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Zhao L, Yin J, Huan J, Han X, Zhao D, Song J, Wang L, Zhang H, Pan B, Niu Q, Lu X. A Bayesian network for estimating hypertension risk due to occupational aluminum exposure. Chronic Dis Transl Med 2024; 10:130-139. [PMID: 38872757 PMCID: PMC11166680 DOI: 10.1002/cdt3.134] [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: 02/21/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background The correlation between metals and hypertension, such as sodium, zinc, potassium, and magnesium, has been confirmed, while the relationship between aluminum and hypertension is not very clear. This study aimed to evaluate the correlation between plasma aluminum and hypertension in electrolytic aluminum workers by the Bayesian networks (BN). Methods In 2019, 476 male workers in an aluminum factory were investigated. The plasma aluminum concentration of workers was measured by inductively coupled plasma mass spectrometry. The influencing factors on the prevalence of hypertension were analyzed by the BN. Results The prevalence of hypertension was 23.9% in 476 male workers. The risk of hypertension from plasma aluminum in the Q2, Q3, and Q4 groups was 5.20 (1.90-14.25), 6.92 (2.51-19.08), and 7.33 (2.69-20.01), respectively, compared with that in the Q1 group. The risk of hypertension from the duration of exposure to aluminum of >10 years was 2.23 (1.09-4.57), compared without aluminum exposure. Area under the curve was 0.80 of plasma aluminum and the duration of exposure to aluminum was based on covariates, indicating that aluminum exposure had important predictive value in the prevalence of hypertension in the occupational population. The results of the study using the BN model showed that if the plasma aluminum of all participants was higher than Q4 (≥47.86 µg/L) and the participants were drinking, smoking, diabetes, central obesity, dyslipidemia, and aged >50 years, the proportion of hypertension was 71.2%. Conclusions The prevalence of hypertension increased significantly with the increase of plasma aluminum level.
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Affiliation(s)
- Le Zhao
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Jinzhu Yin
- Sinopharm Tongmei General HospitalShanxi Health Commission Key Laboratory of Nervous System Disease Prevention and TreatmentDatongShanxiChina
| | - Jiaping Huan
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Xiao Han
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Dan Zhao
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Jing Song
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Linping Wang
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Huifang Zhang
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Baolong Pan
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
- Sixth Hospital of Shanxi Medical University (General Hospital of Tisco)TaiyuanShanxiChina
| | - Qiao Niu
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
| | - Xiaoting Lu
- Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, MOE Key Laboratory of Coal Environmental Pathogenicity and PreventionShanxi Medical UniversityTaiyuanShanxiChina
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Kumari N, Manisha M, Paul S, Ram R. Socioeconomic inequality among smoking and smokeless tobacco uses among males in India: a decomposition analysis. Public Health 2024; 227:176-186. [PMID: 38232566 DOI: 10.1016/j.puhe.2023.12.006] [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: 10/10/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE India is the third-largest tobacco manufacturer and its use in India is characterised by a high prevalence of smoking and smokeless (sl) tobacco use. This results in 1 million deaths per year in the country. Given the high burden of tobacco use, this study examines the regional variations and socio-economic correlates of tobacco use in India. METHODS National Family Health Survey- 5 (2019-2020) have been analysed for the purpose of the study. A sample of 101,839 males aged 15-54 years was included in this study. Primary outcomes of tobacco use were categorised into smoking, smokeless and dual use of smoking and smokeless tobacco use. Bivariate analysis and decomposition analysis was done to study the socio-economic inequality. RESULTS The prevalence of tobacco use among males in India is around 41 percent. As indicated by the results of the logistics regression, age is positively related to smoking among males. Males aged 45-54 years are 2.5 (95 % concentration index [CI]:2.30-2.63) times probable to smoke, 1.4 (95% CI: 1.30-1.47) times probable of smokeless tobacco consumption and 2.2 (95% CI: 2.10-2.35) times more prone to using both types of substances compared to the younger age group. Males who are widower use smokeless 1.69 times (95% CI: 1.44-1.99) higher with reference to unmarried males. Males belonging to Scheduled tribes are 1.2 (95% CI: 1.13-1.25) times more likely to smoke, 1.3 (95% CI: 1.24-1.37) times more likely to use smokeless substances and 1.4 (95% CI: 1.33-1.47) times more likely to have dual use of tobacco than other social groups. Manual workers (both skilled are unskilled) are likely to smoke (odds ratio [OR] = 1.1, 95% CI: 1.02-1.11), use smokeless tobacco (OR = 1.3, 95% CI: 1.23-1.34) and have dual use of tobacco (OR = 1.29, 95% CI: 1.24-1.34) more than that of other categories. The decomposition of the concentration index shows a significant contribution from factors like a no education, ST/SC caste and wealth index. Among the states and union territories, the prevalence of tobacco is high in West Bengal, Tripura, Mizoram, Manipur, Meghalaya and Sikkim. CONCLUSION This study is useful for informing target-based prevention policies since it helps in highlighting regions, socio-economic and demographic groups especially vulnerable to tobacco addiction. In India, males from poorer and vulnerable socio-economic backgrounds are more likely to use tobacco. State wise, the eastern zone starting from West Bengal to the North-Eastern states have higher tobacco use than the rest of the country. There is an urgent need to frame policies for controlling the use of tobacco especially among high-risk groups.
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Affiliation(s)
- N Kumari
- Population Research Center, Udaipur, Rajasthan 313001, India.
| | - M Manisha
- Department of Migration and Urban Studies, International Institute for Population Science, Deonar, Mumbai 400088, India.
| | - S Paul
- Centre for the Study of Regional Development, School of Social Science, Jawaharlal Nehru University, New Delhi 110067, India.
| | - R Ram
- Department of Migration and Urban Studies, International Institute for Population Science, Deonar, Mumbai 400088, India.
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Shaphe MA, Alshehri MM, Alfaifi B, Aljahni MA, Esht V, Malik S, Bautista MJ, Alqahtani AS, Ahmad A, Khan A, Aafreen A, Khan AR. Assessment of Risk Factors and the Relationship between Hypothyroidism with Hypertension in Diabetes Mellitus Patients: A Cross-Sectional Community-Based Study. J Pers Med 2023; 13:1231. [PMID: 37623480 PMCID: PMC10455546 DOI: 10.3390/jpm13081231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: hypertension (HTN) and diabetes mellitus (DM) represent two widely noncommunicable diseases that are prevalent globally, and they often correlate with chronic health issues. There has been an acknowledged connection between diabetes, hypertension, and hypothyroidism for quite some time. However, the extent of thyroid dysfunction among the diabetic population is not uniform and significantly differs across different research studies. This study was conducted with the objective of identifying the risk factors associated with hypothyroidism as well as assessing the relationship between hypothyroidism and hypertension in patients with diabetes. (2) Materials and Methods: Participants aged 18 years and above were included in this study, while pregnant women were excluded. Trained health professionals measured sociodemographic, behavioural, food practices, and anthropometric information about the participants. Each respondent sought medical advice regarding their health, and a face-to-face interview enabled them to express concern about the likelihood of being diagnosed with diabetes mellitus and hypertension. (3) Results: The study encompassed 640 participants, with an average age of 49.20 ± 13.0 years. Among these participants, 65.5% were female, and 34.5% were male. Of the total, 31.25% were diagnosed with diabetes mellitus, and 18.75% had hypertension. Interestingly, co-occurrence of both conditions was observed in 9.68% of the population. A comparison of thyroid function and indicators of blood sugar levels yielded consistent results across the different patient groups. Specifically, for diabetes mellitus (DM) patients, the average levels were 3.4 ± 9.8 pg/mL for fT3, 0.9 ± 0.7 ng/dL for fT4, 3.3 ± 6.2 μiU/mL for TSH, 153.1 ± 68.0 mg/dL for fasting plasma glucose (FPG), 213.2 ± 97.2 mg/dL for postprandial glucose (PPG), and 8.3 ± 3.2% for HbA1c. (4) Conclusion: It is concluded that patients with hypertension had a significant prevalence of diabetes mellitus. Subclinical hypothyroid subjects must be frequently screened for hypertension. Of 120 individuals with hypertension, 45 (37.5%) were also diagnosed with diabetes. This co-occurrence was significantly higher in subjects aged over 50 years (26.7%), in the lower socio-economic class (18.5%), and among those who were married (14.7%). Additionally, patients with hypertension exhibited a high prevalence of diabetes across different educational backgrounds and occupations, with the highest prevalence among postgraduates (37.5%) and professionals (24.0%), respectively. These findings highlight the need for an integrated approach to the management of hypertension and diabetes, particularly in high-risk demographics.
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Affiliation(s)
- Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Mohammed M. Alshehri
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Bushra Alfaifi
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Mohammed A Aljahni
- Physical Education Department, Jazan University, Jazan 45142, Saudi Arabia;
| | - Vandana Esht
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Shazia Malik
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Marissa J Bautista
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Abdulfattah S. Alqahtani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Ausaf Ahmad
- Department of Community Medicine, IIMS&R, Integral University, Lucknow 226026, India;
| | - Ashfaque Khan
- Department of Physiotherapy, Integral University, Lucknow 226026, India; (A.K.); (A.A.)
| | - Aafreen Aafreen
- Department of Physiotherapy, Integral University, Lucknow 226026, India; (A.K.); (A.A.)
| | - Abdur Raheem Khan
- Department of Physiotherapy, Integral University, Lucknow 226026, India; (A.K.); (A.A.)
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Vidya GS, Bhatt G, Kathiresan J, Rai S, Verma M, Goel S. Predictors of hypertension among current smokeless tobacco users in India; analysis from the fourth round of National Family Health Survey (2015-2016). J Family Med Prim Care 2022; 11:5785-5791. [PMID: 36505658 PMCID: PMC9731011 DOI: 10.4103/jfmpc.jfmpc_318_22] [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: 02/07/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Hypertension is a major modifiable risk factor for cardiovascular and cerebrovascular diseases. The association between different risk factors including smoking and hypertension is studied extensively; however, there is a paucity of literature with respect to association between smokeless tobacco use and hypertension in India. In the current study, the relationship between smokeless forms of tobacco use and hypertension is being investigated. Methodology This study analyzed the data from fourth round of National Family Health Survey conducted during 2015-2016. Socio-demographic variables such as age, sex, education, wealth index, body mass index, smoked forms of tobacco use, and smokeless forms of tobacco like paan, gutkha, Khaini, etc., presence of co-morbidities were the independent variables. Hypertension was the dependent variable. Results It was observed from the present analysis that, smokeless tobacco use is a risk factor for hypertension both in the case of females OR-1.1**(1.08-1.13) as well as males OR-1.07**(1.03-1.1). The other predictors observed were overweight, consumption of alcohol, and diabetes. Conclusion It was concluded from the present study, that consumption of smokeless tobacco use acts as an independent risk factor for hypertension.
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Affiliation(s)
- G. S Vidya
- Department of Community Medicine, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Shreyans Rai
- Biostatistician, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
| | - Madhur Verma
- Department of Community/Family Medicine, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,Address for correspondence: Dr. Sonu Goel, Professor of Health Management, Department of Community Medicine and School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
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Marbaniang SP, Lhungdim H, Chauhan S, Srivastava S. Interaction of multiple risk factors and population attributable fraction for type 2 diabetes and hypertension among adults aged 15-49 years in Northeast India. Diabetes Metab Syndr 2021; 15:102227. [PMID: 34311195 DOI: 10.1016/j.dsx.2021.102227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/27/2022]
Abstract
AIMS The aim is to assess the association and population attributable fraction (PAF) of multiple risk factors combination for diabetes and hypertension among adults in the Northeast region of India. METHODS Data used is from the Indian Demographic Health Survey conducted in 2015-16. The study comprised 107, 766 respondents (95,153 females and 12, 613 males) aged 15-49 years. We examined four modifiable risk factors: smoking, alcohol consumption, aerated drinks consumption, and overweight or obesity. PAF was calculated using the relative risk from the multivariable logistic regression models. RESULTS Overweight or obesity in conjunction with smoking was associated with 43.9 % of patients with diabetes. Smoking in conjunction with alcohol and overweight or obesity contributed to 53% of patients with diabetes (PAF = 53 %). The three risk factors combination (i.e., smoking, alcohol, and overweight or obesity) is associated with the most hypertension cases (PAF = 50.7 %). Experiencing all four risk factors is associated with 50.3 % of patients with hypertension. In women, the four-risk combination contributed the most hypertension cases (PAF = 46.8 %). CONCLUSIONS Overweight or obesity was the single most significant factor leading to hypertension and diabetes among the study population. Also, smoking, alcohol, and overweight or obesity together are prominent risk factors for hypertension and diabetes.
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Affiliation(s)
- Strong P Marbaniang
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Hemkhothang Lhungdim
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, 400088, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, 400088, India
| | - Shobhit Srivastava
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, 400088, India
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Nikam KS, Wingkar KC, Joshi RK, Kallur RK. Correlation between cotinine urinary levels & cardiovascular autonomic function tests among smokeless tobacco chewers: A cross-sectional study. Indian J Med Res 2021; 152:633-637. [PMID: 34145103 PMCID: PMC8224156 DOI: 10.4103/ijmr.ijmr_1815_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background & objectives: Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers. Methods: In the present study, 600 participants, 300 smokeless tobacco chewers (STC) and 300 non-tobacco chewers (NTC), between 18 and 65 yr were selected. Various parameters such as anthropometric, systolic blood pressure (SBP), diastolic blood pressure (DBP), autonomic function tests and urinary cotinine levels were measured. Results: Significant difference (P<0.001) was noted in STC and NTC for anthropometric parameters, SBP, DBP and urinary cotinine levels. Sympathetic and parasympathetic autonomic function test showed significant difference on comparison in STC and NTC groups, except in Valsalva ratio. Correlations with urinary cotinine levels were significant for sympathetic autonomic functions, SBP fall (r=0.138, P=0.016), DBP rise (r=−0.141, P≤0.014); parasympathetic autonomic function, heart rate (HR) response to standing (r=−0.208, P≤0.003), deep breathing (r=−0.473, P≤0.001) and Valsalva ratio (r=−0.396, P≤0.0001). Interpretation & conclusions: Correlation between urinary cotinine levels and autonomic function tests elucidates the linkage involving autonomic nervous system damage which can be considered as an important associated relationship for early diagnosis of CVD health risk factors among smokeless tobacco (ST) users.
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Affiliation(s)
- Kiran S Nikam
- Department of Physiology, Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Kanchan C Wingkar
- Department of Physiology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India
| | - Rajesh K Joshi
- Department of Phytochemistry, ICMR-National Institute of Traditional Medicine, Belagavi, Karnataka, India
| | - Rajashekar K Kallur
- Department of Physiology, Gujarat Adani Institute of Medical Sciences, Bhuj, Gujarat, India
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Tobacco Use and Risk Factors for Hypertensive Individuals in Kenya. Healthcare (Basel) 2021; 9:healthcare9050591. [PMID: 34067900 PMCID: PMC8157158 DOI: 10.3390/healthcare9050591] [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: 04/06/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to examine the association between hypertension and tobacco use as well as other known hypertensive risk factors (BMI, waist–hip ratio, alcohol consumption, physical activity, and socio-economic factors among adults) in Kenya. The study utilized the 2015 Kenya STEPs survey (adults aged 18–69) and investigated the association between tobacco use and hypertension. Descriptive statistics, correlation, frequencies, and regression (linear and logistic) analyses were used to execute the statistical analysis. The study results indicate a high prevalence of hypertension in association with certain risk factors—body mass index (BMI), alcohol, waist–hip ratio (WHR), and tobacco use—that were higher in males than females among the hypertensive group. Moreover, the findings noted an exceptionally low awareness level of hypertension in the general population. BMI, age, WHR, and alcohol use were prevalent risks of all three outcomes: hypertension, systolic blood pressure, and diastolic blood pressure. Healthcare authorities and policymakers can employ these findings to lower the burden of hypertension by developing health promotion and intervention policies.
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Muhammad T, Govindu M, Srivastava S. Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross-sectional study. BMC Geriatr 2021; 21:85. [PMID: 33514331 PMCID: PMC7847155 DOI: 10.1186/s12877-021-02027-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/13/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Physical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life. METHODS The present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated. RESULTS About 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only. CONCLUSION The encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.
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Affiliation(s)
- T. Muhammad
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
| | - Manideep Govindu
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
| | - Shobhit Srivastava
- International Institute for Population Sciences, 400088 Mumbai, Maharashtra India
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Xhakaza L, Abrahams-October Z, Mohammednur MM, Pearce B, Adeniyi OV, Johnson R, Benjeddou M. Socio-demographic and modifiable risk factors of diabetes and hypertension among resource constrained patients from rural areas in Mdantsane Township in South Africa. Afr Health Sci 2020; 20:1344-1354. [PMID: 33402984 PMCID: PMC7751544 DOI: 10.4314/ahs.v20i3.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Recently, developing countries have shown a dramatic increase in non-communicable diseases (NCDs). The burden of NCDs in South Africa has increased over the past years resulting in an estimated 37% of all- cause mortality and 16% of disability-adjusted life years. Currently, diabetes mellitus (DM) and hypertension (HTN) are the two most prevalent NCDs associated with the rapid increase in mortality. Objective To demonstrate the socio-demographic and modifiable risk factors of diabetes mellitus (DM) and hypertension (HTN) among South African adults. Methods A cross-sectional analytical study was conducted in the Cecilia Makiwane Hospital serving the residents of Mdantsane. Relevant socio-demographic data, anthropometric measurements, triplicate blood pressure, fasting blood glucose and lipogram analysis were obtained from 265 outpatients. Results Multivariate anlysis shows that; salt intake, smoking, elevated triglycerides and decreased high-density lipoprotein levels were significantly associated with DM with adjusted odds ratio of 0.18 (p=0.002), 0.26 (p=0.048), 2.19 (p=0.006) and 0.38 (p=0.001), respectively. Overweight and obesity were significantly associated with hypertension with odds ratio of 0.03 (p=0.01) and 0.06 (p=0.006), respectively. Conclusion The burden of DM and HTN on society can be drastically reduced with simple lifestyle changes, development of preventative strategies, large-scale screening and better disease management in South Africa.
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Affiliation(s)
- Lettilia Xhakaza
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Zainonesa Abrahams-October
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Mohammedmekin Mohammedseid Mohammednur
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Brendon Pearce
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | | | - Rabia Johnson
- South African Medical Research Council, Parow, Cape Town, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Mongi Benjeddou
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
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Saikia N, Debbarma B. The socioeconomic correlates of substance use among male adults in Northeast India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Shrestha S, Mishra DR, Dhakal N, Bhandari S, Khanal S, Lamsal M. Correlation of urinary cotinine with cardiovascular risk factors in pan masala tobacco users. Indian Heart J 2019; 71:459-463. [PMID: 32248918 PMCID: PMC7136352 DOI: 10.1016/j.ihj.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/03/2019] [Accepted: 10/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tobacco consumption is considered as one of the major risk factors for cardiovascular (CV) morbidity. However, the effect of paan masala tobacco (PMT) (a type of smokeless tobacco) consumption has not been well studied in our context. Our study is aimed to find an association of CV risk factors between PMT users and nonusers and to correlate those parameters with urinary cotinine level, a degradation product of nicotine occurring in tobacco. METHODS This comparative cross-sectional study was carried out among 200 participants. The effect of PMT use on CV risk factors such as blood pressure (BP), lipid profile, and body mass index was measured against urine cotinine level. Statistical tests used were χ2 test for categorical variable, independent t-test, Mann-Whitney U test, and Spearman's correlation applied for numerical variable, and multivariate regression analysis was performed as required. The level of significance was set at p < 0.05. RESULT Mean BP, total cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and median cotinine level were found to be significantly higher in PMT users than in controls (p < 0.001). Urinary cotinine level was positively correlated with mean BP, TC, TG, and LDL-C in PMT users (p < 0.001). Similarly, the odds of having hypercholesterolemia and increased diastolic BP was also significantly higher in PMT users (p < 0.001). CONCLUSION PMT use has an adverse effect on CV risk parameters and there is a rational of cotinine measurement for screening CV risk among PMT users.
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Affiliation(s)
- Sanjeeb Shrestha
- Department of Biochemistry, Gandaki Medical College and Teaching Hospital, Pokhara, Nepal.
| | - Deebya Raj Mishra
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Niraj Dhakal
- Department of Biochemistry, Gandaki Medical College and Teaching Hospital, Pokhara, Nepal.
| | - Suresh Bhandari
- Department of Biochemistry, Gandaki Medical College and Teaching Hospital, Pokhara, Nepal.
| | - Sagar Khanal
- Department of Biochemistry, Lumbini Medical College, Lumbini, Nepal.
| | - Madhab Lamsal
- Department of Biochemistry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
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Huque R, Zaman MM, Huq SM, Sinha DN. Smokeless tobacco and public health in Bangladesh. Indian J Public Health 2019; 61:S18-S24. [PMID: 28928314 PMCID: PMC6349136 DOI: 10.4103/ijph.ijph_233_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Despite the high prevalence of smokeless tobacco (SLT) use among adults in Bangladesh, SLT was not included in the Tobacco Control Law till 2013. Information on SLT use among Bangladeshi people is inadequate for policymaking and implementing effective control measures. With the aim to identify the prevalence and trends of different SLT products, health and economic impacts, manufacture, and sale of and policies related to SLT in Bangladesh, we carried out a literature review, which involved literature search, data extraction, and synthesis. Evidence suggests that in Bangladesh, SLTs range from unprocessed to processed or manufactured products including Sada Pata, Zarda, Gul, and Khoinee. Over 27% of Bangladeshi adults aged 15 years and older use SLT in one form or other. SLT use is associated with age, sex, education, and socioeconomic status. SLT consumption has reportedly been associated with increased prevalence of heart diseases, stroke, and oral cancer and led to around 320,000 disability adjusted life years lost in Bangladesh in 2010. No cessation service is available for SLT users in public facilities. Compared to cigarettes, taxation on SLT remains low in Bangladesh. The amendment made in Tobacco Control Law in 2013 requires graphic health warnings to cover 50% of SLT packaging, ban on advertisement of SLT products, and restriction to sale to minors. However, implementation of the law is weak. As the use of SLT is culturally accepted in Bangladesh, culturally appropriate public awareness program is required to curb SLT use along with increased tax and cessation services.
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Affiliation(s)
- Rumana Huque
- Professor, Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | - M Mostafa Zaman
- Adviser, Research and Publication Unit, World Health Organization, Dhaka, Bangladesh
| | - Syed Mahfuzul Huq
- National Professional Officer (Tobacco Control), World Health Organization, Dhaka, Bangladesh
| | - Dhirendra N Sinha
- Director, Department of Tobacco Control, School of Preventive Oncology, Patna, Bihar, India
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Gupta R, Gupta S, Sharma S, Sinha DN, Mehrotra R. A systematic review on association between smokeless tobacco & cardiovascular diseases. Indian J Med Res 2018; 148:77-89. [PMID: 30264756 PMCID: PMC6172910 DOI: 10.4103/ijmr.ijmr_2020_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND & OBJECTIVES The association of smokeless tobacco (SLT) with cardiovascular diseases has remained controversial due to conflicting reports from various countries. Earlier meta-analyses have shown significantly higher risk of fatal myocardial infarction and stroke in SLT users. However, the risk of hypertension (HTN) with SLT products has not been reviewed earlier. This systematic review was undertaken to summarize the evidence available from global literature on the association of SLT with cardiovascular outcomes - heart disease, stroke and HTN. METHODS A systematic literature search was performed in PubMed and Google Scholar since their inception till October 2017 using pre-decided search terms and inclusion/exclusion criteria. Data were extracted from studies included independently by two authors and reviewed. RESULTS The review included 50 studies - 23 on heart disease, 14 on stroke and 14 on HTN. Majority of the studies evaluating heart disease or stroke were conducted in the European Region and most of these did not find a significant association between SLT use and either of these outcomes. On the other hand, 70 per cent of the studies on HTN were reported from South-East Asian Region and about half of the studies found a higher risk of HTN in SLT users. INTERPRETATION & CONCLUSIONS Current available evidence is insufficient to conclusively support the association of cardiovascular diseases with SLT use due to variability in results and methodological constraints in most of the studies. Region and product-specific well-designed studies are required to provide this evidence to the policymakers. However, advice on cessation of SLT products should be offered to patients presenting with cardiovascular diseases.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Shashi Sharma
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | | | - Ravi Mehrotra
- WHO FCTC Global Knowledge Hub for Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
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Anand A, Sk MIK. The Risk of Hypertension and Other Chronic Diseases: Comparing Smokeless Tobacco with Smoking. Front Public Health 2017; 5:255. [PMID: 29018793 PMCID: PMC5614917 DOI: 10.3389/fpubh.2017.00255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the past, studies have compared smokeless tobacco and non-tobacco users for the risk of various chronic diseases. The differences in the risk of chronic diseases between smokeless tobacco user and smokers have not been explored. The objective of this study is to estimate the risk of chronic diseases among smokeless tobacco users compared to smokers. METHODS The data were used from the Study on Global Ageing and Adult Health (SAGE) Wave-1, conducted in 2007-2008 in India. The study sample is the respondents who reported consuming any form of tobacco in last 1 month. The total sample size was 4,038 respondents. The odds ratio of chronic morbidities was estimated taking smokers as the reference category. RESULTS The odds ratios for (self-reported) diabetes, asthma, and hypertension were not significant for smokeless tobacco user compared to smoked tobacco users. The odds ratio of chronic lung diseases (CLDs) was significantly lower among smokeless tobacco users compared to smoked tobacco users. The odds ratio of hypertension (measured) combined with low education and belonging to lowest wealth quintiles were not significant for smokeless tobacco users compared to smoked tobacco users. Duration of the use of smokeless tobacco and quantity of use was found to have no significant relation with risk of chronic diseases as compared to smoking. CONCLUSION This study did not find the significantly higher risk of chronic morbidities except for CLD for smokeless tobacco users compared to smoked tobacco users. The study suggests that the use of any form of tobacco may have a similar risk of chronic diseases.
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Affiliation(s)
- Ankit Anand
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, India
| | - Md Illias Kanchan Sk
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
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Owolabi EO, Goon DT, Adeniyi OV, Seekoe E. Social epidemiology of hypertension in Buffalo City Metropolitan Municipality (BCMM): cross-sectional study of determinants of prevalence, awareness, treatment and control among South African adults. BMJ Open 2017; 7:e014349. [PMID: 28600362 PMCID: PMC5623394 DOI: 10.1136/bmjopen-2016-014349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study examined hypertension prevalence, awareness, treatment and control and their determinants among adults attending health facilities in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape. DESIGN A cross-sectional analytical study. SETTINGS The three largest outpatient clinics in BCMM. PARTICIPANTS Ambulatory adults (aged 18 years and over) attending the study settings during the study period (n=998). PRIMARY OUTCOME MEASURE The prevalence of hypertension (systolic blood pressure (BP) of ≥140 mm Hg and/or a diastolic BP of ≥90 mm Hg or current medication for hypertension), the awareness of it (prior diagnosis of it) and its treatment and control (Eighth Joint National Committee Criteria of BP <140/90/90 mm Hg). SECONDARY OUTCOME MEASURE Associated factors of hypertension, hypertension unawareness and uncontrolled hypertension. RESULTS Of the 998 participants included, the prevalence of hypertension was 49.2%. Hypertension unawareness was reported by 152 participants (23.1%) with significant gender difference (p=0.005). Male sex, age <45 years, higher level of education, single status, current employment, higher monthly income, current smoking, alcohol usage, absence of diabetes and non-obese were significantly associated (p<0.05) with hypertension unawareness.Of the participants who were aware of having hypertension (n=339), nearly all (91.7%, n=311) were on antihypertensive medication and only 121 participants (38.9%) achieved the BP treatment target. In the multivariate logistic regression model analysis, ageing (95% CI 1.9 to 4.4), being married (95% CI 1.0 to 2.0), male sex (95% CI 1.2 to 2.3), concomitant diabetes (95% CI 1.9 to 3.9), lower monthly income (95% CI 1.2 to 2.2), being unemployed (95% CI 1.0 to 1.9) and central obesity (95% CI 1.5 to 2.8) were the significant and independent determinants of prevalent hypertension. CONCLUSION The prevalence and awareness of hypertension was high in the study population. In addition, the suboptimal control of BP among treated individuals, as well as the significant cardiovascular risk factors, warrant the attention of health authorities of BCMM and the country.
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Affiliation(s)
- Eyitayo Omolara Owolabi
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Daniel Ter Goon
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Faculty of Health Sciences, Walter Sisulu University/Cecilia Makiwane Hospital, East London Hospital Complex, East London, South Africa
| | - Eunice Seekoe
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
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Burden of Hypertension in the Capital of Afghanistan: A Cross-Sectional Study in Kabul City, 2015. Int J Hypertens 2017; 2017:3483872. [PMID: 28127468 PMCID: PMC5239979 DOI: 10.1155/2017/3483872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 01/19/2023] Open
Abstract
Background. This study had the objective to assess the prevalence and associated factors of hypertension in an urban setting, Kabul city, Afghanistan. Materials and Methods. The World Health Organization's STEP-wise approach was adopted and used in Kabul in November 2015. The study analyzed a sample of 1172 adults in the age group of 25–70 years. Demographic, socioeconomic, and behavior data were collected using a structured questionnaire. Fasting venous blood sample was collected to assess the lipid profile and fasting blood sugar. Results. The study showed that the prevalence of hypertension among adult Kabul citizens was 32.3%. From this figure, 599 (51.1%) were females and 573 (48.9%) males with a mean age of 38.6 ± 12.2 years. Illiteracy rate was 49.6% and 77.5% were married. Smoking in adults were 8.1% and mouth snuff users were 9.8%. More than half (57.6%) of the study respondents were overweight and obese and 9.1% were recorded having raised blood sugar. In the multivariate logistic regression analysis, age, general obesity, central obesity, smoking, moderate physical activity, and taking fruits 3 days or less weekly were statistically significant predictors of hypertension. Conclusions. Burden of hypertension is increasing in main urban settings in Afghanistan. Integrated intervention focusing in main modifiable risk factors is needed to detect and prevent hypertension.
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Prevalence of Hypertension and Determination of Its Risk Factors in Rural Delhi. Int J Hypertens 2016; 2016:7962595. [PMID: 27127646 PMCID: PMC4834167 DOI: 10.1155/2016/7962595] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/16/2016] [Accepted: 03/20/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction. Hypertension is an important public health challenge in both economically developing and developed countries. It is one of the risk factors for cardiovascular mortality. Data is available on hypertension in urban population but few studies are reported in rural areas. Materials and Methods. It was a community based cross-sectional study conducted in two rural areas in Delhi among 1005 subjects selected using systematic random sampling method. WHO STEPS approach was used to collect data. Blood pressure, body mass index, and blood sugar were measured. Data analysis was done using SPSS version 16. Odds of hypertension among subjects with risk factors were calculated. p value less than 0.05 was considered significant. Results. The prevalence of hypertension was 14.1% among study subjects. Hypertension was significantly higher in individuals more than 35 years than those less than 35 years. Hypertension was significantly higher in those who take alcohol and in subjects with raised total cholesterol level but in multivariate analysis only age, education, and cholesterol levels were independently associated with hypertension. Conclusion. There is significant burden of hypertension in rural areas in Delhi. Age, education, and cholesterol levels were independent risk factors of hypertension.
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Ahmad S, Shah M, Ahmed J, Khan A, Hussain H, McVey M, Ali A. Association of hypoadiponectemia with smokeless/dipping tobacco use in young men. BMC Public Health 2015; 15:1072. [PMID: 26482904 PMCID: PMC4615338 DOI: 10.1186/s12889-015-2409-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/12/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low levels of adiponectin, an adipocytokine with anti-diabetic, antiatherogenic and cardioprotective properties, is associated with increased risk of coronary disease in young men. Previous studies have demonstrated that smokeless tobacco is linked with a reduction of plasma adiponectin levels. However, the influence of smokeless tobacco (dipping tobacco) on plasma adiponectin levels still remains unknown. This study was conducted to assess the plasma adiponectin levels in young men who were using dipping tobacco. METHODS This was a community based study, which consisted of 186 young lean healthy males aged 20 to 35 years. Among these, 96 men were dipping tobacco users (BMI = 23.07 ± 2.68) and 90 were non-dipping tobacco users (BMI = 23.67 ± 1.46). Serum adiponectin levels were assessed by Enzyme Linked ImmunoSorbent Assay (ELISA). RESULTS A statistically significant difference in the mean adiponectin level between tobacco dipper and non-dipper groups was observed (p = 0.0001). A significant difference between the two groups was also observed in baseline parameters including triglyceride and random blood sugar levels (p < 0.05). However, no significant difference was observed between the two groups in other clinical parameters. CONCLUSIONS Findings of this study suggest that dipping tobacco use was significantly associated with low level of adiponetin in community dwelling young males. This emphasizes the importance of developing community intervention to reduce the use of dipping tobacco, which will reduce the tobacco associated disease burden in the community and will improve public health.
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Affiliation(s)
- Sardar Ahmad
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
- Institute of Basic Medical Sciences, Khyber Medical University, Adjacent PDA building, Phase 5, Hayat Abad, Peshawar, Pakistan.
| | - Jawad Ahmed
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Aslam Khan
- Department of Pharmacology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Hamid Hussain
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Mary McVey
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK.
| | - Asif Ali
- Department of Pathology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
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Sivadasan Pillai H, Ganapathi S. Tobacco Cessation Approaches and Impact on CVD. Glob Heart 2015; 7:129-38. [PMID: 25691309 DOI: 10.1016/j.gheart.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/06/2012] [Indexed: 12/30/2022] Open
Affiliation(s)
- Harikrishnan Sivadasan Pillai
- Department of Cardiology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India; Correspondence: S. Harikrishnan
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Panda R, Persai D, Venkatesan S. Missed opportunities for brief intervention in tobacco control in primary care: patients' perspectives from primary health care settings in India. BMC Health Serv Res 2015; 15:50. [PMID: 25638245 PMCID: PMC4318137 DOI: 10.1186/s12913-015-0714-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND World Health Organization has called for tobacco cessation to be integrated into primary care. Primary Health Centres (PHC) offer opportunities for tobacco-use screening and brief cessation advice but data on such activities in developing countries such as India are limited. The aim of this study was to investigate screening and brief intervention practices of health service providers in primary care. METHODS This cross-sectional study was conducted in 2012 among 1,549 patients aged over 18 years visiting PHCs in 12 districts of two Indian states- Andhra Pradesh and Gujarat. Responses were collected using an interviewer-administered questionnaire. Information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised to quit tobacco use. The primary outcome was whether patients were screened during their visit to the PHC. Data analysis was performed using multi-level logistic regression. RESULTS Less than one-third (447) of patients were screened for tobacco use during their visit to the PHC. People presenting with respiratory complaints were 84% more likely (OR: 1.84; 95% CI: 1.30 to 2.62) to be screened for tobacco use when compared to those with general ailments. Number of quit attempts in the past 12 months was strongly associated with the outcome of being screened for tobacco use, indicating that people who had more than 5 quit attempts were two times more likely to be screened for tobacco use than those who had never attempted to quit tobacco (OR: 1.99; 95% CI: 1.03 to 3.8). Among the 447 patients who were screened for tobacco use, only 136 reported to have been counselled and merely 67 patients received suggestions on ways to quit tobacco. CONCLUSION Our results show that opportunities for screening and providing tobacco use cessation advice were largely missed by the health service providers. Our study suggests that there is an urgent need to incorporate tobacco cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and counselling to quit tobacco.
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Affiliation(s)
| | - Divya Persai
- Public Health Foundation of India, New Delhi, India.
| | - Sudhir Venkatesan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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Bhadoria AS, Kasar PK, Toppo NA, Bhadoria P, Pradhan S, Kabirpanthi V. Prevalence of hypertension and associated cardiovascular risk factors in Central India. J Family Community Med 2014; 21:29-38. [PMID: 24695988 PMCID: PMC3966094 DOI: 10.4103/2230-8229.128775] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To study the difference in the prevalence of hypertension and associated risk factors in urban and rural populations and the association of hypertension with various determinants. MATERIALS AND METHODS A community-based cross-sectional study was conducted in 48 villages and 15 urban wards of Jabalpur District of Central India. Nine hundred and thirty-nine individuals aged 20 years and above (624 from rural areas and 315 from urban areas) were included in the study. The prevalence of hypertension and associated cardiovascular risk factors was assessed in the urban and rural populations. A pretested questionnaire was used to collect data on socio-demographic, behavioral, and dietary factors. Anthropometric measurements of weight, height, waist and hip circumference, and blood pressure measurements were taken using the standard methodology. The glucose oxidase-peroxidase and cholesterol oxidase-cholesterol peroxidase methods were used to measure plasma glucose and serum cholesterol, respectively. Bivariate analysis was followed by multivariate analysis to detect the odds of getting hypertension with various risk factors for the urban and rural populations separately. Hypertension was defined as per Joint National Committee (JNC) - VII criteria. RESULTS The response rate was 97%. Overall prevalence of hypertension was 17%, with 21.4% in the urban population and 14.8% in the rural population. Significantly higher mean values of weight, height, body mass index (BMI), hip circumference (HC), waist circumference (WC), waist hip ratio (WHR), systolic blood pressure (SBP), fasting blood sugar (FBS), and serum cholesterol levels were mapped in the urban population in comparison with the rural population. Multivariate logistic regression analysis identified increasing age, parental history of hypertension, tobacco smoking, tobacco chewing, physical inactivity, high estimated per capita salt consumption, and BMI ≥27.5 kg/m(2) as independent predictors for hypertension in the urban population, while in the rural population, increasing age, physical inactivity, central obesity, tobacco chewing and tobacco smoking were independent predictors for hypertension. CONCLUSION The prevalence of hypertension and other cardiovascular risk factors was high in both urban and rural communities. Therefore, there is a need for comprehensive health promotion programs to encourage lifestyle modification.
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Affiliation(s)
- Ajeet S. Bhadoria
- Department of Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Pradeep K. Kasar
- Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Neelam A. Toppo
- Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Pooja Bhadoria
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Sambit Pradhan
- Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vikrant Kabirpanthi
- Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Iqbal MP, Yakub M. Smokeless tobacco use: a risk factor for hyperhomocysteinemia in a Pakistani population. PLoS One 2014; 8:e83826. [PMID: 24376761 PMCID: PMC3871626 DOI: 10.1371/journal.pone.0083826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022] Open
Abstract
Background Smokeless tobacco (ST) use is highly prevalent in the South Asian populations. While there have been a number of reports on association of ST consumption with cancer, very few studies have been conducted to investigate its relationship with cardiovascular disease. Hyperhomocysteinemia is a well-recognized risk factor for cardiovascular disease; however, its association with ST use has never been investigated. The objective of this study was to evaluate the relationship of ST use with hyperhomocysteinemia in an urban Pakistani population. Methodology/Principal Findings In a cross-sectional study for assessment of risks of hyperhomocysteinemia, 872 healthy adults (355 males and 517 females of age range 18–60 years) were recruited from a low-income population in Karachi, Pakistan. A detailed questionnaire was administered which included information about smoking, non-smoking, use of ST alone (chewing as well as sniffing) and use of ST with betel nuts. Fasting serum/plasma levels of homocysteine, folate, vitamin B12 and pyridoxal phosphate (PLP; a coenzymic form of vitamin B6) were analyzed. In this population, 43.4% males and 15.5% females were found to be regular users of ST products. Laborers and vendors were the major ST consumers. Smoking was not found to be associated with plasma/serum concentrations of homocysteine, folate, vitamin B12 and PLP. However, homocysteine concentrations in the group which consumed ST alone and the group which consumed ST along with betel nut were significantly higher compared to the non-user group (17.7±7.5 µmol/L, 25.48 µmol/L vs. 11.95 µmol/L, respectively; p<0.01). Odds ratio for the association of hyperhomocysteinemia (>15 µmol/L) was 11-fold higher in the ST-consumer group compared to the non-user group, [OR (95%CI) = 11.34 (7.58–16.96); p<0.001], when the model was adjusted for age, gender, folate and vitamin B12 status. Conclusion This study shows a positive association between ST consumption and hyperhomocysteinemia in a low-income urban Pakistani population.
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Affiliation(s)
- Mohammad Perwaiz Iqbal
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- * E-mail:
| | - Mohsin Yakub
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Joshi R, Taksande B, Kalantri SP, Jajoo UN, Gupta R. Prevalence of cardiovascular risk factors among rural population of elderly in Wardha district. J Cardiovasc Dis Res 2013; 4:140-6. [PMID: 24027373 DOI: 10.1016/j.jcdr.2013.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 07/30/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are a leading cause of mortality among adults in India, and their risk factors (tobacco, hypertension, diabetes, overweight, and obesity) are common. Most risk-factor surveys have focused on young and middle aged adults. We measured the prevalence of risk factors for CVD among elderly (age 60 years or more) in rural India. METHODS AND RESULTS In a door-to-door cross-sectional survey we did a non-laboratory based assessment of risk factors (smoking or tobacco use in any form, diabetes mellitus, either known or newly detected hypertension, abnormal waist-hip-ratio, or a high body mass index) among elderly living in 23 villages in rural central India. Laboratory based assessment of risk factors was done in those who had two or more of the five measured conventional risk factors. We compared the distribution of risk factors between men and women. Among 2424 elderly included in the study (51% women, mean age 67), the prevalence of smokeless tobacco use was 50.8% (95% CI 48.1-52.8; smoking 10.5% (95% CI 9.3-11.8); and hypertension46.3% (95% CI 44.3-48.4). Only 10.2% participants were previously known to have had hypertension, and remaining 36.1% were detected to be hypertensive during the survey. A total of 8.2%(95% CI 7.0-9.5) participants were overweight and 4.1% (95% CI 3.3-4.9) had central obesity. The prevalence of dyslipidemia in those who underwent blood based tests was 40.6% (95% CI 36.5-44.9); and hyperglycemia 4.9% (95% CI 3.2-7.1). CONCLUSIONS Strategies to reduce the risk of cardiovascular disorders among elderly should be focused on reducing tobacco use and early detection and optimal control of hypertension.
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Affiliation(s)
- Rajnish Joshi
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram 442102, India ; Department of Medicine, All India Institute of Medical Sciences, Bhopal 462024, India
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Abstract
Tobacco is a leading contributor to morbidity and mortality globally. Metabolic syndrome is a constellation of abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance (with and without glucose intolerance), pro-inflammatory state, and pro-thrombotic state. Tobacco use is associated with various core components of metabolic syndrome. It has been found to play a causal role in various pathways leading on to development this condition, the current article discusses various facets of this association.
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Affiliation(s)
- Yatan Pal Singh Balhara
- Department of Psychiatry, Lady Harding Medical College and Associated Hospitals, New Delhi, India
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Omole OB, Ogunbanjo GA, Ayo-Yusuf OA. Review of alternative practices to cigarette smoking and nicotine replacement therapy: how safe are they? S Afr Fam Pract (2004) 2011. [DOI: 10.1080/20786204.2011.10874077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- OB Omole
- Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - GA Ogunbanjo
- Department of Family Medicine and Primary Health Care, University of Limpopo (Medunsa Campus), Pretoria South Africa
| | - OA Ayo-Yusuf
- c Department of Community Dentistry, School of Dentistry, University of Pretoria, Tshwane, South Africa
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Omole OB, Ngobale KNW, Ayo-Yusuf OA. Missed opportunities for tobacco use screening and brief cessation advice in South African primary health care: a cross-sectional study. BMC FAMILY PRACTICE 2010; 11:94. [PMID: 21114839 PMCID: PMC3009621 DOI: 10.1186/1471-2296-11-94] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/29/2010] [Indexed: 01/30/2023]
Abstract
BACKGROUND Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations. METHODS This cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC nurses. Using an exit-interview questionnaire, information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and patients' level of comfort about being asked about and advised to quit tobacco use. Main outcome measures included patients' self-reports on having been screened and advised about tobacco use during their current clinic visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and multiple logistic regression analysis. RESULTS Of the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9% of the participants were screened for tobacco use during their current visit, indicating the vast majority were not screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they would be 'very comfortable' with being screened. A pregnancy-related clinic visit was the single most significant predictor for being screened during the current clinic visit (OR = 4.59; 95%CI = 2.13-9.88). CONCLUSION Opportunities for tobacco use screening and brief cessation advice were largely missed by clinicians. Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.
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Affiliation(s)
- Olufemi B Omole
- Department of Family Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Kabilabe NW Ngobale
- Department of Family Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Olalekan A Ayo-Yusuf
- Department of Community Dentistry, University of Pretoria, Pretoria, South Africa
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