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Shan J, Yin R, Panuthai S. Body mass index and multimorbidity risk: A systematic review and dose-response meta-analysis. Arch Gerontol Geriatr 2024; 123:105418. [PMID: 38604087 DOI: 10.1016/j.archger.2024.105418] [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: 11/28/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To verify the dose-response relationship between body mass index (BMI) and multimorbidity risk. METHODS PubMed, CINAHL, and Embase were systematically studied until January 25, 2023. Original articles on BMI and multimorbidity risk were included. Random effects model and dose-response meta-analysis were used to estimate the pooled odds ratio (OR) with 95 % confidence interval (CI). Subgroup analysis was performed to explore potential heterogeneity. RESULTS A total of 43 studies involving 969,130 patients (94,978 with multimorbidity) were involved in the meta-analysis. In the longitudinal studies, the pooled results showed that, compared to being a normal BMI, being overweight was much similar with 1.32 times possibility of getting multimorbidity; in persons with obesity the risk was 1.93 times higher; and the risk decreased 0.80 times among underweight persons. Additionally, obesity was 1.75 times as likely to be multimorbidity than those non-obese persons. In the cross-sectional studies, the pooled results demonstrated that persons with overweight and obesity had a 1.38-fold and 2.38-fold risk for multimorbidity, respectively; and the risk decreased 0.90 times among underweight persons compared to those with normal BMI. Besides, obese people are 1.89 times more likely to have multimorbidity than non-obese people. Dose response analysis found the linear connection between BMI and multimorbidity risk (Pnon-linearity=0.762), that for each 1 kg/m2 and 5 kg/m2 increase in BMI, the multimorbidity risk increased by 6 % and 35 %, respectively. CONCLUSIONS Multimorbidity increased linearly with an increase in BMI. Clinicians should pay attention to persons with abnormal weight, to help them achieve normal BMI.
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Affiliation(s)
- Jun Shan
- School of Nursing and Rehabilitation, Nantong University, China; Faculty of Nursing, Chiang Mai University, under the CMU presidential Scholarship, Thailand
| | - Rulan Yin
- Department of Nursing, The First Affiliated Hospital of Soochow University, China; Faculty of Nursing, Chiang Mai University, 110/406 Inthavaroros Road, Suthep, Muang district, Chiangmai 50200, Thailand
| | - Sirirat Panuthai
- Faculty of Nursing, Chiang Mai University, 110/406 Inthavaroros Road, Suthep, Muang district, Chiangmai 50200, Thailand.
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Bekele AG, Alimaw YA, Tegegn MT. Symptomatic Dry Eye Disease and Associated Factors Among Adult Diabetic Patients in Adare General Hospital, Hawassa City, Southern Ethiopia, 2023. Clin Ophthalmol 2023; 17:3429-3442. [PMID: 38026606 PMCID: PMC10656469 DOI: 10.2147/opth.s433679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Symptomatic dry eye disease is a multifactorial ocular surface condition caused by disruption of the precorneal tear film and is a common clinical finding in diabetic patients. However, there was no study on the prevalence and associated factors of symptomatic dry eye disease among diabetic patients in Ethiopia or in the study area. Purpose This study aimed to investigate the prevalence and associated factors of symptomatic dry eye disease among adult diabetic patients in Adare General Hospital, Hawassa City, Southern Ethiopia, in 2023. Methods A hospital-based cross-sectional study design was conducted on 493 adult diabetic patients who were selected using systematic random sampling, from April 23 to June 8, 2023. Data were collected through a face-to-face interview using an ocular surface disease index questionnaire. Binary logistic regression was performed to identify factors potentially associated with symptomatic dry eye disease. Variable with a P value of <0.05 was considered statistically significant. Results A total of 488 subjects participated in this study with a response rate of 99%. The prevalence of symptomatic dry eye disease was 34.8% (95% CI = 30.6-39.1). College and university educational status (AOR = 5.88, 95% CI = 2.25-15.38), government employed (AOR = 2.22, 95% CI = 1.05-4.68), use of visual display unit >5 hours (AOR = 4.41, 95% CI = 1.51-12.87), duration of diabetes ≥11 years (AOR = 3.57, 95% CI = 1.28-9.90), poor glycemic control (AOR = 2.13, 95% CI = 1.21-3.75), allergic conjunctivitis (AOR = 1.99, 95% CI = 1.12-3.54), and debris in the tear film (AOR = 3.63, 95% CI = 1.53-8.61) were positively associated with symptomatic dry eye disease. Conclusion The study revealed a high prevalence of symptomatic dry eye disease. Higher educational status, government employed, use of visual display unit, longer duration of diabetes, poor glycemic control, allergic conjunctivitis, and tear film debris were significantly associated with symptomatic dry eye disease. Breaks in screen use, good glycemic control, and treatment of ocular morbidities such as allergic conjunctivitis and debris in the tear film were recommended for all diabetic patients.
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Affiliation(s)
- Asnake Gezahegn Bekele
- Department of Ophthalmology, Madda Walabu University Goba Referral Hospital, Goba City, Ethiopia
| | - Yezinash Addis Alimaw
- Department of Optometry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Melkamu Temeselew Tegegn
- Department of Optometry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101860. [PMID: 36864977 PMCID: PMC9971315 DOI: 10.1016/j.eclinm.2023.101860] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults. METHODS We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I2 statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945). FINDINGS We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally. INTERPRETATION The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa. FUNDING None.
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Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Dipak Chandra Das
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Global Health Institute, North South University, Dhaka, Bangladesh
- Corresponding author.
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Chen Y, Shi L, Zheng X, Yang J, Xue Y, Xiao S, Xue B, Zhang J, Li X, Lin H, Ma C, Zhang C. Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16756. [PMID: 36554647 PMCID: PMC9779369 DOI: 10.3390/ijerph192416756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Multimorbidity has become one of the key issues in the public health sector. This study aims to explore the patterns and health-ecological factors of multimorbidity in China to propose policy recommendations for the management of chronic diseases in the elderly. (2) Methods: A multi-stage random sampling method was used to conduct a questionnaire survey on 3637 older adults aged 60 and older in Shanxi, China. Association rule mining analysis (ARM) and network analysis were applied to analyze the patterns of multimorbidity. The health-ecological model was adopted to explore the potential associated factors of multimorbidity in a multidimensional perspective. A hierarchical multiple logistic model was employed to investigate the association strengths reflected by adjusted odds ratios and 95% confidence. (3) Results: Multimorbidity occurred in 20.95% of the respondents. The graph of network analysis showed that there were 6 combinations of chronic diseases with strong association strengths and 14 with moderate association strengths. The results of the ARM were similar to the network analysis; six dyadic chronic disease combinations and six triadic ones were obtained. Hierarchical multiple logistic regression indicated that innate personal traits (age, history of genetics, and body mass index), behavioral lifestyle (physical activity levels and medication adherence), interpersonal network (marital status), and socioeconomic status (educational level) were the common predictors of multimorbidity for older adults, among which, having no family history was found to be a relative determinant as a protective factor for multimorbidity after controlling the other covariates. (4) Conclusions: multimorbidity was prevalent in older adults and most disease combinations are associated with hypertension, followed by diabetes. This shows that diabetes and hypertension have a high prevalence among older adults and have a wide range of associations with other chronic diseases. Exploring the patterns and associated factors of multimorbidity will help the country prevent complications and avoid the unnecessary use of the health service, adopting an integrated approach to managing multimorbidity rather than an individual disease-specific approach and implementing different strategies according to the location of residence.
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Affiliation(s)
- Yiming Chen
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Lei Shi
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Xiao Zheng
- Department of Health Management, Shunde Hospital, Southern Medical University, Foshan 528399, China
| | - Juan Yang
- School of Health Management, Bengbu Medical College, Bengbu 233030, China
| | - Yaqing Xue
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Benli Xue
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Jiachi Zhang
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Xinru Li
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Huang Lin
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Chao Ma
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou 510515, China
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- Institute of Health Management, Southern Medical University, Guangzhou 510515, China
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Gardner H, Miles G, Saleem A, Dunin-Borkowska A, Mohammad H, Puttick N, Aksha S, Bhattarai S, Keene C. Social determinants of health and the double burden of disease in Nepal: a secondary analysis. BMC Public Health 2022; 22:1567. [PMID: 35978424 PMCID: PMC9387078 DOI: 10.1186/s12889-022-13905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background As the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for Nepal’s health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal. Methods This is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden. Results The ‘high-burden’ combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.94[95%CI2.94–5.28]), municipalities with higher proportions of vaccine coverage (adjOR12.49[95%CI3.05–51.09]) and malnutrition (adjOR9.19E103[95%CI19.68E42-8.72E164]), lower average number of people per household (adjOR0.32[95%CI0.22–0.47]) and lower indigenous population (adjOR0.20[95%CI0.06–0.65]) compared to the ‘low-burden’ category on multivariable analysis. ‘High-burden’ of non-communicable disease was associated with more accessible municipalities (adjOR1.93[95%CI1.45–2.57]), higher female proportion within the municipality (adjOR1.69E8[95%CI3227.74–8.82E12]), nutritional deficiency (adjOR1.39E17[95%CI11799.83–1.64E30]) and malnutrition (adjOR2.17E131[95%CI4.41E79-1.07E183]) and lower proportions of population under five years (adjOR1.05E-10[95%CI9.95E-18–0.001]), indigenous population (adjOR0.32[95%CI0.11–0.91]), average people per household (adjOR0.44[95%CI0.26–0.73]) and households with no piped water (adjOR0.21[95%CI0.09–0.49]), compared to the ‘low-burden’ category on adjusted analysis. ‘High burden’ of infectious disease was also associated with more accessible municipalities (adjOR4.29[95%CI3.05–6.05]), higher proportions of population under five years (adjOR3.78E9[95%CI9418.25–1.51E15]), vaccine coverage (adjOR25.42[95%CI7.85–82.29]) and malnutrition (adjOR4.29E41[95%CI12408.29–1.48E79]) and lower proportions of households using firewood as fuel (adjOR0.39[95%CI0.20–0.79]) (‘moderate-burden’ category only) compared to ‘low-burden’. Conclusions While this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13905-3.
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Affiliation(s)
- Hannah Gardner
- Institute of Human Sciences, University of Oxford, Oxford, UK.
| | - Georgina Miles
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ayesha Saleem
- UCL Medical School, University College London, London, UK
| | | | - Hannah Mohammad
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natasha Puttick
- Institute of Human Sciences, University of Oxford, Oxford, UK
| | - Sanam Aksha
- School of Public Administration, National Center for Integrated Coastal Research, University of Central Florida, Orlando, USA
| | - Suraj Bhattarai
- Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal
| | - Claire Keene
- Health Systems Collaborative, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
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Adhikari C, Dhakal R, Adhikari LM, Parajuli B, Subedi KR, Aryal Y, Thapa AK, Shah K. Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review. Front Cardiovasc Med 2022; 9:898225. [PMID: 35979024 PMCID: PMC9376353 DOI: 10.3389/fcvm.2022.898225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Health Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal. Materials and methods We searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016–2021) in a systematic way with a controlled vocabulary using a well-designed and pilot tested search strategy, screened them, and a total of 53 articles and reports that matched the screening criteria were included for the review. We then, extracted the data in a pre-designed MS-Excel format, first in one, and then, from it, in two, with more specific data. Results Of 53 included studies, we reported the prevalence and/or proportion of hypertension and diabetes with various denominators. Furthermore, HTA-related findings such as cost, validity, alternative tool or technology, awareness, and intervention effectiveness have been documented and discussed further, however, not summarized due to their sparingness. Conclusion Overall, the prevalence of DM (4.4–18.8%) and HTN (17.2–70.0%) was reported in most studies, with a few, covering other aspects of HTA of DM/HTN. A national policy for establishing an HTA agency and some immediately implementable actions are highly recommended.
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Affiliation(s)
- Chiranjivi Adhikari
- Department of Public Health, SHAS, Pokhara University, Pokhara, Nepal
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
- *Correspondence: Chiranjivi Adhikari
| | - Rojana Dhakal
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Lal Mani Adhikari
- Health Research and Social Development Forum International, Kathmandu, Nepal
| | - Bijaya Parajuli
- Ministry of Health and Population, Gandaki Province, Myagdi Health Office, Myagdi, Nepal
| | - Khem Raj Subedi
- Department of Economics, Far Western University, Tikapur Multiple Campus, Kailali, Nepal
| | | | - Arjun Kumar Thapa
- Department of Economics, School of Humanities and Social Sciences, Pokhara University, Pokhara, Nepal
| | - Komal Shah
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
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Balakrishnan S, Karmacharya I, Ghimire S, Mistry SK, Singh DR, Yadav OP, Gudi N, Rawal LB, Yadav UN. Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal. BMC Geriatr 2022; 22:425. [PMID: 35570271 PMCID: PMC9109315 DOI: 10.1186/s12877-022-03115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background The number of people with multimorbidity is surging around the world. Although multimorbidity has been introduced in policy and practice in developed countries, developing countries like Nepal have not considered it as a matter of public health urgency due to the lack of enough epidemiological data. Multimorbidity profoundly affects older adults’ wellbeing; therefore, it is crucial to estimate its prevalence and determinants. This study aimed to estimate the prevalence of multimorbidity among older adults in Eastern Nepal and identify its correlates. Methodology A community-based cross-sectional survey was conducted in three districts of Eastern Nepal. Data were collected between July and September 2020, among 847 Nepali older adults, aged 60 and older, where study participants were recruited through a multi-stage cluster sampling technique. Semi-structured interviews were conducted at the community settings to collect data. Logistic regression assessed correlates of multimorbidity. SAS 9.4 was used to run all statistical tests and analyses. Results More than half (66.5%) of the participants had at least one of the five non-communicable chronic conditions; hypertension (31.6%), osteoarthritis (28.6%), chronic respiratory disease (18.0%), diabetes (13.5%), and heart disease (5.3%). The prevalence of multimorbidity was 22.8%. In the adjusted model, increased age (for 70–79 years, OR: 3.11, 95% CI: 1.87–5.18; for 80 + years, OR: 4.19, 95% CI: 2.32–7.57), those without a partner (OR: 1.52, 95% CI: 1.00–2.30), residing in urban areas (OR: 1.71, 95% CI: 1.16–2.51), and distant from health center (OR: 1.66, 95% CI: 1.04–2.64) were significantly associated with multimorbidity. Conclusions This study found one in five study participants had multimorbidity. The findings will assist policymakers and stakeholders in understanding the burden of multimorbidity among the older population and identifying the groups in most need of health promotion intervention. Future interventions may include developing horizontal multimorbid approaches and multisectoral strategies specifically tailored to meet the needs of those populations.
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Affiliation(s)
| | - Isha Karmacharya
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | | | - Nachiket Gudi
- Public Health Evidence South Asia (PHESA), Department of Health Information, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Lal Bahadur Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia. .,National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia. .,Centre for Research Policy and Implementation (CRPIN), Biratnagar, Nepal.
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Li T, Guan L, Wang X, Li X, Zhou C, Wang X, Liang W, Xiao R, Xi Y. Relationship Between Dietary Patterns and Chronic Diseases in Rural Population: Management Plays an Important Role in the Link. Front Nutr 2022; 9:866400. [PMID: 35495931 PMCID: PMC9045401 DOI: 10.3389/fnut.2022.866400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 12/14/2022] Open
Abstract
ObjectiveHealth dietary pattern is related with reduced risk of chronic metabolic disease, but the benefits were not fully clear in the Chinese population. The aim of this study was to explore the association between dietary patterns and multiple chronic metabolic diseases in middle-aged and elderly Chinese.MethodsA total of 718 Chinese adults aged ≥ 45 who lived in the Huairou regions of Beijing were included in the present cross-sectional analysis from 2019 to 2020. Dietary data were obtained by food frequency questionnaires (FFQs). Dietary patterns were identified by principal components analysis (PCA). Logistic regression analysis and hierarchical analysis were used to examine the relationship among dietary patterns, health management, and chronic diseases.ResultsFive dietary patterns were discovered in the subjects. The pattern with the higher percentage of energy supply by lipid was a risk factor for hypertension [odds ratio (OR) = 2.067, p = 0.013]. Lower energy intake (OR = 0.512, p = 0.012) and a reasonable ratio of dietary energy supply (OR = 0.506, p = 0.011) were beneficial to diabetes. The substitution of potato for grain might be an effective way of reducing diabetes (OR = 0.372, p < 0.001). The higher intake of high-quality protein was the protective factor for coronary heart disease (CHD; OR = 0.438, p = 0.008). Moderate intervention (OR = 0.185, p = 0.033) and appropriate health education (OR = 0.432, p = 0.016) could greatly subserve the prevention of chronic diseases, especially for hyperlipidemia. Men were more likely to be affected by health education, intervention, and follow-up than women. The prevalence of multimorbidity was higher in women (43.2%) than men (41.5%). The staple food intake and health management were also important factors to prevent multimorbidity.ConclusionDietary pattern with appropriate energy intake, a reasonable source of energy supply, high quality of macronutrients, and moderate management was associated with decreased risk of chronic metabolic diseases. Further studies are needed to clarify the cause–effect relationship between dietary patterns, health management, and chronic diseases and give suggestions to chronic metabolic disease prevention in middle-aged and elderly people in a rural area.
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Affiliation(s)
- Tiantian Li
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Lizheng Guan
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Xuan Wang
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Xiaoying Li
- Department of Geriatics, Beijing Jishuitan Hospital, Beijing, China
| | - Cui Zhou
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Xianyun Wang
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Rong Xiao
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
- Rong Xiao
| | - Yuandi Xi
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
- *Correspondence: Yuandi Xi
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Dhungana RR, Pedisic Z, Pandey AR, Shrestha N, de Courten M. Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review. Front Cardiovasc Med 2021; 8:716080. [PMID: 34708082 PMCID: PMC8542767 DOI: 10.3389/fcvm.2021.716080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. However, no systematic investigation of factors influencing hypertension treatment and control in Nepal is available. This study aimed to systematically review the published literature and synthesise the findings on barriers, enablers, and strategies for hypertension treatment and control in Nepal. Methods: Embase, PubMed, Web of Science, CINAHL, ProQuest and WorldCat, and Nepali journals and government websites were searched for qualitative, quantitative, and mixed-methods studies on factors or strategies related to hypertension treatment and control in Nepal. Information from qualitative studies was analysed using template analysis, while results from quantitative studies were narratively synthesised. Summary findings were framed under “health system”, “provider”, and “patient” domains. The protocol was registered in PROSPERO (registration number: CRD42020145823). Results: We identified 15 studies; ten related to barriers and enablers and five to strategies. The identified barriers associated with the health system were: lack of affordable services and lack of resources. The barriers at the provider's level were: communication gaps, inadequate counselling, long waiting hours for appointments, lack of national guidelines for hypertension treatment, and provider's unsupportive behaviours. Non-adherence to medication, irregular follow-up visits, lack of awareness on blood pressure target, poor help-seeking behaviours, reluctance to change behaviours, perceived side-effects of anti-hypertensive medication, self-medication, lack of family support, financial hardship, lack of awareness on blood pressure complications, and comorbidity were barriers identified at patient level. The following enablers were identified: free essential health care services, family support, positive illness perception, and drug reminders. Strategies implemented at the health system, provider and patient levels were: establishing digital health records at health centres, health worker's capacity development, and health education. Conclusion: There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, health providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | | | - Nipun Shrestha
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Maximilian de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, VIC, Australia
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