de trabalho e em horário de almoço, mostrou-se uma estratégia possível e eficaz para aumentar o conhecimento de homens sobre fatores de risco para doenças cardiovasculares.
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Eik Filho W, Bonjorno LP, Franco AJM, dos Santos MLA, de Souza EM, Marcon SS. Evaluation, intervention, and follow-up of patients with diabetes in a primary health care setting in Brazil: the importance of a specialized mobile consultancy. Diabetol Metab Syndr 2016; 8:56. [PMID: 27508006 PMCID: PMC4977716 DOI: 10.1186/s13098-016-0173-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/24/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies show that educational interventions improve glycemic control in patients with diabetes mellitus (DM), reducing the occurrence of complications associated with the disease. OBJECTIVES To evaluate the effects of a mobile DM consultancy on clinical and laboratory parameters, disease knowledge, and quality of life in patients with type 2 DM (T2DM) at a primary health care network in Brazil. METHODS Randomized clinical trial conducted in a city in southern Brazil with 52 patients with T2DM receiving care at a primary health care setting. The intervention lasted for 6 months and consisted of a follow-up with an endocrinologist (five meetings), treatment adjustment based on clinical evaluation and laboratory tests, and educational activities with conversation maps in DM. The statistical analysis included comparison and association tests, considering p values ≤0.05 as statistically significant. RESULTS The mean age of the patients was 63.8 years. Most participants were female (63.5 %), had low educational level (59.6 %) and family history of T2DM (71.2 %), used only oral hypoglycemic agents to manage their DM (73.2 %), presented unfavorable anthropometric and laboratory parameters, a high or medium risk of complications (84.6 %), and inadequate glycemic control (67.3 %; with 71 % of the high-risk patients presenting a HbA1c level >9 %). Adjustment in pharmacological treatment was required in 63.5 % of the patients. After the intervention, we observed a significant 0.46 % decrease in mean HbA1c level (p = 0.0218), particularly among individuals with inadequate glycemic control (0.71 %; p = 0.0136). Additionally, there was an increase in disease knowledge scores and a significant decrease in mean body mass index, waist circumference, and disease impact scores. CONCLUSION The intervention improved glycemic control and disease knowledge, reduced the values of body mass index and waist circumference, and the impact of the disease on patients' lives. This indicates that care and educational measures improve the experience of the patients with DM and control of the disease.
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Affiliation(s)
- Wilson Eik Filho
- Endocrinology Unit, Department of Medicine, Universidade Estadual de Maringá, and Postgraduate Program in Health Sciences, Health Sciences Center, Universidade Estadual de Maringá, Maringá, Parana Brazil
- Avenida Mandacarú, 1590-Zona 07, Maringá, PR CEP: 87083-240 Brazil
| | | | | | - Márcia Lorena Alves dos Santos
- Department of Statistics, Universidade Estadual de Maringá and Postgraduate Program in Biostatistics, Universidade Estadual de Maringá, Maringá, Parana Brazil
| | - Eniuce Menezes de Souza
- Department of Statistics, Universidade Estadual de Maringá and Postgraduate Program in Biostatistics, Universidade Estadual de Maringá, Maringá, Parana Brazil
| | - Sonia Silva Marcon
- Postgraduate Program in Health Sciences, Health Sciences Center, Universidade Estadual de Maringá, Maringá, Parana Brazil
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Hooper L, Abdelhamid A, Bunn D, Brown T, Summerbell CD, Skeaff CM. Effects of total fat intake on body weight. Cochrane Database Syst Rev 2015:CD011834. [PMID: 26250104 PMCID: PMC10403157 DOI: 10.1002/14651858.cd011834] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In order to prevent overweight and obesity in the general population we need to understand the relationship between the proportion of energy from fat and resulting weight and body fatness in the general population. OBJECTIVES To assess the effects of proportion of energy intake from fat on measures of weight and body fatness (including obesity, waist circumference and body mass index) in people not aiming to lose weight, using all appropriate randomised controlled trials (RCTs) and cohort studies in adults, children and young people SEARCH METHODS We searched CENTRAL to March 2014 and MEDLINE, EMBASE and CINAHL to November 2014. We did not limit the search by language. We also checked the references of relevant reviews. SELECTION CRITERIA Trials fulfilled the following criteria: 1) randomised intervention trial, 2) included children (aged ≥ 24 months), young people or adults, 3) randomised to a lower fat versus usual or moderate fat diet, without the intention to reduce weight in any participants, 4) not multifactorial and 5) assessed a measure of weight or body fatness after at least six months. We also included cohort studies in children, young people and adults that assessed the proportion of energy from fat at baseline and assessed the relationship with body weight or fatness after at least one year. We duplicated inclusion decisions and resolved disagreement by discussion or referral to a third party. DATA COLLECTION AND ANALYSIS We extracted data on the population, intervention, control and outcome measures in duplicate. We extracted measures of weight and body fatness independently in duplicate at all available time points. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity and funnel plot analyses. MAIN RESULTS We included 32 RCTs (approximately 54,000 participants) and 30 sets of analyses of 25 cohorts. There is consistent evidence from RCTs in adults of a small weight-reducing effect of eating a smaller proportion of energy from fat; this was seen in almost all included studies and was highly resistant to sensitivity analyses. The effect of eating less fat (compared with usual diet) is a mean weight reduction of 1.5 kg (95% confidence interval (CI) -2.0 to -1.1 kg), but greater weight loss results from greater fat reductions. The size of the effect on weight does not alter over time and is mirrored by reductions in body mass index (BMI) (-0.5 kg/m(2), 95% CI -0.7 to -0.3) and waist circumference (-0.3 cm, 95% CI -0.6 to -0.02). Included cohort studies in children and adults most often do not suggest any relationship between total fat intake and later measures of weight, body fatness or change in body fatness. However, there was a suggestion that lower fat intake was associated with smaller increases in weight in middle-aged but not elderly adults, and in change in BMI in the highest validity child cohort. AUTHORS' CONCLUSIONS Trials where participants were randomised to a lower fat intake versus usual or moderate fat intake, but with no intention to reduce weight, showed a consistent, stable but small effect of low fat intake on body fatness: slightly lower weight, BMI and waist circumference compared with controls. Greater fat reduction and lower baseline fat intake were both associated with greater reductions in weight. This effect of reducing total fat was not consistently reflected in cohort studies assessing the relationship between total fat intake and later measures of body fatness or change in body fatness in studies of children, young people or adults.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK, NR4 7TJ
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Physical activity of urban middle aged women in different domains: a cross sectional study. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0227-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Vaidya A, Aryal UR, Krettek A. Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site. BMJ Open 2013; 3:e002976. [PMID: 24157816 PMCID: PMC3808775 DOI: 10.1136/bmjopen-2013-002976] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study determined the knowledge, attitude and practice/behaviour of cardiovascular health in residents of a semiurban community of Nepal. DESIGN To increase the understanding of knowledge, attitude and practice/behaviour towards cardiovascular health, we conducted in-home interviews using a questionnaire based on the WHO STEPwise approach to surveillance and other resources, scoring all responses. We also recorded blood pressure and took anthropometric measurements. SETTING Our study was conducted as part of the Heart-Health-Associated Research and Dissemination in the Community project in the Jhaukhel-Duwakot Health Demographic Surveillance Site in two urbanising villages near Kathmandu. PARTICIPANTS The study population included 777 respondents from six randomly selected clusters in both villages. RESULTS Seventy per cent of all participants were women and 26.9% lacked formal education. The burden of cardiovascular risk factors was high; 20.1% were current smokers, 43.3% exhibited low physical activity and 21.6% were hypertensive. Participants showed only poor knowledge of heart disease causes; 29.7% identified hypertension and 11% identified overweight and physical activity as causes, whereas only 2.2% identified high blood sugar as causative. Around 60% of respondents did not know any heart attack symptoms compared with 20% who knew 2-4 symptoms. Median percentage scores for knowledge, attitude and practice/behaviour were 79.3, 74.3 and 48, respectively. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge. Among those with highly satisfactory knowledge, only 14.7% had a highly satisfactory attitude and 19.5% and 13.9% had satisfactory and highly satisfactory practices, respectively. CONCLUSIONS Our study demonstrates a gap between cardiovascular health knowledge, attitude and practice/behaviour in a semiurban community in a low-income nation, even among those already affected by cardiovascular disease.
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Affiliation(s)
- Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
- Nordic School of Public Health NHV, Gothenburg, Sweden
| | - Umesh Raj Aryal
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
- Nordic School of Public Health NHV, Gothenburg, Sweden
| | - Alexandra Krettek
- Nordic School of Public Health NHV, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Gupta R. Prevention & control of CVD in women & children in India. Indian J Med Res 2013; 138:281-4. [PMID: 24135169 PMCID: PMC3818587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Rajeev Gupta
- Department of Medicine, Room 5034, Fortis Escorts Hospital, Malviya Nagar, JLN Marg Jaipur 302 017, India
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