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Kraft AD, Capuno JJ, Calicdan KGR, Cruz GT, O'Donnell O. Missed opportunities for hypertension screening of older people in the Philippines: cross-sectional analysis of nationally representative individual-level data. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 50:101188. [PMID: 39296578 PMCID: PMC11407953 DOI: 10.1016/j.lanwpc.2024.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024]
Abstract
Background Guidelines recommend routine blood pressure measurement at health facilities. We estimated the potential for opportunistic screening for hypertension at health facilities to change the level and distribution of diagnosed hypertension in the older population of the Philippines. Methods We used a representative, nationwide sample of Filipinos aged 60 years and older and classified respondents as a) hypertensive if they had high (≥140/90 mm Hg) blood pressure (BP) or were taking BP medication, b) diagnosed if told have high BP by a doctor, and c) a missed opportunity for diagnosis if they were hypertensive, undiagnosed and had an outpatient visit to a health facility in the past 12 months. We assumed c) would be diagnosed if health facilities operated opportunistic screening. We estimated percentages of hypertensives diagnosed and with a missed opportunity overall, by wealth quintile and covariates, with age-sex and, then, full adjustment. Findings We estimated that opportunistic screening at health facilities would increase the percentage of hypertensives diagnosed from 62.7% (95% CI: 58.2, 67.0) to 74.4% (95% CI: 70.9, 77.6). The increase would be larger in richer groups due to lower (private) healthcare utilization by poorer, undiagnosed hypertensives. Interpretation Opportunistic screening for hypertension, if effectively implemented at health facilities, would substantially increase diagnosis but exacerbate inequality unless barriers discouraging poorer, older Filipinos from accessing outpatient and primary care were lowered. Funding Economic Research Institute for ASEAN and East Asia, Swiss Agency for Development and Cooperation/Swiss National Science Foundation grant 400640_160374.
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Affiliation(s)
- Aleli D Kraft
- School of Economics, University of the Philippines Diliman, Philippines
| | - Joseph J Capuno
- School of Economics, University of the Philippines Diliman, Philippines
| | | | - Grace T Cruz
- Population Institute, University of the Philippines Diliman, Philippines
| | - Owen O'Donnell
- School of Health Policy & Management, School of Economics, Erasmus University Rotterdam, the Netherlands
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2
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Niclou A, Vesi L, Arorae M, Naseri NC, Savusa KF, Naseri T, Young J, Rivara AC, Ocobock C. Indication of mixed glucose and fatty acid use by inferred brown adipose tissue activity in Samoans. Am J Hum Biol 2024; 36:e23998. [PMID: 37823535 PMCID: PMC10939975 DOI: 10.1002/ajhb.23998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Despite the growing rates of global obesity and the known positive associations between brown adipose tissue (BAT) and cardiovascular health, little is known about the metabolic effects of BAT activity in Samoans, a population at high risk of obesity and type II diabetes. Here we assessed the potential effects of inferred BAT activity on metabolic health markers in Samoan adults exposed to mild cold. METHODS Using point-of-care finger prick technology we measured fasting glucose, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels before and after 30 min of cold exposure among 61 individuals (38 females, 23 males, ages 31-54) from 'Upolu Island, Samoa. Respiratory quotient was measured by indirect calorimetry to determine substrate metabolism at room temperature and cold exposure. RESULTS Fasting glucose levels decreased significantly (p < .001) after cold exposure while neither total cholesterol (p = .88), HDL (p = .312), nor LDL (p = .089) changed. Respiratory quotient decreased significantly (p = .009) between exposures, suggesting an increased preference for lipid metabolism as a response to cold. CONCLUSIONS The observed effects of inferred BAT activity on biomarkers suggest BAT activity utilizes both glucose and lipid-derived fatty acids as fuel for thermogenesis. Our work provides evidence for the beneficial metabolic effects of BAT and emphasizes the need for the population-specific development of metabolic treatments involving BAT to ensure the successful and equitable minimization of extreme consequences of obesity and metabolic health.
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Affiliation(s)
- Alexandra Niclou
- Pennington Biomedical Research Center, Baton Rouge, LA
- Department of Anthropology, University of Notre Dame, Notre Dame, IN
| | - Lupesina Vesi
- Obesity, Lifestyle and Genetic Adaptations (OLaGA) Study Group, Apia, Samoa
| | - Maria Arorae
- Obesity, Lifestyle and Genetic Adaptations (OLaGA) Study Group, Apia, Samoa
| | | | | | | | - Jessica Young
- Center for Social Science Research, University of Notre Dame, Notre Dame, IN
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Cara Ocobock
- Department of Anthropology, University of Notre Dame, Notre Dame, IN
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN
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Wang J, Tan F, Wang Z, Yu Y, Yang J, Wang Y, Shao R, Yin X. Understanding Gaps in the Hypertension and Diabetes Care Cascade: Systematic Scoping Review. JMIR Public Health Surveill 2024; 10:e51802. [PMID: 38149840 PMCID: PMC10907944 DOI: 10.2196/51802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/22/2023] [Accepted: 12/27/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade. OBJECTIVE This scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade. METHODS The method of this scoping review has been guided by the framework by Arksey and O'Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management. RESULTS A total of 128 studies were included, with 42.2% (54/128) conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care, 63 (49.2%) focused on diabetes care, and only 18 (14.1%) reported on the care of both diseases. The majority (96/128, 75.0%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4% vs 52/128, 40.6%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings. CONCLUSIONS This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes.
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Affiliation(s)
- Jie Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fangqin Tan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenzhong Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiwen Yu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingsong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yueqing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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4
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Niclou A, Vesi L, Arorae M, Naseri NC, Savusa KF, Naseri T, DeLany JP, McGarvey ST, Rivara AC, Ocobock C. When the cold gets under your skin: Evidence for brown adipose tissue activity in Samoan adults. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:e24848. [PMID: 37740598 PMCID: PMC10843446 DOI: 10.1002/ajpa.24848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/13/2023] [Accepted: 08/28/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES Brown adipose tissue (BAT) is a heat-producing organ aiding nonshivering thermogenesis (NST) during cold stress. Due to its potential cold-adaptive role BAT has been predominantly studied in cold and temperate climate populations, but not among warm-climate adults. This work explores if BAT activity can be inferred in Samoans. MATERIALS AND METHODS We inferred BAT activity by comparing metabolic rate and surface heat dissipation using indirect calorimetry and thermal imaging between room temperature and cold exposure among Samoans (N = 61, females: n = 38) from 'Upolu Island, Samoa. BAT activity was inferred using ANOVA linear regression models with the variables measured at cold exposure as outcomes. T-tests were used to compare changes in surface temperature between room temperature and cold exposure. RESULTS Metabolic rate significantly increased after cooling. In both the supraclavicular area, a known BAT location, and the sternum, a non-BAT location, temperatures decreased significantly upon cold exposure. Differences in supraclavicular temperatures between room temperature and cold were significantly smaller than differences in sternum temperatures between exposures. These results suggest that BAT thermogenesis occurred in known BAT-locations and thus contributed to NST during cooling. CONCLUSIONS This study adds to our understanding of BAT activity across different populations and climates. Further study may illuminate whether the cold-adaptive properties of BAT may have played a role in the successful expansion of populations across the globe, including warm-climate groups.
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Affiliation(s)
- Alexandra Niclou
- Pennington Biomedical Research Center, Baton Rouge, LA
- Department of Anthropology, University of Notre Dame, Notre Dame, IN
| | - Lupesina Vesi
- Obesity, Lifestyle and Genetic Adaptations (OLaGA) Study Group, Apia, Samoa
| | - Maria Arorae
- Obesity, Lifestyle and Genetic Adaptations (OLaGA) Study Group, Apia, Samoa
| | | | | | | | - James P. DeLany
- AdventHealth Orlando, Translational Research Institute, Orlando, FL
| | - Stephen T. McGarvey
- International Health Institute & Departments of Epidemiology and Anthropology, Brown University, Providence, RI
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Cara Ocobock
- Department of Anthropology, University of Notre Dame, Notre Dame, IN
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN
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Kuek T. Type 2 Diabetes Prevalence, Control and Management within Fiji,Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu: A ScopingReview with a Systematic Approach. Curr Diabetes Rev 2024; 20:e220124225914. [PMID: 38258764 DOI: 10.2174/0115733998260306231025151814] [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: 05/18/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population. OBJECTIVES The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects. METHODS This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023. RESULTS A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services. CONCLUSION The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.
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Affiliation(s)
- Timothy Kuek
- Interplast Australia and New Zealand, 250/290 Spring St, East Melbourne VIC, 3002, Australia
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Andersen JA, Rowland B, Gloster E, O’Connor G, Ioanna Bing W, Niedenthal J, Riklon S, McElfish PA. Undiagnosed hypertension and type 2 diabetes mellitus among Marshallese adults in the Republic of the Marshall Islands. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834231225159. [PMID: 38282818 PMCID: PMC10812094 DOI: 10.1177/27550834231225159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024]
Abstract
Background Given the lack of healthcare access in the Republic of the Marshall Island (RMI) and the potential for complications related to type 2 diabetes mellitus (T2DM) and hypertension, it is crucial to examine these conditions among Marshallese in the RMI. Objectives This study aims to identify the proportion of Marshallese adults in the RMI with undiagnosed T2DM and hypertension. Design Using a community-based participatory research approach, screening events were conducted at 20 churches in Majuro Atoll. Methods Participants completed a questionnaire and biometric data measures, including hemoglobin A1c and blood pressure. Results Among participants with blood pressure data (N = 528), 11.9% had readings indicative of hypertension, and 38.1% were undiagnosed. Among participants with hemoglobin A1c (HbA1c) data (N = 450), 45.3% had readings indicative of T2DM, and 39.2% were undiagnosed. Conclusion This study utilized a community-based participatory research approach that promotes equitable and ethical research. Results reaffirm the need to identify strategies for increasing healthcare access and for research to address health disparities in the RMI.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Erin Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Gail O’Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Oyama S, Duckham RL, Pomer A, Rivara AC, Kershaw EE, Wood A, Fidow UT, Naseri T, Reupena MS, Viali S, McGarvey ST, Hawley NL. Association between age at menarche and cardiometabolic risk among Samoan adults. Am J Hum Biol 2024; 36:e23982. [PMID: 37668413 PMCID: PMC10845161 DOI: 10.1002/ajhb.23982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES Recent studies suggest that early menarche may increase cardiometabolic morbidity and mortality. Yet few studies have examined this association in the Pacific Islands, where obesity prevalence is among the highest globally. We sought to examine associations between age at menarche and cardiometabolic risk in Samoa. METHODS Participants were from the Soifua Manuia study (n = 285, age 32-72 years) conducted in Samoa from 2017 to 2019. Logistic regressions were conducted to estimate odds of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome per one-year increase in age at menarche. Linear regressions were conducted to examine associations between age at menarche and continuous measures of adiposity, blood pressure, insulin resistance, and serum lipids. RESULTS Median age at menarche was 14 years (IQR = 2). After controlling for relevant covariates, each one-year increase in age at menarche was associated with a 15% decrease (OR = 0.85, 95% CI: 0.72-1.01, p = .067) in odds of hypertension, but a 21% increase (OR = 1.21, 95% CI: 1.01-1.45, p = .044) in odds of diabetes and 18% increase (OR = 1.18, 95% CI: 0.98-1.42, p = .081) in odds of high total cholesterol. Each additional year in age at menarche was associated with a 1.60 ± 0.52 kg (p = .002) decrease in lean mass and 1.56 ± 0.51 kg (p = .003) decrease in fat-free mass. CONCLUSIONS Associations between age at menarche and cardiometabolic risk may be population-specific and are likely influenced by both current and historical nutritional and epidemiological contexts. Prospective studies are needed to clarify the role of childhood adiposity and other early life exposures on age at menarche and subsequent cardiometabolic risk.
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Affiliation(s)
- Sakurako Oyama
- Yale School of Medicine, New Haven, Connecticut, USA
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
| | - Rachel L Duckham
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
- Australian Institute for Musculoskeletal Sciences, Department of Medicine, Western Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Erin E Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashlee Wood
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ulai T Fidow
- Department of Obstetrics & Gynecology, Tupua Tamasese Meaole Hospital, Apia, Samoa
| | | | | | | | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Nicola L Hawley
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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Lamloum D, Fassio F, Osetinsky B, Tediosi F. Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1606428. [PMID: 37901590 PMCID: PMC10600349 DOI: 10.3389/ijph.2023.1606428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objective: High blood pressure is the leading risk factor for cardiovascular disease. The hypertension care cascade (HCC) is increasingly being used to evaluate the effectiveness of interventions. This systematic review aims to examine HCC in low-income settings. Methods: The search strategy included articles published between January 2010 and April 2023. We excluded studies with incomplete HCC, on fragile patients or aged <18 years, reviews. We used the MOOSE guideline. Five researchers retrieved data on the survey year, country, population, HCC and diagnostic methods for hypertension. We used JBI Critical Appraisal Tools for quality assessment. Results: Ninety-five articles were analyzed. Average hypertension prevalence was 33% (95% CI: 31%-34%), lower in LICs than in LMICs (25% vs. 34%). The overall mean awareness of hypertension was 48% (95% CI: 45%-51%), its treatment was 35% (95% IC: 32%-38%) and its control 16% (95% CI: 14%-18%). In almost all steps, percentages were lower in LICs and in Sub-Saharan Africa. Conclusion: Trends in HCC vary between countries, with poorer performance in LICs. This review highlights the need for interventions tailored to low-income settings in order to improve hypertension care.
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Affiliation(s)
- Demetrio Lamloum
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Islam MT, Bruce M, Alam K. Cascade of diabetes care in Bangladesh, Bhutan and Nepal: identifying gaps in the screening, diagnosis, treatment and control continuum. Sci Rep 2023; 13:10285. [PMID: 37355725 PMCID: PMC10290703 DOI: 10.1038/s41598-023-37519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023] Open
Abstract
Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018-2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1; confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2; CI:1.9, 19.9].
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Affiliation(s)
- Md Tauhidul Islam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
| | - Mieghan Bruce
- School of Veterinary Medicine and Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Koirala T, B C UB, Shrestha C, Paudel U, Dhital R, Pokharel S, Subedi M. Arterial hypertension and its covariates among nomadic Raute hunter-gatherers of Western Nepal: a mixed-method study. BMJ Open 2023; 13:e067312. [PMID: 36997254 PMCID: PMC10069499 DOI: 10.1136/bmjopen-2022-067312] [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] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal. DESIGN A mixed-method study. SETTING The study was carried out at Raute temporary campsites in the Surkhet District of Karnali Province between May and September 2021. PARTICIPANTS The questionnaire-based survey included all males and non-pregnant females of the nomadic Raute group aged 15 years and above. In-depth interviews were conducted among purposively selected 15 Raute participants and four non-Raute key informants to help explain and enrich the quantitative findings. OUTCOME MEASURES The prevalence of hypertension (defined as brachial artery blood pressure of systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg) and its sociodemographic, anthropometric and behavioural covariates. RESULTS Of the 85 eligible participants, 81 (median age 35 years (IQR: 26-51), 46.9% female) were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of males and 30.9% of the total population. Current alcohol and tobacco use were high (91.4% and 70.4%, respectively), with concerning high rates among youths. Males, older people, current drinkers and current tobacco users were more likely to have hypertension. Our qualitative analysis suggests that the traditional forest-based Raute economy is gradually transitioning into a cash-based one that heavily relies on government incentives. Consumption of commercial foods, drinks and tobacco products is increasing as their market involvement grows. CONCLUSION This study found a high burden of hypertension, alcohol and tobacco use among nomadic Raute hunter-gatherers facing socioeconomic and dietary transitions. Further research is needed to assess the long-term impact of these changes on their health. This study is expected to help appraise concerned policymakers of an emerging health concern and formulate context-specific and culturally sensitive interventions to limit hypertension-related morbidities and mortalities in this endangered population.
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Affiliation(s)
- Tapendra Koirala
- Dasharathpur Primary Health Care Center, Surkhet, Karnali Province, Nepal
- Department of Health Services, Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
| | - Udaya Bahadur B C
- Public Health Service Office Surkhet, Ministry of Social Development, Surkhet, Karnali Province, Nepal
| | - Carmina Shrestha
- Health Action and Research Pvt. Ltd, Kathmandu, Bagmati Province, Nepal
| | - Ujjawal Paudel
- Department of Health Services, Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
- Jibjibe Primary Health Care Center, Rasuwa, Bagmati Province, Nepal
| | - Rolina Dhital
- Health Action and Research Pvt. Ltd, Kathmandu, Bagmati Province, Nepal
| | - Sunil Pokharel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Madhusudan Subedi
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Bagmati Province, Nepal
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Zhang JZ, Heinsberg LW, Krishnan M, Hawley NL, Major TJ, Carlson JC, Hindmarsh JH, Watson H, Qasim M, Stamp LK, Dalbeth N, Murphy R, Sun G, Cheng H, Naseri T, Reupena MS, Kershaw EE, Deka R, McGarvey ST, Minster RL, Merriman TR, Weeks DE. Multivariate analysis of a missense variant in CREBRF reveals associations with measures of adiposity in people of Polynesian ancestries. Genet Epidemiol 2023; 47:105-118. [PMID: 36352773 PMCID: PMC9892232 DOI: 10.1002/gepi.22508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/02/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
The minor allele of rs373863828, a missense variant in CREB3 Regulatory Factor, is associated with several cardiometabolic phenotypes in Polynesian peoples. To better understand the variant, we tested the association of rs373863828 with a panel of correlated phenotypes (body mass index [BMI], weight, height, HDL cholesterol, triglycerides, and total cholesterol) using multivariate Bayesian association and network analyses in a Samoa cohort (n = 1632), Aotearoa New Zealand cohort (n = 1419), and combined cohort (n = 2976). An expanded set of phenotypes (adding estimated fat and fat-free mass, abdominal circumference, hip circumference, and abdominal-hip ratio) was tested in the Samoa cohort (n = 1496). In the Samoa cohort, we observed significant associations (log10 Bayes Factor [BF] ≥ 5.0) between rs373863828 and the overall phenotype panel (8.81), weight (8.30), and BMI (6.42). In the Aotearoa New Zealand cohort, we observed suggestive associations (1.5 < log10 BF < 5) between rs373863828 and the overall phenotype panel (4.60), weight (3.27), and BMI (1.80). In the combined cohort, we observed concordant signals with larger log10 BFs. In the Samoa-specific expanded phenotype analyses, we also observed significant associations between rs373863828 and fat mass (5.65), abdominal circumference (5.34), and hip circumference (5.09). Bayesian networks provided evidence for a direct association of rs373863828 with weight and indirect associations with height and BMI.
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Affiliation(s)
- Jerry Z. Zhang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Lacey W. Heinsberg
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Mohanraj Krishnan
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT
| | - Tanya J. Major
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Jenna C. Carlson
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | | | - Huti Watson
- Ngāti Porou Hauora Charitable Trust, Te Puia Springs, Tairāwhiti, New Zealand
| | - Muhammad Qasim
- Ngāti Porou Hauora Charitable Trust, Te Puia Springs, Tairāwhiti, New Zealand
| | - Lisa K. Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
| | - Guangyun Sun
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Hong Cheng
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Take Naseri
- Ministry of Health, Government of Samoa, Apia, Samoa
| | | | - Erin E. Kershaw
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Stephen T. McGarvey
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Department of Anthropology, Brown University, Providence, RI
| | - Ryan L. Minster
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Tony R. Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama Birmingham, Birmingham, AL
| | - Daniel E. Weeks
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
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Reeve E, Lamichhane P, McKenzie B, Waqa G, Webster J, Snowdon W, Bell C. The tide of dietary risks for noncommunicable diseases in Pacific Islands: an analysis of population NCD surveys. BMC Public Health 2022; 22:1521. [PMID: 35948900 PMCID: PMC9364577 DOI: 10.1186/s12889-022-13808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island Countries (PICTs). METHODS Secondary analysis of data from 21,433 adults aged 25-69, who participated in nationally representative World Health Organization STEPs surveys in 8 Pacific Island Countries and Territories between 2002 and 2019. Outcomes of interest were changes in consumption of fruit and vegetables, hypertension, overweight and obesity, and hypercholesterolaemia over time. Also, salt intake and sugar sweetened beverage consumption for those countries that measured these. RESULTS Over time, the proportion of adults consuming less than five serves of fruit and vegetables per day decreased in five countries, notably Tonga. From the most recent surveys, average daily intake of sugary drinks was high in Kiribati (3.7 serves), Nauru (4.1) and Tokelau (4.0) and low in the Solomon Islands (0.4). Average daily salt intake was twice that recommended by WHO in Tokelau (10.1 g) and Wallis and Futuna (10.2 g). Prevalence of overweight/obesity did not change over time in most countries but increased in Fiji and Tokelau. Hypertension prevalence increased in 6 of 8 countries. The prevalence of hypercholesterolaemia decreased in the Cook Islands and Kiribati and increased in the Solomon Islands and Tokelau. CONCLUSIONS While some Pacific countries experienced reductions in diet related NCD risk factors over time, most did not. Most Pacific adults (88%) do not consume enough fruit and vegetables, 82% live with overweight or obesity, 33% live with hypertension and 40% live with hypercholesterolaemia. Population-wide approaches to promote fruit and vegetable consumption and reduce sugar, salt and fat intake need strengthening.
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Affiliation(s)
- Erica Reeve
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Prabhat Lamichhane
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Briar McKenzie
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Colin Bell
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
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13
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Palinkas LA, O’Donnell M, Kemp S, Tiatia J, Duque Y, Spencer M, Basu R, Del Rosario KI, Diemer K, Doma B, Forbes D, Gibson K, Graff-Zivin J, Harris BM, Hawley N, Johnston J, Lauraya F, Maniquiz NEF, Marlowe J, McCord GC, Nicholls I, Rao S, Saunders AK, Sortino S, Springgate B, Takeuchi D, Ugsang J, Villaverde V, Wells KB, Wong M. Regional Research-Practice-Policy Partnerships in Response to Climate-Related Disparities: Promoting Health Equity in the Pacific. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9758. [PMID: 35955120 PMCID: PMC9368677 DOI: 10.3390/ijerph19159758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Although climate change poses a threat to health and well-being globally, a regional approach to addressing climate-related health equity may be more suitable, appropriate, and appealing to under-resourced communities and countries. In support of this argument, this commentary describes an approach by a network of researchers, practitioners, and policymakers dedicated to promoting climate-related health equity in Small Island Developing States and low- and middle-income countries in the Pacific. We identify three primary sets of needs related to developing a regional capacity to address physical and mental health disparities through research, training, and assistance in policy and practice implementation: (1) limited healthcare facilities and qualified medical and mental health providers; (2) addressing the social impacts related to the cooccurrence of natural hazards, disease outbreaks, and complex emergencies; and (3) building the response capacity and resilience to climate-related extreme weather events and natural hazards.
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Affiliation(s)
- Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Meaghan O’Donnell
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Susan Kemp
- School of Counseling, Human Services and Social Work, University of Auckland, Auckland 1010, New Zealand
| | - Jemaima Tiatia
- Te Wānanga o Waipapa, School of Māori Studies and Pacific Studies at the University of Auckland, Auckland 1010, New Zealand
| | - Yvonette Duque
- Asian Disaster Preparedness Center, Bangkok 10400, Thailand
| | - Michael Spencer
- School of Social Work, University of Washington, Seattle, WA 98195, USA
| | - Rupa Basu
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Sacramento, CA 95812, USA
| | | | - Kristin Diemer
- School of Social Work, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Bonifacio Doma
- Department of Chemical Engineering, Mapua University, Manila 1102, Philippines
| | - David Forbes
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Kari Gibson
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Joshua Graff-Zivin
- School of Global Policy and Strategy, University of California, San Diego, CA 92093, USA
| | - Bruce M. Harris
- Provincial Government of New Ireland, Kavieng 631, Papua New Guinea
| | - Nicola Hawley
- Department of Epidemiology and Chronic Disease, School of Public Health, Yale University, New Haven, CT 06520, USA
| | - Jill Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Fay Lauraya
- Office of the President, University of Nueva Caceres, Naga 4400, Philippines
| | | | - Jay Marlowe
- School of Counseling, Human Services and Social Work, University of Auckland, Auckland 1010, New Zealand
| | - Gordon C. McCord
- School of Global Policy and Strategy, University of California, San Diego, CA 92093, USA
| | - Imogen Nicholls
- International Organization for Migration, Canberra, ACT 2601, Australia
| | - Smitha Rao
- College of Social Work, Ohio State University, Columbus, OH 43210, USA
| | | | - Salvatore Sortino
- International Organization for Migration, Majuro 96960, Marshall Islands
| | - Benjamin Springgate
- School of Medicine, LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA
- School of Public Health, LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA
| | - David Takeuchi
- School of Social Work, University of Washington, Seattle, WA 98195, USA
| | - Janette Ugsang
- Asian Disaster Preparedness Center, Bangkok 10400, Thailand
| | - Vivien Villaverde
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Kenneth B. Wells
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
| | - Marleen Wong
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
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